In a periapical radiograph of a lower canine or premolar, a patient experiences pain when biting. What is the most likely diagnosis?

When a patient experiences pain while biting, it often indicates some form of trauma or structural compromise in the tooth or surrounding area. In the context of a lower canine or premolar, the fractured or cracked syndrome usually presents with such symptoms due to the presence of a fracture or crack in the tooth structure, which can lead to pain during functional use—especially when biting on the affected tooth.

Fractured or cracked syndrome is characterized by varying degrees of pain that may be sharp and localized, often elicited specifically during activities like chewing or biting down. Periapical radiographs might not always show the fracture, especially if it is a hairline fracture, but the clinical symptoms will strongly point towards this diagnosis when pain on biting is a significant complaint.

Other possible conditions, while they could involve pain, do not typically align as closely with the specific symptom of pain on biting. For instance, failed endodontic treatment would generally produce pain due to infection or inflammation associated with the surrounding tissues rather than a specific action like biting. A periradicular cyst would often lead to chronic pain or discomfort rather than acute pain elicited by biting forces. Vital pulpitis, though it may cause pain, is more commonly associated with lingering pain to thermal stimuli rather than