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Endodontics · patient case question

What is the pulpal diagnosis?

Patient case: Denosumab, Kennedy Class I RPD with a precision attachment on #21

Scenario: Patient with OSTEOPOROSIS taking DENOSUMAB. Kennedy Class I with a PRECISION ATTACHMENT on tooth #21. The chief complaint involves MOBILITY TYPE 3; the COLD TEST WAS NEGATIVE but the tooth was SENSITIVE TO PERCUSSION. A periapical shows one crown carrying the attachment system, bone resorption to the MIDDLE THIRD of the root, and an inflamed (not infected) periodontal ligament.

  1. Normal pulp with chronic apical abscess
  2. Reversible pulpitis
  3. Symptomatic irreversible pulpitis
  4. Pulp necrosis with symptomatic apical periodontitis
Show answer and explanation

Correct answer: D. Pulp necrosis with symptomatic apical periodontitis

  • A. A chronic apical abscess is defined by intermittent drainage through a sinus tract and is typically ASYMPTOMATIC — the opposite of the percussion sensitivity described.
  • B. Reversible pulpitis also requires a vital, responsive pulp with pain that resolves promptly.
  • C. Irreversible pulpitis requires a VITAL pulp that responds to cold with lingering pain; this tooth does not respond at all.
  • D. Correct. A NEGATIVE cold test means the pulp is NON-VITAL — necrosis. Sensitivity to PERCUSSION localises inflammation to the periodontal ligament, giving SYMPTOMATIC apical periodontitis as the periapical diagnosis.

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