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

2. 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)

3. 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

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

5. Requirements of a successfull diagnostician
Knowledge
Interest
Intuition
Curiosity
Patience
Senses

6. 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

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

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

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

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

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

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

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

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

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

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

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

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

19. 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

20. 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 ISBN
Fig. 4-6

21. 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

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

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

24. 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

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

26. Application of Cold stimuli

27. Application of Warm stimuli

28. 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

29. 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!

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

31. 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)

32. cracked tooth examination
Inspection - magnification
Transillumination
Biting test

33. 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 ISBN
Fig. 4-1

34. 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 ISBN
Fig. 4-1

35. 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 ISBN
Fig. 4-1

36. 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 ISBN
Fig. 4-1

37. 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

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

39. 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: pages

40. 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 -

41. 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 ISBN
Table 4-1

42. 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 ISBN
Table 1-1