A young woman with a root-filled tooth #14 shows a radiopacity superimposed over the periapical region on a panoramic image. She was wearing small earrings during the exposure. What does the radiopacity represent?

Correct answer: B. An artefact from the earring — a real (or ghost) image of the jewellery, not a lesion

• A. Idiopathic osteosclerosis is a well-defined but bone-density opacity with no radiolucent rim, typically in the mandibular premolar-molar region, and it does not appear over a maxillary molar apex in this pattern.
• B. CORRECT. Metallic jewellery left in place produces an ARTEFACT. On a panoramic image, an object outside the focal trough is projected twice — a real image and a blurred, magnified GHOST image displaced to the opposite side and higher up. The first step is always to recognise the artefact, remove the jewellery, and retake the film rather than diagnose a lesion. On a periapical film, the same earring simply superimposes as a well-defined uniformly dense opacity with a shape that does not match any anatomical structure.
• C. Condensing osteitis is diffuse bony sclerosis around the apex of a chronically inflamed tooth, with poorly defined borders blending into normal trabeculae — quite unlike a sharply outlined metallic density.
• D. Extruded gutta-percha would be continuous with the canal and would follow the canal's path — a linear, tapering opacity, not a discrete geometric object.

Note: ⚠️ The source keyed 'ghost image' and marked it as uncertain. True ghost images are a PANORAMIC phenomenon only (blurred, magnified, opposite side, higher). On a periapical, jewellery produces a simple superimposed artefact. Worth clarifying which film the exam item showed.