Advancing dentistry: fractal assessment of bone health in pediatric patients with celiac disease using dental images

Objectives: To assess the effects of a gluten-free diet on bone structure in children with celiac disease using fractal analysis on panoramic radiographs. Method and materials: A total of 49 patients with celiac disease aged 6 to 13 years, separated into two groups as previously and newly diagnosed, and a control group of 32 healthy individuals were evaluated. In previously and newly diagnosed patients with celiac disease, body mass index Z-scores were calculated, calcium, alkaline phosphatase, vitamin D3, and parathormone levels were measured, and bone mineral density Z-scores were obtained from dual energy x-ray absorpti-ometry. In all patients, the fractal dimensions of the right and left temporomandibular condyles were evaluated with the fractal analysis method on panoramic radiographs. Results: The mean values of serum biomarker levels and the body mass index and bone mineral density Z-scores for both celiac groups were within the normal reference range. No statistically significant difference was determined between right and left condyle fractal dimen-sions values in the three groups examined. In terms of both right and left condyle fractal dimensions values, there was a statis-tically significant difference between groups. The highest fractal dimensions values were determined in the previously diagnosed group. Conclusions: Differences in fractal dimensions values were observed among patients with celiac disease following the glu-ten-free diet. Utilizing fractal analysis on panoramic radiographs can prove valuable for dental practitioners in evaluating bone min-eral density due to its cost-effect iveness, easy accessibility, and reduced radiation exposure for patients, enabling them to provide comprehensive oral health care and potential early interventions for patients with celiac disease. (Quintessence Int 2023;54: 822-831; doi: