Which combination of findings best fits a necrotic pulp with symptomatic apical periodontitis?

• A. No spontaneous pain, percussion sensitivity, no radiolucency
• B. Spontaneous pain, percussion sensitivity, no radiolucency
• C. Spontaneous pain, percussion sensitivity, radiolucency present
• D. Spontaneous pain, no percussion sensitivity, no radiolucency

Answer: (B)

A necrotic pulp can trigger inflammation in the periapical tissues, leading to symptomatic apical periodontitis. The hallmark clinical signs are pain that can occur spontaneously and tenderness on percussion, reflecting inflammation of the periapical supporting structures. Radiographic changes, such as a periapical radiolucency, often lag behind symptoms or may not be visible in early stages, so absence of radiolucency does not rule out this condition. Therefore, the combination of spontaneous pain and percussion sensitivity with no radiolucency best fits necrotic pulp with symptomatic apical periodontitis.