Condensing osteitis in the diagnosis consultation at Egas Moniz University Clinic

Abstract

Introduction: Condensing Osteitis or Focal Sclerosing Osteomyelitis Condensing is characterized by the formation of periapical sclerotic bone; it consists on a focalized osseous reaction leading to bone growth resulting from inflammatory stimuli or local low intensity trauma [1–3]. Although described as a result of periapical of pulp inflammation and /or infection [3], it’s also observable in vital teeth as a consequence of occlusal trauma [1,2,4] and, thus, aetiologically not associated with pulp aggression, which may lead to misdiagnosis [5]. Clinically, in most cases, there is absent or mild pain, no lymphadenopathy and no cortical expansion [6]. Radiologically, these radiopaque lesions are associated with previously restored teeth or teeth undergoing trauma [1], mostly in the molar region of the mandible [1,7,8]. Condensing Osteitis is less frequent in the maxilla probably due to lower cortical thickness and abundant irrigation [6]. Its radiological appearance remains even with exodontia of the involved tooth [1].

The objective of this study was to statistically analyze condensing osteitis lesions detected in ortopanthomographies in the diagnosis consultation of the I.U.E.M. university clinic.

Materials and methods: Observational study. The defined study group included patients who attended the diagnosis consultation at Egas Moniz University Clinic. 1947 patients were randomly selected. Frequency tables were determined according to the following criteria: sex, age, location, presence or absence of paresthesia. Non vital teeth and edentulous spaces were excluded. Statistical results were rounded to the centesimals. This paper has been conducted in an ethical and responsible manner, and is in full compliance with all relevant codes of experimentation and legislation.

Results: 62 cases were observed (3,2%). More frequent in female patients (53,22%). No maxillary lesions (0%) were observed in the sample group (100% mandible lesions). Mandibular molars (53,23%) and premolars (43,54%) were the most frequently affected teeth, more specifically tooth 46 (20,97%), tooth 45 (19,35%) and tooth 36 (16,13%). 2 canines (3,23%) were observed to be associated with condensing osteitis. Lower right mandibular teeth were observed to have a higher incidence of condensing osteitis cases (54,84%), when compared to lower left mandibular teeth (45,16%). No cases of paresthesia were observed. Mean age was found to be 39,1 years old.

Discussion and conclusions: Condensing osteitis was observed only in a small minority of the selected study universe and, thus, it can be considered as statistically infrequent. Mandible molar teeth were most frequently affected, which is in accordance to the referenced bibliography. Statistically, only slight differences were observed when considering the gender factor and thus these lesions are expected to occur in both male and female patiens.

Aetiological treatment of pulp inflammation or occlusal trauma is recommended. In other cases, biopsy should be considered and differential diagnosis should include cement-osseous dysplasia, osteoma, cementoblastoma, osteoblastoma, hipercementosis [1]. Although statistically infrequent, Condensing Osteitis must be considered clinically relevant, not only regarding its differential diagnosis, but also because bone biopsies present the clinical implications of being invasive procedures, which can lead to vertical and horizontal bone loss, thus requiring immediate or further surgical procedures for local regeneration and rehabilitation. Furthermore, in the premolar and molar regions of the mandible, the risk of nerve lesion must be considered when performing a bone biopsy.