SlideShare uma empresa Scribd logo
1 de 48
Baixar para ler offline
Diagnosis &
Treatment Planning in
    Endodontics
    Dr Saidah Tootla
Introduction
 Endodontics  is the specialty of dentistry
 that manages the prevention,
 diagnosis, and treatment of the dental
 pulp and the periradicular tissues that
 surround the root of the tooth
Causes of Pulpitis

    Physical irritation
    – Most generally brought on by extensive decay.

    Trauma
    – Blow to a tooth or the jaw

    Anachoresis
    - retrograde infections
Signs and Symptoms
 Pain when biting down
 Pain when chewing

 Sensitivity with hot or cold beverages

 Facial swelling

 Discolouration of the tooth
Endodontic Diagnosis
   Subjective examination
     – Chief complaint
     – Character and duration of pain
     – Painful stimuli
     – Sensitivity to biting and pressure
     – Discolouration of tooth
Important questions?
 What do you think the problem is?
 Does it hurt to hot or cold?
 Does it hurt when you’re chewing?
 When does it start hurting?
 How bad is the pain?
 What type of pain is it?
 How long does the pain last?
 Does anything relieve it?
 How long has it been hurting?
   Objective examination
    – Extent of decay
    – Periodontal conditions surrounding the tooth
      in question
    – Presence of an extensive restoration
    – Tooth mobility
    – Swelling or discoloration
    – Pulp exposure
Challenges in diagnosis of pulpitis
 Referred pain & the lack of
  proprioceptors in the pulp          localizing
  the problem to the correct tooth can often
  be a considerable diagnostic challenge
 Also of significance is the difficulty in
  relating the clinical status of a tooth to
  histopathology of the pulp in concern
 Unfortunately, no reliable symptoms or
  tests consistently correlate the two.
Diagnostic Tests
   Percussion
   Palpation
   Thermal
   Electrical
   Radiographs
1. Percussion tests
 Used to determine whether the inflammatory
  process has extended into the periapical tissues
 Completed by the dentist tapping on the incisal
  or occlusal surface of the tooth in question with
  the end of the mouth mirror handle held parallel
  to the long axis of the tooth
2. Palpation tests

– Used to determine whether the inflammatory
  process has extended into the periapical
  tissues
– The dentist applies firm pressure to the
  mucosa above the apex of the root
3. Thermal sensitivity

            Necrotic pulp will not respond to cold
            or hot

1.   Cold test
       Ice, dry ice, or ethyl chloride used to
         determine the response of a tooth to cold
2.   Heat test
       Piece of gutta-percha or instrument
         handle heated and applied to the facial
         surface of the tooth
Evaluation of thermal test results
4 distinct responses:

   No response        non-vital pulp or false
    negative

   Mild response       normal

   Strong but brief       reversible

   Strong but lingering      irreversible
Diagnosis tx-planning
Causes of false
         positives/negative
   Calcified canals
   Immature apex – usually seen in
    young patients
   Trauma
   Premedication of the patient – pulp
    sedated
4. Electric pulp testing

Delivers a small electrical stimulus to the
               pulp

 Factors that may influence readings:
     Teeth with extensive restorations

     Teeth with more than one canal

     Dying pulp can produce a variety of responses

     Moisture on the tooth during testing

     Batteries in the tester may be weak
Placement of a pulp tester.
Diagnosis tx-planning
5. Radiographs
1.    Pre-operative radiograph
     – Invaluable diagnostic tool
     – Periapical radiolucency
     – Widening of PDL
     – Deep caries
     – Resorption
     – Pulp stones
     – Large restorations
     – Root fractures
Requirements of Endodontic Films
 Show  4-5 mm beyond the apex of the
  tooth and the surrounding bone or
  pathologic condition.
 Present an accurate image of the tooth
  without elongation or fore-shortening.
 Exhibit good contrast so all pertinent
  structures are readily identifiable.
Quality radiograph in endodontics.
Diagnostic Conclusions


• Normal pulp

• Pulpitis
Normal pulp

There are no subjective symptoms or objective
signs. The pulp responds normally to sensory
stimuli, and a healthy layer of dentine
surrounds the pulp
Pulpitis

The pulp tissues have become inflamed

Can be either:
Acute
– inflammation of the periapical area
– usually quite painful

Chronic
– Continuation of acute stage or
–   low grade infection
Acute Pulpitis
 mainly  occurs in children teeth and
  adolescent
 pain is more pronounced than in
  chronic
Symptoms and Signs of acute
             pulpitis
 The pain not localized in the affected tooth
  is constant and throbbing      worse by
  reclining or lying down
 The tooth becomes painful
  with hold or cold stimuli
 The pain may be sharp and stabbing
 Change of color is obvious in the affected
  tooth
 swelling of the gum or face in the
  area of the affected tooth
Diagnosis tx-planning
Forms of acute pulpitis
1. Form of purulent acute where the
 pulp is totally inflamed
2. Form of gangrenous acute where
 the pulp begins to die in a less
 painful manner that can lead into the
 formation of an abscess
Chronic Pulpitis
1.   Reversible
2.   Irreversible
Reversible pulpitis

– The pulp is irritated, and the patient is
  experiencing pain to thermal stimuli
– Sharp shooting pain
– Duration of the pain episode lasts for
  seconds
– The tooth pulp can be saved
– Usually this condition is caused by
  average caries
Irreversible pulpitis

–   The tooth will display symptoms of lingering pain
–   pain occurs spontaneously or lingers minutes
    after the stimulus is removed
–   patient may have difficulty locating the tooth
    from which the pain originates
–   As infection develops and extends through the
    apical foramen, the tooth becomes exquisitely
    sensitive to pressure and percussion
–   A periapical abscess elevates the tooth from its
    socket and feels “high” when the patient bites down
Periradicular abscess

An inflammatory reaction to pulpal infection
that can be chronic or have rapid onset with
pain, tenderness of the tooth to palpation and
percussion, pus formation, and swelling of the
tissues.
Diagnosis tx-planning
Periodontal abscess
 An inflammatory reaction frequently
  caused by bacteria entrapped in the
  periodontal sulcus for a long time. A
  patient will experience rapid onset, pain,
  tenderness to palpation and percussion,
  pus formation, and swelling.
 Destruction of the

 periodontium occurs
Diagnosis tx-planning
Periradicular cyst

 A cyst that develops at or near the root of a
necrotic pulp. These types of cysts develop
as an inflammatory response to pulpal
infection and necrosis of the pulp
Pulp fibrosis

The decrease of living cells within the pulp
causing fibrous tissue to take over the pulpal
canal
Necrotic tooth

– Also referred to as non-vital. Used to
  describe a pulp that does not respond to
  sensory stimulus
– Tooth is usually discoloured
Plan of Treatment
 Depends   widely on the diagnosis
Simple plan of treatment
Visit 1:
 Medical history
 History of the tooth
 Access cavity
 Place rubberdam
 Extirpation + irrigation with sodium hypochlorite
 Placed intra-canal medication (calcium hydroxide)
 Place cotton pellet
 Placed temporary restoration (IRM/Kalzinol)
Visit 2:
 Working length determination

 Debridement using the hybrid technique

 Irrigation

 Placed intra-canal medication (calcium
  hydroxide)
 Place cotton pellet

 Placed temporary restoration
  (IRM/Kalzinol)
Visit 3:
 Obturation with GP using lateral
  condensation

 Placed   temporary/permanent
             restoration (IRM/Kalzinol)
Referral
 To   appropriate discipline
Remember
    Access cavity shapes:
2.   Anterior – inverted triangle
3.   Premolars – round
4.   Molars – rhomboid
    Always use rubberdam
    Never to use Cavit as a temporary
     restoration
    Always place an intra-canal
     medication….calcium hydroxide???
    Always use RC Prep or Glyde when filing
Contraindications for RCT
   Caries extending beyond bone level
   Rubberdam cannot be placed
   Crown of tooth cannot be restored in restorative
    dentistry nor prosthodontics
   Patient is physically/mentally handicapped and
    therefore cannot follow OH instructions
   Putrid OH
   Unmotivated patient
   Severe root resorption
   Vertical root fractures
   Cost factor
Inter & cross-departmental
               diagnosis
 Mobile teeth
 Teeth associated with severe periodontal
  problems
 Confusion between TMJ dysfunctional
  symptoms and RCT pain
 Many decayed teeth
 Sclerosed canal due to trauma
 Uncertainty of prognosis related to
  abscess, severe caries, facial swelling,
  cellulites, and medical condition of patient
Referral to post-grad clinics
 Extensive   internal or external root
  resorption
 Severely curved, narrow, tortuous
  canals
 Full-mouth rehabilitation required
 Multiple exposures due to
  attrition/abrasion
 Problems with occlusion causing the
  need for RCT
Questions????

Mais conteúdo relacionado

Mais procurados

Pulpectomy Procedure Explained in brief
Pulpectomy Procedure Explained in briefPulpectomy Procedure Explained in brief
Pulpectomy Procedure Explained in briefIraqi Dental Academy
 
case history in paediatric dentistry
case history in paediatric dentistrycase history in paediatric dentistry
case history in paediatric dentistrySHIVANISINGH598
 
Post insertion complaints in complete dentures
Post insertion complaints in complete dentures Post insertion complaints in complete dentures
Post insertion complaints in complete dentures Vinay Kadavakolanu
 
Diagnosis in endodontics Sunil M Eraly Malabar Dental College and Research ...
Diagnosis in endodontics   Sunil M Eraly Malabar Dental College and Research ...Diagnosis in endodontics   Sunil M Eraly Malabar Dental College and Research ...
Diagnosis in endodontics Sunil M Eraly Malabar Dental College and Research ...sunileraly
 
Detection and diagnosis of dental caries
Detection and diagnosis of dental cariesDetection and diagnosis of dental caries
Detection and diagnosis of dental cariesGhaith Abdulhadi
 
Pulpotomy Procedure for Pediatrics in Detail
Pulpotomy Procedure for Pediatrics in DetailPulpotomy Procedure for Pediatrics in Detail
Pulpotomy Procedure for Pediatrics in DetailIraqi Dental Academy
 
Pulp vitality test new
Pulp vitality test newPulp vitality test new
Pulp vitality test newsuraj nair
 
PERIAPICAL DISEASES
PERIAPICAL DISEASESPERIAPICAL DISEASES
PERIAPICAL DISEASESAshok Kumar
 
Endodontics periodontal lesions
Endodontics periodontal lesionsEndodontics periodontal lesions
Endodontics periodontal lesionsArshe Gs
 
Stainless steel crowns
Stainless steel crownsStainless steel crowns
Stainless steel crownsmahesh kumar
 
Oral habits - pedodontics
Oral habits - pedodonticsOral habits - pedodontics
Oral habits - pedodonticsDr. Elvis David
 
Case history diagnosis and treatment planning in pediatric dentistry
Case history diagnosis and treatment planning in pediatric dentistryCase history diagnosis and treatment planning in pediatric dentistry
Case history diagnosis and treatment planning in pediatric dentistrySwati manohar
 

Mais procurados (20)

Pulpectomy Procedure Explained in brief
Pulpectomy Procedure Explained in briefPulpectomy Procedure Explained in brief
Pulpectomy Procedure Explained in brief
 
Pulpotomy
Pulpotomy Pulpotomy
Pulpotomy
 
case history in paediatric dentistry
case history in paediatric dentistrycase history in paediatric dentistry
case history in paediatric dentistry
 
Pulp diseases
Pulp diseasesPulp diseases
Pulp diseases
 
Non carious lesion
Non  carious lesionNon  carious lesion
Non carious lesion
 
07.non carious lesions
07.non carious lesions07.non carious lesions
07.non carious lesions
 
Internal bleaching
Internal bleachingInternal bleaching
Internal bleaching
 
Post insertion complaints in complete dentures
Post insertion complaints in complete dentures Post insertion complaints in complete dentures
Post insertion complaints in complete dentures
 
Diagnosis in endodontics Sunil M Eraly Malabar Dental College and Research ...
Diagnosis in endodontics   Sunil M Eraly Malabar Dental College and Research ...Diagnosis in endodontics   Sunil M Eraly Malabar Dental College and Research ...
Diagnosis in endodontics Sunil M Eraly Malabar Dental College and Research ...
 
Ferrule effect
Ferrule effectFerrule effect
Ferrule effect
 
Detection and diagnosis of dental caries
Detection and diagnosis of dental cariesDetection and diagnosis of dental caries
Detection and diagnosis of dental caries
 
Pulpotomy Procedure for Pediatrics in Detail
Pulpotomy Procedure for Pediatrics in DetailPulpotomy Procedure for Pediatrics in Detail
Pulpotomy Procedure for Pediatrics in Detail
 
Ferrule 3
Ferrule 3Ferrule 3
Ferrule 3
 
Pulp vitality test new
Pulp vitality test newPulp vitality test new
Pulp vitality test new
 
PERIAPICAL DISEASES
PERIAPICAL DISEASESPERIAPICAL DISEASES
PERIAPICAL DISEASES
 
Endodontics periodontal lesions
Endodontics periodontal lesionsEndodontics periodontal lesions
Endodontics periodontal lesions
 
Endo perio lesions
Endo perio lesionsEndo perio lesions
Endo perio lesions
 
Stainless steel crowns
Stainless steel crownsStainless steel crowns
Stainless steel crowns
 
Oral habits - pedodontics
Oral habits - pedodonticsOral habits - pedodontics
Oral habits - pedodontics
 
Case history diagnosis and treatment planning in pediatric dentistry
Case history diagnosis and treatment planning in pediatric dentistryCase history diagnosis and treatment planning in pediatric dentistry
Case history diagnosis and treatment planning in pediatric dentistry
 

Destaque

Diagnosis in Endodontics
Diagnosis in EndodonticsDiagnosis in Endodontics
Diagnosis in EndodonticsFatima A
 
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian...
Diagnosis & treatment planing  /certified fixed orthodontic courses by Indian...Diagnosis & treatment planing  /certified fixed orthodontic courses by Indian...
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian...Indian dental academy
 
Diagnosis in endodontics /certified fixed orthodontic courses by Indian dent...
Diagnosis in endodontics  /certified fixed orthodontic courses by Indian dent...Diagnosis in endodontics  /certified fixed orthodontic courses by Indian dent...
Diagnosis in endodontics /certified fixed orthodontic courses by Indian dent...Indian dental academy
 
Contacts and Contours By Dr.Ruchir Kapur
Contacts and Contours By Dr.Ruchir KapurContacts and Contours By Dr.Ruchir Kapur
Contacts and Contours By Dr.Ruchir KapurDr.Ruchir kapur
 
Radiography in endodontics
Radiography in endodonticsRadiography in endodontics
Radiography in endodonticsJuny handA
 
Access cavity preparation posteriors
Access cavity preparation posteriorsAccess cavity preparation posteriors
Access cavity preparation posteriorsDr Ramsundar Hazra
 
Root fractures and its management
Root fractures and its managementRoot fractures and its management
Root fractures and its managementVasundhara naik
 
radiology-paralleling-technique
radiology-paralleling-techniqueradiology-paralleling-technique
radiology-paralleling-techniqueParth Thakkar
 
Radiographs in endodontics
Radiographs in endodonticsRadiographs in endodontics
Radiographs in endodonticsIAU Dent
 
Buccal Object Rule
Buccal Object RuleBuccal Object Rule
Buccal Object RuleTashia Seeba
 
Endodontic Periodontal Relationship, ENDO PERIO LESION
Endodontic Periodontal Relationship, ENDO PERIO LESIONEndodontic Periodontal Relationship, ENDO PERIO LESION
Endodontic Periodontal Relationship, ENDO PERIO LESIONDeepa jinan
 
radio-graphic-techniques-bisecting-and-occlusal
 radio-graphic-techniques-bisecting-and-occlusal radio-graphic-techniques-bisecting-and-occlusal
radio-graphic-techniques-bisecting-and-occlusalParth Thakkar
 
radiographic-caries-diagnosis
radiographic-caries-diagnosisradiographic-caries-diagnosis
radiographic-caries-diagnosisParth Thakkar
 
Traumatic injuries of teeth
Traumatic injuries of teethTraumatic injuries of teeth
Traumatic injuries of teethChelsea Mareé
 

Destaque (20)

Diagnosis in Endodontics
Diagnosis in EndodonticsDiagnosis in Endodontics
Diagnosis in Endodontics
 
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian...
Diagnosis & treatment planing  /certified fixed orthodontic courses by Indian...Diagnosis & treatment planing  /certified fixed orthodontic courses by Indian...
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian...
 
SLOB Technique
SLOB TechniqueSLOB Technique
SLOB Technique
 
Diagnosis in endodontics /certified fixed orthodontic courses by Indian dent...
Diagnosis in endodontics  /certified fixed orthodontic courses by Indian dent...Diagnosis in endodontics  /certified fixed orthodontic courses by Indian dent...
Diagnosis in endodontics /certified fixed orthodontic courses by Indian dent...
 
Contacts and Contours By Dr.Ruchir Kapur
Contacts and Contours By Dr.Ruchir KapurContacts and Contours By Dr.Ruchir Kapur
Contacts and Contours By Dr.Ruchir Kapur
 
Radiography in endodontics
Radiography in endodonticsRadiography in endodontics
Radiography in endodontics
 
Access cavity preparation posteriors
Access cavity preparation posteriorsAccess cavity preparation posteriors
Access cavity preparation posteriors
 
Root resorption
Root resorptionRoot resorption
Root resorption
 
Traumatic Injuries
Traumatic InjuriesTraumatic Injuries
Traumatic Injuries
 
Root fractures and its management
Root fractures and its managementRoot fractures and its management
Root fractures and its management
 
radiology-paralleling-technique
radiology-paralleling-techniqueradiology-paralleling-technique
radiology-paralleling-technique
 
Radiographs in endodontics
Radiographs in endodonticsRadiographs in endodontics
Radiographs in endodontics
 
Buccal Object Rule
Buccal Object RuleBuccal Object Rule
Buccal Object Rule
 
Endodontic Periodontal Relationship, ENDO PERIO LESION
Endodontic Periodontal Relationship, ENDO PERIO LESIONEndodontic Periodontal Relationship, ENDO PERIO LESION
Endodontic Periodontal Relationship, ENDO PERIO LESION
 
radio-graphic-techniques-bisecting-and-occlusal
 radio-graphic-techniques-bisecting-and-occlusal radio-graphic-techniques-bisecting-and-occlusal
radio-graphic-techniques-bisecting-and-occlusal
 
Diseases of the pulp
Diseases of the pulpDiseases of the pulp
Diseases of the pulp
 
radiographic-caries-diagnosis
radiographic-caries-diagnosisradiographic-caries-diagnosis
radiographic-caries-diagnosis
 
Self study-pan-anatomy
Self study-pan-anatomySelf study-pan-anatomy
Self study-pan-anatomy
 
endodontics
endodonticsendodontics
endodontics
 
Traumatic injuries of teeth
Traumatic injuries of teethTraumatic injuries of teeth
Traumatic injuries of teeth
 

Semelhante a Diagnosis tx-planning

Differential Diagnosis in Endodontics
Differential Diagnosis in EndodonticsDifferential Diagnosis in Endodontics
Differential Diagnosis in EndodonticsDr. Sahana Umesh
 
Diagnostic procedures in endodontics
Diagnostic procedures in endodonticsDiagnostic procedures in endodontics
Diagnostic procedures in endodonticsgazi670
 
Diagnosis of pulpal pathology ( Abdullah karamat )
Diagnosis of pulpal  pathology ( Abdullah karamat )Diagnosis of pulpal  pathology ( Abdullah karamat )
Diagnosis of pulpal pathology ( Abdullah karamat )Abdullah Karamat
 
Diagnostic Terminology.pdf
Diagnostic Terminology.pdfDiagnostic Terminology.pdf
Diagnostic Terminology.pdfAltilbaniHadil
 
Lect.5 pulp treatment final
Lect.5 pulp treatment finalLect.5 pulp treatment final
Lect.5 pulp treatment finalAmeer Al-Ameedee
 
4.DISEASE OF HARD TISSUES OF TEETH.pptx
4.DISEASE OF HARD TISSUES OF TEETH.pptx4.DISEASE OF HARD TISSUES OF TEETH.pptx
4.DISEASE OF HARD TISSUES OF TEETH.pptxssuser19cdf21
 
Endodontics Emergency
Endodontics EmergencyEndodontics Emergency
Endodontics EmergencySomya Jain
 
pulp therapy of primary teeth
pulp therapy of primary teeth pulp therapy of primary teeth
pulp therapy of primary teeth FaizaTabassum6
 
Pulp therapy for primary and young teeth
Pulp therapy for primary and young teethPulp therapy for primary and young teeth
Pulp therapy for primary and young teethSaeed Bajafar
 
Clinical endodontic diagnosis 2009
Clinical endodontic diagnosis 2009Clinical endodontic diagnosis 2009
Clinical endodontic diagnosis 2009Lea Foster
 
2 tissue response exam, preprosthetic
2 tissue response exam, preprosthetic2 tissue response exam, preprosthetic
2 tissue response exam, preprostheticHoang Hieu
 
Diagnosis in operative dentistry
Diagnosis in operative dentistryDiagnosis in operative dentistry
Diagnosis in operative dentistryNekunam
 
Veterinary Dentistry for Technicians
Veterinary Dentistry for TechniciansVeterinary Dentistry for Technicians
Veterinary Dentistry for TechniciansKelly Vearil
 
DIAGNOSIS IN ENDODONTICS
DIAGNOSIS IN ENDODONTICSDIAGNOSIS IN ENDODONTICS
DIAGNOSIS IN ENDODONTICSconsendosbpdch
 
hypersensitivity of teeth and its management
hypersensitivity of teeth and its managementhypersensitivity of teeth and its management
hypersensitivity of teeth and its managementPrawin Kushwaha
 
Endodontic diagnosis and treatment planning lecture
Endodontic diagnosis and treatment planning lectureEndodontic diagnosis and treatment planning lecture
Endodontic diagnosis and treatment planning lectureIraqi Dental Academy
 
Introduction to Dentistry 4
Introduction to Dentistry 4Introduction to Dentistry 4
Introduction to Dentistry 4Lama K Banna
 
diagnosis and treatment planning
diagnosis and treatment planningdiagnosis and treatment planning
diagnosis and treatment planningshabeel pn
 

Semelhante a Diagnosis tx-planning (20)

Differential Diagnosis in Endodontics
Differential Diagnosis in EndodonticsDifferential Diagnosis in Endodontics
Differential Diagnosis in Endodontics
 
Diagnostic methods
Diagnostic methodsDiagnostic methods
Diagnostic methods
 
Diagnostic procedures in endodontics
Diagnostic procedures in endodonticsDiagnostic procedures in endodontics
Diagnostic procedures in endodontics
 
Diagnosis of pulpal pathology ( Abdullah karamat )
Diagnosis of pulpal  pathology ( Abdullah karamat )Diagnosis of pulpal  pathology ( Abdullah karamat )
Diagnosis of pulpal pathology ( Abdullah karamat )
 
Diagnostic Terminology.pdf
Diagnostic Terminology.pdfDiagnostic Terminology.pdf
Diagnostic Terminology.pdf
 
Lect.5 pulp treatment final
Lect.5 pulp treatment finalLect.5 pulp treatment final
Lect.5 pulp treatment final
 
4.DISEASE OF HARD TISSUES OF TEETH.pptx
4.DISEASE OF HARD TISSUES OF TEETH.pptx4.DISEASE OF HARD TISSUES OF TEETH.pptx
4.DISEASE OF HARD TISSUES OF TEETH.pptx
 
Endodontics Emergency
Endodontics EmergencyEndodontics Emergency
Endodontics Emergency
 
pulp therapy of primary teeth
pulp therapy of primary teeth pulp therapy of primary teeth
pulp therapy of primary teeth
 
Pulp therapy for primary and young teeth
Pulp therapy for primary and young teethPulp therapy for primary and young teeth
Pulp therapy for primary and young teeth
 
Clinical endodontic diagnosis 2009
Clinical endodontic diagnosis 2009Clinical endodontic diagnosis 2009
Clinical endodontic diagnosis 2009
 
2 tissue response exam, preprosthetic
2 tissue response exam, preprosthetic2 tissue response exam, preprosthetic
2 tissue response exam, preprosthetic
 
Diagnosis in operative dentistry
Diagnosis in operative dentistryDiagnosis in operative dentistry
Diagnosis in operative dentistry
 
Veterinary Dentistry for Technicians
Veterinary Dentistry for TechniciansVeterinary Dentistry for Technicians
Veterinary Dentistry for Technicians
 
DIAGNOSIS IN ENDODONTICS
DIAGNOSIS IN ENDODONTICSDIAGNOSIS IN ENDODONTICS
DIAGNOSIS IN ENDODONTICS
 
DIAGNOSIS IN ENDODONTICS
DIAGNOSIS IN ENDODONTICSDIAGNOSIS IN ENDODONTICS
DIAGNOSIS IN ENDODONTICS
 
hypersensitivity of teeth and its management
hypersensitivity of teeth and its managementhypersensitivity of teeth and its management
hypersensitivity of teeth and its management
 
Endodontic diagnosis and treatment planning lecture
Endodontic diagnosis and treatment planning lectureEndodontic diagnosis and treatment planning lecture
Endodontic diagnosis and treatment planning lecture
 
Introduction to Dentistry 4
Introduction to Dentistry 4Introduction to Dentistry 4
Introduction to Dentistry 4
 
diagnosis and treatment planning
diagnosis and treatment planningdiagnosis and treatment planning
diagnosis and treatment planning
 

Mais de Türk Endodonti Derneği

Endo note 17 problem solving in endodontics
Endo note 17   problem solving in endodonticsEndo note 17   problem solving in endodontics
Endo note 17 problem solving in endodonticsTürk Endodonti Derneği
 
Endo note 10 preparation of straight canal
Endo note 10  preparation of straight canalEndo note 10  preparation of straight canal
Endo note 10 preparation of straight canalTürk Endodonti Derneği
 
Endo note 11 peparation of curved root canal
Endo note 11   peparation of curved root canalEndo note 11   peparation of curved root canal
Endo note 11 peparation of curved root canalTürk Endodonti Derneği
 

Mais de Türk Endodonti Derneği (20)

Pedodontic endodontics-and4951
Pedodontic endodontics-and4951Pedodontic endodontics-and4951
Pedodontic endodontics-and4951
 
Rotary ii
Rotary iiRotary ii
Rotary ii
 
Local anaesthesia 07 03 22 compressed
Local anaesthesia 07 03 22 compressedLocal anaesthesia 07 03 22 compressed
Local anaesthesia 07 03 22 compressed
 
Endo note 16 restoration of root filled
Endo note 16  restoration of root filledEndo note 16  restoration of root filled
Endo note 16 restoration of root filled
 
Endo note 18 ledge formation
Endo note 18   ledge formationEndo note 18   ledge formation
Endo note 18 ledge formation
 
Ms 8 protaper
Ms 8  protaperMs 8  protaper
Ms 8 protaper
 
Endo note 17 problem solving in endodontics
Endo note 17   problem solving in endodonticsEndo note 17   problem solving in endodontics
Endo note 17 problem solving in endodontics
 
Endo note 15 surgical endodoic
Endo note 15   surgical endodoicEndo note 15   surgical endodoic
Endo note 15 surgical endodoic
 
Endo note 14 root resorption
Endo note 14   root resorptionEndo note 14   root resorption
Endo note 14 root resorption
 
Endo note 13 perioendolesion
Endo note 13   perioendolesionEndo note 13   perioendolesion
Endo note 13 perioendolesion
 
D 2 access cavity
D 2  access cavityD 2  access cavity
D 2 access cavity
 
Endo note 10 preparation of straight canal
Endo note 10  preparation of straight canalEndo note 10  preparation of straight canal
Endo note 10 preparation of straight canal
 
Endo note 11 peparation of curved root canal
Endo note 11   peparation of curved root canalEndo note 11   peparation of curved root canal
Endo note 11 peparation of curved root canal
 
Endo note 12 rotary technique
Endo note 12   rotary techniqueEndo note 12   rotary technique
Endo note 12 rotary technique
 
Endo note 5 examination
Endo note 5   examinationEndo note 5   examination
Endo note 5 examination
 
Endo note 4 instruments
Endo note 4   instrumentsEndo note 4   instruments
Endo note 4 instruments
 
Endo note 1 definition and history
Endo note 1    definition and historyEndo note 1    definition and history
Endo note 1 definition and history
 
Endo note 2 iintroduction
Endo note 2   iintroductionEndo note 2   iintroduction
Endo note 2 iintroduction
 
Microbiology aspect in endodontics
Microbiology aspect in endodonticsMicrobiology aspect in endodontics
Microbiology aspect in endodontics
 
Endodontics Chapter 54
Endodontics Chapter 54Endodontics Chapter 54
Endodontics Chapter 54
 

Último

How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17Celine George
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptxmary850239
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxSaurabhParmar42
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17Celine George
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesMohammad Hassany
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice documentXsasf Sfdfasd
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17Celine George
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfMohonDas
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfMohonDas
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?TechSoup
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...Nguyen Thanh Tu Collection
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfYu Kanazawa / Osaka University
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17Celine George
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxDr. Asif Anas
 

Último (20)

How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptx
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptx
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming Classes
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice document
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdf
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdf
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptx
 

Diagnosis tx-planning

  • 1. Diagnosis & Treatment Planning in Endodontics Dr Saidah Tootla
  • 2. Introduction  Endodontics is the specialty of dentistry that manages the prevention, diagnosis, and treatment of the dental pulp and the periradicular tissues that surround the root of the tooth
  • 3. Causes of Pulpitis  Physical irritation – Most generally brought on by extensive decay.  Trauma – Blow to a tooth or the jaw  Anachoresis - retrograde infections
  • 4. Signs and Symptoms  Pain when biting down  Pain when chewing  Sensitivity with hot or cold beverages  Facial swelling  Discolouration of the tooth
  • 5. Endodontic Diagnosis  Subjective examination – Chief complaint – Character and duration of pain – Painful stimuli – Sensitivity to biting and pressure – Discolouration of tooth
  • 6. Important questions?  What do you think the problem is?  Does it hurt to hot or cold?  Does it hurt when you’re chewing?  When does it start hurting?  How bad is the pain?  What type of pain is it?  How long does the pain last?  Does anything relieve it?  How long has it been hurting?
  • 7. Objective examination – Extent of decay – Periodontal conditions surrounding the tooth in question – Presence of an extensive restoration – Tooth mobility – Swelling or discoloration – Pulp exposure
  • 8. Challenges in diagnosis of pulpitis  Referred pain & the lack of proprioceptors in the pulp localizing the problem to the correct tooth can often be a considerable diagnostic challenge  Also of significance is the difficulty in relating the clinical status of a tooth to histopathology of the pulp in concern  Unfortunately, no reliable symptoms or tests consistently correlate the two.
  • 9. Diagnostic Tests  Percussion  Palpation  Thermal  Electrical  Radiographs
  • 10. 1. Percussion tests  Used to determine whether the inflammatory process has extended into the periapical tissues  Completed by the dentist tapping on the incisal or occlusal surface of the tooth in question with the end of the mouth mirror handle held parallel to the long axis of the tooth
  • 11. 2. Palpation tests – Used to determine whether the inflammatory process has extended into the periapical tissues – The dentist applies firm pressure to the mucosa above the apex of the root
  • 12. 3. Thermal sensitivity Necrotic pulp will not respond to cold or hot 1. Cold test  Ice, dry ice, or ethyl chloride used to determine the response of a tooth to cold 2. Heat test  Piece of gutta-percha or instrument handle heated and applied to the facial surface of the tooth
  • 13. Evaluation of thermal test results 4 distinct responses:  No response non-vital pulp or false negative  Mild response normal  Strong but brief reversible  Strong but lingering irreversible
  • 15. Causes of false positives/negative  Calcified canals  Immature apex – usually seen in young patients  Trauma  Premedication of the patient – pulp sedated
  • 16. 4. Electric pulp testing Delivers a small electrical stimulus to the pulp Factors that may influence readings: Teeth with extensive restorations Teeth with more than one canal Dying pulp can produce a variety of responses Moisture on the tooth during testing Batteries in the tester may be weak
  • 17. Placement of a pulp tester.
  • 19. 5. Radiographs 1. Pre-operative radiograph – Invaluable diagnostic tool – Periapical radiolucency – Widening of PDL – Deep caries – Resorption – Pulp stones – Large restorations – Root fractures
  • 20. Requirements of Endodontic Films  Show 4-5 mm beyond the apex of the tooth and the surrounding bone or pathologic condition.  Present an accurate image of the tooth without elongation or fore-shortening.  Exhibit good contrast so all pertinent structures are readily identifiable.
  • 21. Quality radiograph in endodontics.
  • 23. Normal pulp There are no subjective symptoms or objective signs. The pulp responds normally to sensory stimuli, and a healthy layer of dentine surrounds the pulp
  • 24. Pulpitis The pulp tissues have become inflamed Can be either: Acute – inflammation of the periapical area – usually quite painful Chronic – Continuation of acute stage or – low grade infection
  • 25. Acute Pulpitis  mainly occurs in children teeth and adolescent  pain is more pronounced than in chronic
  • 26. Symptoms and Signs of acute pulpitis  The pain not localized in the affected tooth is constant and throbbing worse by reclining or lying down  The tooth becomes painful with hold or cold stimuli  The pain may be sharp and stabbing  Change of color is obvious in the affected tooth  swelling of the gum or face in the area of the affected tooth
  • 28. Forms of acute pulpitis 1. Form of purulent acute where the pulp is totally inflamed 2. Form of gangrenous acute where the pulp begins to die in a less painful manner that can lead into the formation of an abscess
  • 29. Chronic Pulpitis 1. Reversible 2. Irreversible
  • 30. Reversible pulpitis – The pulp is irritated, and the patient is experiencing pain to thermal stimuli – Sharp shooting pain – Duration of the pain episode lasts for seconds – The tooth pulp can be saved – Usually this condition is caused by average caries
  • 31. Irreversible pulpitis – The tooth will display symptoms of lingering pain – pain occurs spontaneously or lingers minutes after the stimulus is removed – patient may have difficulty locating the tooth from which the pain originates – As infection develops and extends through the apical foramen, the tooth becomes exquisitely sensitive to pressure and percussion – A periapical abscess elevates the tooth from its socket and feels “high” when the patient bites down
  • 32. Periradicular abscess An inflammatory reaction to pulpal infection that can be chronic or have rapid onset with pain, tenderness of the tooth to palpation and percussion, pus formation, and swelling of the tissues.
  • 34. Periodontal abscess  An inflammatory reaction frequently caused by bacteria entrapped in the periodontal sulcus for a long time. A patient will experience rapid onset, pain, tenderness to palpation and percussion, pus formation, and swelling.  Destruction of the periodontium occurs
  • 36. Periradicular cyst A cyst that develops at or near the root of a necrotic pulp. These types of cysts develop as an inflammatory response to pulpal infection and necrosis of the pulp
  • 37. Pulp fibrosis The decrease of living cells within the pulp causing fibrous tissue to take over the pulpal canal
  • 38. Necrotic tooth – Also referred to as non-vital. Used to describe a pulp that does not respond to sensory stimulus – Tooth is usually discoloured
  • 39. Plan of Treatment  Depends widely on the diagnosis
  • 40. Simple plan of treatment Visit 1:  Medical history  History of the tooth  Access cavity  Place rubberdam  Extirpation + irrigation with sodium hypochlorite  Placed intra-canal medication (calcium hydroxide)  Place cotton pellet  Placed temporary restoration (IRM/Kalzinol)
  • 41. Visit 2:  Working length determination  Debridement using the hybrid technique  Irrigation  Placed intra-canal medication (calcium hydroxide)  Place cotton pellet  Placed temporary restoration (IRM/Kalzinol)
  • 42. Visit 3:  Obturation with GP using lateral condensation  Placed temporary/permanent restoration (IRM/Kalzinol)
  • 43. Referral  To appropriate discipline
  • 44. Remember  Access cavity shapes: 2. Anterior – inverted triangle 3. Premolars – round 4. Molars – rhomboid  Always use rubberdam  Never to use Cavit as a temporary restoration  Always place an intra-canal medication….calcium hydroxide???  Always use RC Prep or Glyde when filing
  • 45. Contraindications for RCT  Caries extending beyond bone level  Rubberdam cannot be placed  Crown of tooth cannot be restored in restorative dentistry nor prosthodontics  Patient is physically/mentally handicapped and therefore cannot follow OH instructions  Putrid OH  Unmotivated patient  Severe root resorption  Vertical root fractures  Cost factor
  • 46. Inter & cross-departmental diagnosis  Mobile teeth  Teeth associated with severe periodontal problems  Confusion between TMJ dysfunctional symptoms and RCT pain  Many decayed teeth  Sclerosed canal due to trauma  Uncertainty of prognosis related to abscess, severe caries, facial swelling, cellulites, and medical condition of patient
  • 47. Referral to post-grad clinics  Extensive internal or external root resorption  Severely curved, narrow, tortuous canals  Full-mouth rehabilitation required  Multiple exposures due to attrition/abrasion  Problems with occlusion causing the need for RCT