Nail biting (onychophagia) is a common parafunctional habit characterized by repetitive and non-functional biting behavior. Although the effects of nail biting on dental structures and occlusion have been reported, its potential effects on mandibular bone structure remain unclear. This retrospective radiological study aims to evaluate the association between nail biting habit and mandibular bone characteristics using fractal analysis and panoramic morphometric indices. Existing panoramic radiographs of individuals with and without nail biting habits will be retrospectively analyzed. Trabecular bone complexity, mandibular cortical width, panoramic mandibular index, and Klemetti index values will be compared between groups to investigate whether nail biting habit is associated with alterations in mandibular bone morphology.
Children aged 8-10 years who were examined at the Department of Pediatric Dentistry, Faculty of Dentistry, Recep Tayyip Erdoğan University.
Systemically healthy participants.
Participants with available diagnostic-quality panoramic radiographs obtained during routine dental examinations.
Participants with and without a history of nail biting habit.
Participants with systemic diseases or conditions that may affect bone metabolism, including diabetes mellitus, osteoporosis, osteomalacia, renal diseases, hypothyroidism, or hyperparathyroidism.
Participants using medications that may influence bone density or bone metabolism.
Participants with temporomandibular joint disorders affecting the subcondylar region.
Participants with mandibular pathological conditions, including cysts, tumors, or other lesions affecting mandibular bone structure.
The study population will consist of systemically healthy children aged 8-10 years who previously underwent routine dental examination at the Department of Pediatric Dentistry, Faculty of Dentistry, Recep Tayyip Erdoğan University. Existing panoramic radiographs obtained during routine clinical care will be retrospectively analyzed. Participants will be categorized into two groups according to the presence or absence of nail biting habit. A minimum of 100 participants will be included, with equal distribution between the nail biting habit group and the control group and balanced sex distribution. Mandibular bone characteristics will be evaluated using fractal dimension analysis and panoramic radiographic morphometric indices, including mandibular cortical width, panoramic mandibular index, mandibular cortical index (Klemetti index), and other mandibular bone measurements. No intervention will be performed; only existing radiographic records will be assessed.
Case-crossover
Retrospective
Not listed
Mandibular Trabecular Bone Structure Assessed by Fractal Dimension Analysis
Mandibular trabecular bone architecture will be evaluated using fractal dimension analysis on panoramic radiographs. Fractal dimension measurements will be performed using the box-counting method described by White and Rudolph. Four regions of interest (ROIs) in the mandible will be analyzed, including the condylar subcortical region, supracortical region above the mandibular angle, area above the mandibular canal distal to the mental foramen, and anterior region of the mental foramen. Measurements will be performed bilaterally, and the mean fractal dimension value will be calculated for each participant. Higher fractal dimension values indicate greater trabecular bone complexity. The fractal dimension values will be compared between individuals with and without nail biting habit.
Panoramic Mandibular Index (PMI)
The panoramic mandibular index (PMI) will be calculated on panoramic radiographs as the ratio of mandibular cortical width to the distance between the inferior border of the mandible and the inferior margin of the mental foramen. Measurements will be performed bilaterally, and the mean value will be used for analysis.
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