Fractal Analysis as a Predictor of Early Implant Loss: A Retrospective Study

Introduction and aims

Fractal dimension (FD) and lacunarity are increasingly applied to assess trabecular bone structure, yet their predictive value for early dental implant failure remains uncertain. This study investigated whether FD and lacunarity, measured on panoramic radiographs and cone-beam computed tomography (CBCT), can predict early implant loss in the mandible.

Methods

A retrospective case-control study included 48 patients—24 with early implant failure and 24 with implants surviving at least 5 years without periimplantitis. All had panoramic radiographs, and a subset of 30 patients (15 per group) also had CBCT scans. FD and lacunarity were assessed in 3 mandibular regions: frontal, premolar, and molar. ImageJ software with box-counting method was used. FD from panoramic images was calculated using the White and Rudolph method; CBCT-based FD values were derived using both the White and Rudolph and the Kato et al. methods.

Results

No significant differences in FD or lacunarity values were found between groups in any region on either imaging modality (P > .05).

Conclusions

Fractal dimension and lacunarity values obtained from panoramic radiographs and CBCT images did not demonstrate predictive capability for early implant failure. Although fractal analysis offers a non-invasive approach to assess trabecular bone architecture, it should not be used in isolation to estimate implant prognosis.

Clinical Relevance

While fractal analysis may provide complementary insights into bone microstructure, its standalone application lacks sufficient reliability for predicting early dental implant failure. Future studies involving larger cohorts are warranted.