A patient with osteoporosis taking denosumab has an RPD with a precision attachment on tooth #21. Tooth #21 is found to have pulp necrosis and periapical pathology. What is the MOST appropriate pulp diagnosis?

Correct answer: C. Pulp necrosis with symptomatic apical periodontitis

• A. Normal pulp cannot coexist with periapical pathology in this context. If there's a periapical lesion, the pulp is either irreversibly inflamed or necrotic.
• B. Pulp necrosis with ASYMPTOMATIC apical periodontitis has radiographic periapical changes but NO clinical symptoms. If the patient has bite pain, the diagnosis is SYMPTOMATIC.
• C. CORRECT. Pulp necrosis = death of pulp tissue (no response to vitality testing). When combined with clinical symptoms (bite sensitivity, percussion pain), the periapical diagnosis is SYMPTOMATIC apical periodontitis. Together: 'Pulp necrosis + symptomatic apical periodontitis' is the complete diagnosis.
• D. Symptomatic irreversible pulpitis requires a VITAL (responsive) pulp that is inflamed beyond recovery. Necrosis means the pulp is dead, not irreversibly inflamed — these are mutually exclusive.