Diagnosis and determination of the most appropriate treatment options are based on adjunctive tests, including response to percussion, thermal stimuli, and electric pulp testing. In most cases, the results of these adjunctive tests are similar to those obtained for healthy teeth, which is in contrast to most teeth that exhibit irreversible pulpitis. The normal responses should not confuse the practitioner that the pulpal tissue is healthy and therefore requires only conservative treatment. In addition, these tests help to differentiate a true pulp polyp from hyperplastic gingivitis that is overlying a cavitation from a nonvital tooth.Intraoral radiographs, in particular periapical and bite-wing film views, are needed to confirm this diagnosis and to determine the extent of tooth destruction and if the inflammatory lesion involves the surrounding alveolar bone.
Radiographic findings demonstrate a large coronal radiolucency that extends to the pulpal chamber with focal loss of tooth structure, while the root apices may be either open or closed.
Although no bony changes are usually observed, the surrounding alveolar bone may reveal either an incipient periapical radiolucency that is consistent with chronic apical periodontitis or a localized radiopacity that is referred to as focal sclerosing osteomyelitis (condensing osteitis). In addition, vertical alveolar bone height may be decreased surrounding the involved tooth, which is indicative of periodontitis.
Radiographic imaging is required to determine the most appropriate treatment for the involved tooth.
