A radiograph shows a minimally appreciable radiolucent lesion at the periapex of a lower canine. The teeth test VITAL. What is the most likely diagnosis?

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

• A. The mental foramen can mimic periapical pathology but is not specifically at the canine and would be bilateral/symmetric.
• B. Traumatic (simple) bone cyst appears as a radiolucency with scalloping between tooth roots — typically vital teeth — but the periapex location and 'minimally appreciable' size better fit PCOD.
• C. Odontoma would show a mixed radiopaque-radiolucent lesion, often associated with an unerupted tooth.
• D. Periapical cemento-osseous dysplasia (PCOD) classically presents as radiolucent lesions at the periapex of VITAL anterior mandibular teeth (lower incisors and canines) in middle-aged women. The key feature: teeth ARE VITAL (pulp tests normal). This is pathognomonic — radiolucency at periapex + vital tooth = PCOD in early stage.