The same tooth (#19) shows no periapical radiolucency on radiograph, but the patient reports sensitivity to biting. What is the periapical diagnosis?

Correct answer: A. Symptomatic apical periodontitis

• A. CORRECT. Symptomatic apical periodontitis (SAP) is defined as inflammation of the periodontium at the apex of the tooth, producing clinical symptoms (pain on biting/palpation/percussion) regardless of whether radiographic changes are present. Early SAP may have NO radiographic findings, but the clinical symptoms (bite sensitivity) confirm periapical involvement.
• B. Chronic apical abscess has a sinus tract (fistula) and typically minimal or no pain — it represents the draining phase of a chronic abscess.
• C. Asymptomatic apical periodontitis has radiographic evidence of periapical pathology (radiolucency) but produces NO symptoms. This patient has symptoms.
• D. Normal apical tissues have no symptoms and no radiographic findings. Bite sensitivity rules this out.