ORIGINAL ARTICLE The imaging role for diagnosis of idiopathic osteosclerosis: a retrospective approach based on records of 33,550 cases Thiago Oliveira Gamba 1 & Nathália Alves Paz Maciel 1 & Pantelis Varvaki Rados 2 & Heraldo Luís Dias da Silveira 2 & Nádia Assein Arús 2 & Isadora Luana Flores 2 Received: 11 June 2020 /Accepted: 24 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Objective The study aimed to describe the diagnostic imaging features of idiopathic osteosclerosis (IO) to aid in differential diagnosis of similar dentomaxillomandibular conditions. Materials and methods An archive of 550 dentomaxillofacial radiographic (panoramic radiography (PR) and cone beam com- puted tomography (CBCT)) images and 33,000 histopathological records were reviewed to identify IO cases. Chi-square, Student’s t test, and ANOVA tests, with a significance of p < 0.05, were applied for comparative analysis. In addition, we analyzed various studies to present a short review. Results After meticulous observation, 36 images of 34 patients revealed 60 IO lesions in 31 PR and 5 CBCT. Sex, age group, anatomical site, shape, regularity, and root relationship showed statistical significance: sex and age group (p = 0.046), sex and IO regularity (p = 0.007), age group and IO regularity (p = 0.014), anatomical site and IO shape (p = 0.010), anatomical site and IO regularity (p = 0.003), and IO shape and IO regularity (p = 0.002). We presented a short review from 26 articles, including retrospective, cross-sectional, and longitudinal studies, documenting 2307 patients with 2435 IO lesions from 51,160 imagiological examinations. Conclusions A radiographic diagnostic profile of IO may guide the clinical practitioners in differentiating an incidental radiopacity. PR is a preliminary examination, with CBCT facilitating the IO diagnosis. Clinical relevance Knowledge of imaging characteristics variability of idiopathic osteosclerosis is crucial for accurate diagnosis process when incidental radiopacities are found in the panoramic radiographs, thus avoiding unnecessary biopsies. CBCT scans facilitate the interpretation of idiopathic osteosclerosis overlapping the mandibular canal. Keywords Osteosclerosis . Bone lesions . Oral diagnosis . Panoramic radiography . Cone beam computed tomography Introduction Idiopathic osteosclerosis (IO) or idiopathic bone sclerosis is a located growth of compact bone within the cancellous bone [1]. It is a focal area of increased radiodensity of unknown origin, with no painful symptoms or association with inflam- matory, neoplastic, or systemic diseases [2, 3]. IO in the man- dible and maxilla has also been referred to as dense bone * Isadora Luana Flores isadoraluanaflores@gmail.com Thiago Oliveira Gamba thiagodeo.gamba@gmail.com Nathália Alves Paz Maciel napmaciel@ucs.br Pantelis Varvaki Rados pantelis@ufrgs.br Heraldo Luís Dias da Silveira heraldo@ufrgs.br Nádia Assein Arús nadiaarus@yahoo.com.br 1 UCS, School of Dentistry, Caxias do Sul University, Rua Francisco Getúlio Vargas, Caxias do Sul, RS 1130, Brazil 2 School of Dentistry, Federal University of Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos 2492 Sala 503, 90035-004, RS Porto Alegre, Brazil https://doi.org/10.1007/s00784-020-03477-0 / Published online: 31 July 2020 Clinical Oral Investigations (2021) 25:1755–1765