Mandible & maxilla

Osteomyelitis and inflammatory conditions

Condensing osteitis


Editorial Board Member: Molly Housley Smith, D.M.D.
Deputy Editor-in-Chief: Kelly Magliocca, D.D.S., M.P.H.
Abberly Lott Limbach, M.D.

Last author update: 28 March 2023
Last staff update: 14 April 2023

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PubMed Search: Condensing osteitis

Abberly Lott Limbach, M.D.
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Cite this page: Lott Limbach A. Condensing osteitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillacondensingosteitis.html. Accessed February 26th, 2024.
Definition / general
Essential features
  • Dense sclerotic bone, seen radiographically, in area of a tooth with pulpitis or previous restoration
  • Lesion resolves with treatment of affected tooth
Terminology
ICD coding
  • ICD-10: M27.2 - inflammatory conditions of jaws
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
Diagnosis
  • Diagnosis made by imaging of jaw
Radiology description
Radiology images

Contributed by Molly Housley Smith, D.M.D. and John Kalmar, D.M.D., Ph.D.
Apical to carious teeth

Apical to carious teeth

Residual opacity

Residual opacity

Panorex image, condensing osteitis

Panorex



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Missing Image

Periapical

Prognostic factors
  • Most regress after treatment of affected tooth
Case reports
Treatment
  • Treatment of infection in affected tooth with hopeful regression after root canal therapy or extraction (J Mass Dent Soc 2003;52:52)
Gross description
  • Bone, often fragmented
Frozen section description
  • Frozen section not performed
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Molly Housley Smith, D.M.D.
Scant fibrous stroma

Scant fibrous stroma

Nonspecific bone

Nonspecific bone

Remodeling bone

Remodeling bone

Prominent resting and reversal lines

Prominent resting and reversal lines

Positive stains
  • Morphologic and clinical diagnosis, no stains needed
Negative stains
  • Morphologic and clinical diagnosis, no stains needed
Sample pathology report
  • Mandible, partial mandibulectomy:
    • Sclerotic bone consistent with condensing osteitis
Differential diagnosis
  • Idiopathic sclerosis:
    • Not inflammatory or neoplastic
    • Intraosseous radiopacity of noninflammatory trabecular bone
  • Cemento-osseous dysplasia:
    • May demonstrate multiple foci
    • Cellular fibrovascular connective tissue with mixture of bone and cementum-like particles
    • Radiographically characterized by radiolucency or radiopacity surrounded by radiolucency
  • Osteoma:
    • May be associated with Gardner syndrome, particularly when multiple
    • Demonstrates expansion / growth over time with possible displacement of teeth
    • No association with inflammation
Board review style question #1

A panoramic Xray is obtained of a patient's mandible. To confirm the diagnosis of condensing osteitis, which radiographic feature should be present?

  1. Mixed radiopaque / radiolucent lesion
  2. No lesion identified
  3. Radiolucent lesion
  4. Radiopaque lesion
Board review style answer #1
D. Radiopaque lesion. Condensing osteitis is most often seen on panoramic Xray as a radiopaque lesion. There is always a lesion identified as it is how the diagnosis is made. Radiolucent lesions include other cysts such as odontogenic keratocyst, dentigerous cyst or periapical cyst.

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Reference: Condensing osteitis
Board review style question #2
What is the most common histologic finding in condensing osteitis?

  1. Acute osteomyelitis
  2. Compact / sclerotic bone
  3. Marked chronic inflammatory infiltrate
  4. Replacement of bone by fibrous tissue
Board review style answer #2
B. Compact / sclerotic bone. Condensing osteitis is related to chronic inflammation causing sclerotic bone formation. Acute osteomyelitis will not be seen as this is a chronic process. There also will not be a chronic inflammatory infiltrate given the chronicity of the process. There is scant fibrous tissue in this process; it is a reactive boney process.

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Reference: Condensing osteitis
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