Endodontic diagnosis

 

1- Diagnosis (clinical handouts) l Endodontics series 



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Diagnosis and diagnostic tool 

a)patient factors

1-medical history

  • it is the first step and very important to be taken in a written form and patient confirm it in a questionnaire
  1. for example uncontrolled diabetic patient more prone to infection and his immunity less able to compete the infection and less prognosis
  2. patient with hypertension may have problems with anesthesia
  3. patient with thyroid should take plane anesthesia and so on

 

2-dental history

  • give an image about patient attitude and his interest in treatment

 

3-symptoms recording

  1. in his own words in order to reach final accurate diagnosis
  2. is that interfere with your sleep?
  3. is that throbbing pain? Abscess
  4. is this tooth is tall?
  5. and the most important point to be concern is that tooth is vital or not as it determine variable methods of treatment

  • In case of only pulpitis (tooth is still vital) it is preferred in irrigation to increase percent of sodium hypochlorite to remove organic tissue

4- Extra oral assessment

  • is there is swelling sinus pus related to what ??
  • Before starting our work  it is more important point to put in consideration

Testes to performed

1-percussion

  • with the end of the mirror painful or not (apical periodontitis)

2-palpation

  • tender or not

 

3-mobility

  • mobile or not what the grade

4-bite test

  • crack existence test (with tooth sloth or tongue deprosser)
  • pain or biting or not

 

5-Radiograph

  • it is very important in diagnosis to take preoperative x-ray

 

6-Cone Beam CT

  • 3D image to reach the hard to reach area
  • is that should be performed for each tooth subjected to endodontic treatment
  • AAE  our reference said that without an obvious cause don not perform CT it should be a valid  reason
  • CT not recommended for vital tooth unless there is doubt of missed canal or untreated symptoms  or vertical fracture
  • It should be performed before endodontic retreatment

 

7-vitality test

  • should be performed (it is mandatory)
  • is the tooth exposed diseased or not
  • is that is feasible? yes
  • Electric pulp vitality test
  • thermal pulp test (with  separating medium  hot gutta-percha)
  • thermal test cold  (endo froset – cold spray) (ethyl chloride) (dry ice) (ice stick with isolation )
  • with respect to false positive and false negative results


Structure of clinical cases

  •  Chief Complaint
  •  Medical History
  •  Dental History
  •  Clinical Evaluation (Diagnostic Procedures)

  1.       Examinations (Extra-oral and Intra-oral)
  2.      Diagnostic Tests (Summarized in Table)
  3.      Radiographic Findings

  • Pretreatment Diagnosis

  1.     Pulpal
  2.     Apical

  • Treatment Plan

  1.     Recommended
  2.     Alternative