Pulpal & PeriApical Diagnosis.pptx

Difference between Pulpal & PeriApical Diagnosis

1. Pulpal & PeriApical Diagnosis Presented by: Dr faryal afzal

2. Endodontic Diagnosis For every single tooth whether Dead or Alive has two Endodontic Diagnosis, which are; Pulpal Diagnosis Periapical Diagnosis

3. Pulpal Diagnosis Normal Pulp Reversible Pulpitis Symptomatic Irreversible Pulpitis Asymptomatic Irreversible Pulpitis Pulp Necrosis Previously treated Pulp

4. Normal Pulp Asymptomatic And when we test it in a certain way it has Mild to moderate transient response to thermal and electrical stimuli * By transient it mean it subsides when the stimulus is removed & it’s a momentary response * Thermal And Electrical This means its referring to the pulp, those fibers in the pulp are stimulated with thermal and electrical stimuli and these are conveniently tested with: Cold Test & Electric Pulp Test respectively. These are the diagnostic tools for Pulpal Diagnosis.

5. Cold Test Endo Ice = Dichlorodifluoromethane, -30degree C Chilled pallet is applied immediately to middle third of facial surface of crown for 5 seconds Intensity and duration of response provide information about pulpal diagnosis

6. Electrical Pulp Test (EPT) Least reliable pulp vitality testing method Indicates if there are vital sensory fibers present in the pulp, but does not provide any information about vascular supply to the pulp False positives & negatives results Contraindicated if pt has cardiac pacemaker

7. Reversible Pulpitis Symptomatic Thermal (usually cold) stimulus causes quick, sharp, hypersensitive, transient response No complaints of spontaneous response Caused by an irritant that affects the pulp, so irritants can be caries, deep cleaning, deep restorations without a proper liner or base, but if the irritant is removed the pulp reverts to and uninflamed state hence why it is called irreversible. Technically it is a Symptom, not a disease.

8. Symptomatic Irreversible Pulpitis Symptomatic Pulp has been irreversibly damaged beyond repair ; even with removal of the irritant it will not fully heal Characterized by spontaneous intermittent or continuous pain Thermal (often cold) stimulus causes lingering pain Postural changes like bending over or lying down increases blood pressure to the head and may exacerbate dental pain Radiograph are generally insufficient; EPT is of little value for diagnosis so we are really relying a lot on pt History, their explanation of their dental pain and the cold test resuts .

9. Asymptomatic Irreversible Pulpitis Asymptomatic (* asymptomatic means that nerves are responding rather normally and the pulp is basically like a normal pulp in terms of response but microscopically, histologically and physiologically the pulp has been irreversibly damaged and requires treatment) Microscopically similar to previous stage being symptomatic irreversible pulpitis, but no clinical symptoms

10. Pulp Necrosis Usually Asymptomatic but not always Can be partial or total necrosis Due to long term interruption of blood supply to the pulp Crown discoloration may accompany pulp necrosis in anterior teeth

11. Periapical Diagnosis Normal Apical tissues Symptomatic Apical Periodontitis Asymptomatic Apical Periodontitis Acute Apical Abscess Chronic Apical Abscess

12. Normal Apical Tissue Asymptomatic No pain on percussion or palpation * Percussion or palpation and X-rays Are the Main Diagnostic tools for Apical Diagnosis.

13. Percussion & Palpation Percussion = tapping on teeth with a mirror handle tap in a vertical direction along the lon axis of the tooth Palpation= feeling of a gloved finger on gums around apex of the root

14. Symptomatic Apical Periodontitis Painful inflammation around the apex Characterized by painful percussion and intense throbbing pain This is due to Localized inflammatory infiltrate within the PDL

15. Asymptomatic Apical Periodontitis Asymptomatic Apical radiolucency Confirmation of pulpal necrosis

16. Acute Apical Abscess Rapid swelling Severe pain Purulent exudate ( liquefaction necrosis) around apex It is easy to diagnose due to these cardinal features.

17. Chronic Apical Abscess Draining Sinus Tract usually without discomfort In this example above, of what appears to be a kind of smaller abscess not so much of swelling theres actually a tract that communicates with the oral cavity & source of infection associated with one of these teeth, now we insert a Gutta Percha Cone through the sinus tract stop when you feel resistance & then with it in place expose a PA radiograph and find the path and source of sinus tract, as in the above Xray, you can trace it to the premolar.

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