Idiopathic osteosclerosis of the mandible is a common incidental finding on dental imaging.
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Terminology
Idiopathic Osteosclerosis is also known as dense bone islands, enostoses, bone scar, bone whorl or focal periapical osteopetrosis 1,2,3.
Idiopathic osteosclerosis is the preferred terminology because it refers to a benign focal growth of compact bone with increased bone radiodensity without cortical expansion within the cancellous bone 4.
Epidemiology
Idiopathic osteosclerosis is detected on ~5% (range 4-31%) of dental imaging, such variability is due to the lack of a standardized definition 1,2,5.
Some researchers report a higher prevalence of idiopathic osteosclerosis in their third and fourth decade of life and a higher prevalence in women, although there are not statistically significant 6.
Clinical Presentation
Idiopathic osteosclerosis is usually asymptomatic, discovered as an incidental finding on OPG or cone-beam or dental CT 2,5,7.
Pathology
Idiopathic osteosclerosis has an unknown etiology with no associations with infection or systemic disease. It is considered a developmental variation of normal bone architecture, possibly due to the modification of normal turnover or naturation with excessive osseous deposition or retained primary root fragments, bone deposition in reponse to unusual occlusal forces or anatomic variations analogous to tori 1,7.
Idiopatic osteosclerosis is most commonly (90%) in the mandible near the first molar or the premolar region and may be either periapical (80%) or remote to teeth (20%) with normal periodontal space and lamina dura 3,4.
The lesion can be associated with the roots or completely separated from them by normal trabecular bone 2.
Radiographic features
Idiopathic osteosclerosis appears as a well-defined homogenous sclerotic radiopaque foci of dense bone in the mandible 7. It is usually a solitary lesion but can be multiple, varies in size ranging from 2-3 mm to 1-2 cm, with a varying shape and border (e.g. round, elliptical, irregular) 6. Although typically, usually has sharp margins without a radiolucent rim, but occasionally has peripheral spiculation 5.
Treatment and prognosis
Idiopathic osteosclerosis is usually of no significance, but rarely causes changes in tooth position, external root resorption, hinder tooth eruption or orthodontic tooth movement (inclination of teeth) 4.
The finding should be followed up to confirm an accurate clinical diagnosis and differentiate from pathology created by inflammatory processes and systemic diseases and thereby avoid unnecessary biopsies 8.
Differential diagnosis
condensing osteitis (periapical sclerosis osteitis or focal sclerosing osteitis): occurs due to chronic inflammation and is often associated with caries, non-vital teeth and other inflammatory lesions 8
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