Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
            essed preoperatively, greater than normal mobility is frequently seen with sever periodontal disease but sometimes it maybe because of the underlying pathology like neoplasm.


Condition of the crown: e.g.
a- Carious destruction 
b- The presence of large restoration.
c- Presence or absence of the adjoining teeth.
d- Non – vitality.
e- State of the supporting tissue.
f- Shape, position, long axis and size of the crown.
g- Attrition.
  Good P.E.E resulted from correction of data collected from history, clinical examination, radiographs and laboratory aids in addition to that P.E.E need good knowledge and experience in the basic sciences e.g. anatomy, physiology.

In general, P.E.E may help you in:
a- Determine the method of extraction and type of anesthesia.
b- Reduce the time spend for extraction.
c- Reduce the intra and post operative crisis and complications.


2-Radiological evaluation 
  Preoperative clinical assessment maybe supplemental some times by preoperative radiographs, and the positive indications for preoperative radiograph are:
1- History of difficult or unsuccessful extraction.
2- Crown of extensive caries, large restorations, non-vital tooth when diagnosis is not certain and tooth is mal-posed.
3- A tooth which is abnormally resistant to forceps extraction.
4- If after clinical examination you decide to remove the tooth surgically.
5- Any tooth which is in close relation to important or vital structures like neurovascular canal, maxillary sinus, mental nerve, nasal cavity.

6. Attritioned teeth in elderly patient (maybe associated with hypercementosis ) 
7. If a tooth is partially erupted or completely unerupted or retained root.
8. Any tooth which has been subjected to trauma, fracture of the root and/or alveolar bone maybe present.
9. An isolated maxillary molar especially if it is unopposed and over-erupted. The bony support of such a tooth is often weakened by the presence of maxillary sinus and this may predispose to certain of oro-antral communication or fracture of the maxillary tuberosity.
10. Whenever, underlying bony pathology is suspected e.g. cystic lesion, tumors.
Any systemic condition which may predispose to dental or alveolar abnormality like:
a- Ostetitis deforms (Paget`s disease ), in which  the root hypercementosed, ankylosis leading to difficult extraction, infection of the socket.
b- Cleido – cranial dystosis, for pseudo–anadontia (multiple impactions, hooked roots occur, supernumerary teeth).
c- Patient who have received therapeutic irradiation to the jaw who may have to predispose to osteoradionecrosis.
d- Osteopetrosis (marble bone disease), which cause extraction very difficult and predispose to chronic osteomyelities.

  A good radiograph and careful interpretation may give or aid the operator to many factors that may cause difficult extraction, e.g.:
1- Abnormal number of roots, and shape of roots.
2- An unfavorable root pattern.
3- Caries extending to the root mass.
4- Fracture or resorption of the root

            Quiz: