1 Slide 4 Odontogenic cysts are pathological spaces filled with fluid that form around epithelial tissue and

2 fibrocollagenous connective tissue capsule.

7 Slide 5 Decompression or marsupialization treatments are becoming popular alternatives to enucleation, especially in
8 large lesions, as they reduce injury to adjacent tissues, hospitalization, and surgical procedures.
9  However, treatment duration is long, requires continuous follow-up and special appliance use, and the entire lesion
0 cannot be examined histopathologically.

1 Slide 6 Radiographic imaging is used for routine dental health examination and monitoring treatment success.
2  FA method uses mathematical and morphological image-processing system to define microarchitectural structure of
3 trabecular bone from radiographical image.
4  2-dimensional radiographs can be researched by determining a selected area to be investigated.
5  FA method is becoming more widespread in literature, especially for healing in bone structure.
6  However, the effectiveness of decompression treatment for odontogenic cysts in children has not been evaluated using
7 Fractal Analysis (FA).

8 Slide 7 The study aims to evaluate the results of decompression treatment for nonsyndromic odontogenic cysts in
9 children.

0 Slide 9 This study was a retrospective cohort study of pediatric patients with nonsyndromic odontogenic cysts

1  Conducted at the Department of Pediatric Dentistry and Oral and Maxillofacial Surgery at Erciyes University between
2 January 2016 and December 2020
3  Children under 15 without systemic disease, developmental anomaly, or craniofacial syndrome were included
4  Study variables were changes in bone structure (primary outcome) and cyst volume (secondary outcome)
5  Data was collected through medical and dental history, complaints, intraoral and extraoral findings, and panoramic
6 radiographs
7  The cyst was treated by decompression using a removable special-made appliance and biopsy sample was taken for
8 pathological examination
9  Patients were instructed to rinse the cyst cavity with sterile saline and to remove and clean the appliance once a day
0  Radiographs were taken monthly and at 3-month intervals throughout treatment period, follow-up care continued at 6-
1 12 months intervals after treatment
2  In cases where permanent teeth erupted, the appliance was used as a space retainer until eruption.

3 Slide 10 Dental panoramic radiographs taken following manufacturer's recommendations (OP200 D; Instrumentarium
4 Dental).

5  Images viewed using Dell Precision T1500 WorkStation and Dell monitor.
6  Images saved in TIFF format.
7  Fractal dimension (FD) calculation using ImageJ v. 1.52 image software.
8  Two regions of interest (ROIs) selected on panoramic images: ROI1 (center of cyst) and ROI2 (control area).
9  Image processing steps: Gaussian Blur filter, 128 gray tones added, thresholding, erosion, enlargement, black areas
0 turned to white.
1  Trabecular bone structure outlined linearly for fractal size calculation.
2  FD calculated using "fractal box count" function and values recorded for both ROIs in each patient.

3 Slide 12 23 patients were included in the study, with 19 in mixed dentition and 4 in young permanent dentition.

4  Nonsyndromic odontogenic cysts (3 radicular cysts and 20 dentigerous cysts) were present in the mandible (17 cases)
5 or maxilla (6 cases).
6  Mean treatment duration was 10.30 ± 3.08 months, and patients were followed up for an average of 27.78 ± 13.79
7 months.
8  Various symptoms were present in the patients including intraoral swelling, extraoral swelling, pain, dental mobility,
9 and tooth eruption.
0  In the radicular cyst cases, tooth extraction was performed in 2 cases and root canal treatment in 1 case.
1  16 dentigerous cyst cases were caused by infected primary teeth and 4 were caused by unerupted permanent teeth.
2  Permanent teeth erupted in 15 cases, referred to orthodontics in 1 case, and extracted in 1 case.
3  2 surgical complications were observed and treated with a second surgical procedure.
4  Dental complications observed during follow-up included enamel hypomineralization, root curvature, short root
5 maturation, mesial tipping, rotation, and eruption path anomaly.
6  No significant difference was observed between radicular and dentigerous cysts in the evaluation of healing, and no
7 significant difference was observed between genders.

8 Slide 13 Bivariate associations between study variables and FD change are presented in Table 2.

9  No significant relationship was found between age and treatment duration with FD change (P > .05).
0  No significant difference was observed in FD change among gender, cyst type, and jaw groups (P > .05).

1 Slide 14 Table 3 compares FD obtained from the middle cyst and control areas in radiographs taken at three different
2 times (T0, T1, and T2)

3 A significant difference was found between the measurement times in the middle cyst area, with improvement
4 expected and found with treatment
5  The improvement was significant with a P value of less than .001

6 Slide 16 Pediatric patients with odontogenic cysts are treated with minimally invasive surgical procedures such as
7 decompression or marsupialization to preserve anatomical structures, maintain tooth eruption, and achieve a functional
8 position on the arch.

9 The study aims to examine the bone structure changes after decompression treatment in children with odontogenic cysts
0 using Fractal Analysis (FA).

1 Slide 17 The study found a significant increase in Fractal Dimension (FD) values in the cyst area one month post-
2 operation, and at the end of treatment, the FD values were similar to control area values.

3  Decompression treatment is preferred over marsupialization due to its good results and protection of developing teeth.
4  The present study is the first to evaluate bone healing after decompression treatment of odontogenic cysts in children
5 using Fractal Analysis.
6  The study evaluated 23 patients treated with decompression using a modified appliance and evaluated the results for
7 complications in spontaneously erupting permanent teeth.

8 Slide 18 The first priority in treating odontogenic cysts in children is to preserve anatomical structures, maintain
9 eruption of the tooth, and achieve a functional position on the arch.

0  Thedecompression method is popular due to its good results and protection of developing teeth.
1  Thestudy evaluated 23 patients with odontogenic cysts treated with decompression using a special-made appliance,
2 and evaluated for complications in spontaneously erupting permanent teeth.

3 Slide 20 The results showed a significant increase in FD values in the cyst area at the 1-month postoperative period,
4 indicating active bone remodeling. The end treatment FD values were found to be similar to the control area values, and
5 the results indicated that age, gender, cyst type, jaw, and treatment duration did not have a significant effect on FD
6 change. The study also found that dentigerous cysts were the most common type of cyst in pediatric patients, and that
7 75% of the cysts were located in the mandibular posterior region. The study is the first to use FA to evaluate bone
8 healing after decompression treatment of odontogenic cysts in children, and the results provide valuable information for
9 clinical treatment planning and follow-up.