Periapical Radiology Exercise (March 2003)

1. The round opacity opposite the root of the first premolar tooth is
a. mental foramen
b. root remnant
c. torus mandibularis
d. torus palatinus
e. additional tooth

Differential diagnosis of this opacity -
a. hypercementosis
b. enostosis
c. complex odontoma
d. additional toothl
e. b and c

2. The thin, linear horizontal lucency seen in the middle of the maxillary sinus should be recognized as a -
a. fracture
b. artifact
c. nutrient canal
d. nerve groove

The root of the second premolar is
a. in the maxillary sinus
b. not in the maxillary sinus
c. in the nasal cavity
d. not in the nasal cavity

(Note - the periodontal ligament space at the apex of the tooth is visible.)

3. The localized opacity in the maxillary sinus seen apical to the second premolar and the first molar tooth should be identified as
a. odontoma
b. artifact
c. mucositis
d. severe periodontitis

This finding should result in what diagnostic procedure -
a. extraction
b. root treatment
c. vitality test
d. perio treatment
(Note - only vitality test is a diagnostic procedure. Only one diagnostic procedure is in the answer)

4. The thin linear opacity seen on the floor of the
sinus in this edentulous region is
a. ligature wire
b. broken endo file
c. artifact
d. static electricity

(Static electricity will be black)

This opacity is the result of -
a. endo treatment
b. closure of oro-antral fistula
c. removing film too rapidly from cassette
d. broken endo instrument

5. The images of the apices of both premolars
can not be seen clearly due to
a. incorrect kVp
b. incorrect mAs
c. improper processing
d. superimposition of the tongue

6. Anatomic anomaly -
a. taurodontism
b. dentinogenesis imperfecta
c. amelogenesis imperfecta
d. missing tooth
e. hypoplasia

(There probably is a missing first molar tooth but that is unlikely to be an anomaly)

1. Identify the opacity in the area of the root of the
first premolar
a. odontoma
b. root remnant
c. torus mandibularis
d. genial tubercle

Identify the well demarcated lucency along the inferior border of the radiograph
a. odontogenic keratocyst
b. periapical pathology
c. inferior border of the mandible
d. maxillary sinus

(You should note that the radiograph is upside down and that remnants of endo seen in root.)

Is there caries mesially on the second premolar?
a. Yes
b. No
c. Not sure

What will you do to confirm your diagnosis?
a. take a Bite-wing radiograph
b. percuss the tooth
c. do a vitality test
d. remove the bridge

(If you follow the image of the alveolar bone height under the bridge you can see it continuing over the second premolar. The lucency seen is cervical burnout but a Bite-wing radiograph should be taken to confirm.)

What is wrong with the occlusal rest on the canine tooth?

It should be resting on a restoration and not on tooth structure.

2. The opacity seen along the inferior border of the radiograph is
a. mental ridge
b. mylohyoid ridge
c. external oblique ridge
d. inferior border of mandible

The round opacities seen in the middle of the radiograph are -
a. compound odontomas
b. mental foramina
c. lingual tori
d. complex odontomas
e. fixer drops

3. In this periapical radiograph of the mandibular
anterior teeth, the poorly demarcated elliptical
opacity in the middle of the radiograph is
a. mental ridge
b. mylohyoid ridge
c. dorsum of tongue
d. inferior border of mandible

What is the processing error seen in this radiograph?
a. double exposure
b. overlapped films
c. fixer drops
d. developer drops
e. scratched film

How do you explain the black and white areas on the film.
a. Black areas - developer: white areas scratched film
b. White areas - fixer drops
c. White areas emulsion removed
black areas emulsion from other film

4. The vertical, diverging lines at the top of the film are
a. nutrient canal
b. fracture
c. intermaxillary suture
d. artifact

The endodontic restoration
a. lacks lateral condensation
b. is short of the apex
c. is adequate
d. was unnecessary

The alveolar bone height superimposed over the teeth is probably
a. palatal
b. labial
c. interproximal
d. no way to determine

Apply the Principles of Shadow Casting.

5. The linear, vertical lucencies should be
recognized as
a. nutrient canals
b. nutrient foramina
c. fractures
d. artifacts
e. static electricity

What is the main radiographic error in this radiograph?
a. elongation
b. overlapping
c. foreshortening
d. no error

How will you correct the technical error?
a. change horizontal angulation
b. increase negative vertical angulation
c. decrease negative vertical angulation
d. increase positive vertical angulation
e. decrease positive vertical angulation

6. This is an old patient because of
a. bone loss
b. calcified root canals
c. alveolar bone pattern
d. size of restoration

(Also note - the indicating dot should be on the occlusal surface.)

7. The elliptical (vague) opacity seen in the middle
of the incisor teeth is
a. dorsum of tongue
b. odontoma
c. genial tubercles
d. mental ridge

(Where the tongue superimposes on the teeth, the apices of the teeth are not seen as clearly as the should be seen.)

8. Anatomic anomaly noted
a. missing tooth
b. additional root
c. additional cusp
d. additional root canal

1. The opacity seen in the middle at the bottom of this radiograph can be all the following except
a. root remnant
b. odontoma
c. enostosis
d. cemento osseous lesion
e. condensing osteitis

How do you explain the space between the premolar teeth.
a. premolar drifted distally
b. developmental
c. large jaw; small teeth
d. premolar tilted distally

2. This new patient comes in complaining of pain
for about 3 weeks in the maxillary posterior
teeth. There is sensitivity to biting and cold.
Identify the problem.
a. caries
b. high restorations
c. periapical periodontitis
d. maxillary sinusitis

3. This 22 year old black male comes in complaining of bleeding gingival. What must you note from the radiograph?
a. lack of trabeculations
b. caries in second molar
c. gingivitis
d. periodontitis
e. calculus

4. Anatomic anomaly?
a. gemination
b. confusion
c. dilaceration
d. fenestration

5. Technical error seen here?
a. kVp too high
b. mAs too high
c. overlapping
d. double exposure
e. foreshortening

6. The linear opacities noted in the upper right
corner of the radiograph -
a. ear ring
b. nose ring
c. static electricity
d. bent film
e. eye glasses

(Note again the incorrect position of the indicating dot which can interfere with interpretation in the periapical region of a tooth.)