A periapical radiograph shows a small, well-defined radiolucent lesion at the apex of a mandibular canine. The canine is vital on testing. What is the most likely diagnosis?

Correct answer: D. Periapical cemento-osseous dysplasia (PCOD) — early stage

• A. Traumatic bone cyst (simple bone cyst) appears as a well-defined radiolucency in the posterior mandible of young patients, typically scalloping between roots. It is less likely at the apex of a canine.
• B. A periapical abscess would present with a NON-vital tooth and clinical symptoms of infection.
• C. Odontoma typically shows a radiopaque mass (compound or complex) with a surrounding radiolucent halo.
• D. Correct. Early-stage periapical cemento-osseous dysplasia (PCOD) presents as a small radiolucent lesion at the apex of vital mandibular anterior teeth, most commonly in middle-aged Black women. Tooth vitality and the specific location are key differentiating features.