Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis

  • Seval BayrakEmail author
  • Duygu Göller Bulut
  • Kaan Orhan
  • Enver Alper Sinanoğlu
  • Emine Şebnem Kurşun Çakmak
  • Melis Mısırlı
  • Handan Ankaralı
Original Article



This study aimed to evaluate the radiomorphometric indexes and fractal dimension (FD) on dental panoramic radiography (DPR) of Thalassemia Major (TM) patients.


In 59 TM patients and in 59 healthy control subjects, mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), and FD of four different regions (FD1-4) were evaluated and compared using DPRs.


The distribution of MCI in TM patients was similar to control subjects (p > 0.05). The mean MCW was significantly lower in TM patients (p = 0.001). There was no significant difference in PMI between TM patients and control subjects. The mean of FD measured in the supracortical area above the angle of mandible (FD2), in the anterior to the mental foramen (FD4) and mean FD of four different regions was significantly lower in TM patients (p = 0.003, p = 0.001, and p = 0.014, respectively).


The radiomorphometric indices and fractal dimensions evaluated in the panoramic radiograph are capable of identifying thalassemia patients’ jaw bone, and the results of DPR scanning can be used to refer these patients to appropriate medical investigation.


Fractal analysis Osteoporosis Panoramic radiography Thalassemia PMI MCI 



There is no financial support/ funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Seval Bayrak
    • 1
    Email author
  • Duygu Göller Bulut
    • 1
  • Kaan Orhan
    • 2
    • 3
  • Enver Alper Sinanoğlu
    • 4
  • Emine Şebnem Kurşun Çakmak
    • 5
  • Melis Mısırlı
    • 6
  • Handan Ankaralı
    • 7
  1. 1.Dentistry Faculty, Department of Dentomaxillofacial RadiologyBolu Abant İzzet Baysal UniversityBoluTurkey
  2. 2.Dentistry Faculty, Dentomaxillofacial Radiology DepartmentAnkara UniversityAnkaraTurkey
  3. 3.OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Oral &Maxillofacial SurgeryUniversity of Leuven, University Hospitals LeuvenLeuvenBelgium
  4. 4.Dentistry Faculty, Department of Dentomaxillofacial RadiologyKocaeli UniversityKocaeliTurkey
  5. 5.Türkiye Public Hospitals Agency, Ministry of HealthAnkaraTurkey
  6. 6.Dentistry Faculty, Department of Dentomaxillofacial RadiologyNear East UniversityNicosiaCyprus
  7. 7.Medicine Faculty, Department of Biostatistics and Medical InformaticsIstanbul Medeniyet UniversityIstanbulTurkey

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