1. Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics

4. The Role of Endodontic Vitality Testing in a Differential Diagnosis

7. Endodontic Differential Diagnosis Medical / Dental Extraoral Examination Intraoral Examination Tactile Exam Definitive Diagnosis Vitality Tests Radiographs

8. Extraoral Visual Examinations Facial Asymmetry ? Yes / No Aggressive Swelling ? Yes / No Facial Injuries ? Yes / No Purulent Drainage ? Yes / No

9. Intraoral Visual Examination Palpation Radiographs ProbingsPercussionMobility

11. Palpation / Digital Examination Palpation Examination Light Digital Pressure Soft Tissues Location Indurated, Swollen Fluctuant Pain Intensity No Pain, Tender, Acute Pain

15. Intraoral Visual Examination

19. Oops

21. Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics

22. Vitality Assessment & Tools Thermal Cold Heat Vital Test Cavity Electric Pulp Tester Selective Anesthesia Tooth Slooth™ Fiber Optic Light Tentative Diagnosis

23. Establish A Point of Reference Challenge Adjacent/ Contralateral Tooth Challenge Opposing Tooth or Arch Challenge Tooth in Question Challenge Quadrant

24. Vitality Assessment & Tools Thermal Cold Heat Vital Test Cavity Electric Pulp Tester Selective Anesthesia Tooth Slooth™ Fiber Optic Light Radiographs

25. Tooth Responses Hypo Responsive W.N.L. Hyper Responsive Responses From Tooth (-) (-) / (+) (+ +), (+ + +) MomentaryLingersSpontaneous

26. Endodontic Differential Diagnosis Medical / Dental Extraoral Examination Intraoral Examination Tactile Exam Definitive Diagnosis Vitality Tests Radiographs

27. Dental History - The Science Recognize Understanding Interpreting

28. Dental History - The Art Asking the RIGHT questions ACTIVE listening

29. Dental Emergencies Tooth Trauma Toothache Toothache Non-Pulpal Involvement Tooth Knocked Out Loose Tooth Fractured Tooth Chipped Tooth Concussion

30. Diagnosing Oro-facial Pain Dental Non-Dental

31. Interpreting the Language of Pain Subjective Coloring Acute Acute Chronic Low Grade Pain Hx of Pain IntenseSharp Spon- taneous Deep, Gnawing

32. Understanding the Language of PainSignsSymptoms DentalNon-DentalDentalNon-Dental +

33. Inflammation Cellular Neurologic Vascular Humoral

34. Language of Pulp Pain Dental Pulp Pulpal Inflammation AsymptomaticSymptomatic AcuteChronic

35. Physiology of Pulpal Pain A-Delta Fibers Pain Human Dental Pulp Afferent Impulses C-Fibers

36. Physiology of Pulpal Pain A-delta Fibers: –Located in Pulp-Dentin Interface –Myelinated –Large Diameter

37. A-delta Fibers – Cold / Heat Thermoreceptor for Pain Quick Sharp Short

38. Physiology of Pulpal Pain C- Fibers: ·Located Centrally in the Pulp ·Unmyelinated ·Small Diameter

39. C-Fibers - Heat Thermoreceptor for Pain Steady Dull / Gnawing Prolonged / Spontaneous

40. Acute Pulpal Origin Acute Pulpal Pain Temporary Pain Short Duration Cold AbscessSpontaneous Constant Pres- sure Swell- ing Fever Heat Increa -sing Cold Hot Throb -bing Cold Relief DiffuseLocalized

41. Chronic Pulpal Origin Chronic Pulpal Pain DullIntermittentRecurrent Deep Acute Tolerable Acute Acute Acute

42. Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics

54. Mobility - Depressibility Examination Integrity of the Attachment Apparatus

55. Tooth Mobility Evaluation Mobility Examination Light Lateral Pressures Adjacent Teeth Suspect Teeth Class I Class II Class III

59. Periodontal Ligament Reaction

60. Trauma Vital Pulp Necrotic Pulp P.D.L. Reaction HealthySick Egressing Out Perio Disease Egressing Out

66. Thermal Responses

67. Cold Stimulus Challenge ColdTest Tooth Ethyl Chloride RefrigerantsIce Hyper Response CarbonIce W.N.L. Hypo Response Relief

71. Cold Test

73. Heat Challenge

76. Heat Stimulus Challenge HeatTest Tooth Warm Gutta Percha Hot Tap Water Hyper Response Rubber Disc Friction W.N.L. No Response Delayed Response

77. Early Pulpal Injury Thermal Challenge Normal Pulp Inflamed Pulp Aged Pulp Late

78. Neural Responses

79. Electric Response Assessment Electric Pulp Tester Adjacent Tooth Suspect Tooth Contralateral Tooth Hyper Response W.N.L. Hypo Response No Response

84. Neuron Activity Neural Responses Vital Pulp Necrotic Pulp Total Necrosis Partial Necrosis Aged Tissues Trauma to Pulp Young Tissues

86. Sensory Pathways

88. Identifies Source of Tooth Pain Sensory Pathways Identifies Referred Pain From Tooth Identifies Non - Tooth Pain

89. Anesthetic Diagnosis Selective Anesthesia Ligamental Injections Local Anesthesia Relieves Suspect Tooth RegionalBlocks Reveals Referral Pain Reveals Trigger Sites Reveals Referral Pain

92. Test Cavity Challenge

93. Test Cavity No Anesthetic Prepare Shallow Access Penetrate Into Dentin / Chamber No Response Slight Response Acute Response Pulpal Necrosis Degenerating Pulp Vital Pulp

94. 100% Healthy Extent of Pulp Vitality Test Cavity Vital Pulp Endodontic Access Necrotic Degenerating

99. Fractured Tooth Assessment Tooth Slooth™ Bite & Release Sharp Pain Engage Cusp Tip Shallow Fx Cuspal Fx Vertical Fx Horizontal Fx No Pain

100. Occlusal Provocation

101. VitalTooth Damage to Crown NecroticTooth Damage to Root Damage to Socket

102. Crack Detection

104. Tooth Slooth™

108. Checking for crack/fracture

109. Crack MB cusp

110. Deep isolated pocket

113. Transillumination

115. Fiber Optic Light Exam Thru Cervical Line Light Conductance Through & Through Abrupt Stoppage Surface Crazing Thru Line Angles Thru Cusps Tips

116. Superficial Cracks Transillumination Hard Tissue Integrity Deep Fractures Moderate Crazing

117. Acute Crack

118. Misdiagnosis

120. The Endodontic- Restorative Continuum

121. Decision Making

122. Host Resistance Endo - Perio Patient Dental I.Q. Operator Limitations How Critical is Tooth? Cost Effectiveness Treatment Alternatives Sequence of Treatment Use of Specialist History Etiology Endo and / or Perio

123. Determination of Prognosis Periodontal Prognosis Endodontic Prognosis Restorative Prognosis

124. Periodontal Prognosis Bone loss Pocketing Health of Periodontium

125. Periodontal Concerns General periodontal status Isolated periodontal defect

126. Endodontic Prognosis Vitality Periapical area Canals negotiable? Posts present?

127. Endodontic Diagnosis Vital Tooth Reversible Irreversible

128. Electric Pulp Tester

130. Cold Test

133. Tooth Restorability Caries Chip in enamel Chip into dentin Cusp fracture Tooth fracture Root amputation

134. Restorative Prognosis determined by… Structural Integrity

140. Treatment Alternatives Restore as is... Restore as is... and extract Extract –No further treatment –Fixed partial denture –Removable partial denture –Implant and hope

141. Financial Considerations At UOP In Private Practice

142. Ferrule Effect What is it? Facial/Lingual vs Mesial/Distal Anterior Tooth Posterior Tooth How wide / thick?

143. How to achieve the ferrule Prep into sulcus Crown lengthening Extrusion

144. Ferrule 1.5 -2 mm long1.5 -2 mm long Parallel wallsParallel walls Totally encircle toothTotally encircle tooth End on sound tooth surfaceEnd on sound tooth surface Not invade attachment apparatusNot invade attachment apparatus

145. Core Replaces missing tooth structureReplaces missing tooth structure Supports rehabilitationSupports rehabilitation

146. Core Materials Cast metalCast metal AmalgamAmalgam Composite resinComposite resin Glass Ionomer / Glass Ionomer Silver materialsGlass Ionomer / Glass Ionomer Silver materials

147. Fractured Cusp into Furcation

148. Crown/restorative disassembly

149. Tooth isolated for endodontics

150. Resin syringe

151. Build-up matrixed

152. Crown lengthening

153. Post-op crown lengthening