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The clinical and radiographic features of gigantic dense bone islands of the jaw were reviewed in 21 subjects to better determine the pathogenesis of this condition. Most of the islands were asymptomatic. They showed a striking predilection for occurrence in the premolar to molar region of the mandible. The greatest dimension of gigantic dense bone islands measured on panoramic radiographs ranged from 2.5 to 7.0 cm, and they were most commonly structureless radiopaque areas. None showed bony expansion buccolingually, nor did they displace adjacent teeth or bony anatomic structures. It is concluded that gigantic dense bone island is not a benign bone neoplasm and is perhaps merely a large counterpart of smaller dense bone islands or idiopathic osteosclerosis.