Objective <p>The aim of the present study was to conduct a systematic review of the literature on changes in the trabecular bone of individuals with and without bruxism assessed through fractal analysis of panoramic radiographs.</p> Methods <p>The review followed the PRISMA guidelines and used the PECOS strategy to formulate the research question and eligibility criteria, considering observational studies that analyzed changes in the mandibular trabecular bone of adults with and without bruxism. Two reviewers made the selection and a third reviewer intervened in cases of disagreement. Data were extracted and managed using the Rayyan software. Risk of bias was assessed using the Joanna Briggs tool.</p> Results <p>After the removal of duplicates and screening, eight studies were included in the review. Individuals with bruxism had lower fractal dimension values in the condylar region and higher values in the mandibular angle as well as the gonial and alveolar regions than those without bruxism. However, the meta-analysis found no statistically significant differences between participants with and without bruxism in the condylar and gonial regions, indicating that bruxism is not associated with evident structural changes in these areas.</p> Conclusion <p>The present review revealed a relationship between bruxism and mandibular bone remodeling, with variations related to sex and age. However, the meta-analysis found no structural differences in the condyle or gonion between individuals with and without bruxism.</p> Clinical relevance <p>These findings broaden the understanding of the impacts of bruxism on bone structure and can assist in the development of more effective clinical and therapeutic strategies. The protocol was registered with the Prospective International Register of Systematic Reviews under number CRD42023464946.</p>