Extensive hyperdense zone in the mandible. A case report.

Abstract

Hyperdense zones are considered a generic term to define an area of increased density regardless of its cause. Idiopathic hyperdense zones are referred in literature as enostosis, focal osteosclerosis, periapical osteopetrosis or bone scar and are found as imaging finding during a rutine radiograph. They have greater predilection for long bones, but can also appear in the maxillary bones in certain occasions, often located in the jaw, especially in the molar region, with an informed incidence rate that varies from 2,3 to 9,7% depending on the population in which the study is being applied. In 40% of the cases, in spite of being of idiopathic origin, they seem to be associated with patients with occlusal trauma or can be a result of a predominant development of isolated bone during bone growth. The case of a 36-year-old female patient is described, who presents hyperdensity that differs in form, location and imaging features from the commonly documented in this type of anatomical variations. It was diagnosed as idiopathic osteosclerosis, periodic imaging controls were established. The purpose of this case report is to emphasize the importance of performing an appropriate differential diagnosis among hyperdense lesions at maxillofacial level.

An updated review of idiopathic osteosclerosis of the jaws

“…The prevalence of IO can be determined using DPR 3 , 29 , 23 , while taking into account radiographic artifacts due to overlapping images that can be difficult to interpret when IO is present in the anterior area 22 . The use of CBCT has demonstrated the presence of regional block of the mandibular nerve by proximity to IO 8 , 22 , partial paresthesia of the lower lip or orofacial pain with characteristics of neuropathic pain 8 , 10 , 22 , 24 - 28 , 35 due to compression in branches of the incisive nerve 28 and by compression of the IDN by IO, causing neuropathies such as neuropraxia, axonotmesis, neurotmesis 24 , 25 , 35 .…”

“…In cases of IO in implantology, it is necessary to apply a specific drilling protocol with irrigation of an isotonic solution at 5 °C 8 , 23 . In oral and maxillofacial surgery, accurate differential diagnosis can avoid the need for biopsy 13 , and it should be taken into account that a high incidence of recurrence has been reported following the resection of IO 28 . Apart from oral medicine, IO has also been described in long bones and hip bones 14 , 15 .…”

“…The characteristics of IO are that of a radiopaque round mass 27 or hyperdense area 28 , with a uniform background, surrounding a bone trabecular lesion without structural alteration 27 .…”

“…A specific protocol of saline irrigation at 5 °C may be required to avoid an increase in temperature at the time of drilling denatured bone matrix proteins, negatively affecting the primary stability of the implant and osseointegration processes (8, 23) . The incidence of recurrence is high after surgical removal of IO, requiring the need for resection with safe margins 28 . It should be taken into account that differential diagnosis would avoid the need for biopsy 13 .…”

“…In the literature, IO is also known as enostosis, osteosclerosis focus, periapical osteopetrosis or bone scar 8 , 22 , 24 - 28 . There is currently no literature guiding the differential diagnosis of IO 1 , 3 .…”