## 4 Discussion
patients with bruxism compared to those without bruxism [2]. However, another study by [PERSON] et al. from 2021 with 252 individuals evaluated eight paired mandibular regions of interest (the bilateral condylar and gonali regions and the bilateral dentate regions between the apical areas of the first molar and second premolar and between the first premolar and canine). Fractal dimensions (FDs) were calculated at each site. This study showed that FD values in the gonali region on both sides in patients with bruxism were significantly lower compared to control individuals [13]. The inconsistency observed between the findings of these studies may indicate that panoramic radiographs are not a suitable screening tool for diagnosis of bruxism. Additionally, performing fractal analysis on panoramic radiographs does not always yield accurate FD values, as panoramic radiographs are prone to technical errors, superimpositions, and low quality. A study performed by [PERSON] et al. showed that FD values in panoramic radiographs were lower than those in periapical radiographs for the same ROIs [24]. However, since, in this study, ROIs located in the condylar and gonali region were investigated, panoramic radiographs were selected as the screening tool. Another study was performed by [PERSON] et al. in 2022 to evaluate bone density in sleep bruxers among pediatric patients using panoramic radiographs, and three regions (the geometric center of the condyle, the angle region under the mandibular canal, and the distal region of the mental foramen) were evaluated. It was determined that there were no differences in FD values in the right and left in all regions in either sex. Moreover, for the angle and condyle regions, the sleep bruxism group had significantly higher FD values than the control group and a moderate negative correlation existed between age and condyle FD values among controls. Therefore, the FD values used to evaluate trabeculation of the mandibular bone are affected by sleep bruxism in the mandibular angle and condyle regions [25]. Furthermore, in 2023, [PERSON] et al. compared bone structure in bruxer and non-bruxer individuals with bone apposition. A total of 200 bilateral jaw samples were studied (80 probable bruxer and 20 non-bruxer G0 individuals). Each mandibular apposition was classified in the groups G0, G1, G2, or G3 based on severity. FDs were calculated by selecting seven regions of interest from each sample. When the probable bruxer group was compared to the non-bruxer G0 group, it was discovered that FDs were statistically higher in the mandibular angle and cortical bone regions in the probable bruxer group. Regarding FD averages in cortical bone, there was a statistically significant difference between probable bruxer G0 and non-bruxer G0 grades. The relationship between FDs and gender was observed to be significant for the canine apex and canine distal regions. In comparison to G0 non-bruxer individuals, bruxer individuals were observed to have higher levels of FDs in the mandibular angle region and cortical bone [26]. The findings of the present study indicated that the condylar regions in both sides had the highest FD values compared to other examined ROIs and, therefore, the condylar regions had higher trabecular complexity than other locations. Moreover, this study showed that the FD values of alveolar regions were lowest. [PERSON] et al. 's study from 2005 compared the trabecular structures of dentate and edentulous regions and their FD values. They showed that the lower FD values in the alveolar regions with dentition were because these regions had a more organized trabecular structure and were better designed to resist occlusal forces compared to edentulous regions [27]. In agreement with the findings of this study, [PERSON] et al., who used the box-counting method to determine FDs in individuals with bruxism, showed that the lowest FD values were related to the alveolar regions in both the bruxer and non-bruxer groups [2]. Furthermore, [PERSON] et al.