Periapical Pathology — ORE Part 1 MCQ

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ModerateRadiology & ImagingPeriapical PathologyORE Part 1

A periapical radiograph shows a well-defined, round radiolucency at the apex of an upper central incisor. The tooth has a large composite restoration. The tooth does not respond to electric pulp testing or cold testing. What is the most likely diagnosis?

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Correct answer: D — Periapical granuloma or radicular cyst

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

The most likely diagnosis is periapical granuloma or radicular cyst (Option A). The key diagnostic feature is the non-vital tooth (confirmed by negative EPT and cold response). Both granulomas and cysts are inflammatory periapical lesions arising from pulpal necrosis and apical periodontitis. They cannot be distinguished on radiographs alone; histology would be required. Options B–E are incompatible: incisive canal cysts (B) are developmental non-endodontic lesions affecting vital teeth; periapical cemental dysplasia (C) and lateral periodontal cysts (D) also typically present with vital teeth; traumatic bone cysts (E) affect posterior teeth and are not associated with non-vital pulps. The well-defined, round radiolucency at the apex of a non-vital tooth is classic for inflammatory periapical pathology.

Reference: Radicular Cyst – Surgical Management and Pathology. National Center for Biotechnology Information, PubMed Central, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132303/