Reliable Necrosis Sign Trauma — ORE Part 1 MCQ
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Correct answer: D — An enlarging periapical radiolucency on serial radiographs
Answer: A. An enlarging periapical radiolucency on serial radiographs is the most reliable option because it provides objective evidence of progressive apical disease consistent with pulpal necrosis after trauma. UK SDCEP guidance includes an expanding periapical area among findings indicating that revascularisation is unlikely, while emphasising that diagnosis should not rely on one indirect test alone. Grey crown discolouration may suggest necrosis, but is not definitive. A negative cold response immediately after trauma is particularly unreliable because transient neural dysfunction can occur in a still-vital pulp. Percussion tenderness and mobility can result from recent trauma, occlusal interference or periodontal-ligament injury, rather than pulp necrosis. In practice, diagnosis is based on serial clinical and radiographic assessment, but among these single findings, A is best.
Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Assessment and Review, section 4.4.5 Assessment of Dental Trauma, 2012. https://www.sdcep.org.uk/media/sy2ldxp2/sdcep-ohar-version-1-0.pdf