Mandible / maxilla
Osteomyelitis
Condensing osteitis



Topic Completed: 1 February 2015

Revised: 8 February 2019

Copyright: 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Condensing osteitis [title]


Annie S. Morrison, M.D.
Kelly Magliocca, D.D.S., M.P.H.
Page views in 2018: 2,652
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Cite this page: Morrison A. Osteomyelitis: condensing osteitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/mandiblemaxillacondensingosteitis.html. Accessed August 25th, 2019.
Definition / general
  • Localized areas of radiographic bone sclerosis associated with apices of inflamed, dead or dying teeth (pulpitis or pulpal necrosis)
  • The association with an area of inflammation, usually the apex of an associated tooth, is critical, because these lesions can resemble several other intrabony processes that produce a somewhat similar radiographic pattern
  • This secondary sclerosis of bone is not considered a true / classical osteomyelitis
Terminology
  • Synonyms for condensing osteitis
    • Focal sclerosing osteitis
    • Focal sclerosing osteomyelitis
  • Cortical bone
    • Cortical bone, synonymous with compact bone, is one of two types of osseous tissue that form bones
    • It forms the cortex, or outer shell, of most bones, and is denser, harder, stronger and stiffer than cancellous bone
  • Idiopathic Osteosclerosis
    • In jaws, localized radiographic bone sclerosis is usually not associated with the apex of a tooth and not associated with an inflammatory condition, although its etiology is not clear
    • Also called dense bone island, bone scar, bone whorl, bone eburnation, enostosis and focal periapical osteopetrosis
    • Also found in other bones, primarily pelvis and long bones
  • Medullary bone / medullary cavity / marrow cavity
    • Central cavity where red or yellow bone marrow (adipose tissue) are stored
    • Has walls of spongy bone (cancellous bone) and is lined by endosteum which are osteoprogenitor cells
  • Periapical granuloma
    • Acute or chronic inflammation admixed with fibrous or granulation tissue locally at the apical or periapical region of a tooth
    • Lacks epithelium (i.e. no cyst lining) which distinguishes it from a periapical cyst
    • Located at apex of a necrotic or partially necrotic tooth root
Sites
  • Apical region of inflamed dead or dying teeth (pulpitis or pulpal necrosis)
  • Usually seen in premolar and molar areas of mandible
    • Dental pulp of the involved tooth demonstrates pulpitis or necrosis upon formal testing
  • Rarely seen adjacent to a sound, unrestored tooth suggesting that other causative factors such as malocclusion may be operative
Pathophysiology / etiology
  • Possible osteoblastic response causing secondary sclerosis in response to a low grade inflammatory stimulus from an inflamed dental pulp
Clinical features
  • Most common radiopaque lesion of jaws, occurs in 4 - 7% of population
  • Most frequently seen in young adults, but also older adults
  • Asymptomatic, most lesions are discovered on routine radiographic examination
  • No clinical or radiographic expansion of jaw is present
Diagnosis
  • Requires clinical and radiographic correlation
  • Localized, usually uniform zone of increased density adjacent to the apex of a dead / dying tooth, no clinical and radiographic expansion of jaw
Radiology description
  • The classic alteration consists of a localized, usually uniform zone of increased radiodensity adjacent to the apex of a tooth
    • Tooth may exhibit a radiographically widened periodontal ligament space or an radiolucent apical inflammatory lesion such as periapical granuloma
  • Is a non-expansile intraosseous process
  • Radiographic differential diagnosis includes periapical cemental dysplasia, osteoma, complex odontoma, cementoblastoma, osteoblastoma and hypercementosis
Treatment
  • May represent a physiologic bone reaction to a known stimulus; thus, in a classic case, the radiopaque bone lesion itself need not be removed
  • The inflamed tooth that stimulated the focal sclerosing osteomyelitis should first be diagnosed and treated
  • For a necrotic tooth pulp or irreversible pulpitis, dental extraction or endodontic therapy is performed causing many cases to partially regress (and not enlarge) radiographically
  • For nonclassic radiographic or clinical cases, bone lesion biopsy may be useful to rule out more significant lesions
Clinical images
Missing Image

Condensing osteitis

Gross description
  • Biopsies are often minute
Micro description of bone lesions
  • Replacement of marrow spaces and cancellous bone by dense, sclerotic compact bone
  • Bone may show prominent incremental lines
  • May see fibrosis replacing fatty marrow, or scant connective tissue
  • Usually no / minimal inflammation
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