## 4 Discussion
used fractal analysis with osteoporotic patients using bisphosphonates to assess the trabecular structure in three separate ROIs from the mandibular corpus, the gonali, and the interdental areas. Their findings showed that FD values were lower in the interdental region [28]. In contrast to previous studies, [PERSON] et al. demonstrated that the FD values obtained from the alveolar region with dentition were higher than those from the edentulous region [29]. It is probable that the employment of different methods for measuring FDs (based on volume calculation) throughout the fractal analysis procedures led to the discrepancy between the findings of [PERSON] et al. and those of the present study. The authors of the current study utilized the box-counting method, which has been reported in the literature the most frequently [3]. Unlike the present study, some previous studies showed that individuals' sex affects FD values [2; 30; 31]. In [PERSON] et al. 's study, the authors calculated the FD values of 70 participants, 35 of whom had TMJ arthritis, in the condylar region by using cone beam computed tomography images [31]. This study showed that FD values in females were significantly lower than in males. In addition, [PERSON] et al. 's study demonstrated that FD values were lower in females compared to males [2]. On the other hand, some studies showed that the sex of the participants and FD values had no effects on each another [5; 32; 33]. [PERSON] et al. 's study from 2008 determined the effect of chronic periodontitis on FD values using the periapical radiographs of 56 males and 52 females. It was shown that gender and FD were not correlated [5]. Moreover, [PERSON] et al. 's study utilized fractal analysis of the panoramic radiographs of 28 females and 23 males to evaluate the effect of chronic renal failure on the trabecular structure of the mandible. In this study, gender did not lead to significant differences in FD values [32]. The reason for these discrepancies between the findings of previous studies and this study could be related to the various modalities of the radiographs used. Due to the more dynamic structure of trabecular bone compared to cortical bone, age-related alterations have a greater impact on trabecular bone structures [34]. The results of this study showed that there were significant differences between the age ranges of 60-69 and 70-79 in right condyle and gonial region and left gonial and alveolar region and, therefore, that higher age leads to lower FD values in individuals in these age ranges. Unlike the present study, [PERSON] et al. 's study showed a relation between age, osteoporosis, and FD values. In [PERSON] et al. 's study, the changes in the trabeculation of the mandibular bones in individuals who had bruxism were examined and only a slight negative connection between age and FD measures was found in the right condyle region; no other significant correlations were found [2]. The difference between the findings of the present study and those of [PERSON] et al. 's study may be related to the lower sample size of [PERSON] et al. 's study compared to this study. Moreover, in contrast to the findings of the present study, [PERSON] et al. randomly selected six premenopausal females and six postmenopausal males and measured their FD values from their periapical radiographs. They observed that the group with the higher average age had greater FD values [35]. It is reasonable to conclude that variations in the modalities of the employed radiographs are the cause of the discrepancy between the findings of the two studies. One of the limitations of this study was that, due to anatomic variations and technical errors, the ROIs in the panoramic radiographs could not be standardized in all cases. However, since panoramic radiographs are commonly obtained for dental patients, they application for different diagnostic purposes must be investigated. Further studies on existing CBCT images of patients with bruxism can be performed to test the observed findings.