Diagnosis Challenge

Tooth no. 46: hypersensitive to cold and sweets over the past few months but the symptoms have subsided. Now there is no response to thermal testing and there is tenderness to biting and pain to percussion. Radiographically, there are diffuse radiopacities around the root apices.

• Pulp necrosis; asymptomatic apical periodontitis

• Reversible pulpitis; normal apical tissues

• Symptomatic irreversible pulpitis; normal apical tissues

• Pulp necrosis; symptomatic apical periodontitis with condensing osteitis

Following the placement of a full gold crown on tooth #17, the patient complained of sensitivity to both hot and cold liquids; Now the discomfort is spontaneous. Upon application of Endo-Ice® on this tooth, the patient experienced pain and upon removal of the stimulus, the discomfort lingered for 12 seconds. Responses to both percussion and palpation were normal; radiographically, there was no evidence of osseous changes

• Pulp necrosis; asymptomatic apical periodontitis

• Reversible pulpitis; normal apical tissues

• Symptomatic irreversible pulpitis; normal apical tissues

• Pulp necrosis; symptomatic apical periodontitis with condensing osteitis

Tooth # 26 has occlusal-mesial caries, and the patient has been complaining of sensitivity to sweets and to cold liquids. There is no discomfort to biting or percussion. The tooth is hyper-responsive to Endo-Ice® with no lingering pain.

• Pulp necrosis; asymptomatic apical periodontitis

• Reversible pulpitis; normal apical tissues

• Symptomatic irreversible pulpitis; normal apical tissues

• Pulp necrosis; symptomatic apical periodontitis with condensing osteitis

Mandibular right lateral incisor (#42) has an apical radiolucency that was discovered during a routine examination. There was a history of trauma more than 10 years ago and the tooth was slightly discolored. The tooth did not respond to Endo-Ice® or to the EPT; the adjacent teeth responded normally to pulp testing. There was no tenderness to percussion or palpation in the region.

• Pulp necrosis; asymptomatic apical periodontitis

• Reversible pulpitis; normal apical tissues

• Symptomatic irreversible pulpitis; normal apical tissues

• Pulp necrosis; symptomatic apical periodontitis with condensing osteitis

Maxillary left lateral incisor (#22) exhibits an apical radiolucency. There is no history of pain, and the tooth is asymptomatic. There is no response to Endo-Ice® or to the EPT, whereas the adjacent teeth respond normally to both tests. There is no tenderness to percussion or palpation.

• Pulp necrosis; asymptomatic apical periodontitis

• Reversible pulpitis; normal apical tissues

• Symptomatic irreversible pulpitis; normal apical tissues

• Pulp necrosis; symptomatic apical periodontitis with condensing osteitis