Establishment of endodontic diagnosis. history, patient examination 4th year, 2nd semester

ENDODONTICS is a fascinating challenge to conserve teeth with diseased or necrotic pulps so that they can serve the patients throughout their life without representing any danger to their health Birger Nygaard-Östbye (1960)

The objectives of Endodontic diagnostic procedures Assemble collective information regarding signs, symptoms and history That information is then combined with results from the clinical examination and tests

Endodontic diagnostics are based on Anamnesis Present complaint Present oral pathosis dental history Medical history Clinical examination Crow, pulp, APICAL AREA Radiological examination

Requirements of a successfull diagnostician Knowledge Interest Intuition Curiosity Patience Senses

History, anamnesis Present dental illness (questions): How long have you had this problem? How painful is it? How often does it hurt? When does it hurt? What makes it hurt? When does it go away? What kind of treatment have you had? Medical history: Illnesses, medications, history of bleeding

I. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 1-1

II. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 1-1

III. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 1-1

IV. 60. 62. 61. 63. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 1-1

V. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 1-1

Endodontic history I. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Table 2-1

Endodontic history II. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Table 2-1

Endodontic history III. Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Table 2-1

Successful Endodontics Accurate Diagnosis Successful Endodontics Optimal treatment of root canals infection control! Proper Treatment Decision

Parts of Extra oral examination Inspection Palpation (Radiology if needed)

Intraoral examination Transillumination Coronal evaluation Pulpal evaluation Percussion Palpation Periodontal evaluation Radiographic examination

Palpation Sensitivity to finger pressure on the mucosa over the apex of a tooth Fluctuation is palpable

Percussion Very gently tap the occlusal surfaces of teeth Tender to percussion: sign of periapical inflammation Apical periodontitis: an extension of pulpal inflammation, it may also result from: Impact trauma Traumatic occlusion Sinusitis affecting maxillary teeth

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 4-6

Vitality/ sensitivity examination Clinical examination Vitality/ sensitivity examination Thermal tests: cold or hot stimuli Cold stimuli: Cold drink, ice stick Ethyl chloride Fluori-methane spray Carbon dioxide dry „ice” stick Hot stimuli: A stick of heated gutta-percha or hot water It can help locate a symptomatic tooth with necrotic pulp

Pulp vitality test Vitality testing: mechanical thermal electrical Sensitive tooth – no other symptom: - tooth vital, Pulp healthy pulp

Mechanical vithality test Probing of exposed dentin) Cavity preparation – removal of old restauration (without, anesthesia) High specificity

Application of thermal stimulation I. Thermal tests: cold or hot stimuli Cold stimuli: Cold drink, ice stick Ethyl chloride (-10,-25°C) Fluori-methane spray Carbon dioxide dry „ice” stick Hot stimuli: A stick of heated gutta-percha or hot water It can help locate a symptomatic tooth with necrotic pulp

Application of thermal stimulation II. Temperature change causes modification fluid movement Irritation of extensions of odontoblast Irritation of free nerve endings

Application of Cold stimuli

Application of Warm stimuli

Electric pulp test I. Many factors affect the level of response: Enamel thickness Probe placement on the tooth Dentin calcification Interfering restorative materials Patient’s level of anxiety

Electric pulp test II. Electric pulp tester: Digitest Sirotest Digipex II. Dentometer Precautions: using an electric pulp tester on patients, who have an indwelling cardiac pacemaker, is contraindicated!

Other tests laser Doppler flowmeter Hughes probeye camera: detecting temperature changes Occlusal pressure test Anesthetic test Test cavity

Radiographic examination Root anatomy Conditions inside the tooth (pulp stones, internal resorptions) Conditions outside the tooth (external resorption) Periradicular lesions (resorption, osteitis, apical abscess, cyst, osteofibrosis, cementoblastoma, hypercementosis)

cracked tooth examination Inspection - magnification Transillumination Biting test

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 4-1

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 4-1

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 4-1

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Fig. 4-1

Diagnostics The importance of proper diagnostic provides The base of proper treatment In case of irreversible Pulpitis necrotic Pulp, periapical pathosis - root canal treatment the only one treatment choice is

Differential diagnosis I. Localisation Tender to percussion HYPERAEMY + - PP.AC.PART. PP.AC.TOT. Rare PP.CHRON. (+++) GANGRAENA +- PERIOD.AC. +++ PERIOD.CHR. PERIOSTITIS

Differential diagnosis II. Stimulus Rtg signs HYPERAEMY Cold, heat - PP.AC.PART. Cold PP.AC.TOT. PP.CHRON. (+) GANGRAENA Heat + PERIOD.AC. PERIOD.CHR. PERIOSTITIS ++ Textbook of endodontology: 9-17. pages

Differential diagnosis III. Type of pain HYPERAEMY Only by stimulus PP.AC.PART. Spontanous PP.AC.TOT. Sharp,throbbing, at night PP.CHRON. Not typical GANGRAENA Not typical or by stimulus PERIOD.AC. By bite PERIOD.CHR. - PERIOSTITIS Spontanous or -

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Table 4-1

Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A Donald E. Arens, Alan H. Gluskin, Christine I. Peters, Ove A. Peters: Practical Lessons in Endodontic Treatment. Quintesence Publishing 2009. ISBN 978-086715-483-2 Table 1-1