A patient has a vital tooth with radiolucency at the apex and a blunted apex. What is the most likely diagnosis?

In the scenario described, the presence of a vital tooth along with a radiolucency at the apex and a blunted apex points towards a specific diagnosis related to the status of the tooth and surrounding tissues. Hypercementosis, where there is an excessive deposition of cementum on the root surfaces, typically does not result in the formation of a radiolucency at the apex, as it is characterized by a thickening of the root rather than a loss or alteration of bone density at the apex.

In contrast, the combination of a vital tooth with an apical radiolucency and a blunted apex strongly suggests a condition such as apical periodontitis or a dental granuloma. These conditions often arise following pulp necrosis or chronic inflammation resulting in an adaptive response where the apical end may become blunted.

Granulomas often develop as a response to chronic irritation or inflammation but in the context of a vital tooth, the most reasonable interpretation is that the tooth is responding adaptively to a mild but persistent irritant, which aligns with the blunted apex diagnosis. Therefore, the characteristics presented lead to the understanding that while hypercementosis results in thickening and does not correlate to a radiolucency at the apex, other