Endo Diagnosis

8/7/2019 Endo Diagnosis

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SO FAR WE HAVE EMPHASIZEDHOW TO PERFORM A ROOT CANAL

How to ACCESS

How to CLEAN AND SHAPE

How to OBTURATE


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BUT HOW ABOUT WHY?

Why do we ACCESS?

Why do we CLEAN AND SHAPE?

Why do we OBTURATE?


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WE TOLD YOU THAT THE

REASON WHY WE PERFORM AROOT CANAL

TO PREVENT APICALPERIODONTITIS


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BUT WHAT DOES THIS MEAN?In other words,

we want to prevent inflammation (infection) of thetissues surrounding the apex of a tooth.

This infection may lead to destruction of theperiodontal tissues.

The infection may spread.


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THE MOUTH IS FILLED WITHPOTENTIAL PATHOGENS


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The pulp canalmay act as apath for

pathogens toenter thesurroundintissues andspreadthroughout thebody


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EXTRA-ORAL DRAINAGE THROUGHCHIN


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LUDWIGS ANGINA


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SO IN ROOT CANAL THERAPYWE WANT TO:

(1) CLEAN OUT THE TOOTH OFALL PULP TISSUE (A SOURCE OF

NUTRITION FOR BACTERIA)


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AND

(2) FILL THE CANAL SPACE SO

WITHIN THE TOOTH AND CANNOT MIGRATE INTO THE

PERIAPICAL TISSUES


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BUT BEFORE BEGINNING ANY

ENDODONTIC PROCEDURE,2 DIAGNOSES ARE REQUIRED:

1. PULPAL

2. APICAL (PERIAPICAL)

AND THE TOOTH MUST BERESTORABLE!!!


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PULPAL DIAGNOSES


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THE PULP WILL BE ALIVE(VITAL)

OR

THE PULP WILL BE DEAD

(NECROTIC)


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THINK OF THIS AS VITAL


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VITAL PULP CLASSIFICATIONS:

NORMAL PULPREVERSIBLE PULPITIS

IRREVERSIBLE PULPITISPULP NECROSIS

PREVIOUSLY INITIATED THERAPYPREVIOUSLY TREATED


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NORMAL PULP

A clinical diagnostic category in

which the pulp is symptom freeand normally response to vitality

testing


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NORMAL PULP

+HEAT +

EPT (Electrical pulp testing) +


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REVERSIBLE PULPITIS

A clinical diagnosis based upon

indicating that the inflammationshould resolve and the pulp return

to normal


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REVERSIBLE PULPITIS

Possible Signs and Symptoms

Cold ++ (Does not linger)Heat ++ (Does not linger)

+No spontaneous painInitiate appropriate restorative

treatment as long as the tooth isrestorable


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IRREVERSIBLE PULPITIS(Symptomatic or Asymptomatic)

subjective and objective findingsindicating that the vital inflamed

pulp is incapable of healing


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SYMPTOMATIC IRREVERSIBLE

PULPITIS

Lingering thermal pain,

spontaneous pain, referred pain


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SYMPTOMATIC IRREVERSIBLE

PULPITIS

Possible Signs and SymptomsCold +++ (Lingers)

Spontaneous Pain

EPT +May not allow patient to sleep

Initiate endodontic treatment as long

as the tooth is restorable


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VISUAL ANALOG SCALETO RATE PAIN

TO 10 BEING THE WORST PAINEVER


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BUT THERE MAY BE SOMETHINGABOVE LEVEL 10 PAIN


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BEYOND 10 PAIN


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BUT SERIOUSLY, IF YOU CANPREPARE A REVERSE CROWN,

YOU CAN PREP ANYTHING!!!

STRENGTHEN YOUR CLINICALSKILLS AND ENHANCE YOUR

PATIENT CARE


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ENDODONTICS RELIES UPON FIXED

PROSTHODONTICS ESPECIALLY FORPOSTERIOR TEETH


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ASYMPTOMATIC IRREVERSIBLEPULPITIS

No clinical symptoms but

inflammation produced by caries,caries excavation, trauma, etc.

Initiate endodontic treatment aslong as the tooth is restorable.


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PULP NECROSIS

A clinical diagnostic category indicating.

non-responsive to vitality testing.Initiate endodontic treatment as long

as the tooth is restorable.


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PREVIOUSLY INITIATED THERAPY

A clinical diagnostic category

previously treated by partialendodontic therapy (e.g.pulpotomy, pulpectomy)


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PREVIOUSLY INITIATED THERAPY


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PREVIOUSLY TREATED

A clinical diagnostic categoryindicating that the tooth has been

endodontically treated and thecanals are obturated with various

filling materials, other thanintracanal medicaments


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PREVIOUSLY TREATED


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APICAL (PERIAPICAL) DIAGNOSES

Normal apical tissues

Asymptomatic apical periodontitisAcute apical abscess

Chronic apical abscess


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NORMAL APICAL TISSUES

Teeth with normal periradicular tissuesthat will not be abnormally sensitive to

percussion or palpation testing. Thelamina dura surrounding the root isintact and the periodontal ligament

space is uniform


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SYMPTOMATIC APICALPERIODONTITIS

Inflammation, usually of the apicalperiodontium, producing clinical

symptoms including painful responseto biting and pain/tenderness to

percussion . It may or may not beassociated with an apical radiolucentarea


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ASYMPTOMATIC APICALPERIODONTITIS

Inflammation and destruction of apical,

appears as an apical radiolucent areaand does not produce clinical

symptoms. No abnormal tendernessto percussion.


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CHRONIC APICAL ABSCESS

An inflammatory reaction to pulpalinfection and necrosis

,little or no discomfort (to

percussion) and the intermittentdischarge of pus through an

associated sinus tract


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RADIOLUCENCIES ARE INDICATIVE OFBONE DESTRUCTION


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SINUS TRACT WITH PUS(Dipping sauce for the shrimp sushi)


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SINUS TRACT WITH GUTTA-PERCHA


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After the completion of this,

performed on a patient


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CONCLUSION

THANK YOU!!!


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LABORATORYSUGGESTIONS

March 2, 2009

Brett Nagatani

M i l/Di l R di h


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Mesial/Distal RadiographsAlternative Method With Plastic Box

LABORATORY AND WREB


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LABORATORY AND WREB

MESIAL/DISTAL RADIOGRAPH

BUCCAL/LINGUAL RADIOGRAPH

DO NOT SUBMIT THESE RADIOGRAPHSWITH THE REQUIRED RADIOGRAPHS!!!


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Where is the pulp chamber?Bur has passed chamber Bur not centered


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Where is the pulp chamber?Angle Bur Towards Long Axis Angle Bur Centrally


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GATES-GLIDDEN FORMULA

(GG)(20) + 30 = GG Size

(2GG)(20) + 30 = 70(3GG)(20) + 30 = 90

(4GG)(20) + 30 = 110

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Endo Diagnosis