VRF J-Shaped Radiolucency — ORE Part 1 MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: E — Vertical root fracture (VRF)
The combination of J-shaped/'halo' radiolucency extending from the apex, a root-treated tooth, symptomatology, and a narrow deep probing defect localised to the same aspect is pathognomonic for vertical root fracture (VRF). Literature confirms that J-shaped and 'halo' radiolucencies, associated with deep probing depths (≥5 mm) and perilateral bone loss, show the highest diagnostic association with VRF among all periradicular pathologies in treated teeth. The radiographic pattern reflects a fracture line propagating from the root apex, typically originating from the internal canal wall. Failed root canal treatment presents with broader periapical radiolucency, not characteristic lateral J-shaped patterns. Lateral canals produce apical lesions without the deep narrow periodontal defect signature. External cervical resorption occurs coronally, and periapical granuloma is non-specific, lacking the J-shaped pattern and deep lateral probing signature of VRF.
Reference: Tsesis I, Rosen E, Taschieri S, et al. Diagnosis and treatment of vertical root fractures: a systematic review. Int Endod J. 2016;49(12):1205-1216 and case-control evidence from Patel et al. Int Endod J. 2022;55(Suppl 3):804-826. https://pubmed.ncbi.nlm.nih.gov/10503867/