Fractal Dimension and Lacunarity Detection of Mandibular Bone on Digital Panoramic Radiographs: A Potential Diagnostic Indicator for Osteoporosis in Smokeless Tobacco Chewers

 AIM – To use digital panoramic radiographs to assess/evaluate/study the fractal dimension and lacunarity trabecular pattern in mandibular bone to identify the early osteoporotic alterations in patients who chew smokeless tobacco and identify any differences compared to non-tobacco chewers.  Materials and Methods – 90 digital OPG scans of completely dentulous patients between age 20 – 40 years were examined, out of which 45 patients with smokeless tobacco habit for more than 2 years and 45 were of healthy patients as control group. The mandibular trabecular bone's FD and lacunarity were evaluated using the ImageJ programme and the FracLac plugin on digital panoramic radiographs.  Settings and Designs – Prospective Cross Sectional Case Control Descriptive Observational Study, Department of Oral Medicine and Radiology.  Results – The differences between the research and control groups' mean FD values were statistically significant (P0.001). The case groups' mean FD was lower than the control groups, with SLTs having the lowest FD value. There was a significant difference in lacunarity between SLTs and controls (P0.001).  Conclusions – Differences in the values of FD & Lacunarity detected between the cases and controls, which discriminates texture differences of trabecular bone in SLT users. The analysis showed correlations with each other, detecting alterations in the trabecular pattern. Furthermore, it can be used as a practical, non-invasive method to assess osteoporotic changes in smokeless tobacco users during a routine examination for further management. Study with larger sample size should be done for more precise results.