Periapical Osseous Dysplasia — ORE Part 1 MCQ

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HardOral PathologyPeriapical Osseous DysplasiaORE Part 1

A patient presents with multiple well-defined periapical radiolucencies on an OPG affecting teeth that test vital. There is no history of trauma. The radiolucencies are round, well-corticated, and approximately 5–8 mm in diameter. What is the most likely diagnosis?

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Correct answer: B — Periapical cemental dysplasia (early stage)

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

The correct answer is **A: Periapical cemental dysplasia (early stage)**. **Key discriminator:** Pulp vitality. In osseous dysplasia, teeth remain vital—this is the essential feature that distinguishes it from inflammatory and neoplastic mimics. Multiple radicular cysts (B) and periapical granulomas (C) arise from non-vital teeth with necrotic pulps, so they fail immediately when vitality testing is positive. Metastatic deposits (D) and multiple myeloma (E) do not present with well-corticated, small periapical radiolucencies centred on vital teeth. Periapical cemental dysplasia (PCD, a subset of cemento-osseous dysplasia) is a benign, asymptomatic fibro-osseous lesion that characteristically affects the periapical region in vital teeth. The early osteolytic stage produces radiolucencies that mimic endodontic pathology radiographically—a common diagnostic pitfall—but clinical vital testing and the absence of pain or symptoms permit correct diagnosis. Multiple adjacent teeth are often affected in a similar pattern, as in this case. No treatment is indicated; conservative follow-up is standard practice.

Reference: Periapical cemento-osseous dysplasia: a case report with twelve-year follow-up and review of literature. Int Endod J. 2014; and Difficulties in the diagnosis of periapical translucencies and in the classification of cemento-osseous dysplasia. BMC Oral Health. 2019. https://pubmed.ncbi.nlm.nih.gov/25425097/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617922/