Endodontics · single question
A patient complains of pain when biting. A periapical radiograph is taken. What is the most likely finding?
Show answer and explanation
Correct answer: B. Vertical root fracture
B) Vertical root fracture — CORRECT.
Pain specifically upon BITING (particularly biting on a single cusp) with a history of extensive restorations or endodontic treatment is pathognomonic for vertical root fracture (VRF). Radiographic signs: a "halo" radiolucency around the root (J-shaped radiolucency), widened PDL space, or may be subtly visible. Clinical test: "tooth sleuth" or cotton roll bite test isolates the painful cusp.
A) Periapical abscess: Causes pain to percussion and palpation — not specifically to biting on a single cusp.
C) Irreversible pulpitis: Spontaneous, lingering pain to temperature — not primarily pain to biting.
D) Periodontal pocket: May cause pain to biting in advanced cases but the radiographic finding described is VRF.
Pain specifically upon BITING (particularly biting on a single cusp) with a history of extensive restorations or endodontic treatment is pathognomonic for vertical root fracture (VRF). Radiographic signs: a "halo" radiolucency around the root (J-shaped radiolucency), widened PDL space, or may be subtly visible. Clinical test: "tooth sleuth" or cotton roll bite test isolates the painful cusp.
A) Periapical abscess: Causes pain to percussion and palpation — not specifically to biting on a single cusp.
C) Irreversible pulpitis: Spontaneous, lingering pain to temperature — not primarily pain to biting.
D) Periodontal pocket: May cause pain to biting in advanced cases but the radiographic finding described is VRF.