Evaluation of Trabecular Structure Using Fractal Analysis in Patients Taking Proton Pump Inhibitors

Objective: The aim of this study was to evaluate the changes in the trabecular bone structure in patients using proton pump inhibitors (PPI) by performing measurements with fractal analysis, mandibular cortical width (MCW) and panoramic mandibular index (PMI) on panoramic radiographs. Materials and Methods: This study consists of 46 patients (20 males and 26 females) using PPI drugs regularly for at least 1 year and systemically healthy 46 persons (20 males, 26 females) as the control group. Fractal analysis was performed in five regions: the mandibular angle (ROI1), posterior mandible (ROI2), interdental area between apical of the second premolar and the first molar (ROI3), maxillary tuber region (ROI4), anterior mandible (ROI5). PMI and MCW as an indicative of osteoporosis, were measured on the panoramic radiographs. Results: For re-evaluated measurements, interobserver and intraobserver agreements were found to be 0.985 and 0.987, respectively. ROI2-4 (1.732, 1.334, 1.333; respectively) were significantly lower in PPI users, whereas, there was no significant in ROI1 (1.605) and ROI5 (1.694). The values MCW and PMI were not statistically significant in PPI users. Conclusion: Posterior region of the mandible, maxillary tuberosity and interdental region had lower trabecular microstructures in PPI users. The results of this study show that patients using PPI at least one year should be considered as regarding osteoporotic changes during dental treatment.