Post-Extraction Bone Changes in Molars Within Personalized Implant-Prosthetic Therapy as Evaluated with Fractal...

Background: Implant-prosthetic therapy requires a detailed assessment of the bone structure before designing a personalized treatment plan. Tooth extraction at the molar level is followed by a series of bone changes dependent on the patient's general condition and age and the area in which it was performed. The fractal analysis of cone beam computed tomography (CBCT) represents a way to assess the quality of post-extraction bone regeneration. The purpose of this study was to analyze the alveolar bone changes after tooth extraction using fractal analysis on CBCT images. Methods: This retrospective study included pre- and post-extraction CBCTs at 3 months of 60 patients who underwent 100 extractions of first and/or second molars. Fractal analysis on CBCT images was performed using ImageJ, and the data obtained from the measurements were statistically processed. A multiple regression model was used to assess factors influencing bone remodeling. Results: Fractal analysis performed on CBCT images showed that most patients experienced advanced bone remodeling, this being more pronounced in those from rural areas, in the vertical plane at the mandible and at the second molar. The multiple regression model showed that the factors that play an important role in predicting bone resorption are represented by age group (age above 56 years old is associated with less bone resorption), location (bone resorption is more pronounced at the mandible level), and molar (bone resorption for the second molar is higher). Conclusions: Post-extraction bone changes were influenced by the age of the patient and by the location of the extraction, with the maxilla and first molar having better fractal analysis values compared to the mandible and second molar. These results emphasize the importance of training implantologists in CBCT evaluation to improve personalized implant-prosthetic treatment decisions.