ENDODONTIC DIAGNOSIS AND
TREATMENT PLANNING
BY: DR. FAMIA FOZAN
LEARNING OBJECTIVES
• At the end of this presentation, the audience will be able to :
• Understand the importance of thorough history , clinical examination and
investigations in leading the clinician towards accurate diagnosis
• Develop knowledge about different pulpal and periapical pathosis
• Able to identify adjuctive conditions that can coexist with pulpal and
periapical diagnosis
• Able to implement their gained knowledge during practise and formulate
an effective treatment plan
INTRODUCTION
ACCURATE DIAGNOSIS
True Emergency or an Urgency
TREATMENT PLAN
THE 1ST STEP IN DIAGNOSIS MAKING : THE
SUBJECTIVE EXAMINATION
• Chief Complaint : The primary reason(s) for which patient is seeking dental
care.
Dental history: the history of present illness
past dental history
• Medical history: Active and/or communicable disease
Drugs , radiotherapy
Allergies
OBJECTIVE EXAMINATION
• Extra oral examination and Vital signs:
BP ,RR ,pulse ,facial swelling, discoloration
,lymphadenopathy,erythema, sinus tract etc
• Intra oral examination :
Soft and hard tissue examination : inspection, palpation, percussion
• Clinical tests :
Periodontal inflammation tests: inspection, palpation, percussion, bite test
CONTD…
• Pulp Sensitivity Tests
1. Cold test : Ice sticks, dry ice , ethyl chloride spray
2. Heat Test: Heated gp, frictional heat from rubber Prophy cup
3. Electric Pulp Testing
• Selective Anesthesia : Used to narrow the
focus of pain when patient can’t identify offending tooth
• Caries Removal : Used to assess the depth of cavity
• Radiographic Examination
TYPES OF PULPAL PATHOSIS AND DIAGNOSIS
• Reversible Pulpitis
• Irreversible Pulpitis
Symptomatic
Asymptomatic
• Hyperplastic Pulpitis
• Pulp Calcification
• Pulp Necrosis
TYPES OF PERIAPICAL PATHOSIS AND
DIAGNOSIS
• Symptomatic Apical Periodontitis
• Asymptomatic Apical Periodontitis
• Acute Apical Abscess
• Chronic Apical Abscess
• Condensing Osteitis
ADJUNCTS TO ENDODONTIC DIAGNOSIS
• Longitudinal fractures
• Trauma
• Resorption
• Endodontic – periodontic pathosis
LONGITUDINAL FRACTURES
• Further diagnostic aids for longitudinal fractures:
1. Transillumination: craze lines vs cracked tooth
2. Wedging forces and bite test : cracked tooth vs split tooth
3. Restoration removal
4. Staining with methylene blue
5. Surgical assessment : in case of VRF
BITE
TEST
TRANSILLUMINATION
STAINING
SURGICAL
EXPOSURE
CLASSIFICATION OF LONGITUDINAL
FRACTURES
• Craze lines:
CRAZE
LINES
Common in posterior teeth
FRACTURED
CUSP
• Fractured cusp : usually in teeth with
Extensive caries or restoration
CRACKED
TOOTH
• Cracked Tooth: an incomplete fracture
More centered than fractured cusp
• Split tooth: a complete fracture
usually an extension and end result of cracked tooth
SPLIT
TOOTH
• Vertical root fracture: Initiate and confined to root
tooth usually has history of rct and post
deep narrow periodontal defect
and J-shaped radiolucency
TYPES OF RESORPTION
• Internal root resorption: perforating
nonperforating
• External Root Resorption:
Apical EIRR
Lateral EIRR
Pressure Resorption
• Invasive Cervical Root Resorption
BALLOON
SHAPED
RADIOLUCENCY
ENDODONTIC – PERIODONTIC LESIONS
• Connection between pulp tissue and periodontium:
Apical foramen , lateral canals, dentinal tubules
CLASSIFICATION
• Primary periodontal defects of Endodontic Origin: a coronally extended periapical lesion
• Primary Periodontal defects: Of periodontal origin
• Primary periodontal defects of Endodontic – Periodontic origin:
True Combined Lesions
TREATMENT PLANNING: PHASING
TREATMENT
• Emergency Treatment: patient presenting with pain and/or swelling, trauma r
• Definitive Treatment : Involve the referral to specialised dental professionals
Endodontist, Periodontist, Orthodontist, Oral surgeon, Prosthodontist, or
Paediatric dentist
The Comprehensive treatment plan: Treatment options along with their
expected outcomes , merits and demerits
Followups , further precautions and care and adjunctive procedures
SUMMARY ?
MCQS
During a review of the patient’s medical history, it is noted that the
patient is on intravenous bisphosphonates. What significance does it
hold for patient and treatment plan?
a) Possible side effect of bleeding disorder
b) Possible side effect of osteonecrosis of jaw
c) Inability to obtain adequate anesthesia
d) Lowered pain threshold
How does electrical pulp testing determine the degree of pulpal
inflammation?
a) A shorter response indicates healthier pulp
b) A midrange response indicates pulp inflammation
c) A midrange response indicates partial necrosis
d) It can only be used to determine the presence or absence of vital tissue
Which is one of the 4 characteristics of a periapical lesion of endodontic
origin?
a) The lamina dura of tooth socket is intact
b) The radiolucency remains at the apex in radiographs at different cone angles
c) The radiolucency tends to resemble a round circle
d) It is usually associated with an irreversible pulpitis
In which situation is caries removal necessary to obtain a definitive
pulpal diagnosis?
a) Deep caries with no symptoms and negative pulp testing
b) Deep caries with no symptoms and positive pulp testing
c) Shallow caries with mild symptoms and positive pulp testing
d) Shallow caries with mild symptoms and negative pulp testing
Which of the following conditions is most likely to be interpreted as tooth
ache by a patient?
a) TMJ dysfunction
b) Inflammation of parotid gland
c) Acute angina pectoris
d) Maxillary sinusitis