Dense bone islands (DBIs) are usually asymptomatic and do not require any treatment. This case report presents a DBI of an unusual presentation, which was an incidental finding on a radiograph of a 15-year-old orthodontic patient. The DBI lesion was 24 mm in size, occupying at least 50% of the alveolar process between the upper right canine and lateral incisor, extending up the lateral aspect of the anterior margin of the right nasal fossa. Generally, DBIs are 2-3 mm in size and more commonly found in the mandible in the molar and premolar region. This article further discusses the impact of DBIs on orthodontic treatment such as difficulty with achieving space closure and adequate root tip or torque. We also examine the potential medical implications of DBIs. This is clinically important, especially if multiple DBIs, or osteomas which have a similar radiographic appearance to DBIs, are found in a patient as they may be associated with adenomatous intestinal polyps, which, if not treated, have a 100% chance of becoming malignant transformation.

The \"Dense Bone Island\" (DBI) is a radiopaque lesion referred in leterature as idiopathic osteosclerosis, enostosis, focal osteosclerosis, periapical osteopetrosis, and bone scar. The DBI are accidentally found in routinary Xray of bone structures. In the maxillary bones, often localized in the mandible, especially in the molar region, with a reported incidence ranging from 2.3 to 9.7%. DBI does not seem to develop until the first phase of adolescence and it is usually found in adolescents and in young adults. In 40% of cases DBI seems to increase in size after a 10 year follow-up, because the DBI found in jaws and in long bones seem to increase proportionally to the bone growth. A case of a 26 years old patient and the surgical treatment is presented. This is the first reported case where complete X-ray Orthopantomography follow-up showed the evolution of the lesion since its onset.