What is the diagnosis of tooth #11 given findings including no response to cold test, a periapical radiolucency, no tenderness to percussion, and a fistula apical to #11?

• A. Necrotic pulp/Chronic apical abscess
• B. Normal apical tissues
• C. Reversible pulpitis
• D. Acute apical abscess

Answer: (A)

When the pulp is non-vital and there is a periapical radiolucency with a fistula draining at the apex, the picture fits a necrotic pulp with chronic apical abscess (chronic apical periodontitis with a sinus tract). The nonresponse to cold confirms the pulp is dead. The radiolucency shows bone loss at the apex from a long-standing infection. The apical fistula demonstrates that the infection has found a drainage pathway, which is typical of a chronic process. The absence of tenderness to percussion supports a chronic rather than acute stage.

Normal apical tissues wouldn’t have a radiolucency or a non-vital pulp. Reversible pulpitis would show a positive response to cold and no periapical radiolucency. Acute apical abscess often presents with pain and percussion tenderness (and sometimes swelling), which aren’t observed here.