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Dx:Mandible-Maxilla Idiopathic Osteosclerosis
KEY FACTS
Terminology
Synonyms: Dense bone island, bone scar, bone whorl, bone
eburnation, enostosis, focal osteopetrosisDefinition: Localized
area of increased radiodensity (radiopacity) of unknown cause and
without association toinflammatory, dysplastic, or neoplastic
process
Imaging
Well-defined,nonexpansile, homogeneous radiopacity without
radiolucent periphery
Location: Mandible > maxilla, premolar/molar areaWithin
confines of buccal and lingual cortices
Size: Varies from 1 mm to 2 cm; average ~ 5 mmGiant dense bone
island(> 2 cm) is thought to be just larger variant
May have radiolucent areas
Top Differential Diagnoses
Sclerosing osteitis (condensing osteitis)
Periapical cemental dysplasia
Hypercementosis
Mandibular torus
Gardner syndrome
Clinical Issues
Asymptomatic
May increase in size in young patients
Rarely may cause ectopic eruption
No treatment necessary
Diagnostic ChecklistConsiderGardner syndrome if multiple
lesions
When in close proximity to teeth, look for presence of normal
periodontal ligament spaceto rule out sclerosingosteitis caused by
pulpal inflammation
TERMINOLOGY
Synonyms
Dense bone island, bone scar, bone whorl, bone eburnation,
enostosis, focal osteopetrosis
Definitions
Localized area of increased radiodensity (radiopacity) of
unknown cause andwithout association toinflammatory, dysplastic, or
neoplastic process
IMAGING
General Features
Best diagnostic clue: Well-defined,nonexpansile, homogeneous
radiopacity without radiolucent periphery
LocationMandible > maxillaPremolar/molar areaWithin confines
of buccal and lingual cortices
SizeVaries from 1 mm to 2 cm
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Average size ~ 5 mmGiant dense bone island(> 2 cm) is thought
to be just larger variantNonexpansile and same location
predilection: Mandibular molar-premolar area
Morphology: Varies: Round, elliptical, irregular
Radiographic Findings
Intraoral plain filmWell-defined radiopacityUsually
homogeneously radiopaque but may have areas of radiolucencyMay be
in close proximity to apex and roots of teethDifferentiate from
sclerosing osteitis (condensing osteitis) by absence of
inflammatory process andnormalperiodontal ligament (PDL) space
CT Findings
CBCTNonexpansile area of high densitywithin confines of buccal
and lingual cortical platesMay be contiguous with buccal or lingual
cortex
DIFFERENTIAL DIAGNOSIS
Sclerosing Osteitis (Condensing Osteitis)Inflammatory process
producing dense reactive bone at apexof pulpally involved tooth
(dead or dying)
Periodontal ligament space presents as widenedradiolucency
between tooth root and radiopacity
Associated coronal etiology such as caries, fractured tooth, or
large restoration
Periapical Cemental Dysplasia
Nonneoplastic replacement of normal bone at tooth apex by
dysplastic cementum &/or abnormal bone
Radiopacity is surrounded by radiolucency
Hypercementosis
Excessive production of cementum, primarily around apical area
of tooth root
Periodontal ligament space surrounds cementum giving radiolucent
periphery
Mandibular Torus
Exophytichyperplastic normal bone on lingual of mandible
Usually midroot of mandibular premolar teeth
May look similar on plain film imagingCBCT imaging, occlusal
view, or clinical examination will demonstrate exophytic nature
Gardner Syndrome
Multiple osteomas
Usually exophytic in ramus and inferior border of mandible
Precancerous colonic polyposis
CLINICAL ISSUES
PresentationMost common signs/symptoms: Asymptomatic
Demographics
Age: Develops in early adolescence
Gender: Females males
Natural History & Prognosis
May increase in size in young patients
