ABE Endodontic Diagnosis and Radiology 2 — Questions and Answers
Question 1: A patient reports spontaneous, lingering pain that woke them from sleep. Cold testing produces prolonged pain lasting over 30 seconds. What is the most likely pulpal diagnosis?
- Symptomatic irreversible pulpitis (Correct answer)
- Symptomatic reversible pulpitis
- Pulp necrosis
- Previously initiated therapy
Correct answer: Symptomatic irreversible pulpitis
Spontaneous pain, nocturnal symptoms, and lingering cold response are hallmark signs of symptomatic irreversible pulpitis.
Question 2: Which CBCT artifact is caused by highly attenuating materials such as gutta-percha or metallic posts and appears as bright streaks across the image?
- Beam hardening artifact (Correct answer)
- Ring artifact
- Motion artifact
- Partial volume averaging artifact
Correct answer: Beam hardening artifact
Beam hardening artifacts arise when dense materials preferentially absorb low-energy photons, producing bright streak patterns on CBCT images.
Question 3: A tooth responds normally to cold testing but produces pain with biting and has a negative EPT response. Radiographically, a widened PDL space is present. What is the most likely diagnosis?
- Symptomatic apical periodontitis with pulp necrosis (Correct answer)
- Cracked tooth with irreversible pulpitis
- Symptomatic reversible pulpitis
- Condensing osteitis
Correct answer: Symptomatic apical periodontitis with pulp necrosis
Negative EPT with biting pain and widened PDL space indicates pulp necrosis with periapical inflammation causing symptomatic apical periodontitis.
Question 4: The Clark (SLOB) rule in periapical radiography is used to determine the:
- Buccolingual position of roots or objects (Correct answer)
- Mesiodistal curvature of canals
- Working length accuracy
- Presence of vertical root fractures
Correct answer: Buccolingual position of roots or objects
The SLOB (Same Lingual Opposite Buccal) rule uses two angulated exposures to determine whether a structure is buccal or lingual in position.
Question 5: Chronic apical abscess is BEST distinguished from an acute apical abscess by which clinical feature?
- Presence of a sinus tract with minimal pain (Correct answer)
- Severe spontaneous pain with rapid swelling
- Positive response to cold testing
- Absence of radiographic bone loss
Correct answer: Presence of a sinus tract with minimal pain
A chronic apical abscess typically presents with a sinus tract (parulis) allowing drainage, resulting in minimal or no pain unlike the acute variant.
Question 6: Which finding on CBCT is considered PATHOGNOMONIC for a vertical root fracture?
- Halo pattern of bone loss around the root (Correct answer)
- Apical radiolucency confined to the apex
- Condensing osteitis adjacent to the root
- Widening of the periodontal ligament space at the mid-root
Correct answer: Halo pattern of bone loss around the root
A halo or J-shaped pattern of bone loss extending from the apex along the lateral root surface is the hallmark CBCT finding for vertical root fracture.
Question 7: When performing electronic apex locator measurements, which condition is most likely to cause a FALSE apical reading (reading apex before the true terminus)?
- Perforated root with file contacting periodontal tissue (Correct answer)
- Dry canal with no electrolyte
- Canal flooded with sodium hypochlorite
- File binding in a curved canal
Correct answer: Perforated root with file contacting periodontal tissue
A root perforation causes the file to contact the periodontal ligament prematurely, triggering a false apex reading before reaching the actual foramen.
ABE Endodontic Diagnosis and Radiology 2
A patient reports spontaneous, lingering pain that woke them from sleep.
Cold testing produces prolonged pain lasting over 30 seconds.
What is the most likely pulpal diagnosis?