• Restorative Dentistry and Endodontics
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• v.48 no.3
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• pp.23.1-23.8
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• 2023

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.

• Journal of Veterinary Clinics
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• v.33 no.2
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• pp.135-137
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• 2016

A 6-month-old, weighing 2.8 kg, female, domestic short-haired cat presented with open fracture at right distal radius about a month ago. Based on radiological findings, hyperplasia at the right radioulna and left humerus was found. Results of the cytological examination were inflammatory reaction and reactive osteoblast. Distal radial ostectomy proceeded with necrotic bone debridement. Three weeks after operation, the radial bone lysis was seen on radiograph but clinical condition improved. Hyperplasia at the right radioulna and left humerus was dissolved. Two months after operation, she can use her both forelimbs despite right elbow have been diagnosed as arthrosclerosis because of periosteal reaction. Six months after operation, clinical symptoms of limbs were not detected. In this case, open fracture was treated through delayed surgical debridement procedure, therefore hematogenous osteomyelitis occurs at another forelimb. The longer a wound remains open, the more likely it is that infection will develop. The infection can occur to fracture bone and seed from hematogenous spread to another normal bone. In conclusion, when open fracture occurs, early antibiotic treatment and urgent surgical intervention are recommended.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.316-320
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• 2008

Purpose: Pachydermoperiostosis is a rare hereditary disease characterized by finger clubbing, periosteal reaction, and pachydermia. The underlying pathogenic mechanism of this disease remains unclear. This disease is known to be associated with a variety of diseases such as cranial suture defect, bone marrow failure, hypertrophic gastropathy, Crohn's disease, and female escuchen. Methods: A 50-year-old male had digital clubbing of both hands, coarse hypertrophic skin changes of face, progressive thickening and furrowing on the scalp(cutis verticis gyrata), persistent pain in the limbs and joints. Other cutaneous features include moderate blepharoptosis, pole-like lower legs and feet. Results: We performed surgical excision for hypertrophic skin change of scalp because of frequent eczematous skin change, severe itching sensation and cosmetic problem. Diagnosis is confirmed by bony proliferative periosteal reaction, pathologic findings, and characteristic clinical findings. Conclusion: Pachydermoperiostosis is manifested by finger clubbing, and hypertrophic skin changes causing coarse facial features with thickening and periosteal bone formation. We experienced a case of pachydermoperiostosis. Brief review of related literature is given.

• Imaging Science in Dentistry
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• v.45 no.2
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• pp.109-115
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• 2015

Central odontogenic fibroma (COF) is a rare benign tumor that accounts for 0.1% of all odontogenic tumors. A case of COF (simple type) of the mandible in a four-year-old boy is described in this report. The patient showed asymptomatic swelling in the right inferior border of the lower jaw for one week. A panoramic radiograph showed a poorly-defined destructive unilocular radiolucent area. Cone-beam computed tomography showed expansion and perforation of the adjacent cortical bone plates. A periosteal reaction with the Codman triangle pattern was clearly visible in the buccal cortex. Since the tumor had destroyed a considerable amount of bone, surgical resection was performed. No recurrence was noted.

• Imaging Science in Dentistry
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• v.51 no.2
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• pp.195-201
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• 2021

Unusual radiographic findings of intraosseous ameloblastoma have been reported and discussed. In the case discussed herein, cone-beam computed tomography (CBCT) clearly showed many radiographic features that were ambiguous on conventional radiographs, including an ill-defined periphery, extensive superficial buccal extension with minimal lingual extension, obvious bucco-crestal expansion, and multiple triangular (Codman's triangle-like) areas of periosteal reaction. Based on the above-mentioned findings, the differential diagnosis was a long-term infected benign or low-grade malignant lesion. An incisional biopsy was performed, and the histopathologic diagnosis was acanthomatous ameloblastoma. Recurrence of the lesion was clearly detected on CBCT images at 4 and 8 years after surgery. These unusual radiographic findings have never been reported to be associated with ameloblastoma, and thus may contribute to novel concepts in radiographic interpretation in the future. This report also underscores the important role played by CBCT as a comprehensive diagnostic tool and for definite confirmation of recurrence.

• Imaging Science in Dentistry
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• v.52 no.3
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• pp.319-326
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• 2022

This report presents the case of a 5-year-old boy with a hard swelling on the right side of the mandible body. An important point of this case is that the primary imaging finding was fine spicules in the inferior border of the mandible on panoramic radiography without significant changes in bone density. Cone-beam computed tomography views revealed a lytic lesion on the lingual side of the right mandibular body with the destruction of the lingual cortex and periosteal reaction from the midline to the first molar area. Careful attention to this radiographic finding in the primary stage in the absence of other significant imaging findings, particularly in children, could result in the early diagnosis of desmoplastic fibroma. Therefore, a better prognosis can be expected following early surgical treatment.

• Imaging Science in Dentistry
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• v.32 no.2
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• pp.81-87
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• 2002

Purpose : To investigate the diagnostic significance of cortical changes in the bone of diseased jaws utilizing computed tomography (CT). Materials and Methods: Computed tomographic images of 91 patients, consisting of 7 osteomyelitis, 46 cysts, 18 benign tumors, and 20 malignant tumors, were analyzed. The pattern of cortical expansion was classified into three types: no expansion (N), buccal or lingual expansion (B/L), and buccolingual expansion (B & L). The pattern of cortical destruction was classified into four types: no destruction (N), point destruction (PO), gross destruction (GR), and permeative destruction (PE). The pattern of periosteal reaction was classified into four types: parallel, irregular, spicule, and Codmans triangle. The relationship between the pattern of cortical bone changes and diseases of the jaws was assessed. Results: When the pattern of cortical expansion was compared to diseases of the jaw, N-type was most prevalent in cases of osteomyelitis and malignant tumors, B/L-type with cysts, and B&L-types with benign tumors. Comparison between the pattern of cortical bone destruction with diseases of the jaw showed strong correlations between PO and PE-types to osteomyelitis, N-type with cysts, N and GR-types with benign tumors, and GR-type with malignant tumors. Finally, the relationship between the pattern of periosteal reaction to diseases of the jaw showed a strong correlation between parallel-type to osteomyelitis and spicule-type to malignant tumors. Conclusion : The pattern of cortical expansion and cortical destruction is useful in differentiating diseases of the jaws.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.5
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• pp.341-345
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• 2010

Introduction: Skeletal homeostasis is normally maintained by the stability between bone formation by osteoblasts and bone resorption by osteoclasts. However, the correlation between the inflammatory reaction and osteoblastic differentiation of cultured osteoprogenitor cells has not been fully investigated. This study examined the effects of inflammatory cytokines on the osteoblastic differentiation of cultured human periosteal-derived cells. Materials and Methods: Periosteal-derived cells were obtained from the mandibular periosteum and introduced into the cell culture. After passage 3, the periosteal-derived cells were further cultured in an osteogenic induction Dulbecco's modified Eagle's medium (DMEM) medium containing dexamethasone, ascorbic acid, and $\beta$-glycerophosphate. In this culture medium, tumor necrosis factor (TNF)-$\alpha$ with different concentrations (0.1, 1, and 10 ng/mL) or interleukin (IL)-$1{\beta}$ with different concentrations (0.01, 0.1, and 1 ng/mL) were added. Results: Both TNF-$\alpha$ and IL-$1{\beta}$ stimulated alkaline phosphatase (ALP) expression in the periosteal-derived cells. TNF-$\alpha$ and IL-$1{\beta}$ increased the level of ALP expression in a dose-dependent manner. Both TNF-$\alpha$ and IL-$1{\beta}$ also increased the level of alizarin red S staining in a dose-dependent manner during osteoblastic differentiation of cultured human periosteal-derived cells. Conclusion: These results suggest that inflammatory cytokines TNF-$\alpha$ and IL-$1{\beta}$ can stimulate the osteoblastic activity of cultured human periosteal-derived cells.

• Imaging Science in Dentistry
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• v.39 no.3
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• pp.163-168
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• 2009

Purpose : To assess the clinical findings and hard tissue changes of osteomyelitis of the jaws using computed tomographic (CT) image analysis. Materials and Methods : We reviewed and interpreted the CT images of 163 patients (64 males and 99 females, age range from 10 to 87 years) who visited the Seoul National University Dental Hospital from April 23, 2006 to December 31, 2008 and were diagnosed as osteomyelitis of the jaws through clinical, radiologic, and histopathologic examination. Each CT findings was investigated for frequency, correlation with age and gender. Results : Of the 163 patients, 31 (19.0%) were affected on the maxilla, 135 (82.8%) were affected on the mandible, and 3 (1.8%) were affected on the both jaws simultaneously. The mean age of the patients who were affected on the maxilla was 61.0 years and that of the patients who were affected on the mandible was 56.2 years. On the maxilla, the most frequent site of disease was the posterior area (83.9%) and on the mandible, mandibular body (83.0%), followed by angle (48.1%), ramus (38.5%), condyle (13.3%), incisal area (9.6%), and coronoid process (3.0%). Among the 31 maxillary osteomyelitis, defect in the trabecular bone was observed in 28 (90.3%), osteosclerosis 20 (64.5%), defect in the cortical bone 27 (87.1%), sequestrum 17 (54.8%), and periosteal reaction 2 (6.5%). Among the 135 mandibular osteomyelitis, defect in the trabecular bone was observed in 100 (74.1%), osteosclerosis 104 (77.0%), defect in the cortical bone 116 (85.9%), sequestrum 36 (26.7%), and periosteal reaction 67 (49.6%). Conclusion : Of our cases, the maxillary osteomyelitis was visibly observed more frequently in females than males. The incidence is the highest in seventies (28.8%) and the lowest in teens (3.1%). The osteomyelitis of the jaws was observed more frequently in males than females before the age of 50, and observed more frequently in females after the age of 50. The most noticeable point was that the sequestrum was observed more often on maxillary osteomyelitis and the periosteal reaction was observed more often on mandibular osteomyelitis.

• Imaging Science in Dentistry
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• v.51 no.1
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• pp.73-80
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• 2021

Purpose: The purpose of this study was to evaluate the cone-beam computed tomographic (CBCT) imaging and histopathological characteristics of osteoradionecrosis(ORN) and medication-related osteonecrosis of the jaw(MRONJ). Materials and Methods: Ten surgical specimens from segmental mandibulectomy (3 ORN and 7 MRONJ) were analyzed using CBCT. The CBCT parameters were as follows: high-resolution mode (tube voltage, 90.0 kV; tube current, 4.00 mA; rotation time, 16.8 s; field of view, 56 mm×56 mm; thickness, 0.099 mm). Histopathological characteristics were evaluated using histological slides of the surgical specimens. The Pearson chi-square test was used to compare ORN and MRONJ in terms of CBCT findings(internal texture, sequestrum, periosteal reaction and cortical perforation) and histopathological characteristics(necrotic bone, inflammatory cells, reactive bone formation, bacteria, Actinomyces, and osteoclasts). A P value less than 0.05 was considered to indicate statistical significance. Results: MRONJ showed periosteal reaction on CBCT more frequently than ORN (7 of 7 [100%] vs. 0 of 3 [0%], P<0.05). Regarding histopathological characteristics, MRONJ showed osteoclasts more frequently than ORN (6 of 7 [85.7%] vs. 0 of 3 [0%], P<0.05). Conclusion: This study evaluated the CBCT imaging and histopathological characteristics of ORN and MRONJ, and the findings suggest that CBCT could be useful for the evaluation of ORN and MRONJ.