The radiopaque lesion: A diagnostic consideration

This study attempts to designate that some periapical and periodontal radiopacities can be caused by inflamed or necrotic pulps and periodontitis. An hypothesis is offered to explain the formation of a periapical sclerotic lesion. The increase in periapical bone density can often mask an occult granulomatous lesion and it can be obscured by inadvertently superimposing tori over apical radiolucencies. The increased reactive periapical sclerosis is not necessarily clue to an osteitis. This is especially true of dense trabecular bone patterns that are noted in cases of occlusal stress and in periodontitis. It is questionable whether the use of the terms condensing osteitis or sclerosing osteitis is appropriate. Endodontic or periodontic therapy in cases associated with increased bone density produce a normalization of the bone trabeculae. The lesions that do not respond to the specific treatment may be due to anatomic landmarks, increase in functional stimuli producing excessive bone production, local and systemic disorders. Diagnostic features of the radiopaque lesion are discussed.