Oral Radiology & Imaging

A 27-year-old with proximal sensitivity on #26–27; clinical exam inconclusive; you need to assess interproximal caries.

An impacted maxillary canine must be localized before exposure. Two periapicals are taken at different horizontal angulations. The canine image moves in the same direction as the tube shift.

A 56-year-old with mandibular posterior swelling; panoramic shows multilocular “soap-bubble” radiolucency in the ramus/angle; teeth are vital.

A pregnant patient (first trimester) with suspected acute apical abscess of #46 needs imaging.

A 65-year-old requires implant planning for #36; ridge width and IAN position uncertain.

A panoramic shows bilateral radiopaque “ghost” images superior/posterior to mandibular molars; patient wore large hoop earrings.

Your periapical of #11 shows foreshortened root apex.

For suspected TMJ disc displacement without reduction, which imaging is most informative?

A 10-year-old with high caries risk needs radiographs. How to minimize dose?

You suspect early osteomyelitis of the mandible after spreading infection; initial plain films are normal.

A floor-of-mouth swelling painful at meals; you suspect submandibular sialolithiasis.

A mandibular molar shows periapical radiolucency but tests vital; patient is asymptomatic; middle-aged Black woman; multiple similar periapical changes.

You need to distinguish internal from external root resorption on #21. Two PAs with different horizontal angulations show the defect moving relative to the canal.

Incidentally, a panoramic shows irregular calcifications at C3–C4 level near the angle of the mandible. Patient has vascular risk factors.

A digital bitewing shows apparent cervical radiolucency on #36 mesial. Tactile exam is hard and smooth; a second view shows normal contour.

For panoramic imaging, which protective measure is typically avoided to prevent superimposition artifacts?

A 9-year-old gagging child cannot tolerate intraoral bitewings but needs proximal caries assessment.

You suspect vertical root fracture in a root-filled mandibular molar with J-shaped radiolucency.

Implant planning in posterior maxilla shows close sinus floor. Which adjunct is most useful?

After positioning for a panoramic, the resulting image shows skinny, blurred anterior teeth and spine superimposed.

A radiopaque mass is noted above #16 roots with curved “J-shaped” outline; patient asymptomatic.

A 54-year-old with suspected MRONJ after extraction presents with exposed bone; you need to map sequestra and cortical integrity.

You plan a periapical survey for endodontic treatment. Which receptor/technique combo optimizes accuracy and reduces retakes?

A patient with chronic sinus symptoms has unilateral maxillary sinus opacification and periapical lesion on #16.

Screening for TMD in a patient with long-standing crepitus and limited opening; bony changes suspected.

You notice discrete radiopaque nodules within the facial artery region on panoramic.

When is CBCT contraindicated as a screening tool?

A periapical film shows cone-cut on the distal of #27 due to misaligned PID.

A 32-year-old with suspected periapical pathology on #21 after trauma; you want to monitor healing over time.

A 15-year-old shows a scalloped radiolucency between roots of vital mandibular premolars on panoramic.

How can you reduce patient dose most effectively in intraoral radiography?

A 40-year-old with suspected sialadenitis of the parotid needs imaging.

A panoramic shows widened anterior teeth and exaggerated smile line with stretched mandibular angle.

Which modality best detects recurrent caries beneath large metallic restorations?

During implant planning, you must evaluate proximity to the nasopalatine canal for a #11 implant.

A patient with suspected condensing osteitis at #46 (nonvital history) has periapical radiopacity.

On a bitewing, heavy radiopaque deposits on mesial #36 and distal #35 are seen interproximally.

A 60-year-old with diffuse “cotton wool” skull radiopacities and hypercementosis needs extractions.

A two-dimensional periapical suggests a radiolucent lesion overlapping the mental foramen at #34–35 apices; teeth are vital.

You plan to monitor a periapical lesion size change over 6 months after RCT. What is essential for valid comparison?

A 33-year-old with recurrent pain on #26 after RCT; periapical film equivocal; you need to assess buccolingual extent of a suspected lesion.

A dental assistant notices every periapical is slightly elongated with overlapped contacts.

A 29-year-old with recent trauma; suspicion of horizontal root fracture on #11.

A panoramic shows anterior teeth widened and blurred; chin up, occlusal plane flat.

You need to monitor moderate periodontitis progression over time.

A 7-year-old requires caries assessment but cannot tolerate sensors; you want to keep dose minimal.

A radiolucency below mandibular canal, well-circumscribed, posterior mandible; tooth vitality normal; asymptomatic adult male.

You plan #16 endodontics and need to know MB2 likelihood and canal curvature.

A periapical shows a radiolucent oval near #35 apex that shifts relative to the apex with tube shift. Tooth is vital.

A CBCT volume for implant planning shows streaking around an amalgam-filled #36 obscuring alveolar crest.

A 62-year-old with irregular sunburst periosteal reaction around mandibular lesion; pain and swelling present.

An unerupted tooth-like radiopaque mass with surrounding radiolucent rim in anterior maxilla of a child.

You suspect Eagle syndrome from facial pain; panoramic shows elongated calcified stylohyoid ligament bilaterally.

A digital periapical shows generalized “grainy” noise and low contrast.

For orthodontic assessment of skeletal relationships and airway, which single image is most appropriate initially?

A 58-year-old on denosumab requires imaging to evaluate suspected MRONJ extent.

You need to evaluate soft tissue tumor boundaries in the masticator space.

A 45-year-old with deep caries on #16; panoramic suggests proximity to maxillary sinus septum.

A periapical shows radiopaque projection at CEJ on distal root of #36; tooth is vital; food impaction noted.

A patient’s bitewing shows a radiolucent crescent under a large amalgam; clinically, margins are intact, no softness.

You need to evaluate condylar hyperplasia/asymmetry in a young adult.

A radiolucent lesion with flecks of radiopacity in posterior mandible of a 35-year-old; cortical expansion; teeth vital.

A pediatric lateral cephalogram shows enlarged adenoids narrowing nasopharyngeal airway; child has mouth breathing.

A 50-year-old with a radiopaque mass intimately fused to the apex of a vital mandibular molar with surrounding radiolucent rim; painful on percussion.

An elderly patient’s panoramic shows multiple “rice-grain” calcifications over the tonsillar region.

A 42-year-old with painful swelling at submandibular region; US suggests ductal stone; you consider duct imaging.

After endodontic surgery planning, you must identify proximity of the mental loop before apical surgery on #45.

A 26-year-old with suspected external cervical resorption on #11; irregular radiolucency at cervical area; tooth vital.

Your sensor consistently cuts off the apices on maxillary molar PAs.

A 38-year-old with unexplained unilateral mandibular cortical thinning on CBCT; no dental pathology; history of facial trauma years ago.