PERIAPICAL RADIOPACITIES

. Condensing or sclerosing osteitis

Condensing or sclerosing osteitis is a sclerosis of bone induced by
inflammation or infection.
In contrast to rarefying osteitis in which bone resorption is a predominant
process whereas in condensing osteitis there is proliferation of bone tissue.
Condensing and rarefying ostetis both occur at the apex of pulpless tooth or
infected pulp.
Highly concentrated products of infection are thought to act as irritant and
produce bone resorption,while diluted irritants induce bone proliferation.
 CLINICAL FEATURES
1) 50% of cases are in patient’s under 30 years of age.
2) Ratio of male to female is 3:2.
3) Teeth commonly involved are mandibular, 1st molars and premolars.
4) The pulps involved teeth are non vital although sclerosing may have
commenced before complete pulp become non-vital in such case the
tooth may be positive to electric pulp testing.
5) There is usually no pain ,swelling ,drainage or associated
lymphadenitis.
 RADIOGRAPHIC FEATURES
1) They vary in size,shape and contour.
2) Small lesions are often cupped around the open.
 Differential Diagnosis

1) Periapical Idiopathic osteosclerosis

2) Periapical cementoosseous dysplasia or focal cementoosseous
dysplasia
3) Unerupted tooth
4) Hypercementotis
5) Foreign body introduced during root canal therapy.
 MANAGEMENT
1)Extraction of infected tooth or RCT is indicated.
2)It has been reported that 80% of lesions of condensing osteitis
partially or totally regresses whereas 15% remain unchanged.
 Periapical Idiopathic osteosclerosis
1) Also called Enostosis ,Dense bone island ,Bone whorls, Bone
eburnation.
2) It is common finding on full mouth radiographs of dentulous
patients of over 12 years of age ,About 5% of patients within this
age group have at least one periapical osteosclerotic lesion.
3) The cause is not apparent or understood.
 CLINICAL FEATURE
1) 2:1 female to male ratio of occurrence.
2) More common in black female patient.
3) More commonly seen in mandibular 1st premolar and canine
4) The associated teeth are invariably healthy, have vital pulp and are
asymptomatic.
5) There is no pain , cortical change , softness , expansion , drainage or
lymphadenitis.
6) Increased incidence in cases of colorectal cancer or adenomas.
 RADIOGRAPHIC FEATURES
1) The radiopacity vary from few mm to 2cm in diameter.
2) Its shape is round to very irregular and sometime triangular.
3) Degree of density may vary from slight accentuated trebacular
pattern to dense homogeneous radio opaque mass.
4) Border may be well defined or vague and well contoured or ragged.
5) Bilateral lesion are also discovered.
 DIFFERNTIAL DIAGNOSIS
1) Condensing osteitis
2) Mature fibrosseous lesion of periodontal ligament origin
3) Hypercementosis
4) Abnormal dense alveolar bone caused by heavy occlusal stress
5) Complex odontoma , paget’s disease , cementoblastoma, osteoma,
metastatic prostatic carcinoma and hamartoma.
 MANGEMENT
1) Areas of periapical idiopathic osteosclerosis are not of clinical
significance except that they should be disntinguished from
condensing ostetitis since this lesion requires endodontic
treatment.
2) In rare cases when there is root resorption the affected teeth have
to be treated endodontically or extracted.