Radiographic findings, prosthodontic planning and periodontal diagnosis

Correct answer: D. An elongated styloid process or mineralised stylohyoid ligament

• A. Coronoid hyperplasia limits opening through impingement on the zygoma — a different entity.
• B. A submandibular stone is a discrete radiopacity in the floor of the mouth or gland, better shown on an occlusal film.
• C. Carotid calcifications appear as vertical radiopacities adjacent to the cervical vertebrae. They are an important incidental finding warranting medical referral, but they are unrelated to Eagle syndrome.
• D. Correct. Eagle syndrome is elongation of the styloid process or ossification of the stylohyoid ligament, producing throat pain, dysphagia and pain on turning the head — symptoms easily mistaken for a dental or TMJ complaint.

Note: The normal styloid process is roughly 25 mm. Beyond about 30 mm it is considered elongated, though many elongated processes are entirely asymptomatic.

Correct answer: A. A common path of insertion for all abutments

• A. Correct. A multi-unit fixed restoration is rigid and must seat as one piece. If the abutment preparations do not share a single path of insertion, the bridge simply cannot be placed.
• B. Shade matters aesthetically but does not determine whether the prosthesis can be delivered at all.
• C. The opposing occlusion must be assessed, but it does not govern the geometry of the preparations.
• D. Cement selection follows the restorative material and is a later decision.

Correct answer: A. Oral mucositis

• A. Correct per the recall key. Mucositis is the classic chemotherapy-related mucosal complication — diffuse erythema and painful ulceration of non-keratinised mucosa.
• B. Primary herpetic gingivostomatitis is a childhood illness with fever and generalised gingival involvement; recurrent intraoral herpes in an immunosuppressed adult is possible but would appear on keratinised mucosa.
• C. Malignancy must always be excluded in a persistent lesion, but a diffuse mucosal presentation does not fit.
• D. Traumatic ulceration is solitary and related to an identifiable cause.

Note: ⚑ The timing does not fit well. Mucositis is acute — it begins within days of chemotherapy and resolves within weeks of finishing. Mucosal lesions a full year later point instead to graft-versus-host disease (if transplanted), candidiasis, or a lichenoid reaction. The key is kept as recalled, but treat the timing as a flaw in the item rather than a rule to memorise.

Correct answer: D. Bilateral edentulous areas posterior to the remaining natural teeth

• A. That describes Class III, a bounded unilateral saddle, which is entirely tooth-borne.
• B. That describes Class IV, a single anterior edentulous area crossing the midline. By definition Class IV admits no modification spaces.
• C. That describes Class II, the unilateral distal extension.
• D. Correct. Class I is the bilateral distal extension case — the most demanding to design, because support is shared between teeth and mucosa and rotation about the fulcrum line must be controlled.

Note: Applegate's rules: classify after any extractions, and let the most posterior edentulous area determine the class.

Correct answer: A. Necrotising periodontal disease

• A. Correct. Punched-out, cratered interdental papillae with a grey pseudomembrane, pain and a distinctive fetid odour make the diagnosis. Stress, smoking, poor hygiene and immunosuppression are the usual predisposing factors.
• B. Desquamative gingivitis is a clinical description of erythema and sloughing, usually a manifestation of lichen planus or a vesiculobullous disease, and is not acutely painful in this way.
• C. Granulomatosis with polyangiitis produces the strawberry gingivitis of granular red hyperplastic tissue, with sinus and renal involvement — rare and quite different.
• D. Ordinary plaque-induced gingivitis is not painful and does not destroy the papillae or produce this odour.

Note: Pain, interdental necrosis and bleeding are the three defining features. Loss of attachment distinguishes necrotising periodontitis from necrotising gingivitis.