Pulp Canal Obliteration — ORE Part 1 MCQ

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ModerateEndodonticsPulp Canal ObliterationORE Part 1

An upper central incisor becomes progressively yellow-brown during the 6 months after a sporting injury. It is non-tender and gives no response to sensibility testing. A periapical radiograph shows marked narrowing and near-complete loss of the pulp canal space, with no periapical radiolucency. What is the most likely diagnosis?

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Correct answer: C — Pulp canal obliteration

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

A is correct. Pulp canal obliteration (also termed calcific metamorphosis) is a recognised sequel of traumatic injury. It presents with progressive yellow/orange crown discolouration and radiographic narrowing or apparent loss of the pulp space. A reduced or absent response to sensibility testing may occur and does not alone establish pulp necrosis. Internal resorption would produce an enlargement of the pulp space, often with a pink hue, rather than canal narrowing. External resorption alters the root surface or contour rather than obliterating the canal. Pulp necrosis with an abscess would require supporting features such as pain, swelling, sinus formation or periapical disease; these are absent. Normal ageing produces gradual secondary dentine deposition, but not this relatively rapid post-traumatic presentation.

Reference: Scottish Dental Clinical Effectiveness Programme. Oral Health Assessment and Review: Full Guidance, 2021. https://www.sdcep.org.uk/media/sy2ldxp2/sdcep-ohar-version-1-0.pdf