London Endodontics
Dr. Victor Wagner & Dr. Anu Bhalla
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Miscellaneous Cases - Case 1

We see radiolucencies (rarefying osteitis) often, but true periapical radiopacities are much less frequent. Rare conditions can cause this, but there are 4 more common causes:
  1. Condensing or Sclerosing Osteitis: Is a reaction of the adjacent trabecular bone to mild irritation and there is no radiolucent rim around it.
  2. Idiopathic Osteosclerosis (periapical): These areas occur more often in the mandibular premolar area, often they are irregular in shape. They also have no radiolucent rim around them.
  3. Hypercementosis: Excess cementum, often forming a "club shaped" root. It is distinguished by being the only one that will have a complete PDL space around it since it is part of the tooth.
  4. Mature Periapical Cemental Dysplasia: In the early stages of development, there are radiolucencies associated with the area (it could be completely radiolucent). Once mature, it becomes more uniformly dense, usually rounded, with well defined smooth borders. It is distinct as it will have a thin radiolucent rim around it, more diffuse than a PDL space, representing a more fibrous tissue at the borders.
These conditions usually require no treatment (as long as the pulps are within normal limits), and should just be monitored regularly. If in doubt, I suggest consulting with an Oral Pathologist, Oral Radiologist, or Oral Surgeon to distinguish these from the more rare conditions that may require intervention.