CEJ to Bone Crest Distance — MFDS Part 1 MCQ

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ModerateAnatomy (Head & Neck)CEJ to Bone Crest DistanceMFDS Part 1

A correctly exposed horizontal bitewing radiograph is taken for an adult with clinically healthy periodontal tissues and no attachment loss. Approximately how far from the interproximal cementoenamel junction should the alveolar bone crest normally be located?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — 1–2 mm apical to the CEJ

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

The correct answer is A. On a correctly exposed bitewing, the interproximal alveolar crest at a site without attachment loss is normally approximately 1–2 mm apical to the cementoenamel junction; published measurements give a range of about 0.4–1.9 mm. A crest almost level with the CEJ, as in B, is more coronal than usually expected, while a crest coronal to the CEJ, as in D, is not the normal adult relationship. Distances exceeding 2 mm require assessment for periodontal bone loss and other local or radiographic explanations; current SDCEP guidance uses more than 2 mm but less than 4 mm on bitewings as a marker of early bone loss. The larger distances in C and E are therefore not expected in an intact healthy periodontium.

Reference: Hausmann E, Allen K, Carpio L, Christersson LA, Clerehugh V. What alveolar crest level on a bite-wing radiograph represents bone loss? Journal of Periodontology. 1991;62(9):570–572. https://pubmed.ncbi.nlm.nih.gov/1941497/