Effect of Regenerative Endodontic Treatment on Bone Structure in Children: A Fractal Analysis Approach

Background and Objectives: This study retrospectively investigated the impact of regenerative endodontic treatments (RET) on the healing of periapical lesions in young permanent molars with open apices. Our objective was to evaluate the relationship between treatment outcomes and changes in the fractal dimension (FD) of the periapical bone before and after RET. The study was conducted at the Department of Pediatric Dentistry, Necmettin Erbakan University between January 2020 and December 2024. Materials and Methods: We examined panoramic radiographs from systematically healthy patients aged 6-16 years who underwent RET in the posterior mandible between January 2020 and December 2024. Changes in periapical bone were assessed using fractal analysis before treatment and after a 6-month follow-up. Additionally, mental index (MI), mandibular cortical width (MCW), mental length (ML), and periapical index (PAI) values were evaluated. Radiographs were taken with a Planmeca ProOne^® device and analyzed using ImageJ v1.54 software. Results: Comparison of FD values between treated and contralateral tooth areas, as well as before and after RET, revealed an average FD value of 1.27 ± 0.05 after regeneration, increasing to 1.29 ± 0.27 at the 6-month follow-up. Significant increases were observed in MCW (p = 0.005/p = 0.049) and ML (p = 0.022/p = 0.001) in the 35-36 and 45-46 regions post-RET, though MI values showed no significant change. Importantly, PAI scores demonstrated significant improvement after RET. Conclusions: The findings suggest that RET is effective in promoting the healing of periapical lesions in young permanent molars. The observed increases in cortical width and improvements in PAI scores support the positive impact of this treatment on bone healing. Furthermore, FD analysis, when combined with radiomorphometric indices, could provide a valuable and objective tool for evaluating RET outcomes.