Differential diagnosis of radiopaque maxillary lesions

Description of clinical cases: Case 1: A 13-year-old female patient with radiopaque findings associated with a tooth 36. Asymptomatic lesion, whose clinical and radiographic characteristics favor the diagnosis of idiopathic osteosclerosis, and control is recommended. Case 2: A 54-year-old female patient with tumoriform lesion in the posterior mandible, asymptomatic and hard to palpation. Radiopaque lesion with well defined regular limits. An excisional biopsy was performed, whose anatomopathological examination revealed the diagnosis of osteoma. Case 3: A 38-year-old female patient with several radiopaque lesions in the mandible. An incisional biopsy was performed, whose anatomopathological examination corroborated the diagnosis of cemento-osseous dysplasia. Case 4: A 35-year-old female patient with intraosseous radiopaque lesion. An excisional biopsy was performed, whose anatomopathological examination confirmed the diagnosis of odontoma, of the complex type. Case 5: A 65-year-old male patient with extensive bone exposure area in the posterior right maxillary region, clinically compatible with maxillary osteonecrosis associated with bisphosphonates. Surgical removal of the bone sequestration was performed, eliminating the area of necrosis. Discussion: Asymptomatic areas of sclerotic bone may be found frequently in radiographic examinations. Some of these lesions are related to inflammatory processes that occur in the bone and others appear to have a non-inflammatory origin. The differential diagnosis of radiopaque lesions of the jaws can be approached by categorization according to their appearance, relationship with the tooth and exact location with reference to this same tooth. Conclusion: The role of the clinician is to recognize the origin of the lesions in the oral cavity. Careful evaluation of the presence of radiographic changes and clinical signs may allow the development of a correct diagnosis and approach. Definitive diagnosis can be obtained by histological evaluation of the lesion. Keywords: radiopaque lesions, idiopathic osteosclerosis, osteoma, cemento-osseous dysplasia, odontoma, osteonecrosis of the jaw