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      A Localized Sclerosing Osteomyelitis at the Periapex of a Vital Tooth: Report of a Misdiagnosis

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          Abstract

          Osteomyelitis is an inflammatory infectious condition of bones, occurringeither acutely or chronically. The clinical course of the disease leads to destructive or sclerosing patterns of the involved bone. This report presents a case of chronic focal sclerosing osteomyelitis in a 19-year-old male with a history of an uncontrolled convulsive condition. The lesion was first diagnosed as an osteoblastoma. Chronic trauma or traumatic occlusion has the potential to induce osteomyelitis and should be considered a possible diagnosis in differentiating periapical radiopacities, even in relation with vital teeth.

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          Most cited references9

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          Imaging features of avulsion injuries.

          Avulsion injuries are common among participants in organized sports, especially among adolescent participants. Imaging features of both acute and chronic avulsion injuries of the pelvis, knee, ankle and foot, shoulder, and elbow were evaluated to help distinguish these injuries from more serious disease processes such as neoplasm and infection. At radiography, acute injuries (ie, those resulting from extreme, unbalanced, often eccentric muscular contractions) may be associated with avulsed bone fragments, whereas subacute injuries have an aggressive appearance that may include areas of mixed lysis and sclerosis. Chronic injuries (ie, those resulting from repetitive microtrauma or overuse) or old inactive injuries may be associated with a protuberant mass of bone and may bear a striking resemblance to a neoplastic or infectious process. Although not usually required, computed tomography is helpful in the diagnosis if radiographic findings are equivocal or if the injury is not in the acute phase. MR imaging is best suited for the evaluation of injuries to muscles, tendons, and ligaments. Recognition of characteristic imaging features and familiarity with musculotendinous anatomy will aid in accurate diagnosis of avulsion injuries.
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            Bone tumor mimics: avoiding misdiagnosis.

            Whether discovered incidentally or as part of a focused diagnostic evaluation, the finding of a benign osseous lesion that has radiologic features resembling a bone tumor is not uncommon. Some of the more common benign and nonneoplastic entities that can sometimes be confused with tumors are the following: cortical desmoid, Brodie abscess, synovial herniation pit, pseudocyst, enostosis, intraosseous ganglion cyst, fibrous dysplasia, stress fracture, avulsion fracture (healing stage), bone infarct, myositis ossificans, brown tumor, and subchondral cyst. Accurate diagnosis and management of these lesions require a basic understanding of their epidemiology, clinical presentations, anatomic distributions, imaging features, differential considerations, and therapeutic options. This in-depth review of 13 potential bone tumor mimics will assist the radiologist in correctly identifying these benign lesions and in avoiding misdiagnosis and related morbidity. This review will also aid the radiologist in making appropriate recommendations to the referring physician for management or further imaging.
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              Sclerosing osteomyelitis of Garrè (periostitis ossificans).

              The diagnosis of sclerosing osteomyelitis of Garrè, or periostitis ossificans, is suggested by a history of hard swelling of the mandible accompanied by a carious dentition. Computed tomography, nuclear medicine scanning, and pantomography are used to illustrate the appearance of this condition arising in a 25-year-old woman. The differential diagnosis of mandibular thickening and associated bony sclerosis is discussed.
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                Author and article information

                Journal
                J Dent Res Dent Clin Dent Prospect
                J Dent Res Dent Clin Dent Prospect
                Journal of Dental Research, Dental Clinics, Dental Prospects
                Journal of Dental Research, Dental Clinics, Dental Prospects
                Tabriz University of Medical Sciences
                2008-210X
                2008-2118
                Summer 2011
                5 September 2011
                : 5
                : 3
                : 102-105
                Affiliations
                1Assistant Professor, Department of Oral Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                2Assistant Professor, Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                3Post-graduate Student, Department of Oral Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                Author notes
                [* ]Corresponding Author; dr.owlia@ 123456gmail.com
                Article
                10.5681/joddd.2011.023
                3442448
                22991615
                bfaac79a-3faa-464b-a43a-6fa0c6cb60be
                © 2011 The Authors; Tabriz University of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 March 2011
                : 23 June 2011
                Categories
                Case Report

                Dentistry
                chronic trauma,chronic sclerosing osteomyelitis,osteoblastoma
                Dentistry
                chronic trauma, chronic sclerosing osteomyelitis, osteoblastoma

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