Evaluation of bone changes in patients born premature using mandibular indices and fractal dimension analysis on dental panoramic radiographs

Our study aims to assess mandibular trabecular bone microarchitecture and cortical bone density in prematurely born children compared to term-born peers, using fractal dimension (FD) analysis and mandibular cortical index (MCI) and panoramic mandibular index (PMI) derived from panoramic radiographs. Our study included 152 panoramic radiographs obtained for diagnostic purposes from 76 premature group (30 girls and 46 boys) and 76 control group (30 girls and 46 boys). The mean age of the premature group was 7.35 ± 1.92, and that of the control group was 7.33 ± 1.9. Analyses revealed that premature individuals had a significantly higher prevalence of deteriorated cortical bone patterns (MCI Type 2/3) compared to controls (p < 0.001). Logistic regression analysis showed that increasing age (OR: 0.541; p = 0.002) and gestational age (OR: 0.696; p = 0.045) significantly reduced the risk of developing porous bone structure. FD values in the left condyle and right interdental region were statistically significantly higher in the control group than in the patients born premature group (p < 0.05). FD analysis shows partially compromised mandibular trabecular microarchitecture in patients born premature. MCI distribution reveals greater cortical bone thinning and irregularity. These findings suggest reduced quality and long-term fragility. Clinical caution is necessary regarding alveolar resorption. Monitoring the potential long-term effects of increased preterm survival on bone quality and jawbone structure represents an important clinical requirement from both pediatric and dental perspectives.