Effects of Different Treatment Methods Used in Patients with Rheumatoid Arthritis on the Trabecular and Cortical Structure of the Mandible

Background/Objectives: To appraise the mandibular bone structure of patients with rheumatoid arthritis (RA) who were treated with different drugs using fractal dimension (FD) analysis and panoramic radiomorphometric indices and investigate the effects of RA on the jaw bone. Methods: A total of 90 panoramic radiographs were analyzed in this study: 30 were from patients with RA using conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and glucocorticoids, 30 were from patients with RA using tumor necrosis factor-alpha (TNF-alpha) inhibitors, and 30 were from systemically healthy individuals. In panoramic radiographs, panoramic mandibular index (PMI), mandibular cortical thickness measurements, mandibular cortical index (MCI), and FD analysis taken from four different regions were evaluated. Results: The lowest FD analysis value was observed in patients using csDMARDs and glucocorticoids and in the condyle region (p = 0.001). Although PMI and posterior index (PI) were found to be significantly lower in patients using csDMARDs and glucocorticoids compared with the others (p = 0.001), no significant difference was observed between the groups in terms of anterior index (AI), symphysis index (SI), and molar index (MI) values (p > 0.05). When MCI was analyzed, there was no significant difference between the groups (p > 0.05). Conclusions: It was observed that the trabecular structure in the condyle and posterior region of the mandible was negatively influenced by RA and csDMARD and glucocorticoid drug use. Radiomorphometric indices and FD analysis on panoramic radiographs can be used to evaluate osteoporotic alterations in individuals with RA. These assessments are valuable in predicting the prognosis of conditions such as bone healing after tooth extraction and other surgical procedures and osseointegration after implant surgery.