Dx: Mandible-Maxilla Idiopathic Osteosclerosis

KEY FACTS

Terminology Synonyms: Dense bone island, bone scar, bone whorl, bone eburnation, enostosis, focal osteopetrosis Definition: Localized area of increased radiodensity (radiopacity) of unknown cause and without association to
inflammatory, dysplastic, or neoplastic process

Imaging Well-defined, nonexpansile, homogeneous radiopacity without radiolucent periphery Location: Mandible > maxilla, premolar/molar area
Within confines of buccal and lingual cortices

Size: Varies from 1 mm to 2 cm; average ~ 5 mm Giant 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 Checklist Consider Gardner syndrome if multiple lesions When in close proximity to teeth, look for presence of normal periodontal ligament space to rule out sclerosing osteitis 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 and without association to
inflammatory, dysplastic, or neoplastic process
IMAGING

General Features Best diagnostic clue: Well-defined, nonexpansile, homogeneous radiopacity without radiolucent periphery Location Mandible > maxilla Premolar/molar area
Within confines of buccal and lingual cortices

Size Varies from 1 mm to 2 cm

Average size ~ 5 mm
Giant dense bone island (> 2 cm) is thought to be just larger variant

Nonexpansile and same location predilection: Mandibular molar-premolar area Morphology: Varies: Round, elliptical, irregular Radiographic Findings Intraoral plain film Well-defined radiopacity Usually homogeneously radiopaque but may have areas of radiolucency May be in close proximity to apex and roots of teeth Differentiate from sclerosing osteitis (condensing osteitis) by absence of inflammatory process andnormal periodontal ligament (PDL) space CT Findings CBCT Nonexpansile area of high density within confines of buccal and lingual cortical plates May be contiguous with buccal or lingual cortex
DIFFERENTIAL DIAGNOSIS

Sclerosing Osteitis (Condensing Osteitis) Inflammatory process producing dense reactive bone at apex of pulpally involved tooth (dead or dying) Periodontal ligament space presents as widened radiolucency 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 Exophytic hyperplastic normal bone on lingual of mandible

Usually midroot of mandibular premolar teeth May look similar on plain film imaging CBCT 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

Presentation Most common signs/symptoms: Asymptomatic Demographics Age: Develops in early adolescence Gender: Females males Natural History & Prognosis May increase in size in young patients

Stable in adults Rarely may cause ectopic eruption May form in tooth sockets following extraction Implant placement into sites of osteosclerosis is questionable Treatment No treatment necessary
DIAGNOSTIC CHECKLIST

Consider Gardner syndrome if multiple lesions Image Interpretation Pearls If close to apex of tooth, look for normal PDL space to rule out sclerosing osteitis