DAY 2 — CASE 13: For the tooth with the chronic fistula, what is the pulpal diagnosis?

Correct answer: A. Pulp necrosis

• A. PULP NECROSIS is the correct diagnosis. A chronic draining sinus tract indicates dead (necrotic) pulp with periapical pathology. The periapical granuloma (radiolucency) results from necrotic pulp tissue driving chronic apical inflammation. Pulp necrosis = non-vital, no response to vitality testing, periapical RL.
• B. Asymptomatic irreversible pulpitis: No spontaneous pain but pulp is irreversibly damaged (deep caries, deep restoration). The pulp is still vital at this stage — not consistent with a chronic draining sinus tract.
• C. Symptomatic irreversible pulpitis: Spontaneous, lingering pain in a vital pulp that cannot recover. The tooth with a chronic sinus tract is not vital.
• D. Reversible pulpitis: Mild pulpal inflammation, pain only with stimuli, resolves with stimulus removal. The pulp is vital — not consistent with a draining sinus tract.