Skip to main content

Radiological evaluation of the periosteal reactions in the jaws: a retrospective CBCT study



The objective of this study is to evaluate the relationship between the radiological features of periosteal reactions (PR) and histopathological features of the lesions.


A total of 4605 CBCT images were evaluated and they were classified according to their radiological differential diagnosis. Images with pathologies were listed according to their histopathological examinations as cystic lesions, benign tumours, malignant tumours, fibro-osseous lesions and osteonecrosis, while images without pathologies were listed as traumas and others. All groups were reclassified as with or without the presence of detected PR.


Pathologies and traumas were detected in 1801 of 4605 patients. There were 3 PR in 1140 cystic lesions, 4 PR in 102 benign tumours, 16 PR in 43 malignant tumours, 67 PR in 156 osteonecrosis/osteomyelitis cases and 3 PR in 262 trauma cases. As a result of the chi-square test between groups, there was a significant relationship between histopathologic diagnoses and periosteal reaction patterns (p = 0.000).


Although there is a significant overlap between the patterns of PRs, PRs can be used to narrow the possibilities in the differential diagnosis. However, PRs alone are not sufficient variables for differential diagnosis in the absence of cortical bone destruction, localization, clinical and systemic findings.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10


  1. Fukuda K. Periosteal reaction. Nippon Igaku Hoshasen Gakkai Zasshi. 1999;59(7):306–12.

    PubMed  Google Scholar 

  2. Rana RS, Wu JS, Eisenberg RL. Periosteal reaction. AJR Am J Roentgenol. 2009;193(4):W259–72.

    Article  Google Scholar 

  3. Appel W, Schulz RD, Barth V, Wissmann C. Radiological findings in periosteal reaction due to inflammation (author’s transl). Radiologe. 1979;19(8):317–28.

    PubMed  Google Scholar 

  4. Wenaden AE, Szyszko TA, Saifuddin A. Imaging of periosteal reactions associated with focal lesions of bone. Clin Radiol. 2005;60(4):439–56.

    Article  Google Scholar 

  5. Volberg FM Jr, Whalen JP, Krook L, Winchester P. Lamellated periosteal reactions: a radiologic and histologic investigation. AJR Am J Roentgenol. 1977;128(1):85–7.

    Article  Google Scholar 

  6. Shopfner CE. Periosteal bone growth in normal infants. A preliminary report. Am J Roentgenol Radium Ther Nucl Med. 1966;97(1):154–63.

    Article  Google Scholar 

  7. Zhao J, Li Y, Wu W, Zhang Z, Ding Y. Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report. Oncol Lett. 2015;9(1):191–4.

    Article  Google Scholar 

  8. de Sa Neto JL, Simao MN, Crema MD, Engel EE, Nogueira-Barbosa MH. Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference. Radiol Bras. 2017;50(3):176–81.

    Article  Google Scholar 

  9. Li C, Cong Y, Liu X, Zhou X, Zhou G, Lu M, et al. The progress of molecular diagnostics of osteosarcoma. Front Biosci (Landmark Ed). 2016;21:20–30.

    Article  Google Scholar 

  10. Peersman B, Vanhoenacker FM, Heyman S, Van Herendael B, Stam M, Brys P, et al. Ewing’s sarcoma: imaging features. JBR-BTR. 2007;90(5):368–76.

    PubMed  Google Scholar 

  11. Kundu ZS. Classification, imaging, biopsy and staging of osteosarcoma. Indian J Orthop. 2014;48(3):238–46.

    Article  Google Scholar 

  12. Anbiaee N, Ebrahimnejad H, Sanaei A. Central odontogenic fibroma (simple type) in a four-year-old boy: atypical cone-beam computed tomographic appearance with periosteal reaction. Imaging Sci Dent. 2015;45(2):109–15.

    Article  Google Scholar 

  13. Ida M, Tetsumura A, Kurabayashi T, Sasaki T. Periosteal new bone formation in the jaws. A computed tomographic study. Dentomaxillofac Radiol. 1997;26(3):169–76.

    Article  Google Scholar 

  14. Hayashi Y, Shimizutani K, Koseki Y. Radiographic study of periosteal new bone formation in osteomyelitis of the mandible. Oral Radiol. 1992;8(1):19–26.

    Article  Google Scholar 

  15. Kojima Y, Kawaoka Y, Sawada S, et al. Clinical significance of periosteal reaction as a predictive factor for treatment outcome of medication-related osteonecrosis of the jaw. J Bone Miner Metab. 2019;37(5):913–9.

    Article  PubMed  Google Scholar 

  16. Kricun ME. Parameters of diagnosis. 1st ed. Philadelphia, USA: WB Saunders Company; 1993.

    Google Scholar 

  17. Ved N, Haller JO. Periosteal reaction with normal-appearing underlying bone: a child abuse mimicker. Emerg Radiol. 2002;9(5):278–82.

    Article  Google Scholar 

  18. Maia Ferreira Alencar CH, Sampaio Silveira CR, Cavalcante MM, Maia Vieira CG, Diógenes Teixeira MJ, Neto FA,. de Abreu A, Chhabra A. "Periosteum: An imaging review". Eur J Radiol Open. 2020;7:100249.

  19. Liu D, Zhang J, Li T, et al. Chronic osteomyelitis with proliferative periostitis of the mandibular body: report of a case and review of the literature. Ann R Coll Surg Engl. 2019;101(5):328–32.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gomes JPP, Veloso JRC, Altemani AMAM, et al. Three-Dimensional Volume Imaging to Increase the Accuracy of Surgical Management in a Case of Recurrent Chordoma of the Clivus. Am J Case Rep. 2018;19:1168–1174.

Download references


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Gürkan Ünsal.

Ethics declarations

Conflict of interest statement

Gürkan Ünsal, Merva Soluk-Tekkeşin, Kıvanç Bektaş-Kayhan and İlknur Özcan declare that they have no conflict of interest.

Human rights statements and informed consent

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study, file number 2018/71, was found ethically appropriate at the meeting of Istanbul University, Faculty of Dentistry, Clinical Research Ethics Committee dated 18.07.2018. Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ünsal, G., Soluk-Tekkeşin, M., Bektaş-Kayhan, K. et al. Radiological evaluation of the periosteal reactions in the jaws: a retrospective CBCT study. Oral Radiol (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Periosteal reaction
  • Odontogenic tumours
  • Odontogenic cysts
  • Osteonecrosis
  • Jaw fractures