Bruxism assessment combining fractal analysis, clinical evaluation, and self-reports: a case-control study

OBJECTIVE: The aim of this study was to investigate the effects of bruxism using a combined method of fractal bone analysis, clinical testing, and patient-reported outcomes. METHODS: Thirty-five bruxism patients and 35 controls underwent: (I) Validated questionnaires assessing both sleep and awake bruxism, (II) Clinical examinations including: tooth wear, masticatory muscle pain on palpation (masseter, temporal, and lateral pterygoid muscles), soft tissue impressions (buccal/lingual), percussion and cold test sensitivity, and periodontal parameters (pocket depth, gingival and plaque indexes), (III) Radiographic analyses: panoramic radiographs for structural evaluation and fractal dimension analysis of mandibular first molars using ImageJ software, focusing on periapical mesial/distal regions, interdental areas, and alveolar crest on periapical radiographs. Statistical analyses included independent t-tests and Mann-Whitney U tests (α = 0.05). RESULTS: The bruxism group showed significantly higher female prevalence (p < 0.05), lower education (p < 0.05), and more systemic diseases (p < 0.05). Patients reported greater awareness of grinding/clenching (p < 0.001), with 60% experiencing temporal pain, 65.7% morning headaches, and 77.1% morning fatigue. Clinical findings included higher tooth wear (p < 0.001), buccal/lingual impressions (p < 0.001), masseter hypertrophy (p < 0.001), percussion sensitivity (p < 0.001) and cold sensitivity (p < 0.001). Muscle palpation revealed pain in masseter (91.4%), temporal (54.3%), and lateral pterygoid (57.1%) muscles (all p < 0.001 vs. controls). Radiographically, bruxism patients exhibited more periodontal ligament widening, bone loss, and lamina dura changes (all p < 0.001). Periodontal analysis showed deeper pockets (p < 0.05) and higher gingival indices (p < 0.05), but lower plaque indices (p < 0.05). Fractal analysis demonstrated increased fractal dimension value in interdental areas (p < 0.05) but no differences in other regions (p > 0.05). CONCLUSION: Bruxism correlates with distinct trabecular bone changes detectable via fractal analysis, alongside characteristic clinical and self-reported markers.