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https://doi.org/10.15644/asc48/3/2

Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje

Elen de Souza Tolentino ; Zavod za stomatologiju i oralnu radiologiju Sveučilišta Maringá, PR, Brazil
Paulo Henrique Capel Gusmão ; Ravel Institut, PR, Brazil
Guilherme Saintive Cardia ; Bauru Stomatološki fakultet, Sveučilište São Paulo, SP, Brazil
Lívia de Souza Tolentino ; University of São Paulo, SP, Brazil
Lilian Cristina Vessoni Iwaki ; Zavod za stomatologiju i oralnu radiologiju Sveučilišta Maringá, PR, Brazil
Pablo Andrés Amoroso-Silva ; Bauru Stomatološki fakultet, Sveučilište São Paulo, SP, Brazil

Puni tekst: hrvatski, pdf (440 KB) str. 183-192 preuzimanja: 223* citiraj
APA 6th Edition
Tolentino, E.d.S., Gusmão, P.H.C., Cardia, G.S., Tolentino, L.d.S., Iwaki, L.C.V. i Amoroso-Silva, P.A. (2014). Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje. Acta stomatologica Croatica, 48 (3), 183-192. https://doi.org/10.15644/asc48/3/2
MLA 8th Edition
Tolentino, Elen de Souza, et al. "Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje." Acta stomatologica Croatica, vol. 48, br. 3, 2014, str. 183-192. https://doi.org/10.15644/asc48/3/2. Citirano 30.09.2020.
Chicago 17th Edition
Tolentino, Elen de Souza, Paulo Henrique Capel Gusmão, Guilherme Saintive Cardia, Lívia de Souza Tolentino, Lilian Cristina Vessoni Iwaki i Pablo Andrés Amoroso-Silva. "Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje." Acta stomatologica Croatica 48, br. 3 (2014): 183-192. https://doi.org/10.15644/asc48/3/2
Harvard
Tolentino, E.d.S., et al. (2014). 'Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje', Acta stomatologica Croatica, 48(3), str. 183-192. https://doi.org/10.15644/asc48/3/2
Vancouver
Tolentino EdS, Gusmão PHC, Cardia GS, Tolentino LdS, Iwaki LCV, Amoroso-Silva PA. Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje. Acta stomatologica Croatica [Internet]. 2014 [pristupljeno 30.09.2020.];48(3):183-192. https://doi.org/10.15644/asc48/3/2
IEEE
E.d.S. Tolentino, P.H.C. Gusmão, G.S. Cardia, L.d.S. Tolentino, L.C.V. Iwaki i P.A. Amoroso-Silva, "Idiopatska osteoskleroza čeljusti u brazilskoj populaciji: retrospektivno istraživanje", Acta stomatologica Croatica, vol.48, br. 3, str. 183-192, 2014. [Online]. https://doi.org/10.15644/asc48/3/2
Puni tekst: engleski, pdf (440 KB) str. 183-192 preuzimanja: 355* citiraj
APA 6th Edition
Tolentino, E.d.S., Gusmão, P.H.C., Cardia, G.S., Tolentino, L.d.S., Iwaki, L.C.V. i Amoroso-Silva, P.A. (2014). Idiopathic Osteosclerosis of the Jaw in a Brazilian Population: a Retrospective Study. Acta stomatologica Croatica, 48 (3), 183-192. https://doi.org/10.15644/asc48/3/2
MLA 8th Edition
Tolentino, Elen de Souza, et al. "Idiopathic Osteosclerosis of the Jaw in a Brazilian Population: a Retrospective Study." Acta stomatologica Croatica, vol. 48, br. 3, 2014, str. 183-192. https://doi.org/10.15644/asc48/3/2. Citirano 30.09.2020.
Chicago 17th Edition
Tolentino, Elen de Souza, Paulo Henrique Capel Gusmão, Guilherme Saintive Cardia, Lívia de Souza Tolentino, Lilian Cristina Vessoni Iwaki i Pablo Andrés Amoroso-Silva. "Idiopathic Osteosclerosis of the Jaw in a Brazilian Population: a Retrospective Study." Acta stomatologica Croatica 48, br. 3 (2014): 183-192. https://doi.org/10.15644/asc48/3/2
Harvard
Tolentino, E.d.S., et al. (2014). 'Idiopathic Osteosclerosis of the Jaw in a Brazilian Population: a Retrospective Study', Acta stomatologica Croatica, 48(3), str. 183-192. https://doi.org/10.15644/asc48/3/2
Vancouver
Tolentino EdS, Gusmão PHC, Cardia GS, Tolentino LdS, Iwaki LCV, Amoroso-Silva PA. Idiopathic Osteosclerosis of the Jaw in a Brazilian Population: a Retrospective Study. Acta stomatologica Croatica [Internet]. 2014 [pristupljeno 30.09.2020.];48(3):183-192. https://doi.org/10.15644/asc48/3/2
IEEE
E.d.S. Tolentino, P.H.C. Gusmão, G.S. Cardia, L.d.S. Tolentino, L.C.V. Iwaki i P.A. Amoroso-Silva, "Idiopathic Osteosclerosis of the Jaw in a Brazilian Population: a Retrospective Study", Acta stomatologica Croatica, vol.48, br. 3, str. 183-192, 2014. [Online]. https://doi.org/10.15644/asc48/3/2

Rad u XML formatu

Sažetak
Svrha: Željelo se opisati slučajeve idiopatske osteoskleroze (IO), pripremiti pregled literature o istoj tematici te analizirati glavna svojstva, dijagnoze, diferencijalne dijagnoze i načine liječenja. Materijali i metode: Retrospektivno su analizirana 354 ortopantomograma u potrazi za veličinom, oblikom i lokacijom IO-a te demografske karakteristike pacijenta. Pregled literature u bazama
Medline i Lilacs temeljio se na sintagmama idiopatska osteoskleroza, skleroza kosti, otočići guste kosti i čeljusti. Rezultati: Idiopatska osteoskleroza pronađena je na 5,6 posto ortopantomograma (n = 20 pacijenata, 22 fokusa). Pacijenti su bili zdravi, u dobi od 5 do 51 godine (srednja vrijednost = 29,8 godina), a omjer između muškaraca i žena iznosio je 3 : 2. OI je uglavnom uočen u premolarnoj/molarnoj regiji u području apeksa korijena, između korijena, udaljen od zuba, lateralno od zuba te u bezubim područjima. Distribucija između desne i lijeve strane čeljusti bila je podjednaka za svih 22 fokusa, a samo jedan slučaj otkriven je u maksili. IO je dobro lokaliziran i definiran, radioopaktan i uglavnom okrugao ili ovoidan te katkad iregularnog oblika. U nekim slučajevima sliči kondenzirajućem ostitisu, ali diferencijalna dijagnoza može uključivati kompleksni odontom, fokalnu cementnokoštanu displaziju ili zaostatni korijen. O toj je temi pregledano dvadeset istraživanja. Zaključak: Pojavnost IO-a u brazilskoj populaciji iznosi 5,6 posto, raspon godina tijekom istraživanja bio je od 5 do 51 (srednja vrijednost = 29,8), a omjer između muških i ženskih sudionika iznosio je 3 : 2. Radioopaktne lezije uočene su na različitim lokacijama, no najčešće u mandibuli. Ovi rezultati i pregled literature potkrjepljuju hipotezu o idiopatskoj osteosklerozi kao o posljedici varijacije u razvoju normalne kosti, što ne zahtijeva liječenje.

Ključne riječi
skleroza kosti; čeljust; Brazil

Hrčak ID: 127318

URI
https://hrcak.srce.hr/127318

▼ Article Information



Introduction

Idiopathic osteosclerosis (IO) is described as a non-expansible radiopaque alteration of trabecular bone of unknown origin, asymptomatic, with various shapes and sizes, affecting both the maxilla and the mandible, with higher prevalence in the mandibular molar and premolar region (1-9).

Its radiopacity may resemble other pathologies of the jaws, such as condensing osteitis, root segments, hypercementosis, cementoblastoma, impacted teeth, focal cemento-osseous dysplasia (6, 10), and, on rare occasions, complex odontomas [6]. However, accurate diagnosis can be based on detailed analysis of the lesions’ morphology as shown on radiographs and on clinical signs and symptoms.

The etiology of IO is unclear; traumatic occlusion being a hypothesis (1). Since it can be considered anatomical variation of trabecular bone (1, 5, 8, 10), no therapy is recommended, only radiographic monitoring (7, 8).

Clinicians often refer potential IO cases to radiologists for a second opinion or to surgeons for excision of the lesions. Although commonly found in radiographs, there are few studies on IO. The aim of this retrospective study was to report case series of patients with IO, to review the literature on the subject, and to discuss its main characteristics, diagnosis, differential diagnosis, and treatment.

Material and Methods

The sample consisted of 354 panoramic radiographs of patients who attended a radiology clinic in Maringá-PR, Brazil. Inclusion criteria were radiographs that showed the entire maxilla and mandible (condyles included), had no distortion, no asymmetry, and no error due to inadequate patient positioning for exposure (6). The radiographs were examined by a single dental radiologist on a standard light-box under dimmed lighting. The radiographs were taken for reasons other than IO examination, such as evaluation of third molar extraction, implant placement, or routine procedures.

As in MacDonald-Jankowski (1999) (6), a radiopaque area would be considered an IO when all the following criteria were satisfied:

1. Symptomless (8);

2. Not a mixed radiolucent-radiopaque lesion with the appearance of a fibro-osseous lesion (1, 11) or an odontoma (6);

3. Not directly associated with deep caries or large restorations (8, 9);

4. Not a thickening of the lamina dura (1, 11);

5. Not surrounded by a radiolucent halo (5);

6. Not associated with resorption of the adjacent teeth (6);

7. No evidence of displacement of the inferior alveolar canal, maxillary sinus floor or adjacent teeth to the lesion, suggesting an expansive lesion (2);

8. When remnants of deciduous or permanent teeth were clearly identifiable and excluded from the diagnosis (8);

9. Not typical of any other condition (3).

Statistical analysis

Patients’ demographic information (sex and age) was noted, as well as size, shape and location of the IOs. Data analysis used Chi-square Test with significance level less than 5%, using Sigma Stat JadelTM Scientific for Windows (Jadel Corporation, Chicago, IL, USA).

Literature review

The review of the literature was limited to studies published in English-language and was carried in the Medline and Lilacs databases, using the terms idiopathic osteosclerosis OR bone sclerosis OR dense bone island AND jaws. Only studies that satisfied criteria 1 to 9 above were included.

Human rights statements and informed consent

The study was approved by the Standing Committee on Ethics in Human Research, in accordance with the principles of the Helsinki Declaration as revised in 2008, and all patients signed an informed consent.

Results

Twenty-two foci of IO were identified in 20 out of the 354 patients—around 5.6% of the sample. Patients’ age and sex, and size, shape and location of the IOs are shown in Table 1. All patients were healthy with age ranging from 5 to 51 years (mean age = 29.8), and a male-female ratio of 3:2. Prevalence of IO did not show statistical differences for the variables age and sex. Of the 22 foci, 19 (95%) occurred in the mandible and, of those, 57% were in the molar region.

Table 1 – Data from the patients and characteristics of the IOs.
CaseAgeGenderJawSideLocalizationSize (mm)Shape
1
32
F
mandible
right
1st molar apex
3
rounded
2
43
F
mandible
right
away from the teeth, premolar region
5
ovoid
3
19
M
mandible
right
premolar region
18
irregular
4
21
M
mandible
right
away from the teeth (premolar/canine region)
7
rounded
5
7
F
mandible
left
between the roots of a deciduous molar
10
irregular
6
22
F
mandible
left
laterally to the 2nd premolar (edentulous area)
10
triangular
7
18
M
mandible
left
canine region
12
elliptical
8
23
M
mandible
left
1st premolar apex
11
rounded
9
22
F
mandible
right
2nd molar apex
4
rounded
10
20
M
mandible
left
2nd molar apex
8
ovoid
11
17
M
mandible
right
1st premolar apex
6
rounded
12
22
M
mandible
left
2nd molar apex
18
irregular
13
43
M
mandible
right
molar region (edentulous)
4
ovoid
14
40
F
maxilla
right
between premolars
5
irregular
15
5
M
mandible
left
away from the teeth, molar region
6
irregular
16
51
M
mandible
left
molar region (edentulous)
11
elliptical
17
33
F
mandible
right
/left
away from the teeth (molar region)
laterally to the 2nd premolar
2/2
rounded/
ovoid
18
21
F
mandible
left
away from the teeth (molar region)
1.5/3
rounded/
ovoid
19
37
M
mandible
left
molar region (edentulous)
2
rounded
2041Mmandibleright1st premolar apex6rounded

Most IOs were located in the premolar/molar region, at the root apices, between the roots, away from the teeth, laterally to the tooth, and in edentulous areas (Figures 1-5). They were equally distributed between right and left sides of the jaws. With the exception of one IO in the maxilla, between the premolars (Figure 3C), the remaining foci were in the mandible, with a statistical higher prevalence for the latter (p<0.01). Two cases occurred in the lower canine region (Figure 1D/1G).

Figure 1 Size, shape and localization of IOs in the mandible. The upper row displays radiographs of right side and the lower rows of the left side. A: 3mm-rounded IO near the first molar apex (female, 32 years); B: 5mm-ovoid IO away from the teeth (female, 43 years); C: 1.3cm-irregular shaped IO between premolar and molar (male, 19 years); D: 7mm-rounded IO away from the teeth, in the canine/premolar region (male, 21 years); E: 1cm-irregular shaped IO between the roots of deciduous molar (female, 7 years); F: 1cm-triangular IO in an edentulous area laterally to the second premolar region (female, 22 years); G: 1.2cm-elliptical IO in the canine region (male, 18 years); H: 11mm-rounded IO in the first premolar apex (male, 23 years).
ASC_48(3)_183-192-f1
Figure 5 Panoramic radiographs of two patients with two IOs (arrows) each in the mandible. A: female, 33 years; B: female, 21 years.
ASC_48(3)_183-192-f5
Figure 3 Radiographs of IOs and of root segments. A: IO in an edentulous area of the mandible (male, 43 years); B: root segment of mandibular molar; C: IO in the maxilla (female, 40 years); D: root segment of maxillary molar.
ASC_48(3)_183-192-f3

The radiographs showed IOs as localized, well-defined non-expansible radiopaque areas, mostly round or ovoid in shape but sometimes irregular. In some cases IOs were similar to condensing osteitis (Figure 2) or residual roots (Figure 3A).

Figure 2 IOs in the apices of healthy teeth (white arrows), which may be misdiagnosed as condensing osteitis (black arrows). A: female, 22 years; B: male, 20 years; C: male, 17 years; D: male, 22 years.
ASC_48(3)_183-192-f2

Of the 20 patients, 18 had one IO and 2 had two IOs in the mandible (Figure 4, 5). Two patients had lesions often included in the differential diagnosis of IO: a complex odontoma and a focal cemento-osseous dysplasia (Figure 6).

Figure 4 IOs (arrows) in patients differing in age; A: 5 years-old male patient, molar area; B: 51 years-old male patient, edentulous area.
ASC_48(3)_183-192-f4
Figure 6 Differential diagnosis of IOs. A: residual root (white arrow), complex odontoma (dashed arrow), IO (black arrow) (male, 37 years); B: focal cemento-osseous dysplasia (white arrow), IO (black arrow) (male, 41 years).
ASC_48(3)_183-192-f6

All IOs were asymptomatic and detected on panoramic radiographs. Some cases required periapical radiographs to confirm the diagnosis. Radiographic monitoring was the only management recommended for all cases, which showed no further complications.

Review of the literature

The literature review found 20 studies (1-3, 5-21) published between 1984 and 2013, as displayed in Table 2.

Table 2 – Data of the literature review and the present work.
StudyStudy designSynonymPopulationExamPrevalenceMean ageGender
predilection
Localization
Austin and Moule, 1984 [14]
Cross-sectional
Mandibular osteosclerosis
Chinese/Indo-Chinese
N=100
Panoramic radiographs
31%
14-35
F=M
Mandibular molars/premolars
Geist and Katz, 1990 [1]
Retrospective
IO
American
N=1921
Full-mouth radiographs
5.4%
21-40
F=M
Mandibular premolar region
Kafe et al., 1992 [19]
Case control
IO
Israeli
N=283
Panoramic radiographs
-
52
-
-
Kawai et al., 1992 [2]
Retrospective
IO
Japanese
N=1203
Panoramic radiographs
9.7%
9-73
F=M
Mandibular molars/premolars
McDonnell, 1993 [3]
Cross-sectional
Dense bone island
ns
N= 107
Radiographs (ns)
-
36
F
Mandibular first molar region
Kawai et al., 1996 [15]
Cross-sectional
Dense bone island
Japanese
N=21
Panoramic/periapical radiographs
-
30.6
F=M
Mandibular molars/premolars
Petrikowski and Peters, 1997 [16]
Longitudinal
Dense bone island
Canadian
N=2991
Panoramic radiographs
2.3%
16.7
F=M
Mid/posterior mandible
Younetsu et al., 1997 [5]
Retrospective
IO
Japanese
N=1047
Panoramic radiographs and CT
6.1%
31
F=M
Mandibular first molar region
Willians and Brooks, 1998 [10]
Retrospective
IO
ns
N=1585
Full-mouth radiographs
5.7%
44
F=M
Mandibular molars/premolars
MacDonald-Jankowski, 1999 [6]
Systematic review
IO
Chinese/Britain
N=7308
Panoramic radiographs
4.1-6.7%
31
F=M
Mandibular premolar region
Halse and Molven, 2002 [18]
Prospective
IO
ns
N=210
Intraoral radiographs
-
47
F=M
Mandibular molars/premolars
Bsoul et al., 2004 [7]
Literature review
IO/enostosis/dense bone island/focal periapical osteopetrosis
-
-
-
-
-
-
Marques-Silva et al., 2007 [11]
Case report
IO
-
Panoramic radiographs
-
20
-
Mandibular second molar region
Avramidou et al., 2008 [12]
Cross-sectional
Radiopaque lesions
Greek
N=3153
Panoramic radiographs
1.96%
ns
F=M
Mandibular molars/premolars
Mariani et al., 2008 [17]
Case report
Dense bone island
-
Panoramic radiographs and CT
-
26
-
Mandibular first molar region
Miloglu et al., 2009 [13]
Retrospective
IO
Turkish
N=6154
Panoramic radiographs
2.44%
26.2
F
Mandibular molars/premolars
Araki et al., 2011 [9]
Cross-sectional
IO
Japanese
N=100
Panoramic radiograph/ CBCT
-
41.9
F
Mandibular molars/premolars
Sisman et al., 2011 [8]
Retrospective
IO
Turkish
N=2211
Panoramic radiographs
6.1%
26
F=M
Mandibular molars
Verzak et al., 2012 [20]
Retrospective
IO
Croatian
N=1200
Panoramic radiographs
2.4%
35
F=M
Mandibular molars/premolars
Moshfegh et al., 2013 [21]
Cross-sectional
IO
Iranian
N=787
Panoramic radiographs
9.5%
31.9
F
Mandibular premolars
Present workRetrospectiveIOBrazilian
N=354
Panoramic radiographs5.6%29.8MMandibular molars/premolars

M: Male; F: female
ns: not specified

Discussion

Austin and Moule (1984) (14) used the term osteosclerosis in 1984 to describe regions with increased bone density not directly related to infections or systemic diseases. They used bone sclerosis as a general term to describe areas of increased bone formation which lead to increased radiopacity. Although these bone alterations have several synonyms, such as bone sclerosis (14), dense bone island (3, 7, 15, 17), bone scar, focal periapical osteopetrosis, or enostosis [7], IO is often preferred because of their unknown origin (1, 2, 5, 6, 8, 10-12, 18-21).

Although the term idiopathic describes a lesion of unknown etiology, Goaz and White (1999) (4) assert that IO may be the result of retained deciduous molar roots that have been resorbed and replaced by sclerotic bone. In addition, there is evidence of association between increasing incidence of IO and colorectal cancer or adenoma (19), and some authors believe that IO is caused by traumatic occlusion [1]. Marques-Silva et al. (2007) (12) claim that IO may cause changes in tooth position or problems during orthodontic treatment, and reported a case of tooth resorption caused by ectopic eruption rote caused by IO (12). However, IO is usually considered a developmental variation of normal bone architecture unrelated to local stimuli (1, 5, 8, 10, 20), a viewpoint with which the authors of the present study agree. The cases reported in this study showed that IOs did not cause any harm to the patients, and no specific etiology was associated with the lesions.

Studies showed that the prevalence of IO varied from the lowest 1.96% among Greeks (13) to the highest 31% in a Chinese/Indo-Chinese population (14). The present study found an incidence of 5.6% in a Brazilian sample, with a male-female ratio of 3:2 that did not prove significant. Although some studies found higher prevalence of IO among women (3, 9, 10, 21), most found no significant difference between sexes (1, 2, 5, 6, 8, 11, 14-16, 18, 20). As for age, IO may occur in any stage [8], although it is more frequently found in the third and fourth decades of life (2, 3, 8, 10). In the present study, IO was found in patients ranging in age from 5 to 51 years.

On radiographic evaluation, IO is often round, elliptical or irregular in shape, with size varying from 2-3mm to 7 cm (1, 14, 16), although it may encompass the whole body of the mandible (6, 15). In the present study, the biggest IO measured 1.8cm and, similar to previous research, the lesions were found in different areas: near the root apices, between teeth, away from or adjacent to the teeth (6). Higher incidence of IO in the mandibular molar and premolar region was found in this study, as previously described (2, 9-11, 13, 15, 18, 20).

Since IO can be found near root apices (6) and tend to be associated with changes in the lamina dura, Petrikowski et al. (1997) (16) assert that IO may be misdiagnosed, given that on radiograph other lesions show similar characteristics. Condensing osteitis is one possibility in differential diagnosis of IO (10-12, 20). Although condensing osteitis also develops in the periapical areas, it is a response to a low-grade inflammatory stimulus, such as deep caries, large restoration, or pulpitis, and the associated teeth are usually non-vital or show considerable inflamed pulps. IOs, on the other hand, are developmental variations of normal bone unrelated to local stimuli (10, 20). In the present study, six IOs were near tooth apices (Figures 1H, 2, 6B), some being very similar to condensing osteitis. However, the associated teeth were healthy or had shallow restorations.

Other differential diagnoses of IO are root segments, exostosis, hypercementosis, foreign bodies, fibro-osseous lesions, odontomas, cementoblastomas, and even impacted teeth should be taken into consideration (6, 10-13). In this study, one case of IO in an edentulous area resembled root segment (Figure 3A), accurately diagnosed as IO through periapical radiographs.

Although IO can be found either in the maxilla or the mandible, the higher prevalence of IO in the inferior molar region (2, 3, 5, 8, 15, 16) may contribute to the diagnosis of IO. Differentiation of IO from root segments should take into consideration extraction history and lines of a residual root fragment, while accurate images of impacted teeth are enough to confirm the difference (10).

IOs are likely to undergo changes in a young population, showing potential to expand over time (16). Sclerotic lesions can either expand or stabilize (11). However, it is unclear whether periodic monitoring is sufficient or whether they should be considered insignificant findings and simply disregarded. The present study does not elucidate the matter, as monitoring is not an objective of the study.

Because IOs are not clinically significant, being asymptomatic and usually incidentally discovered on radiographs, it is difficult to determine their manifestation. In this study, all IOs were primarily diagnosed on panoramic radiographs, while few cases needed periapical radiographs to confirm the diagnosis. Diagnosis was based on bone morphology, no expansion or radiolucent halo, and lack of symptoms. The literature review showed that only three studies used conventional or cone beam computed tomography (CBCT) to diagnose IO (5, 9, 17). Araki et al. (2011) [9] state that CBCT may reveal the initial aspect of bone sclerosis, and Yonetsu et al. (1997) (5) affirm that CBCT allows the investigation of the internal density of IOs. However, clinical routine still uses panoramic radiograph as one of the main imaging examinations.

Although IO may cause root resorption, nerve compression, dental impaction, dental displacement, and difficulties in orthodontic movement (12), these are rare consequences, not found in this study. Because IOs are asymptomatic, not expansive, and with limited growth, surgical intervention is not recommended, while radiographic monitoring is suggested (7).

Conclusion

Incidence of IO in the Brazilian sample was 5.6%, age ranging from 5 to 51 years (mean=29.8), and male-female ratio of 3:2. The radiopaque lesions occurred in different locations, with significantly higher incidence in the mandible. The findings and the literature review corroborate the hypothesis that IO should be considered developmental variation of normal bone that do not require treatment.

Notes

[1] Conflicts of interest The authors declare they have no conflict of interest.

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