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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 34  |  Issue : 3  |  Page : 304-308

Radiographic analysis of idiopathic osteosclerosis of jaws in Indian sub-population: A cross-sectional study


Department of Oral Medicine and Radiology, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India

Date of Submission07-Apr-2022
Date of Decision21-Aug-2022
Date of Acceptance22-Aug-2022
Date of Web Publication26-Sep-2022

Correspondence Address:
Harini Parthiban
Department of Oral Medicine and Radiology, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_116_22

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   Abstract 


Context: Idiopathic osteosclerosis may be congenital or developmental in origin and are asymptomatic. It usually manifests as an incidentaloma and hence it can be encountered in the panoramic radiograph during routine radiographic examination. Aim: This study aims to determine the prevalence of idiopathic osteosclerosis in the Indian population using digital panoramic radiographs. Methods and Material: A cross-sectional study was carried out with a total of 2000 digital panoramic radiographs for the presence of idiopathic osteosclerosis in the Indian sub-population. The area that appeared as an obvious bony island, either round, oval, or irregular shape with a definite internal structure, was selected as a criterion for diagnosis and categorized into five types based on location: inter radicular, inter radicular and separate, apical and inter radicular, apical, and separate. After evaluation, it was correlated based on age, gender, type, and location. Statistical Analysis Used: Statistical analysis was performed using Pearson's Chi-square test. Results: A total of 90 areas of osteosclerosis were found, and a prevalence rate of 4.5% was obtained. The separate type of osteosclerosis showed the highest rate of occurrence. The prevalence rate was identified to be higher in female subjects, and the majority of the lesions occurred among the age group of 12-21 years. Conclusions: This study showed the prevalence of 4.5% on digital panoramic radiographs and found a significant value (p-value 0.042) between the types of idiopathic osteosclerosis and its location.

Keywords: Bony islands, idiopathic osteosclerosis, panoramic radiographs, prevalence


How to cite this article:
Parthiban H, Lakshmi SJ, Somasundaram E, Kumar B S. Radiographic analysis of idiopathic osteosclerosis of jaws in Indian sub-population: A cross-sectional study. J Indian Acad Oral Med Radiol 2022;34:304-8

How to cite this URL:
Parthiban H, Lakshmi SJ, Somasundaram E, Kumar B S. Radiographic analysis of idiopathic osteosclerosis of jaws in Indian sub-population: A cross-sectional study. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 Dec 10];34:304-8. Available from: http://www.jiaomr.in/text.asp?2022/34/3/304/356946




   Introduction Top


An incidental finding is an unsuspected finding and is unallied to the actual diagnostic exploration. They may constitute a conundrum in diagnosis because the consequence is ambiguous.[1] Dense Bony Island is conceded as a focus of compact bone confined to spongiosa, representing a developmental error of endochondral ossification.[2] It is a well-defined localized radiopaque mass with variable sizes and shapes. The internal aspect appears radiopaque, homogenous with ground glass/stippled appearance.[3] Dense bone islands in close proximity to the inferior alveolar nerve canal will usually be asymptomatic but sometimes it may develop into idiopathic pain in the orofacial region.[4] Exact identification and integrative management are of extreme importance because they may harm the patients in the near future. The participants who are engaged in research work or clinicians should emphasize the patient's its presence, and significance and further investigations should be carried out if necessary.


   Subjects and Methods Top


Source of data collection

The study was carried out in the Oral Medicine and Radiology Department. The protocol of the research was initially investigated and agreed upon by the institutional review board and ethical committee and followed all the recommendations of the Helsinki Declaration (2013).

Method of data collection

Digital panoramic radiographs taken in the period between January 2018 and December 2019 were procured from archives for evaluation and it was a retrospective study conducted with a sample size of 2000 digital panoramic radiographs with no blinding. Evaluation and assessment of each panoramic radiograph were done under the guidance of an experienced Oral and Maxillofacial Radiologist (20 years of experience). The inclusion criteria were the digital panoramic radiographs of all age groups and gender. The exclusion criteria were the digital panoramic radiographs with faults/errors and also with indefinite data or indecisive diagnosis. Idiopathic osteosclerosis were categorized into five types based on the location: interradicular, interradicular and separate, apical and interradicular, apical, and separate [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5].
Figure 1: Shows the interradicular type of idiopathic osteosclerosis

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Figure 2: Shows the interradicular-separate type of idiopathic osteosclerosis

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Figure 3: Shows the apical-interradicular type of idiopathic osteosclerosis

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Figure 4: Shows the separate type of idiopathic osteosclerosis

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Figure 5: Shows the apical type of idiopathic osteosclerosis

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   Results Top


The analysis of the data was done using SPSS (Statistical Package for Social Sciences software) version 16.0 (Windows version 17.0 SPSS Inc. Chicago, IL, US, US). The significance (α) level was fixed at 5% (P ≤ 0.05). Analysis was performed using the Pearson's Chi-square test in this research to evaluate the significance of the association between idiopathic osteosclerosis and age/gender/location/types.

Out of 2000 panoramic radiographs (digital), idiopathic osteosclerosis was noted in 90 radiographs and was found to be highest in the second (28%) and third (27%) decades of life. Idiopathic osteosclerosis was identified to be more in females (51%) than males (49%) in this study. Most of the osteosclerosis lesions were present in premolar and molar regions of the lower jaw. [Table 1] shows the correlation between different age groups and the location of osteosclerosis (p-value 0.264). [Table 2] shows the significant association between types of idiopathic osteosclerosis and its location (p-value 0.042). [Table 3] depicts the association of types of idiopathic osteosclerosis and age groups (p-value 0.768). The correlation of osteosclerosis with gender and location is depicted in [Table 4] (p-value of 0.935). [Table 5] shows the distribution of idiopathic osteosclerosis with respect to gender, and, type, and no significant differences were yielded (p value: 0.847). A prevalence rate of 4.5% was obtained in this study.
Table 1: Distribution of idiopathic osteosclerosis based on age groups and location

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Table 2: Distribution of idiopathic osteosclerosis in accordance with types and location

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Table 3: Distribution of idiopathic osteosclerosis based on age groups and types

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Table 4: Distribution of idiopathic osteosclerosis based on gender and location

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Table 5: Distribution of idiopathic osteosclerosis based on gender and types

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   Discussion Top


Idiopathic osteosclerosis is a non-odontogenic sclerotic lesion and will be asymptomatic with no inflammatory events, remain the same size, or sometimes it may show a considerable amount of growth, and ceases when the patients' skeletal maturity is attained.[5] The nutrient canal was suggested as a factor in the formation of the bony island.[6] Radiopaque lesions may evolve in the periapical region due to occlusal overload from the abutment teeth of fixed or removable prosthesis and was termed as compensatory osteosclerosis.[7]

A well-defined round, oval, or irregular-shaped radiopaque structure with the homogenous area as the internal structure is considered a diagnostic criterion and was similar to Geist et al., Tadahiko Kawaii et al., Moshfeghi et al.[8],[9],[10] Most of the studies followed the same criteria for evaluation based on the location except in Tadahiko Kawai et al., Masao Araki et al.[11],[12] studies where they categorized idiopathic osteosclerosis into solitary, Peripheral enostosis I, II, and periapical (P-region), body (B-region), edentulous (E-region), respectively.

On the evaluation of 2000 digital panoramic radiographs, a prevalence of 4.5% was obtained. The prevalence in the Japanese population was reported to be 9.7% and was found to be higher than our study.[9] Ozkan Miloglu et al.[13] investigated the frequency of osteosclerosis in the Turkish population, and the prevalence rate (2.44%) was lower than our study (4.5%).

There was an almost equal distribution of idiopathic osteosclerosis in the second (28%) and third (27%) decades of life which was similar to Tadahiko Kawai et al., Yildiray Sisman et al.[11],[14] 23% of the lesions were present in the age group of 32-41 years, and the least was encountered in the fifth and sixth decades, which was in contrast to a study by Lalitha Chintala et al.,[2] where the prevalence rate was higher among fifth and sixth decades.

The prevalence rate was identified to be more in females (51%) than males (49%) which was similar to a few other studies.[2],[6],[10],[13],[15] In contrast, studies by Yildiray Sisman et al., Zeljko Verzak et al., showed a high prevalence rate in male subjects but did not show any significant difference among the male and female subjects.[7],[14]

Most of the osteosclerosis lesions were present in the molar and premolar regions as reported in other studies.[2],[6],[7],[11],[14],[15] In contrast, few studies concluded that the premolar region was most commonly involved in the evolution of idiopathic osteosclerosis.[8],[10]

Out of five types, a separate type of idiopathic osteosclerosis was most commonly present which was similar to Gangwal Jain et al. and Moshfeghi et al.[10],[15] Apical type of osteosclerosis was presented as the second most common type in our study, which was in contrast to a few studies, where it was reported as the most frequent type.[2],[8],[14]

Routine radiographic examination during orthodontic treatment had paved the way for the evaluation of an incidental finding and is a warning signal for orthodontists because it may sometimes be found to cause delayed movement of the tooth during treatment. Idiopathic osteosclerosis has a higher density of bone and is suitable for the placement of implants without an aftermath effect.[16] Sometimes idiopathic osteosclerosis may cause impaction, and malposition of teeth due to obstruction of the tooth germ.[4]

Occult idiopathic osteosclerosis in jaws was considered the warning signal for the development of adenomatous polyposis in the future. Hence, panoramic radiographs were described as a marker for the detection of colorectal neoplasia in first-degree relatives.[17]

The identification of an incidental finding will make the diagnostician go for other specialized imaging modalities which cause an additional radiation dose to the affected individual. To avoid these circumstances, practitioners should be aware of the unexpected findings and their significance.[1]


   Limitations and Future Prospects Top


The limitation of the research was that the symptoms or the history of colorectal neoplasia could not be gathered due to the retrospective design of the study and few radiopacities were not included due to inconclusive diagnosis.

Future research can be carried out in various population groups in India with a bigger sample size which will be useful in correlating with the available data. CBCT is considered as a newer imaging modality for diagnosing dense bone islands due to various slices with 3D reconstruction facilities. It may also provide information regarding the association of bony islands with the adjacent tooth and other vital structures.


   Conclusion Top


This study showed the prevalence rate of idiopathic osteosclerosis in the Indian sub-population (4.5%). Panoramic radiography is a simpler and most convenient technique that aids in the detection of incidentaloma or incidental findings. Although idiopathic osteosclerosis or dense bone island has no clinical significance, it is essential to distinguish it from other pathological conditions. These lesions remain static for years and the sclerotic area may sometimes cause expansion of the bone, or increases in its size which require regular follow-up and is essential for an accurate diagnosis. The prevalence rate of idiopathic osteosclerosis should be evaluated in different populations which may guide dental practitioners to diagnose, and also it can prevent unwanted surgical exploration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lumbreras B, Donat L, Hernández-Aguado I. Incidental findings in imaging diagnostic tests: A systematic review. Br J Radiol 2010;83:276-89.  Back to cited text no. 1
    
2.
Chintala L, Bhavya B, Chaitanya YC, Chaitanya PV, Mamatha D, Sathwik G. Dense bony islands of the maxillofacial region: A radiological study. Int J Appl Dent Sci 2017;3:258-60.  Back to cited text no. 2
    
3.
Austin BW, Moule AJ. A comparative study of the prevalence of mandibular osteosclerosis in patients of Asiatic and Caucasian origin. Aust Dent J 1984;29:36-43.  Back to cited text no. 3
    
4.
Nahuincopa P, Romero L. An updated review of idiopathic osteosclerosis in the jaws. Rev Cient Odontol (Lima) 2021;9:e050.  Back to cited text no. 4
    
5.
Van Hoe S, Bladt O, Van Der Steen K, Van den Eynde H. Sclerotic lesions of the jaw: A pictorial review. J Belgian Soc Radiol 2021;105:1-9.  Back to cited text no. 5
    
6.
Greenspan A. Bone island (enostosis): Current concept- a review. Skeletal Radiol 1995;24:111-5.  Back to cited text no. 6
    
7.
Verzak Z, Celap B, Modric VE, Soric P, Karlovic Z. The prevalence of idiopathic osteosclerosis and condensing osteitis in Zagreb population. Acta Clin Croat 2012;51:573-7.  Back to cited text no. 7
    
8.
Geist JR, Katz JO. The frequency and distribution of idiopathic osteosclerosis. Oral Surg Oral Med Oral Pathol 1990;69:388-93.  Back to cited text no. 8
    
9.
Kawai T, Murakami S, Kishino M, Sakuda M. Gigantic dense bone island of the jaw. Oral Surg Oral Med Oral Pathol Oral radiol Endod 1996;82:108-15.  Back to cited text no. 9
    
10.
Moshfeghi M, Azimi F, Anvari M. Radiologic assessment and frequency of idiopathic osteosclerosis of jawbones: An interpopulation comparison. Acta Radiol 2013;55:1239-44.  Back to cited text no. 10
    
11.
Kawai T, Hirakuma H, Murakami S, Fuchihata H. Radiographic investigation of idiopathic osteosclerosis of the jaws in Japanese dental outpatients. Oral Surg Oral Med Oral pathol 1992;74:237-42.  Back to cited text no. 11
    
12.
Araki M, Matsumoto N, Matsumoto K, Ohnishi M, Honda K, Komiyama K. Asymptomatic radiopaque lesions of the jaws: A radiographic study using cone-beam computed tomography. J Oral Sci 2011;53:439-44.  Back to cited text no. 12
    
13.
Miloglu O, Yalcin E, Buyukkurt MC, Acemoglu H. The frequency and characteristics of idiopathic osteosclerosis and condensing osteitis lesions in a Turkish patient population. Med Oral Pathol Oral Cir Buccal 2009;14:e640-5.  Back to cited text no. 13
    
14.
Sisman Y, Ertas ET, Ertas H, Sekerci AE. The frequency and distribution of idiopathic osteosclerosis of the jaw. Eur J Dent 2011;5:409-14.  Back to cited text no. 14
    
15.
Jain PG, Nair P, Choudhary PJ, Sathe R, Sood M, Agarwal K. Sclerosing lesions of the jaw bones: A prevalence study in Bhopal population. Int J Recent Sci Res 2018;9:25764-9.  Back to cited text no. 15
    
16.
Ahmad NS, Mei JYS, Ibrahim N, Fauzi AA, Wahab RMA. Asymptomatic radiopacity of mandible causing delayed orthodontic tooth movement: A case report. J Res Med Dent Sci 2020;8:72-5.  Back to cited text no. 16
    
17.
Kaffe I, Rozen P, Horowit I. The significance of idiopathic osteosclerosis found in panoramic radiographs of sporadic colorectal neoplasia patients and their relatives. Oral Surg Oral Med Oral Pathol 1992;74:366-70.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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