Patient with osteoporosis taking Denosumab, Kennedy Class I, precision attachment on tooth #21. Chief complaint: Type 3 mobility. Cold test negative. Sensitive to percussion. PA X-ray shows crown with attachment system, bone resorption to middle third of root, inflamed (not infected) periodontal ligament. What is the pulp diagnosis?

Correct answer: A. Pulp necrosis with symptomatic apical periodontitis

• A. Correct. A negative cold test indicates pulp necrosis, and percussion sensitivity indicates periapical inflammation, together forming pulp necrosis with symptomatic apical periodontitis.
• B. Reversible pulpitis would show a positive cold test response, inconsistent with the negative finding here.
• C. A normal pulp would test positive to cold and would not be percussion-sensitive.
• D. Irreversible pulpitis implies a vital (responsive) pulp; a negative cold test indicates non-vitality instead.