{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:39:19Z","timestamp":1791088759804,"version":"4.1.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":65,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence regarding the microarchitectural characteristics of newly formed bone after transcrestal sinus lifting remains limited. This retrospective longitudinal study aimed to quantitatively evaluate trabecular microarchitectural changes in peri-implant bone using fractal analysis in patients who underwent transcrestal sinus lifting with simultaneous implant placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical and radiographic records of 76 patients treated with transcrestal sinus lifting and simultaneous implant placement in the posterior maxilla were retrospectively reviewed. Baseline and approximately 6-month follow-up panoramic radiographs were analyzed. Fractal analysis was performed on predefined regions of interest (ROIs) representing mesial and distal peri-implant trabecular bone, apical trabecular bone, and superior and inferior maxillary tuberosity trabecular bone.<\/jats:p>\n                    <jats:p>The primary outcome was the change in peri-implant fractal dimension (FD) values over time. Secondary outcomes included changes in maxillary tuberosity FD values and inter-regional differences between peri-implant and tuberosity areas. Apical FD values were assessed as exploratory outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Peri-implant FD values increased significantly from baseline to 6 months (1.182\u2009\u00b1\u20090.054 vs. 1.233\u2009\u00b1\u20090.058;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cohen\u2019s d\u2009=\u20091.28). In contrast, median FD values in the maxillary tuberosity region remained stable over time (1.252 [1.215\u20131.286] vs. 1.256 [1.212\u20131.289];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.116;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.18). At baseline, peri-implant FD values were significantly lower than those of the maxillary tuberosity region (1.180 [1.154\u20131.222] vs. 1.252 [1.215\u20131.286];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.83), and although this difference remained significant at 6 months (1.249 [1.193\u20131.272] vs. 1.256 [1.212\u20131.289];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), the effect size decreased (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.62). Exploratory analysis also showed a significant increase in median apical FD values (1.182 [1.145\u20131.225] vs. 1.253 [1.220\u20131.289];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.84).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients undergoing transcrestal sinus lifting with simultaneous implant placement, peri-implant FD values increased during the 6-month follow-up period, while FD values in the maxillary tuberosity reference region remained stable. These findings suggest that fractal analysis may provide a reproducible adjunctive radiographic method for monitoring trabecular pattern changes after transcrestal sinus lifting. However, FD changes should not be interpreted as direct evidence of histological bone maturation or implant stability without further clinical validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-08816-3","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:33:26Z","timestamp":1780914806000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fractal analysis of bone architecture changes following transcrestal sinus lifting with simultaneous implant placement"],"prefix":"10.1186","volume":"26","author":[{"given":"Mert","family":"Keles","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim Burak","family":"Yuksel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"issue":"2","key":"8816_CR1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.ijom.2022.01.021","volume":"52","author":"P Jia","year":"2023","unstructured":"Jia P, Li W, Tang Y, Gao M, Qiu L, Zhu Y. Radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning: one-year results of a randomized controlled trial. Int J Oral Maxillofac Surg. 2023;52(2):255\u201363.","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"8","key":"8816_CR2","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/jcpe.13488","volume":"48","author":"R Carvalho","year":"2021","unstructured":"Carvalho R, Botelho J, Machado V, Mascarenhas P, Alcoforado G, Mendes JJ, et al. Predictors of tooth loss during long-term periodontal maintenance: an updated systematic review. J Clin Periodontol. 2021;48(8):1019\u201336.","journal-title":"J Clin Periodontol"},{"issue":"6","key":"8816_CR3","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1111\/jopr.13983","volume":"34","author":"JC Coutant","year":"2025","unstructured":"Coutant JC, Canepa C, Naveau A, Sedarat C, Lauverjat Y, Ella B. Evaluation of thin-threaded implants primary stability in type IV bone right after maxillary sinus floor elevation: a human cadaver study. J Prosthodont. 2025;34(6):593\u2013601.","journal-title":"J Prosthodont"},{"key":"8816_CR4","doi-asserted-by":"publisher","first-page":"e13145","DOI":"10.7717\/peerj.13145","volume":"10","author":"I Karadag","year":"2022","unstructured":"Karadag I, Yilmaz HG. Evaluation of change in trabecular bone structure surrounding dental implants by fractal dimension analysis and comparison with radiomorphometric indicators: a retrospective study. PeerJ. 2022;10:e13145.","journal-title":"PeerJ"},{"issue":"3","key":"8816_CR5","doi-asserted-by":"publisher","first-page":"e70007","DOI":"10.1111\/cid.70007","volume":"27","author":"R Scaini","year":"2025","unstructured":"Scaini R, Saleh MH, Lai HC, Sangiorgi M, Zucchelli G, Testori T. Indications and regenerative techniques for lateral window sinus floor elevation with ridge augmentation. Clin Implant Dent Relat Res. 2025;27(3):e70007.","journal-title":"Clin Implant Dent Relat Res"},{"issue":"4","key":"8816_CR6","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1007\/s12663-025-02585-2","volume":"24","author":"PM Dhore","year":"2025","unstructured":"Dhore PM, Gandevivala A, Natarajan S. Sinus lifting procedure using osseodensification versus osteotome technique via transcrestal approach: a systematic review. J Maxillofac Oral Surg. 2025;24(4):929\u201336.","journal-title":"J Maxillofac Oral Surg"},{"issue":"6","key":"8816_CR7","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1111\/cid.13389","volume":"26","author":"AM Decker","year":"2024","unstructured":"Decker AM, Stuhr S, Testori T, Wang HL. Clinical and radiographic changes following transcrestal sinus augmentation: a scoping review of the last 25 years. Clin Implant Dent Relat Res. 2024;26(6):1338\u201353.","journal-title":"Clin Implant Dent Relat Res"},{"issue":"3","key":"8816_CR8","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.ijom.2022.06.020","volume":"52","author":"MTM Elghobashy","year":"2023","unstructured":"Elghobashy MTM, Shaaban AM, Melek LNF. Radiographic comparison between Densah burs and osteotome for graftless internal sinus lifting with simultaneous implant placement: a randomized clinical trial. Int J Oral Maxillofac Surg. 2023;52(3):388\u201395.","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"1","key":"8816_CR9","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1111\/prd.12518","volume":"93","author":"N Donos","year":"2023","unstructured":"Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: which are the factors affecting the clinical outcome? Periodontol 2000. 2023;93(1):26\u201355.","journal-title":"Periodontol 2000"},{"issue":"1","key":"8816_CR10","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1186\/s12903-023-03245-y","volume":"23","author":"M \u00c7itir","year":"2023","unstructured":"\u00c7itir M, Karslioglu H, Uzun C. Evaluation of mandibular trabecular and cortical bone by fractal analysis and radiomorphometric indices in bruxist and non-bruxist patients. BMC Oral Health. 2023;23(1):522.","journal-title":"BMC Oral Health"},{"issue":"6","key":"8816_CR11","doi-asserted-by":"publisher","first-page":"748","DOI":"10.3390\/diagnostics15060748","volume":"15","author":"MA Sevimay","year":"2025","unstructured":"Sevimay MA, G\u00fcrsu M, \u00c7ege MA, \u00c7ankal DA, Akarslan Z, \u00c7etiner S. Fractal dimension analysis of mandibular trabecular bone in patients receiving antiresorptive therapy for osteoporosis and oncologic conditions. Diagnostics. 2025;15(6):748.","journal-title":"Diagnostics"},{"issue":"1","key":"8816_CR12","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s11282-021-00536-4","volume":"38","author":"YN Kaba","year":"2022","unstructured":"Kaba YN, \u00d6ner N\u0130, Amuk M, Bilge S, Soylu E, Demirba\u015f AE. Evaluation of trabecular bone healing using fractal dimension analysis after augmentation of alveolar crests with autogenous bone grafts: a preliminary study. Oral Radiol. 2022;38(1):139\u201346.","journal-title":"Oral Radiol"},{"issue":"1","key":"8816_CR13","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1186\/s12880-025-01976-8","volume":"25","author":"H Akp\u0131nar","year":"2025","unstructured":"Akp\u0131nar H, Ozbey F, Y\u0131ld\u0131r\u0131m B. Comparison of trabecular bone structure using fractal dimension analysis in patients undergoing lateral window and transcrestal sinus lift procedures: a retrospective cohort study. BMC Med Imaging. 2025;25(1):430.","journal-title":"BMC Med Imaging"},{"issue":"1","key":"8816_CR14","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1186\/s12903-024-04953-9","volume":"24","author":"S Soler-Alcaraz","year":"2024","unstructured":"Soler-Alcaraz S, Guerrero-S\u00e1nchez Y, Del \u00c1guila OG, Bernabeu-Mira JC, Camacho-Alonso F. Analysis of bone quality formation in sinus lifts with immediate implants. BMC Oral Health. 2024;24(1):1214.","journal-title":"BMC Oral Health"},{"issue":"3","key":"8816_CR15","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1111\/cid.12783","volume":"21","author":"H Liu","year":"2019","unstructured":"Liu H, Liu R, Wang M, Yang J. Immediate implant placement combined with maxillary sinus floor elevation utilizing the transalveolar approach and nonsubmerged healing for failing teeth in the maxillary molar area: a randomized controlled trial clinical study with one-year follow-up. Clin Implant Dent Relat Res. 2019;21(3):462\u201372.","journal-title":"Clin Implant Dent Relat Res"},{"issue":"1","key":"8816_CR16","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/clr.70055","volume":"37","author":"AIA Fettouh","year":"2026","unstructured":"Fettouh AIA, Ghallab NA, Adel N, Nasser R, Gamal N, Samy M, et al. Graftless sinus floor elevation using the lateral or transcrestal approach. a randomized clinical trial with one year follow-up. Clin Oral Implants Res. 2026;37(1):87\u201397.","journal-title":"Clin Oral Implants Res"},{"issue":"6","key":"8816_CR17","doi-asserted-by":"publisher","first-page":"20200559","DOI":"10.1259\/dmfr.20200559","volume":"50","author":"B Vadiati Saberi","year":"2021","unstructured":"Vadiati Saberi B, Khosravifard N, Nooshmand K, Dalili Kajan Z, Ghaffari ME. Fractal analysis of the trabecular bone pattern in the presence\/absence of metal artifact-producing objects: Comparison of cone-beam computed tomography with panoramic and periapical radiography. Dentomaxillofac Radiol. 2021;50(6):20200559.","journal-title":"Dentomaxillofac Radiol"},{"issue":"1","key":"8816_CR18","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/prd.12464","volume":"91","author":"R Farina","year":"2023","unstructured":"Farina R, Franzini C, Trombelli L, Simonelli A. Minimal invasiveness in the transcrestal elevation of the maxillary sinus floor: a systematic review. Periodontol 2000. 2023;91(1):145\u201366.","journal-title":"Periodontol 2000"},{"issue":"8","key":"8816_CR19","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.bjoms.2024.05.006","volume":"62","author":"M Kadkhodazadeh","year":"2024","unstructured":"Kadkhodazadeh M, Alimardani Y, Azadi A, Daneshvar A, Amid R, Khaleghi A. Clinical outcomes of implants placed with transcrestal maxillary sinus elevation: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2024;62(8):685\u2013703.","journal-title":"Br J Oral Maxillofac Surg"},{"issue":"1","key":"8816_CR20","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1186\/s12903-022-02352-6","volume":"22","author":"Z-Z Lin","year":"2022","unstructured":"Lin Z-Z, Xu D-Q, Wang Y, Gao X, Cai Q, Ding X. Factors impacting new bone formation in transcrestal sinus floor elevation followed by implant placement: a cross-sectional study. BMC Oral Health. 2022;22(1):319.","journal-title":"BMC Oral Health"},{"issue":"11","key":"8816_CR21","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1111\/clr.14155","volume":"34","author":"S Shi","year":"2023","unstructured":"Shi S, Han L, Su J, Guo J, Yu F, Zhang W. Clinical efficacy of transcrestal sinus floor augmentation, in comparison with lateral approach, in sites with residual bone height\u2009\u2264\u20096\u00a0mm: A systematic review and meta-analysis. Clin Oral Implants Res. 2023;34(11):1151\u201375.","journal-title":"Clin Oral Implants Res"},{"issue":"1","key":"8816_CR22","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1186\/s12903-025-06695-8","volume":"25","author":"E Sozen","year":"2025","unstructured":"Sozen E, Aytugar E, Ertas ET, Cene E, Kara MI. Evaluation of graft osteogenesis using fractal dimension analysis on cone-beam computed tomography images following maxillary sinus lift surgery. BMC Oral Health. 2025;25(1):1346.","journal-title":"BMC Oral Health"},{"issue":"1","key":"8816_CR23","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1007\/s11282-024-00784-0","volume":"41","author":"N Dundar","year":"2025","unstructured":"Dundar N, Aslan E, Mutlu O. Fractal dimension, lacunarity, and bone area fraction analysis of peri-implant trabecular bone after prosthodontic loading. Oral Radiol. 2025;41(1):120\u201330.","journal-title":"Oral Radiol"},{"issue":"1","key":"8816_CR24","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40729-020-00209-7","volume":"6","author":"HC K\u0131\u015f","year":"2020","unstructured":"K\u0131\u015f HC, G\u00fclery\u00fcz G\u00fcrbulak A. Evaluation of the peri-implant bone trabecular microstructure changes in short implants with fractal analysis. Int J Implant Dent. 2020;6(1):13.","journal-title":"Int J Implant Dent"},{"issue":"7","key":"8816_CR25","doi-asserted-by":"publisher","first-page":"4967","DOI":"10.1007\/s00784-022-04464-3","volume":"26","author":"K \u00d6zt\u00fcrk","year":"2022","unstructured":"\u00d6zt\u00fcrk K, K\u0131\u015f HC. Peri-implant bone microstructural analysis and comparison of resonance frequency analysis before prosthetic placement: a retrospective study. Clin Oral Investig. 2022;26(7):4967\u201375.","journal-title":"Clin Oral Investig"},{"issue":"2","key":"8816_CR26","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s11282-025-00865-8","volume":"42","author":"CSC Vieira","year":"2026","unstructured":"Vieira CSC, de Oliveira GJPL, de Rezende Barbosa GL. Comparison of fractal analysis in panoramic radiography and panoramic reconstructions obtained by cone beam computed tomography. Oral Radiol. 2026;42(2):313\u201321.","journal-title":"Oral Radiol"},{"issue":"1","key":"8816_CR27","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s11282-018-0316-1","volume":"35","author":"G Magat","year":"2019","unstructured":"Magat G, Ozcan Sener S. Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography. Oral Radiol. 2019;35(1):35\u201342.","journal-title":"Oral Radiol"},{"issue":"3","key":"8816_CR28","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1007\/s11282-024-00743-9","volume":"40","author":"E Yavuz","year":"2024","unstructured":"Yavuz E, Yardimci S. Comparison of periapical radiography, panoramic radiography, and CBCT in the evaluation of trabecular bone structure using fractal analysis. Oral Radiol. 2024;40(3):394\u2013400.","journal-title":"Oral Radiol"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-08816-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08816-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08816-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:16:43Z","timestamp":1786508203000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12903-026-08816-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8816"],"URL":"https:\/\/doi.org\/10.1186\/s12903-026-08816-3","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"assertion":[{"value":"19 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective longitudinal observational study was approved by the Lokman Hekim University Scientific Research Ethics Committee, Ankara, Turkey (Decision No: 2025\/190; meeting date: 27 June 2025). The study was based exclusively on anonymized retrospective clinical and radiographic records obtained during routine patient care. No additional intervention, radiographic examination, or patient contact was performed for research purposes. Therefore, informed consent to participate was not obtained. All procedures were conducted in accordance with the principles of the Declaration of Helsinki, and the study was designed and reported in line with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1425"}}