A radiolucency is seen at the CERVICAL region of a tooth. Each of the following belongs in the differential EXCEPT:

Correct answer: C. A periapical (endodontic) abscess

• A. A PERIODONTAL abscess arises within an existing periodontal pocket at the CERVICAL/lateral aspect of the root — exactly this location. Pulp typically tests VITAL.
• B. A lateral periodontal cyst is a developmental odontogenic cyst arising from rests of the dental lamina, classically a well-defined teardrop-shaped radiolucency at the LATERAL/CERVICAL aspect of a vital mandibular premolar or canine.
• C. CORRECT — this is the EXCEPTION. A periapical endodontic lesion is centered at the root APEX, where the pulpal blood supply exits through the apical foramen. A radiolucency at the CERVICAL third is not the location of a periapical abscess (unless it is tracking from a lateral canal, which is a different entity).
• D. A central giant cell granuloma can occur in the anterior mandible crossing the midline and may present at various levels including the cervical region.

Note: Cervical radiolucency should also raise external cervical resorption — a favorite CBCT question.