Endodontic intervention in osteomyelitis with proliferative periostitis: a rare case report and scoping review

Osteomyelitis with proliferative periostitis (OMPP) is a rare, chronic inflammatory condition primarily affecting children and adolescents. It is characterized by new subperiosteal bone formation in response to a low-grade odontogenic infection. This report presents the successful endodontic management of a 10-year-old male patient with asymptomatic extraoral swelling in the right mandibular region. Radiographic examination revealed a periapical lesion associated with the right first molar and a lamellar periosteal reaction compatible with OMPP. Root canal treatment was performed over three appointments, including the use of calcium hydroxide as intracanal dressing for five months due to communication delays. Swelling regressed gradually, with complete clinical and radiographic remission observed at the six-month follow-up. A review of 16 published cases of OMPP treated by endodontic approaches was conducted. Most patients were children or adolescents, and the mandibular first molar was the most commonly affected tooth. Although treatment protocols varied, the majority of cases were managed conservatively with root canal therapy, with or without intracanal dressing and antibiotics. The average follow-up duration was over two years, and favorable outcomes were reported in all cases. This case and literature review support the effectiveness of conservative endodontic treatment for OMPP and highlight the importance of preserving permanent teeth in young patients. The careful selection of imaging modalities, adherence to conservative protocols, and long-term follow-up are key elements for successful management of this condition.