Prometric Exam Questions for Endodontics Specialists 2026: 20 MCQs with Answers on Pulp Diagnosis, Vital Pulp Therapy, Working Length, Irrigation, Obturation, Retreatment, Cracked Teeth, Resorption, Trauma, Microsurgery and Antibiotics

The specialist endodontics paper (END5021 at DHA, with CEN5022 for consultants, and the equivalent SCFHS, QCHP and NHRA papers) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. Candidates with an MDS, MS, MClinDent, a three-year endodontic residency or an Arab Board sit it after the authority confirms the specialist title. Endodontics is one of the busiest specialist dental services in the Gulf, where high caries rates and heavy restorative histories create a constant flow of referrals. The paper is diagnostic and procedural: name the pulpal condition, choose the treatment, know the numbers. This set covers what recurs. The licensing route is in the specialist dentist guide.

Diagnosis

Question 1

A patient has sharp pain to cold on a lower first molar that lingers for 30 seconds after the stimulus is removed, with spontaneous pain at night and no tenderness to percussion. Radiograph shows a deep restoration close to the pulp with normal periapical tissues. The pulpal and periapical diagnoses are:

1. Reversible pulpitis with normal apical tissues
2. Symptomatic irreversible pulpitis with normal apical tissues, for which root canal treatment (or vital pulp therapy in selected cases) is indicated
3. Pulp necrosis with symptomatic apical periodontitis
4. Hypersensitivity

Answer: B. Lingering pain and spontaneous pain distinguish irreversible from reversible pulpitis, in which pain is sharp but resolves within seconds; the AAE diagnostic terminology is the standard the papers use.

Question 2

Which statement about pulp sensibility testing is correct?

1. A positive electric pulp test proves the pulp is healthy
2. Cold and electric tests assess nerve response, not blood supply, so they can give false negatives in immature teeth, recently traumatised teeth and calcified canals, and false positives in multirooted teeth with partial necrosis; results are compared with control teeth and interpreted with history, percussion, palpation and radiographs
3. Heat testing is the most reliable single test
4. Testing is unnecessary when a radiolucency is present

Answer: B. Pulse oximetry and laser Doppler assess vitality (blood flow) but are not routinely available; a tooth with a periapical radiolucency and a positive cold response suggests a non-endodontic lesion or an adjacent tooth as the source.

Question 3

A patient reports sharp pain on biting that is relieved on release, localised to a lower second molar with a large intact amalgam, and the tooth responds normally to cold. The most likely diagnosis and the useful diagnostic steps are:

1. Acute apical abscess; incision and drainage
2. Cracked tooth; bite testing on individual cusps with a Tooth Slooth, transillumination, staining, removal of the restoration to inspect for the crack, and CBCT if needed, with management depending on crack depth and pulp status (orthodontic band or cuspal-coverage restoration, root canal treatment if irreversible pulpitis, extraction if the crack extends into the root)
3. Reversible pulpitis; fluoride varnish
4. Periodontal abscess; scaling

Answer: B. A vertical root fracture, by contrast, typically presents with a narrow isolated deep periodontal pocket, a J-shaped or halo radiolucency and a sinus tract, and the prognosis is hopeless.

Question 4

An upper lateral incisor has a large periapical radiolucency, no response to cold, and a sinus tract on the buccal gingiva. A gutta-percha point placed in the sinus tract on radiograph points to the apex. The diagnosis is:

1. Symptomatic apical periodontitis
2. Pulp necrosis with chronic apical abscess, treated by root canal treatment; the sinus tract usually closes within days of adequate chemomechanical disinfection and does not need separate treatment
3. Periapical cyst requiring surgery first
4. Lateral periodontal cyst

Answer: B. Radiographs cannot distinguish a granuloma from a cyst; persistent lesions after good treatment may be true cysts, extraradicular infection or foreign body reactions and are managed surgically.

Vital pulp therapy

Question 5

During caries removal in a 25-year-old's lower molar with reversible pulpitis, a 1 mm pinpoint pulp exposure occurs in a clean, dry field with haemostasis achieved within two minutes. The best management is:

1. Root canal treatment in all cases of exposure
2. Direct pulp capping with a hydraulic calcium silicate cement (MTA or Biodentine) under rubber dam, followed by an immediate well-sealed restoration; outcomes with bioceramics exceed those with calcium hydroxide
3. Zinc oxide eugenol temporary and review in a year
4. Extraction

Answer: B. The quality of the coronal seal is the main determinant of success; haemostasis that cannot be achieved within a few minutes suggests irreversible inflammation and favours pulpotomy or root canal treatment.

Question 6

Which statement about full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis is best supported by current evidence?

1. It is contraindicated in all mature teeth
2. Full pulpotomy with a calcium silicate cement under aseptic conditions shows success rates comparable to root canal treatment in several trials at two to five years, and is an accepted option in selected teeth with restorable crowns and no periapical pathology, especially in young patients, with long-term follow-up
3. It should always be followed by root canal treatment within a month
4. Calcium hydroxide is the preferred pulpotomy material

Answer: B. The ESE position statement supports vital pulp therapy as a biological alternative; case selection and material choice are tested.

Access, working length and shaping

Question 7

Which tooth most often has a canal that is missed during root canal treatment, and where is it found?

1. The lower canine, with a lingual canal
2. The upper first molar, with a second mesiobuccal (MB2) canal present in the majority of teeth, located palatal and slightly mesial to the main MB orifice along a line towards the palatal canal, best found with magnification, troughing and sometimes CBCT
3. The upper central incisor, with two canals
4. The lower first premolar, which never has two canals

Answer: B. Lower incisors have two canals in up to 40%, lower first premolars in about 25%, and the lower first molar has a distolingual or middle mesial canal in a minority; a missed canal is a leading cause of failure.

Question 8

The electronic apex locator reads 0.0 at the apical foramen. The working length should be set at:

1. The 0.0 reading
2. About 0.5 to 1.0 mm short of the 0.0 (foramen) reading, at or near the apical constriction, confirmed with a radiograph, because the constriction is the narrowest point and the ideal termination of preparation and obturation
3. 2 mm beyond the apex
4. 3 mm short of the radiographic apex

Answer: B. Modern apex locators are accurate within 0.5 mm in most canals and work in the presence of irrigants and blood; the radiographic apex averages 0.5 to 1 mm from the foramen, which often exits laterally.

Question 9

Which statement about nickel-titanium instrument separation is correct?

1. Heat-treated files fracture more often than conventional NiTi
2. Cyclic fatigue in curved canals and torsional stress when the tip binds are the two mechanisms; prevention includes a glide path, straight-line access, avoiding excessive apical pressure, using instruments in a lubricated canal, respecting the manufacturer's speed and torque, limiting use and discarding deformed files, and inspecting after each canal; heat-treated alloys improve flexibility and fatigue resistance
3. Reciprocating files cannot fracture
4. Separated fragments must always be removed

Answer: B. A separated fragment is managed by removal, bypass or incorporation into the obturation depending on location, stage of cleaning and risk; the patient is informed and it is documented.

Question 10

Which irrigation protocol is best supported for disinfection of the root canal system?

1. Chlorhexidine alone throughout
2. Sodium hypochlorite (about 2.5 to 5.25%) as the main irrigant for tissue dissolution and antimicrobial action, delivered with a side-vented needle short of working length and activated (ultrasonic or sonic), followed by EDTA 17% to remove the smear layer, with a final rinse; hypochlorite and chlorhexidine are never mixed because they form a precipitate
3. Hydrogen peroxide as the main irrigant
4. Saline alone

Answer: B. A sodium hypochlorite accident (extrusion beyond the apex) causes sudden severe pain, swelling and bruising and is managed with reassurance, cold then warm compresses, analgesia, antibiotics if indicated and close review.

Obturation and restoration

Question 11

The ideal apical extent of the root filling is:

1. 2 mm beyond the radiographic apex to seal the foramen
2. At the working length, 0.5 to 2 mm short of the radiographic apex, with a dense fill and no voids; fillings more than 2 mm short or extruded beyond the apex are associated with lower success, especially in teeth with apical periodontitis
3. 5 mm short of the apex
4. Level with the radiographic apex in every case

Answer: B. Warm vertical compaction, carrier-based and single-cone bioceramic techniques give comparable outcomes when the canal is well prepared; the sealer fills what the core material cannot.

Question 12

A root-filled lower molar has lost its temporary restoration and has been exposed to saliva for six weeks. The appropriate management is:

1. Place the definitive crown immediately
2. Retreat the root canal, because coronal leakage for weeks allows bacterial recontamination of the obturation; then restore promptly with a cuspal-coverage restoration, since root-filled posterior teeth without coverage have significantly higher fracture and failure rates
3. Replace the temporary and review in a year
4. Extract the tooth

Answer: B. Studies show the quality of the coronal restoration influences periapical health as much as the quality of the root filling.

Retreatment and complications

Question 13

A root-filled upper premolar with a post and crown has a persistent periapical radiolucency and symptoms two years after treatment; the root filling is 4 mm short with an untreated second canal visible on CBCT. The preferred first option is:

1. Apical surgery because the tooth is crowned
2. Non-surgical retreatment through the crown or after its removal, locating and treating the missed canal, since the cause is intraradicular infection that surgery alone does not address; apical microsurgery is reserved for cases where retreatment is impossible or has failed
3. Extraction and implant
4. Antibiotics for six weeks

Answer: B. Retreatment success is lower than primary treatment but still high when the cause is identified; the post is removed with ultrasonics where it blocks access.

Question 14

During access on a calcified lower molar, a furcal perforation occurs. The best management is:

1. Fill the perforation with gutta-percha
2. Control haemorrhage, avoid contamination, and seal immediately with MTA or another bioceramic repair material, with prognosis depending on size, location (crestal and furcal perforations are worst), time to repair and the material used
3. Extract the tooth
4. Leave it and obturate the canals

Answer: B. MTA has transformed the prognosis of perforation repair; a matrix (collagen) may be placed to prevent over-extrusion in large defects.

Question 15

A radiograph of an asymptomatic upper central incisor shows a pink spot on the crown and a well-defined radiolucency in the cervical area with the canal outline visible through it. The diagnosis and management are:

1. Internal resorption; root canal treatment alone
2. External cervical resorption; CBCT to classify extent (Patel classification), then surgical or internal access to remove the granulomatous tissue, treatment of the defect with trichloroacetic acid and restoration with glass ionomer or composite, with root canal treatment if the pulp is involved; extraction for extensive untreatable lesions
3. Caries; composite restoration
4. Normal anatomy

Answer: B. Internal resorption shows a symmetrical ballooning of the canal with the canal outline lost, and the pulp is partly vital; it is treated by root canal treatment. External cervical resorption is associated with orthodontics, trauma, bleaching and some systemic factors.

Trauma and surgery

Question 16

A 9-year-old's permanent central incisor with an open apex becomes necrotic after trauma. The treatment options with the best evidence for continued root development or an apical barrier are:

1. Conventional gutta-percha root filling
2. Regenerative endodontic procedures (revitalisation) with minimal instrumentation, disinfection with low-concentration hypochlorite and an intracanal antibiotic paste or calcium hydroxide, induction of a blood clot and a bioceramic barrier, or an MTA apical plug (apexification) where regeneration is not possible or has failed
3. Extraction and implant
4. Pulpotomy

Answer: B. Long-term calcium hydroxide apexification weakens dentine and is used less; discoloration from minocycline and MTA is a recognised side effect to warn about.

Question 17

Which statement about apical microsurgery is correct?

1. A 45-degree bevel and amalgam retrograde filling are standard
2. Modern technique uses magnification, a 0 to 10-degree root-end resection of about 3 mm to remove most lateral canals and ramifications, ultrasonic retrograde preparation of 3 mm, and a bioceramic or MTA root-end filling, giving success rates around 90%, far higher than traditional surgery
3. Surgery is the first choice for all failed root fillings
4. Root-end filling is unnecessary

Answer: B. Indications include failed retreatment or impossible retreatment (posts, separated instruments), persistent lesions, and biopsy of suspicious lesions.

Pharmacology and evidence

Question 18

Which patient with an endodontic problem needs systemic antibiotics?

1. A patient with symptomatic irreversible pulpitis and severe pain
2. A patient with an acute apical abscess with systemic involvement (fever, malaise, lymphadenopathy, diffuse spreading swelling or trismus), or a medically compromised patient, in addition to drainage and definitive treatment; localised abscesses, pulpitis and chronic lesions do not need antibiotics
3. Every patient with a periapical radiolucency
4. A patient with a sinus tract

Answer: B. Antibiotics do not relieve pulpitis pain; Gulf authorities audit antibiotic prescribing in dentistry, and amoxicillin (or clindamycin or azithromycin in allergy) for about five days is the usual choice when indicated.

Question 19

Which analgesic strategy is most effective for post-endodontic pain in a healthy adult?

1. Opioids as first line
2. Pre-emptive or immediate post-operative non-steroidal anti-inflammatory drug (for example ibuprofen 400 to 600 mg) combined with paracetamol 1,000 mg, which outperforms either alone and opioid combinations, with opioids reserved for severe pain not controlled by this regimen
3. Paracetamol alone
4. Antibiotics for pain

Answer: B. Effective local anaesthesia for a "hot" lower molar may require supplemental intraosseous or intraligamentary injection and articaine buccal infiltration after an inferior alveolar nerve block.

Question 20

Which statement about single-visit versus multiple-visit root canal treatment is supported by the evidence?

1. Multiple visits give significantly higher healing rates in all cases
2. Healing rates are similar for single-visit and multiple-visit treatment in vital and necrotic teeth, with slightly more post-operative pain reported in some single-visit studies and no difference in long-term outcome; single visits are appropriate when the canal can be dried and fully prepared, while interappointment calcium hydroxide is used for weeping canals or when time is limited
3. Single-visit treatment is contraindicated in necrotic teeth
4. Calcium hydroxide for one week sterilises every canal

Answer: B. The overall success of primary root canal treatment is about 85 to 95% for teeth without a periapical lesion and lower with pre-existing lesions; the prognosis questions on the paper rest on these figures.

How to practise

• Master the diagnostic terminology and the test interpretations, including cracks and resorption types.
• Learn the numbers: working length relative to the foramen, hypochlorite concentrations, resection length, success rates.
• Know the evidence positions: vital pulp therapy, single versus multiple visits, antibiotics, retreatment before surgery.
• Practise under time in the Endodontics bank or the Consultant Endodontics bank, using the error-log method.

Related sets: general dentistry questions, prosthodontics questions and paediatric dentistry questions. The image-practice plan is in dental exam preparation.

Frequently asked questions

How many questions are in the Prometric endodontics specialist exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which endodontics topics come up most?

Pulpal and periapical diagnosis, vital pulp therapy, working length and irrigation, obturation quality, retreatment versus surgery, resorption, trauma and antibiotic indications.

Does the exam include radiographs and CBCT images?

Yes. Expect image-based diagnosis of periapical lesions, resorption, missed canals and procedural errors.

Can a general dentist with an endodontics diploma get the specialist title?

No. The specialist title requires a recognised full-time postgraduate endodontics programme of about three years.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.