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A dual approach to third molar complexity: correlating fractal analysis with the pederson difficulty index -
1Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Bilecik Şeyh Edebali University, Pelitozu District Fatih Sultan Mehmet Boulevard No:27, Bilecik, 11100, Turkey. knurcakan@gmail.com.
Background:
This study aimed to evaluate the correlation between the Pederson Difficulty Index and fractal dimension analysis in impacted mandibular third molars, assessing whether fractal dimension analysis can serve as an adjunctive tool for predicting surgical difficulty.
Methods:
A total of 171 impacted mandibular third molars were retrospectively analyzed using digital panoramic radiographs. The Pederson Difficulty Index classified surgical difficulty based on angulation, impaction depth, and ramus relationship. Fractal dimension analysis was performed on three regions of interest: mesial, distal, and apical. Pearson correlation and one-way ANOVA assessed relationships between fractal dimension values and surgical difficulty categories.
Results:
No statistically significant correlation was found between fractal dimension values and gender across all regions of interest (p > 0.05). However, fractal dimension values demonstrated a non-significant increasing trend in distal and apical regions with increasing surgical difficulty, while mesial fractal dimension values decreased. These findings suggest potential trabecular bone adaptations related to third molar impaction, though further validation with three-dimensional imaging is required.
Conclusion:
FD analysis offers a non-invasive and quantitative means of evaluating trabecular bone microarchitecture, which may assist clinicians in identifying areas of low or high bone resistance prior to surgical intervention. These insights can inform key surgical decisions such as flap design, osteotomy direction, and the selection of instruments (e.g., rotary tools vs. piezosurgery) to reduce trauma. Although FD should not replace established indices like the Pederson Index, it may complement them by adding microstructural depth to morphological assessments. Future integration with three-dimensional imaging and prospective clinical validation is essential to establish FD as a routine element in surgical planning.
