Restor Dent Endod.  2023 Aug;48(3):e23. 10.5395/rde.2023.48.e23.

Radiographic patterns of periosteal bone reactions associated with endodontic lesions

• Jalali P
• Riccobono J
• Augsburger RA
• Tahmasbi-Arashlow M

• KMID: 2548226
• DOI: http://doi.org/10.5395/rde.2023.48.e23

Abstract

Objectives
The formation of new bone by periosteum due to an insult is called periosteal bone reaction (PBR). This study assessed the cone beam computed tomography (CBCT) patterns of periosteal bone reactions associated with periapical inflammatory lesion (apical periodontitis/periapical rarefying osteitis).
Materials and Methods
Twenty-two small field of view CBCT images of patients with PBR were selected from a database of a private practice limited to endodontics. The volume of the periapical inflammatory lesion, the presence of cortical fenestration, the distance of the root apices to the affected cortex, and the location, pattern, and longest diameter of the periosteal reaction were recorded. Statistical analysis was performed using Wilcoxon Ranksum, Fischer’s exact, Spearman Correlation Coefficient, and paired t-test.
Results
In all cases, periosteal bone reaction manifested as either parallel (90.9%) or irregular (9.1%). No correlation was found between periapical inflammatory lesion volume and the periosteal reaction's longest diameter (p > 0.05). Cortical fenestration was noted in 72.7% of the cases. In addition, the findings showed that periosteal reactions were located mostly on the buccal and were present 53.8% and 100% of the time in the mandible and maxilla, respectively.
Conclusions
The periosteal reactions of endodontic origin had a nonaggressive form (i.e., parallel or irregular), and none of the lesions resulted in a periosteal reaction with an ominous Codman’s triangle or spicule pattern.

Keyword

Cone beam computed tomography; Differential diagnosis; Imaging; jaw; Periapical periodontitis; Periosteal bone reaction

Figure

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  Figure 1 The volume of the apical periodontitis/periapical rarefying osteitis was calculated using Mimics Innovation Suite.

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  Figure 2 Cone beam computed tomography images of 7 cases with periosteal reactions (red arrow) and periapical inflammatory lesion (yellow arrow). (A-C), (E-G) manifesting parallel periosteal reactions, and (D) showing irregular periosteal reaction.

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