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Endodontics · single question

A periapical radiolucency is noted at the apex of a tooth that tests VITAL on pulp testing. What is the most appropriate next diagnostic step?

  1. Fine-needle aspiration biopsy, to help characterize the lesion (e.g., fluid-filled vs. solid) since vitality argues against a pulpal/periapical origin
  2. Immediate surgical excisional biopsy without further workup
  3. Begin root canal treatment empirically
  4. No further workup is needed since the radiolucency is likely benign
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Correct answer: A. Fine-needle aspiration biopsy, to help characterize the lesion (e.g., fluid-filled vs. solid) since vitality argues against a pulpal/periapical origin

A vital pulp essentially rules out a typical odontogenic periapical lesion (which requires pulp necrosis). Aspiration biopsy is a useful, minimally invasive first step to characterize an unexplained radiolucency (distinguishing a cyst, vascular lesion, or solid mass) before deciding on excisional biopsy or other management.

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