Fractal Dimension Analysis of Trabecular Bone Structure Around Implants After Transcrestal Sinus Floor Elevation: A Retrospective Radiographic Investigation

By
Irfan Ustundag
Sevval Ilkyaz
Numan Dedeoglu
Selman Bolukbasi
Mehmet Sait Simsek
Yunus Çetiner
Bahadir Sancar
September 3, 2026

Frontiers In Medicine

Overview

This study evaluated changes in trabecular bone structure around dental implants after transcrestal sinus floor elevation (TSFE) using fractal dimension analysis. Results indicated no significant differences in structural complexity among varying elevation heights over 12 months.

Background

The posterior maxilla presents unique challenges for dental implant placement due to anatomical constraints such as sinus pneumatization and bone resorption. Maxillary sinus augmentation techniques, including transcrestal sinus floor elevation (TSFE), are employed to enhance bone volume for implant stability. Understanding the impact of different elevation heights on peri-implant bone structure is crucial for optimizing surgical outcomes.

Data Highlights

No statistically significant differences in fractal dimension changes were observed among the 3 mm, 4 mm, and 5 mm groups (P > 0.05).

Key Findings

No significant temporal changes in fractal dimension for the 4 mm and 5 mm groups (P > 0.05).
The 3 mm group showed a significant decrease in distal fractal dimension at 6 months compared to the apical region (P = 0.006).
A significant increase in distal fractal dimension was noted from 6 to 12 months in the 3 mm group (P = 0.013).
Overall, structural complexity did not differ significantly across the three elevation heights over 12 months.

Clinical Implications

The findings suggest that varying the height of sinus membrane elevation during TSFE does not significantly affect peri-implant trabecular bone complexity over a year. Clinicians should consider these results when planning sinus augmentation procedures and monitoring bone healing.