Evaluation of the Relationship Between Pederson Difficulty Index and Fractal Dimension of Alveolar Bone in Impacted Mandibular Third Molar Teeth

Impacted mandibular third molar surgery is one of the most common procedures in oral and maxillofacial surgery, and an accurate preoperative assessment of surgical difficulty remains clinically important. The Pederson difficulty index is widely used for radiographic difficulty estimation, whereas fractal dimension analysis provides a quantitative assessment of trabecular bone complexity. This retrospective observational study aimed to evaluate the relationship between the Pederson difficulty index and the fractal dimension of the alveolar bone surrounding impacted mandibular third molars on panoramic radiographs. A total of 207 impacted mandibular third molars were obtained from 113 patients. Demographic data, tooth side, and Pederson difficulty categories were recorded. Each impacted tooth was classified as easy, moderate, or difficult according to the Pederson difficulty index (PDI). Fractal dimension measurements were performed in three predefined regions of interest: mesial, apical, and distal alveolar trabecular bone. The study population had a mean age of 22.63 ± 4.36 years, and the tooth-side distribution was balanced between teeth 38 and 48. No significant association was found between sex or tooth side and the Pederson difficulty category. Mesial, apical, and distal fractal values did not differ significantly according to sex or Pederson difficulty category. Panoramic radiography-based fractal dimension measurements were not significantly associated with Pederson difficulty categories for impacted mandibular third molars.