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.
