Abstract
BackgroundDense Bone Islands (DBIs) are anatomic variants defined as radiopaque lesions consisting of hamartomatous cortical bone, often presenting as incidental radiographic findings. DBIs can also be known as idiopathic osteosclerosis, bone whorl, focal periapical osteopetrosis, bone scar and enostosis. We found a paucity of literature for management and reporting of this condition in children. For this reason, the authors describe sixteen cases of children and adolescents with dense bony islands and suggest a pathway for management.Case seriesCases presented to the RNENT and Eastman Dental Hospital or private practice, either as chance findings or for diagnosis and treatment planning of undiagnosed radiopaque areas. The individuals were aged between 10 and 17 years; 6 boys and 10 girls. All radiographic reports described DBIs. Diagnoses were confirmed by a Dental and Maxillofacial Radiology Consultant and advised no intervention. In some cases, monitoring was advised. Caution in orthodontic tooth movement was advised for five patients.ConclusionDBIs are common findings that seldom require treatment; however, caution should be exercised when undertaking orthodontic movement in the area of a DBI due to a potential risk of root resorption. Accurate identification and multidisciplinary management are of utmost importance.
Highlights
Dense Bone Islands (DBIs) are anatomic variants defined as radiopaque lesions consisting of hamartomatous cortical bone, often presenting as incidental radiographic findings
DBIs can be known as idiopathic osteosclerosis, bone whorl, focal periapical osteopetrosis, bone scar and enostosis (Yonetsu et al 1997)
Nakano et al in 2002 found a 7% increase in size of a DBI on a 10-year-old girl. This is in agreement with Petrikowski and Peters’ conclusion for children and teenagers that about 40% of DBIs are thought to DBIs are often of no clinical significance, dental extraction of a tooth embedded into a DBI may result in an infected socket and pain of the edentulous area (Marmary and Kutiner 1986)
Summary
Dense Bone Islands (DBIs) are anatomic variants defined as radiopaque lesions consisting of hamartomatous cortical bone, often presenting as incidental radiographic findings. Case 16 (Fig. 16) had a large bone island on the buccal aspect of the maxillary alveolar process, occupying at least 50% of the alveolar process between UR3 and UR2 and extending to the right nasal fossa. In this case, following multidisciplinary discussion, orthodontic treatment was deemed contra-indicated in the area of the dense bone island. Caution in orthodontic tooth movement was advised for five patients (cases 2, 3 5, 12 and 16), with orthodontic tooth movement in the area of the dense bone island being contraindicated due to increased risk of resorption of adjacent tooth roots
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