ADEX Radiographic Interpretation 2 — Questions and Answers
Question 1: Which radiographic feature best distinguishes a periapical abscess from a periapical granuloma?
- A granuloma appears as a well-defined radiolucency while an abscess is always ill-defined
- Both appear identical radiographically and cannot be differentiated (Correct answer)
- An abscess shows calcification within the lesion
- A granuloma shows root resorption while an abscess does not
Correct answer: Both appear identical radiographically and cannot be differentiated
Periapical abscesses and granulomas cannot be reliably distinguished from each other radiographically; histopathologic examination is required for definitive diagnosis.
Question 2: On a bitewing radiograph, what does a triangular-shaped radiolucency at the crestal bone between two teeth most likely indicate?
- External root resorption
- Early interproximal bone loss due to periodontal disease (Correct answer)
- Burnout artifact at the cervical region
- Normal interdental septum anatomy
Correct answer: Early interproximal bone loss due to periodontal disease
A triangular radiolucency at the crestal bone interproximally is characteristic of early horizontal bone loss associated with periodontal disease.
Question 3: A radiograph reveals a radiolucent lesion with scalloped borders surrounding the crowns of multiple impacted teeth. What is the most likely diagnosis?
- Dentigerous cyst
- Adenomatoid odontogenic tumor
- Gorlin-Goltz syndrome (nevoid basal cell carcinoma) (Correct answer)
- Ameloblastoma
Correct answer: Gorlin-Goltz syndrome (nevoid basal cell carcinoma)
Multiple odontogenic keratocysts surrounding impacted teeth are pathognomonic of Gorlin-Goltz syndrome (nevoid basal cell carcinoma syndrome).
Question 4: The lamina dura appears as a thin radiopaque line surrounding the root on a periapical radiograph. What does loss of the lamina dura most commonly indicate?
- Normal aging of the periodontium
- Hyperparathyroidism or Paget's disease (Correct answer)
- Impacted third molar pressure
- Dental fluorosis
Correct answer: Hyperparathyroidism or Paget's disease
Loss of the lamina dura is associated with metabolic conditions such as hyperparathyroidism, Paget's disease, and osteomalacia.
Question 5: Which type of bone loss pattern on a radiograph is most commonly associated with localized aggressive periodontitis?
- Generalized horizontal bone loss
- Vertical or angular bone loss localized to first molars and incisors (Correct answer)
- Furcation involvement of all posterior teeth
- Diffuse crestal bone loss with no pattern
Correct answer: Vertical or angular bone loss localized to first molars and incisors
Localized aggressive periodontitis classically presents with vertical bone loss concentrated around first molars and incisors in an otherwise healthy periodontium.
Question 6: A patient's panoramic radiograph shows a radiopaque mass with a 'cotton-wool' or 'ground-glass' appearance in the jaw. What condition does this most likely represent?
- Osteosarcoma
- Florid cemento-osseous dysplasia or Paget's disease of bone (Correct answer)
- Condensing osteitis
- Fibrous dysplasia in early stage
Correct answer: Florid cemento-osseous dysplasia or Paget's disease of bone
A 'cotton-wool' or 'ground-glass' radiographic pattern in the jaws is characteristic of Paget's disease of bone or florid cemento-osseous dysplasia.
Question 7: On a periapical radiograph, internal root resorption appears as:
- An irregular radiolucency external to the root surface widening the PDL space
- An oval or round radiolucent enlargement within the root canal space (Correct answer)
- A radiopaque mass within the pulp chamber
- Blunting of the root apex with a smooth contour
Correct answer: An oval or round radiolucent enlargement within the root canal space
Internal root resorption presents as a round or oval radiolucent widening originating from within the root canal, caused by pulpal cells.
ADEX Radiographic Interpretation 2
Which radiographic feature best distinguishes a periapical abscess from a periapical granuloma?