Endodontic Diagnosis. first part in diagnosispptx

Endodontic Diagnosis

1. Dr: Abdalmagid Alhammaly Operative and Endodontic Department

2. Making a diagnosis is a process that begins with collecting accurate information from the patient verbally, conducting a clinical examination , carrying out special tests and assimilating the facts to determine the disease or the problem that the patient has. disease or the problem that the

3. Chief complaint

4. Reversible pulpitis Irreversible pulpitis Necrosis Apical periodontitis Apical abscess Sinus tract Apical granuloma

5. Reversible pulpitis: Short, sharp sensitivity to cold Localized to the affected tooth Questionable restoration, coronal fracture

6. Irreversible pulpitis: Spontaneous pain, lingering, sporadic, poorly localized to a specific tooth Can radiate away from the source

7. Pulp necrosis None, or vague history of intermittent symptoms which completely settle

8. Apical periodontitis Percussive tenderness Tenderness upon palpation of periapical soft/hard tissues of the affected tooth

9. Acute apical abscess Severe pain and swelling Intra-oral: often fluctuant Extra-oral: more diffuse progressing to cellulitis

10. Chronic apical abscess (sinus tract) Little or no symptoms Discharging suppurating sinus

11. Give time to your patient and listen to them carefully

12. Pain with sweets and cold!!

13. Listen to patient Key words Night A nalgesics D aily activity

14. The mnemonic ‘SOCRATES’ is a guide to questioning with the patient: S ite Where is the pain? O nset When did the pain start, and was it sudden or gradual? C haracter What is the pain like? An ache? Stabbing? R adiation Does the pain radiate anywhere? A ssociations Are there any other signs or symptoms associated with the pain? T ime course Does the pain follow any pattern? E xacerbating/relieving factors Does anything change the pain? S everity H o w s e v e r e i s t h e p ai n ? ( u s e a s c a l e b e t w een 1 - 1 )

15. Optimise the clinical examination by using good light, magnification and ensuring nothing obscures vision

16. Which one

17. Examine to localize Vital teeth tests Cold test Selective anaesthesia

18. Application point of pulp test stimulus (red dot)

19. Selective anasthesia

20. Pulp tests : • Suspect teeth should be tested after a control tooth/teeth • Cold tests are considered the first line test to give an indication of pulp health • Be wary of false negative pulp tests particularly in older patients, heavily restored teeth and teeth that have experienced recent trauma

21. Examine to localize Nonvital teeth tests palpation Tracing test percussion

22. Tooth restorable or not • Volume of remaining coronal natural tooth structure • Fractures and hairline infractions in the tooth • Mobility,

23. *Coronal tooth structure To obtain predictable results, there should be at least 2mm of circumferential supra-gingival tooth structure and not less than 30% of the original coronal tooth structure remaining

24. Vertical root fracture J shaped lesion related to the root Deep isolated pocket Pain on biting that worsen on releasing By Apex locator

25. Radiographic imaging Conventional periapical radiographs should be taken with justification after the clinical examination A good quality periapical radiograph is required to make an endodontic diagnosis 3mm of sound tissue should be seen beyond any pathological finding

26. Diagnosis After assimilation of the symptoms, clinical examination and results of the special tests, a diagnosis or provisional diagnoses can be made.

27. Mandibular right first molar had been hypersensitive to cold and sweets over the past few months but the symptoms have subsided. Now there is no response to thermal testing and there is tenderness to biting and pain to percussion. symptomatic apical periodontitis with condensing osteitis .

28. the patient complained of sensitivity to both hot and cold liquids; now the discomfort is spontaneous. Upon application of Endo-Ice® on this tooth, the patient experienced pain and upon removal of the stimulus, the discomfort lingered for 12 seconds. Responses to both percussion and palpation were normal Symptomatic irreversible pulpitis

29. Maxillary left first molar has occlusal-mesial caries and the patient has been complaining of sensitivity to sweets and to cold liquids. There is no discomfort to biting or percussion.The tooth is hyper-responsive to Endo-Ice® with no lingering pain. reversible pulpitis

30. There was a history of trauma more than 10 years ago and the tooth was slightly discolored. The tooth did not respond to Endo-Ice® or to the EPT; the adjacent teeth responded normally to pulp testing. There was no tenderness to percussion or palpation in the region pulp necrosis; asymptomatic apical periodontitis.

31. Mandibular left first molar demonstrates a relatively large apical radiolucency encompassing both the mesial and distal roots along with furcation involvement. Periodontal probing depths were all within normal limits. The tooth did not respond to thermal (cold) testing and both percussion and palpation elicited normal responses chronic apical abscess.

32. Maxillary left first molar was endodontically treated more than 10 years ago. The patient is complaining of pain to biting over the past three months. There appear to be apical radiolucencies around all three roots. The tooth was tender to both percussion and to the Tooth Slooth ®. previously treated; symptomatic apical periodontitis.

33. Maxillary left lateral incisor exhibits an apical radiolucency. There is no history of pain and the tooth is asymptomatic. There is no response to Endo-Ice® or to the EPT, whereas the adjacent teeth respond normally to both tests. There is no tenderness to percussion or palpation . asymptomatic apical periodontitis.

34. Periodontal Conditions

35. External Resorption

36. Internal Resorption

37. Crown Fractures

38. Horizontal Root Fractures

39. vertical Root Fractures

40. Cracked Tooth

41. Apical Periodontitis

42. Periodontal Conditions

43. Separated Instruments

44. Perforations

45. Post Perforations

46. Periodontal Conditions

47. Periodontal Conditions

48. Periodontal Conditions

49. Periodontal Conditions