Tooth #2 shows percussion sensitivity, no EPT response, no radiolucency, and spontaneous pain. Which diagnosis best fits these findings?

• A. Necrotic pulp/Symptomatic apical periodontitis
• B. Symptomatic irreversible pulpitis
• C. Reversible pulpitis
• D. Normal apical tissues

Answer: (B)

The main idea here is using the patient’s pain history, tenderness testing, vitality testing, and radiographs to distinguish pulpal and periradicular conditions. Spontaneous pain points to significant pulpal inflammation that isn’t likely to calm on its own, and sensitivity to percussion indicates that inflammation has extended to or affected the periradicular tissues. The absence of radiolucency means there isn’t visible apical bone loss yet, so we’re not dealing with established periapical disease on the radiograph.

In this scenario, the combination of spontaneous pain with percussion sensitivity and a lack of radiographic apical breakdown fits symptomatic irreversible pulpitis. The pulp is inflamed to a degree that it cannot recover, producing ongoing pain even after stimuli are removed, and it often presents with tenderness to tapping or percussion as the surrounding tissues respond to the inflammatory process. A normal radiograph supports the idea that the issue is still primarily pulpal rather than advanced periradicular disease.

Reversible pulpitis would show pain only to stimuli and would not usually include spontaneous pain or percussion tenderness. Necrotic pulp with symptomatic apical periodontitis would more often show a nonvital vitality test and, over time, radiographic evidence of periapical change; the current picture points away from necrosis. Normal apical tissues would lack spontaneous pain and percussion sensitivity entirely, with a normal vitality response.