The radiopaque lesion: A diagnostic consideration

Abstract

This study attempts to designate that some periapical and periodontal radiopacities can be caused by inflamed or necrotic pulps and periodontitis. An hypothesis is offered to explain the formation of a periapical sclerotic lesion. The increase in periapical bone density can often mask an occult granulomatous lesion and it can be obscured by inadvertently superimposing tori over apical radiolucencies. The increased reactive periapical sclerosis is not necessarily clue to an osteitis. This is especially true of dense trabecular bone patterns that are noted in cases of occlusal stress and in periodontitis. It is questionable whether the use of the terms condensing osteitis or sclerosing osteitis is appropriate. Endodontic or periodontic therapy in cases associated with increased bone density produce a normalization of the bone trabeculae. The lesions that do not respond to the specific treatment may be due to anatomic landmarks, increase in functional stimuli producing excessive bone production, local and systemic disorders. Diagnostic features of the radiopaque lesion are discussed.

Histologic Examination of Condensing Osteitis in Cadaver Specimens

“…Inflammatory jaw lesions are commonly observed and have been reported to occur in 58% of all cases observed in one survey (3). The majority of such lesions appear as radiolucent changes, a smaller percentage as mixed (radiopaque/radiolucent) lesions, and the least as only radiopacities.…”

“…Of the latter category, condensing osteitis is the lesion most commonly reported. However, this diagnosis is routinely made on radiographic evaluation alone, and such lesions are apparently rarely biopsied (1)(2)(3)(4)(5).…”

“…The typical radiographic features of condensing osteitis include diffuse radiopaque borders that are concentrically arranged around a root apex that may or may not have a radiolucent inflammatory lesion (2). Condensing osteitis predominates in the mandible and is most frequently associated with the mandibular first molar and in female patients (3,4). It may be found in edentulous areas or associated with teeth that are root canal treated, carious, or with inflamed or necrotic pulps (3)(4)(5)(6)(7).…”

“…Condensing osteitis predominates in the mandible and is most frequently associated with the mandibular first molar and in female patients (3,4). It may be found in edentulous areas or associated with teeth that are root canal treated, carious, or with inflamed or necrotic pulps (3)(4)(5)(6)(7). The condition is presumed to be pathosis forming in response to a long-standing, low-grade inflammatory stimulus (8,9).…”

Histological evaluation of a tooth with hyperplastic pulpitis and periapical osteosclerosis

“…Stahl et al (1969) have shown that in the early stages of pulp inflammation there is increased fibroblastic, cementoblastic and osteoblastic activity in the periapical region. In teeth with or without periapical radiolucencies, radiography shows that the inflammation is surrounded by bone of increased density, which returns to normal when the inflammation subsides (Bender & Mori 1985).…”