Comparative Radiomics Analysis of Trabecular Bone Surrounding Dental Implants on Panoramic Radiographs in Smokers and Non-Smokers

Background/Objectives: Smoking is associated with adverse dental implant outcomes, but early smoking-related changes in peri-implant trabecular bone texture remain insufficiently characterized. This study evaluated longitudinal changes in panoramic radiomics features around dental implants in active smokers and non-smokers. Methods: This retrospective study included 47 patients and 110 implant sites, with 55 implant sites per group. Panoramic radiographs obtained at 0–7 days (T0), 4–6 weeks (T1), and 10–14 weeks (T2) after implant placement were analyzed. Twenty-eight first-order gray-level co-occurrence matrix (GLCM) and gray-level run length matrix (GLRLM) features were extracted; features with intraclass correlation coefficients ≥ 0.75 were included in mixed repeated-measures analyses. Results: Twenty-six features met the reliability threshold. Following BH-FDR correction across the 26 group-by-time interaction tests, significant interactions remained for GLCM Contrast (adjusted p = 0.010) and GLRLM Short Run Emphasis (SRE; adjusted p = 0.033). The Entropy interaction did not remain statistically significant after correction (adjusted p = 0.075). Contrast increased in smokers but remained relatively stable in non-smokers, whereas SRE decreased in smokers and increased in non-smokers. Conclusions: Smoking status was associated with divergent early peri-implant radiographic texture trajectories, particularly for Contrast and SRE. These findings indicate quantitative imaging differences rather than direct evidence of impaired osseointegration and warrant prospective validation.