# Evaluation of the Effects of Smoking on Trabecular Bone Microarchitecture Using Cone-Beam Computed Tomography in Periodontal Disease

## TL;DR

This study investigates how smoking affects bone structure in people with periodontal disease using CT scans.

## Contribution

The study introduces a novel use of CBCT and BoneJ to assess trabecular bone changes in periodontitis patients.

## Key findings

- Smoking and periodontal status did not significantly alter bone morphometric parameters.
- Posterior bone volume fraction correlated with clinical attachment loss in periodontitis patients.

## Abstract

Objectives: The quality and structure of alveolar bone play a critical role in periodontal health and disease. Tobacco use has long been associated with negative impacts on bone and periodontal tissues. This cross-sectional study aimed to determine whether smoking induces quantifiable deterioration in trabecular bone microarchitecture in individuals with periodontal disease through bone morphometric analysis of cone-beam computed tomography (CBCT) images.

Method and materials: Ninety systemically healthy patients, comprising both smokers (≥10 cigarettes/day) and non-smokers who required CBCT imaging for various indications, were included. Clinical periodontal parameters (plaque index, gingival index, probing pocket depth, clinical attachment loss (CAL), bleeding on probing) were recorded. Participants were grouped by smoking status and subdivided by periodontal diagnosis: gingivitis, mild (stages I and II), moderate, and severe (stages III and IV) periodontitis (n = 15 per subgroup). Mandibular first molars and central incisors were selected without restorations, endodontic lesions, or root canal treatments. Two 5 × 5 × 10 mm volumetric regions of interest (ROIs) were analyzed around the periapical regions of related teeth: posterior and anterior ROIs (180 ROIs). Trabecular bone microarchitecture was examined using the BoneJ plugin of ImageJ software (National Institutes of Health, Bethesda, Maryland) to measure the bone morphogenic parameters (BMPs): degree of anisotropy (DA), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp). Statistical analysis was conducted using the Student's t-test, one-way ANOVA, and Kruskal-Wallis tests (Clinical Trial: NCT06676358).

Results: Differences in BMPs were observed between groups, and correlation was identified between age, gender, and BMPs (p > 0.05). However, a significant correlation was found between posterior BV/TV and CAL (p < 0.05), and an increasing trend in Tb.Th with higher attachment loss of the related first molar was noted in the posterior ROI.

Conclusion: While periodontal status and smoking did not affect BMPs, posterior BV/TV was associated with CAL in periodontitis patients.