Condensing osteitis, also known as focal sclerosing osteomyelitis, is a rare periapical inflammatory condition characterized by the formation of sclerotic bone near the roots of premolars and molars. This condition arises as a response to dental infections, such as periapical pulp inflammation or low-intensity trauma. The lesion typically appears as a radiopacity in the periapical area due to the sclerotic reaction. While most commonly associated with non-vital teeth, condensing osteitis can also occur in vital teeth following occlusal trauma. The condition was first described by Dr. Carl Garré in 1893.

Signs and symptoms

Patients are typically asymptomatic, and the condition is most often detected incidentally during routine radiographic examinations. In rare symptomatic cases, patients may report mild pain.

Causes

The cause of condensing osteitis is not clear, but it is thought to happen due to irritation or inflammation that increases osteoblastic activity. Chronic pulpitis is one of the main factors. This is when bacteria enters the pulp of the tooth, often from untreated cavities. This leads to ongoing mild inflammation that causes bone growth near the root of the tooth. Another main factor is periapical infections. These infections start at the tip of the tooth root, often from dead pulp tissue or

occlusal trauma Occlusal trauma is the damage to teeth when an excessive force is acted upon them and they do not align properly.Bibb, CA: Occlusal Evaluation and Therapy in the Management of Periodontal Disease. In Newman, MG; Takei, HH; Carranza, FA; editors: ...

Pathophysiology

Condensing osteitis happens when the bone around the tooth reacts to long-term inflammation. This involves excessive bone growth, leading to the formation of sclerotic bone in the jaw. Ongoing tooth infections, like pulpitis, release chemicals that attract immune cells and activate

osteoblast Osteoblasts (from the Greek combining forms for " bone", ὀστέο-, ''osteo-'' and βλαστάνω, ''blastanō'' "germinate") are cells with a single nucleus that synthesize bone. However, in the process of bone formation, osteoblasts fu ...

s. Osteoblasts create extra bone in response to inflammation, making the area look more sclerotic. Unlike typical infections, condensing osteitis doesn't destroy bone or produce

pus Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during infections, regardless of cause. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collect ...

it just adds more bone to the affected area.

Diagnosis

Diagnosis typically involves a clinical examination by a dentist or

endodontist Endodontics () is the dental specialty concerned with the study and treatment of the dental pulp. Overview Endodontics encompasses the study (practice) of the basic and clinical sciences of normal dental pulp, the etiology, diagnosis, prevent ...

, complemented by imaging studies such as

cone-beam computed tomography Cone beam computed tomography (or CBCT, also referred to as C-arm CT, cone beam volume CT, flat panel CT or Digital Volume Tomography (DVT)) is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, ...

. Radiographically, condensing osteitis presents as a localized radiopaque lesion at the root apex of the affected tooth. Root canal rvg

Treatment

Condensing osteitis is usually benign and asymptomatic. Treatment depends on the underlying cause and severity.

Endodontic treatment Root canal treatment (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for the infected Pulp (tooth), pulp of a tooth that is intended to result in the elimination of infection and the p ...

is the primary intervention in cases of pulpal infection. Other treatment options include Antibiotics that are prescribed for associated bacterial infections and tooth Extraction: Reserved for cases where the tooth is irreversibly damaged due to pulpitis.

Prognosis

The prognosis is excellent. Following root canal therapy, the sclerotic bone often remodels, restoring normal bone structure over time.

Epidemiology

This affects 4-7% of the human population. It mainly occurs during early adolescence/young adults but can occur at any age and in any gender.

Research direction

Recent research has focused on the prevalence and management of condensing osteitis and thus has pointed out the need for further investigation into its pathophysiology and treatment. For instance, studies on the frequency and distribution of

mandibular In jawed vertebrates, the mandible (from the Latin ''mandibula'', 'for chewing'), lower jaw, or jawbone is a bone that makes up the lowerand typically more mobilecomponent of the mouth (the upper jaw being known as the maxilla). The jawbone i ...

condensing osteitis in specific populations, such as the Taiwanese population, have provided useful epidemiological data. These studies indicate that prevalence may be related to cultural, dietary, or even genetic factors, thus constituting a background for conducting research in different population groups. Case reports, such as the documentation of a female patient aged 35 years with condensing osteitis, further support that there is variability in clinical presentation and outcome. These cases serve to further the understanding not only of the condition itself but also the deficits in both

diagnostic Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

and therapeutic approaches, underlining the need for individual treatment strategies, as well as follow-up over a long period of time regarding changes in bone after intervention. Future studies may be directed at the

molecular A molecule is a group of two or more atoms that are held together by attractive forces known as chemical bonds; depending on context, the term may or may not include ions that satisfy this criterion. In quantum physics, organic chemistry, ...

mechanisms of osteoblastic activity and bone sclerotization in response to

chronic inflammation Chronic systemic inflammation is the result of release of pro-inflammatory cytokines from immune-related cells and the chronic activation of the innate immune system. It can contribute to the development or progression of certain conditions such ...

. Identifying specific inflammatory or genetic markers may lead to earlier diagnosis and targeted therapies. Clinical practices may also be greatly improved by investigating the place of advanced imaging technologies, such as cone-beam computed tomography, in enhancing diagnostic accuracy and monitoring treatment outcomes. Condensing osteitis will be more clearly understood when epidemiological data is combined with clinical case studies and molecular research to enhance patient care and outcomes by both dental and medical specialties.

References

External links

{{Medical resources , DiseasesDB = 33858 , ICD10 = , ICD9 = , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeshID = Inflammations Osteitis Pathology of the maxilla and mandible