Periapical Osseous Dysplasia — ORE Part 1 MCQ

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HardRadiology & ImagingPeriapical Osseous DysplasiaORE Part 1

A 55-year-old woman has a well-defined, round 10 mm radiolucency at the apex of the lower right second premolar. The tooth responds normally to pulp sensibility testing and is asymptomatic. A periapical radiograph taken five years previously shows no change in lesion size or appearance. What is the most likely diagnosis?

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Correct answer: D — Early periapical cemento-osseous dysplasia

The best answer is **A. Early periapical cemento-osseous dysplasia**. In its early osteolytic phase, this lesion may appear as a well-defined periapical radiolucency. However, the associated tooth is typically vital and the lesion is usually asymptomatic; the unchanged five-year appearance further supports a benign dysplastic lesion. An inflammatory radicular cyst and a periapical granuloma require pulpal infection/necrosis and are therefore inconsistent with normal sensibility responses. A lateral periodontal cyst is characteristically located on the lateral root surface rather than centred at the apex. Cementoblastoma is usually attached to and obscures the root outline, commonly produces root resorption and is more typical in younger patients.

Reference: Yoshida H, et al. Why was the concordance rate of imaging and clinical diagnosis in cemento-osseous dysplasia low? A retrospective study of 55 cases. 2025. https://pubmed.ncbi.nlm.nih.gov/41723446/