Rarefying Osteitis

Definition: Loss of bone due to inflammation.  This term includes an abscess, cyst and/or granuloma as these can not typically be differentiated on a radiograph and are identified histopathologically.  This is associated with a non-vital tooth.  It takes 8 – 14 days for bone loss to be visible on a 2-D radiograph (periapical or pantomograph).  A tooth may be necrotic without visible bone loss on a radiograph.  Sometimes referred to as apical rarefying osteitis or lateral rarefying osteitis based on location.

Radiographic Features:

Location: Associated with a tooth, typically found at the apex. Can be found on the lateral aspect of a root when associated with a lateral canal.

Edge: Well-defined to Well-localized.

Shape: Round to ovoid, starts as a tear-drop shape at the apex with the lamina dura and periodontal ligament space pulling away from a tooth apex or source of inflammation.

Internal: Radiolucent.

Other: None.

Number: May be single or multiple.

(click image to enlarge)

Rarefying osteitis

(left – arrow pointing to area of inflammation apical to the maxillary lateral incisor) (right-without arrow)

Rarefying osteitis

apical to maxillary lateral incisor

Rarefying osteitis

apical to maxillary left central incisor

Rarefying osteitis

apical to maxillary right posterior teeth

Rarefying osteitis

apical to mandibular first premolar

Rarefying osteitis

example of lateral rarefying osteitis on maxillary canine