CGCG Root Divergence — ORE Part 1 MCQ

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HardRadiology & ImagingCGCG Root DivergenceORE Part 1

A 35-year-old patient presents with a multilocular radiolucency in the anterior mandible. Intraoral examination reveals root divergence (separation of roots) of adjacent teeth, but periapical radiographs show no evidence of root resorption. Vitality tests confirm that all associated teeth are vital. What is the most likely diagnosis?

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Correct answer: A — Central giant cell granuloma

Central giant cell granuloma (CGCG) is the correct answer. The key diagnostic features supporting this diagnosis are: (1) multilocular radiolucency in the anterior mandible—the typical location for CGCG; (2) root divergence (tooth displacement) characteristic of expansile lesions; and (3) critically, the absence of root resorption. Although CGCG commonly causes root divergence and loss of lamina dura, resorption is rare. This distinguishes it from ameloblastoma and odontogenic keratocyst, both of which frequently cause root resorption. Vitality of associated teeth is consistent with CGCG, which is a non-inflammatory lesion. Aneurysmal bone cyst and Langerhans cell histiocytosis typically present with more aggressive features and resorption patterns. The combination of displacement without resorption is pathognomonic for CGCG.

Reference: Freedman PD, Lumerman H. Central giant cell granuloma of the jaws. A clinico-radiological study. J Oral Maxillofac Surg. 1990 Oct;48(10):1318–22. https://pubmed.ncbi.nlm.nih.gov/2598590/