Journal of Indian Academy of Oral Medicine and Radiology

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 28  |  Issue : 3  |  Page : 242--245

Retrospective panoramic radiographic analysis for idiopathic osteosclerosis in Indians


Srikanth H Srivathsa 
 Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India

Correspondence Address:
Dr. Srikanth H Srivathsa
Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka
India

Abstract

Introduction: Idiopathic osteosclerosis is an area of increased radiodensity observed on panoramic radiographs. The prevalence of this entity is not known, especially in Indians. Aims and Objectives: To determine the prevalence and epidemiological characteristics of idiopathic osteosclerosis. Materials and Methods: Six hundred and forty panoramic radiographs were retrospectively analyzed for the presence of idiopathic osteosclerosis by a single trained oral radiologist. Statistical Analysis: The data obtained were analyzed using Microsoft Excel (Version 2007) for Windows. Results: Idiopathic osteosclerosis was identified in 32 individuals with a prevalence of 5%. There were 21 female (65.7%) and 11 male (34.3%) participants. There were 31 single, unilateral (96.85%) osteosclerotic lesions and 1 (3.15%) bilateral lesion. Right side localization was noted in 19 participants (57.57%) and left side localization in 14 participants (42.42%). Conclusion: This study illustrates the prevalence of idiopathic osteosclerosis in Indians. Further, it depicts the characteristics of idiopathic osteosclerotic lesions.



How to cite this article:
Srivathsa SH. Retrospective panoramic radiographic analysis for idiopathic osteosclerosis in Indians.J Indian Acad Oral Med Radiol 2016;28:242-245


How to cite this URL:
Srivathsa SH. Retrospective panoramic radiographic analysis for idiopathic osteosclerosis in Indians. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2019 Nov 20 ];28:242-245
Available from: http://www.jiaomr.in/text.asp?2016/28/3/242/195660


Full Text

 Introduction



Afocal area of increased density of bone, appearing as intense radioopacity on radiographs, that cannot be attributed to any known cause is termed as idiopathic osteosclerosis (IO). This entity is entirely asymptomatic and it is identified on radiographs incidentally.[1] Different terminologies have been used in literature to describe this entity such as dense bone island, bone eburnation, bone whorl, bone scar, enostosis and focal periapical osteopetrosis.[1],[2] A review of literature revealed no prevalence studies among Indian population. Hence, this study was conducted with the objective to determine the prevalence and characteristics of IO in Indian population.

 Materials and Methods



Six hundred and forty panoramic radiographs of adult individuals, aged 20–80 years, were retrospectively screened for IO. Institutional ethical committee clearance was obtained for the study. These radiographs were obtained for evaluation of various dental and maxillofacial complaints such as pre-orthodontic evaluation, prosthodontic, periodontic and oral surgical procedures. The radiographs depicting the maxillae and the mandible fairly well were selected. All radiographs were obtained with a single panoramic radiographic machine (Rotograph 230 EUR, FIAD SpA–20094, Trezzano S/Naviglio, Villa, Italy) operating between 65–75 kVp, 10 mA, and 16 s using T-Mat G/Lanex medium film/screen combination (Eastman Kodak Co., Rochester, NY, USA). All the radiographs were processed automatically, dried, labeled and stored until interpretation. Exclusion criteria included radiographs not exhibiting the jaws, motion blurring, images with artifacts and central pathologies in the area of interest.

All the 640 radiographs were analyzed by a single trained oral radiologist in ambient viewing conditions, and IO was documented when meeting the defining criteria, as described in literature.[3] Following this, IO was further classified based on the demographics, laterality (unilateral/bilateral), and location. The data thus obtained was tabulated in a specifically developed proforma, and was subjected to statistical analysis. The standard deviation and prevalence was calculated using Microsoft Excel (Version 2007, Microsoft, WA, USA) for Windows.

 Results



Six hundred and forty panoramic radiographs were analyzed for the presence of IO. There were 320 male and 320 female participants. The age of the participants ranged from 20 to 80 years. IO was identified in 32 participants. The age range of participants with IO was from 21 to 73 years, with a mean age of the 39.8 years [Graph 1]. A total of 33 IO lesions were identified in 32 participants, amounting to a prevalence of 5%. There were 21 female (65.7%) and 11 male (34.3%) participants. There were 31 single, unilateral (96.85%) osteosclerotic lesions and 1 (3.15%) bilateral lesion [Figure 1]. Right side localization was noted in 19 participants (57.57%) and left side localization in 14 participants (42.42%) [Graph 2]. IO was mostly noted around the periapical area of mandibular first molars in 12 participants (36.36%) [Figure 2] followed by mandibular first premolar in 9 participants (27.3%) [Figure 3]. The mandibular second molar and premolars were localized in 5 participants each (15.16%) followed by the mandibular canine in only 2 participants (6%) [Graph 3]. The standard deviation and variance is summarized in [Table 1].[INLINE:1]{Figure 1}[INLINE:2]{Figure 2}{Figure 3}[INLINE:3]{Table 1}

 Discussion



In a recent study from Turkey, the prevalence of IO was found to be 6.1%,[4] and another study reported a prevalence of 31%.[1] In the present study, the prevalence was 5%. Hence, it can be said that the prevalence ranges from 2.4–31%. Literature reports most IOs to be clustered around the third and fourth decades of life.[4] In the present study the IOs were found more toward the fifth decade (N = 12) followed by the fourth decade (N = 8). Although the exact reason for the occurrence of IO in the 3rd and 4th decade of life is not known, it is suggested that it is the period of maximum bone acquisition.[1] Mandible is considered to be a preferred site for occurrence when compared to the maxilla. Studies have shown that IO occurs more commonly in males (6.3%) than females (5.9%),[4] however, in contrast, another study reported a female preponderance.[1] In the present study, all the cases were localized in the mandible and were mostly in females (N = 21).

It is found that most of the IOs occur as a single area of radioopacity, followed by two areas. Multiple areas of IO are considered very rare.[1],[4] When occurring in the maxilla, they are said to be concentrated in the anterior region whereas in the mandible it is around the root apices of molars or premolars.[4] In the current study, all IOs occurred in the mandible, and none in the maxilla, almost all the IOs occurred as single radioopacity (N = 31) and one area of two IOs. Further, mandibular molar localization was the predominant location, followed by the first premolar region. However, IO was also noted as anterior as the canine and as posterior as the second molar. Among the sides, right side localization (N = 19) was more predominant than the left side (N = 14).

Radiographically, IO has been described to appear as elliptical to round radioopaque mass varying from 3 mm up to 2 cm.[4] The internal architecture is said to be uniformly radioopaque with coarse trabeculae or sometimes even with ground glass appearance.[5] It is nonexpansile and sometimes irregular in shape, and rarely can occupy the entire height of the mandible.[3],[6] One follow up study of IO found that early lesions tend to change and increase in size.[4] In contrast, another study found no changes in the size of lesions.[1] Although the exact etiology of this entity is not known, it is considered to be related to increased occlusal stress on the bone, as analogous lesions have been identified in the long bones. In addition, it is considered to be a process similar to the formation of tori or enostosis.[6] No research has been done to explore the etiology of this entity at a cellular level.

Criteria for identification is available in the literature. Accordingly, IO is asymptomatic, well-defined radioopacity devoid of a radiolucent border, with structure not identifiable as a tooth, not associated with a carious tooth, and not a superimposition of images such as sialolith, exostosis.[3] A classification of IO is proposed based on the location:[1],[4]

Inter-radicularInter-radicular and separateApical and inter-radicularApicalSeparate.

Differential diagnosis for IO should consist of exostosis, root segments, foreign bodies and impacted teeth.[1] Other rare syndromes, such as Worth syndrome and Van-bauchem disease, can also show osteosclerosis, however, they tend to be diffuse and involve other cranial bones showing a hereditary pattern of transmission.[7] Histopathologically, IO consists of dense calcified or ossified tissue without marrow spaces and no inflammatory cell infiltration.[2] It is suggested that, because the lesions are asymptomatic, they can be left alone without any intervention, and hence require no treatment.[2]

 Conclusion



IO is an area of increased radioopacity visible in either jaw on radiographs. The prevalence of this entity is quite low in the Indian population. When ever one finds a radioopacity either in the mandible or maxilla, it is extremely important to recognize it and further differentiate it from other lesions. If the radiographic features suggest IO, then no further intervention or investigations would be necessary. This study is successful in determining the prevalence and characteristics of IO in Indians.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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