{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:02:49Z","timestamp":1793379769399,"version":"4.5.0"},"reference-count":50,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"st1\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effects of functional appliance treatment on mandibular trabecular structure using fractal dimension (FD) analysis of dental panoramic radiographs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This study was conducted using digital panoramic radiographs of 45 patients with Class II malocclusion treated with functional appliances (treatment group, mean age: 11.39 \u00b1 0.97 years; 23 girls, 22 boys) acquired before (T0) and after (T1) treatment and the panoramic radiographs of 45 control subjects who had undergone no orthodontic treatment (control group, mean age: 11.31 \u00b1 0.87 years; 23 girls, 22 boys). FD values in the condylar process, mandibular corpus, and mandibular angle were analyzed from the panoramic radiographs of both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analysis of changes in FD between T0 and T1 revealed significant increases in the FD values of the right and left condylar processes and right mandibular corpus in the treatment group (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) and in the right condylar process in the control group (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). Between-group comparisons demonstrated that the treatment group showed greater changes in the condylar process (right,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001; left,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05) and right mandibular corpus (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05) compared to controls. Correlation analysis between the cephalometric and FD changes in the treatment group showed the right condylar process changes were negatively correlated with GoGn\/SN angle (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05) and positively correlated with Co-Go (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05), although these correlations were weak.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FD analysis demonstrated significant changes in trabeculation of the condyle and mandibular corpus in the treatment group compared to the control group. Functional appliance treatment may lead to skeletal correction by altering skeletal form and trabeculation of the mandibular bone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/012020-39.1","type":"journal-article","created":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T13:54:13Z","timestamp":1595858053000},"page":"783-793","source":"Crossref","is-referenced-by-count":41,"title":["Evaluating the effects of functional orthodontic treatment on mandibular osseous structure using fractal dimension analysis of dental panoramic radiographs"],"prefix":"10.2319","volume":"90","author":[{"given":"Emre","family":"Cesur","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seval","family":"Bayrak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emine \u015eebnem","family":"Kursun-\u00c7akmak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Arslan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ay\u015feg\u00fcl","family":"K\u00f6kl\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaan","family":"Orhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-90-6-783-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"159","article-title":"Treatment timing for twin-block therapy","volume":"118","author":"Baccetti","year":"2000","unstructured":"Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              Toth\n              LR,\n            \n            \n              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Radiol","first-page":"23","article-title":"Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study","volume":"35","author":"Demiralp","year":"2019","unstructured":"Demiralp\n              K\u00d6,\n            \n            \n              Kur\u015fun-\u00c7akmak\n              E\u015e,\n            \n            \n              Bayrak\n              S,\n            \n            \n              Akbulut\n              N,\n            \n            \n              Atakan\n              C,\n            \n            \n              Orhan\n              K.\n            \n          \n          Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study.\n\t\t\t\t\tOral 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therapy","volume":"118","author":"Baccetti","year":"2000","unstructured":"Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              Toth\n              LR,\n            \n            \n              McNamara\n              JA\n              Jr.\n            \n          \n          Treatment timing for twin-block therapy.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2000;\n\t\t\t\t\t118:\n\t\t\t\t\t159\u2013\n\t\t\t\t\t170."},{"key":"i0003-3219-90-6-783-b02","series-title":"Angle Orthod","first-page":"4","article-title":"Effective condylar growth and chin position changes in activator treatment: a cephalometric roentgenographic study","volume":"71","author":"Ruf","year":"2001","unstructured":"Ruf\n              S,\n            \n            \n              Baltromejus\n              S,\n            \n            \n              Pancherz\n              H.\n            \n          \n          Effective condylar growth and chin position changes in activator treatment: a cephalometric roentgenographic study.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2001;\n\t\t\t\t\t71:\n\t\t\t\t\t4\u2013\n\t\t\t\t\t11."},{"key":"i0003-3219-90-6-783-b03","series-title":"Oral Radiol","article-title":"Effects of wear time differences of removable functional appliances in Class II patients: prospective MRI study of TMJ and masticatory muscle changes","author":"Cesur","year":"2019","unstructured":"Cesur\n              E,\n            \n            \n              \u00d6zdiler\n              O,\n            \n            \n              K\u00f6kl\u00fc\n              A,\n            \n            \n              Orhan\n              K,\n            \n            \n              Seki\n              U.\n            \n          \n          Effects of wear time differences of removable functional appliances in Class II patients: prospective MRI study of TMJ and masticatory muscle changes.\n\t\t\t\t\tOral Radiol.\n\t\t\t\t\t2019.\n\t\t\t\t\tdoi:10.1007\/s11282-019-00379-0"},{"issue":"(7)","key":"i0003-3219-90-6-783-b04","series-title":"Dentomaxillofac Radiol","first-page":"20190216","article-title":"Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in Class II patients treated by removable functional appliances: a prospective fMRI study","volume":"48","author":"Ozdiler","year":"2019","unstructured":"Ozdiler\n              O,\n            \n            \n              Orhan\n              K,\n            \n            \n              Cesur\n              E,\n            \n            \n              K\u00f6kl\u00fc\n              A,\n            \n            \n              Alg\u0131n\n              O.\n            \n          \n          Evaluation of temporomandibular joint, masticatory muscle, and brain cortex activity in Class II patients treated by removable functional appliances: a prospective fMRI study.\n\t\t\t\t\tDentomaxillofac Radiol.\n\t\t\t\t\t2019;\n\t\t\t\t\t48(7):\n\t\t\t\t\t20190216.\n\t\t\t\t\tdoi:10.1259\/dmfr. 20190216"},{"key":"i0003-3219-90-6-783-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"98","article-title":"Long-term mandibular adaptations to protrusive function: an experimental study in Macaca mulatta","volume":"92","author":"McNamara","year":"1987","unstructured":"McNamara\n              JA\n              Jr,\n            \n            \n              Bryan\n              FA.\n            \n          \n          Long-term mandibular adaptations to protrusive function: an experimental study in Macaca mulatta.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t1987;\n\t\t\t\t\t92:\n\t\t\t\t\t98\u2013\n\t\t\t\t\t108."},{"key":"i0003-3219-90-6-783-b06","series-title":"Am J Orthod","first-page":"562","article-title":"The scope and limitations of treatment with the activator","volume":"61","author":"Tulley","year":"1972","unstructured":"Tulley\n              WJ.\n            \n          \n          The scope and limitations of treatment with the activator.\n\t\t\t\t\tAm J Orthod.\n\t\t\t\t\t1972;\n\t\t\t\t\t61:\n\t\t\t\t\t562\u2013\n\t\t\t\t\t577."},{"key":"i0003-3219-90-6-783-b07","series-title":"Am J Orthod","first-page":"557","article-title":"Activators: a practical approach","volume":"66","author":"Hirzel","year":"1974","unstructured":"Hirzel\n              HC,\n            \n            \n              Grewe\n              JM.\n            \n          \n          Activators: a practical approach.\n\t\t\t\t\tAm J Orthod.\n\t\t\t\t\t1974;\n\t\t\t\t\t66:\n\t\t\t\t\t557\u2013\n\t\t\t\t\t570."},{"key":"i0003-3219-90-6-783-b08","series-title":"Angle Orthod","first-page":"513","article-title":"Twin block appliance with acrylic capping does not have a significant inhibitory effect on lower incisor proclination","volume":"87","author":"van der Plas","year":"2017","unstructured":"van der Plas\n              MC,\n            \n            \n              Janssen\n              KI,\n            \n            \n              Pandis\n              N,\n            \n            \n              Livas\n              C.\n            \n          \n          Twin block appliance with acrylic capping does not have a significant inhibitory effect on lower incisor proclination.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2017;\n\t\t\t\t\t87:\n\t\t\t\t\t513\u2013\n\t\t\t\t\t518."},{"key":"i0003-3219-90-6-783-b09","series-title":"Dentomaxillofac Radiol","first-page":"270","article-title":"Fractal dimension on dental radiographs","volume":"30","author":"Bollen","year":"2001","unstructured":"Bollen\n              AM,\n            \n            \n              Taguchi\n              A,\n            \n            \n              Hujoel\n              PP,\n            \n            \n              Hollander\n              LG.\n            \n          \n          Fractal dimension on dental radiographs.\n\t\t\t\t\tDentomaxillofac 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Radiol","first-page":"20180442","article-title":"Mandibular indexes and fractal properties on the panoramic radiographs of the patients using aromatase inhibitors","volume":"91","year":"2018","unstructured":"G\u00f6ller Bulut D, Bayrak S, Uyeturk U, Ankaral\u0131 H.\n\t\t\t\t\tMandibular indexes and fractal properties on the panoramic radiographs of the patients using aromatase inhibitors.\n\t\t\t\t\tBr J Radiol.\n\t\t\t\t\t2018;\n\t\t\t\t\t91(1091):\n\t\t\t\t\t20180442.\n\t\t\t\t\tdoi:10.1259\/bjr.20180442"},{"key":"i0003-3219-90-6-783-b12","series-title":"Oral Radiol.","article-title":"Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis","author":"Bayrak","year":"2019","unstructured":"Bayrak\n              S,\n            \n            \n              G\u00f6ller Bulut\n              D,\n            \n            \n              Orhan\n              K,\n            \n            et al.\n\t\t\t\t\t\n  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