ABE Endodontic Diagnosis and Radiology 3 — Questions and Answers
Question 1: A 45-year-old patient presents with a tooth that is asymptomatic and non-responsive to both cold and EPT testing. Radiograph shows a diffuse periapical radiolucency with well-defined borders. What is the periapical diagnosis?
- Asymptomatic apical periodontitis (Correct answer)
- Symptomatic apical periodontitis
- Acute apical abscess
- Normal apical tissue
Correct answer: Asymptomatic apical periodontitis
Asymptomatic apical periodontitis is defined by a non-vital pulp with radiographic periapical changes but no clinical symptoms.
Question 2: Which of the following best describes the radiographic appearance of condensing osteitis?
- Diffuse radiopaque mass surrounding the root apex (Correct answer)
- Well-defined radiolucency with corticated borders
- Widened periodontal ligament space only
- Lamina dura loss without density changes
Correct answer: Diffuse radiopaque mass surrounding the root apex
Condensing osteitis appears as a diffuse radiopaque area around the root apex representing a focal sclerosing osteomyelitis reaction.
Question 3: A dentist anesthetizes tooth #30 with an IANB and the patient still reports cold sensitivity. The tooth has a positive cold response and no periapical pathology. What test should be performed next?
- Selective anesthesia of adjacent teeth to localize the source (Correct answer)
- Repeat IANB injection at higher dose
- Begin endodontic treatment on tooth #30
- Order CBCT imaging immediately
Correct answer: Selective anesthesia of adjacent teeth to localize the source
When the symptomatic tooth cannot be identified after anesthesia, selective anesthesia of adjacent teeth helps localize the true source of pain.
Question 4: In the AAE diagnostic classification, 'previously initiated therapy' refers to a tooth that has:
- Partial pulp removal or pulpotomy performed previously (Correct answer)
- Completed root canal treatment with obturation
- Never received any endodontic procedure
- A post and crown placed over completed treatment
Correct answer: Partial pulp removal or pulpotomy performed previously
Previously initiated therapy describes a tooth where partial endodontic treatment (e.g., pulpotomy or partial instrumentation) has been performed but not completed.
Question 5: Which radiographic technique produces the LEAST geometric distortion of periapical structures?
- Paralleling technique with film holder (Correct answer)
- Bisecting angle technique
- Occlusal radiograph
- Panoramic radiograph
Correct answer: Paralleling technique with film holder
The paralleling technique places the film parallel to the tooth's long axis and directs the X-ray beam perpendicularly, minimizing distortion.
Question 6: A sinus tract is traced with a gutta-percha point and radiograph shows it tracking to the lateral surface of the root rather than the apex. This finding is MOST suggestive of:
- Vertical root fracture or lateral canal (Correct answer)
- Apical abscess with fistulous tract
- Periodontal abscess with endodontic involvement
- Developmental groove on root surface
Correct answer: Vertical root fracture or lateral canal
A sinus tract tracing to the lateral root rather than the apex strongly suggests a vertical root fracture or a lateral canal serving as the source of infection.
Question 7: Which periodontal probing finding is MOST consistent with a vertical root fracture on a single-rooted, previously root-canal-treated tooth?
- Narrow, isolated deep probing defect on one aspect of the root (Correct answer)
- Generalized horizontal bone loss on all teeth
- Uniform 4–5 mm pocketing around the entire tooth
- No probing defects but positive bite test
Correct answer: Narrow, isolated deep probing defect on one aspect of the root
Vertical root fractures typically produce a narrow, isolated 'spiking' periodontal pocket on one surface corresponding to the fracture line.
ABE Endodontic Diagnosis and Radiology 3
A 45-year-old patient presents with a tooth that is asymptomatic and non-responsive to both cold and EPT testing.
Radiograph shows a diffuse periapical radiolucency with well-defined borders.
What is the periapical diagnosis?