ENDODONTIC DIAGNOSIS

February 19, 2009

Brett Nagatani
 SO FAR WE HAVE EMPHASIZED
HOW TO PERFORM A ROOT CANAL

How to ACCESS

How to CLEAN AND SHAPE

How to OBTURATE
 BUT HOW ABOUT WHY?

Why do we ACCESS?

Why do we CLEAN AND SHAPE?

Why do we OBTURATE?
 WE TOLD YOU THAT THE
REASON WHY WE PERFORM A
ROOT CANAL
IS:

TO PREVENT APICAL
PERIODONTITIS
 BUT WHAT DOES THIS MEAN?
In other words,

we want to prevent inflammation (infection) of the

tissues surrounding the apex of a tooth.

This infection may lead to destruction of the

periodontal tissues.

The infection may spread.

THE MOUTH IS FILLED WITH
POTENTIAL PATHOGENS
The pulp canal
may act as a
path for
pathogens to
enter the
surrounding
tissues and
spread
throughout the
body
EXTRA-ORAL DRAINAGE THROUGH
CHIN
LUDWIG’S ANGINA
 SO IN ROOT CANAL THERAPY
WE WANT TO:

(1) CLEAN OUT THE TOOTH OF

ALL PULP TISSUE (A SOURCE OF
NUTRITION FOR BACTERIA)
 AND

(2) FILL THE CANAL SPACE SO

THAT BACTERIA CAN NOT LIVE
WITHIN THE TOOTH AND CAN
NOT MIGRATE INTO THE
PERIAPICAL TISSUES
BUT BEFORE BEGINNING ANY
ENDODONTIC PROCEDURE,
2 DIAGNOSES ARE REQUIRED:

1. PULPAL

2. APICAL (PERIAPICAL)

AND THE TOOTH MUST BE

RESTORABLE!!!
PULPAL DIAGNOSES
THE PULP WILL BE ALIVE
(VITAL)

OR

THE PULP WILL BE DEAD

(NECROTIC)
THINK OF THIS AS VITAL
THINK OF THIS AS NECROTIC
 VITAL PULP CLASSIFICATIONS:

NORMAL PULP
REVERSIBLE PULPITIS
IRREVERSIBLE PULPITIS
PULP NECROSIS
PREVIOUSLY INITIATED THERAPY
PREVIOUSLY TREATED
 NORMAL PULP

A clinical diagnostic category in

which the pulp is symptom free
and normally response to vitality
testing
 NORMAL PULP

COLD +
HEAT +
EPT (Electrical pulp testing) +
 REVERSIBLE PULPITIS

A clinical diagnosis based upon

subjective and objective findings
indicating that the inflammation
should resolve and the pulp return
to normal
 REVERSIBLE PULPITIS

Possible Signs and Symptoms

Cold ++ (Does not linger)
Heat ++ (Does not linger)
EPT +
No spontaneous pain
Initiate appropriate restorative
treatment as long as the tooth is
restorable
 IRREVERSIBLE PULPITIS
(Symptomatic or Asymptomatic)

A clinical diagnosis based on

subjective and objective findings
indicating that the vital inflamed
pulp is incapable of healing
 SYMPTOMATIC IRREVERSIBLE
PULPITIS

Lingering thermal pain,

spontaneous pain, referred pain
 SYMPTOMATIC IRREVERSIBLE
PULPITIS

Possible Signs and Symptoms

Cold +++ (Lingers)
Heat +++ (Lingers)
Spontaneous Pain
EPT +
May not allow patient to sleep
Initiate endodontic treatment as long
as the tooth is restorable
 VISUAL ANALOG SCALE
TO RATE PAIN

“ZERO” BEING NO PAIN

TO “10” BEING THE WORST PAIN

EVER
BUT THERE MAY BE SOMETHING
ABOVE LEVEL 10 PAIN
BEYOND 10 PAIN
 BUT SERIOUSLY, IF YOU CAN
PREPARE A REVERSE ¾ CROWN,
YOU CAN PREP ANYTHING!!!

YOUR PRACTICE NOW WILL

STRENGTHEN YOUR CLINICAL
SKILLS AND ENHANCE YOUR
PATIENT CARE…
ENDODONTICS RELIES UPON FIXED
PROSTHODONTICS ESPECIALLY FOR
POSTERIOR TEETH
 ASYMPTOMATIC IRREVERSIBLE
PULPITIS

No clinical symptoms but

inflammation produced by caries,
caries excavation, trauma, etc.
Initiate endodontic treatment as
long as the tooth is restorable.
 PULP NECROSIS

A clinical diagnostic category indicating

death of the dental pulp. The pulp is
non-responsive to vitality testing.
Initiate endodontic treatment as long
as the tooth is restorable.
PREVIOUSLY INITIATED THERAPY

A clinical diagnostic category

indicating that the tooth has been
previously treated by partial
endodontic therapy (e.g.
pulpotomy, pulpectomy)
PREVIOUSLY INITIATED THERAPY
 PREVIOUSLY TREATED

A clinical diagnostic category

indicating that the tooth has been
endodontically treated and the
canals are obturated with various
filling materials, other than
intracanal medicaments
PREVIOUSLY TREATED
APICAL (PERIAPICAL)
DIAGNOSES
APICAL (PERIAPICAL) DIAGNOSES

Normal apical tissues

Symptomatic apical periodontitis
Asymptomatic apical periodontitis
Acute apical abscess
Chronic apical abscess
 NORMAL APICAL TISSUES

Teeth with normal periradicular tissues

that will not be abnormally sensitive to
percussion or palpation testing. The
lamina dura surrounding the root is
intact and the periodontal ligament
space is uniform
 SYMPTOMATIC APICAL
PERIODONTITIS

Inflammation, usually of the apical

periodontium, producing clinical
symptoms including painful response
to biting and pain/tenderness to
percussion. It may or may not be
associated with an apical radiolucent
area
 ASYMPTOMATIC APICAL
PERIODONTITIS

Inflammation and destruction of apical

periodontium that is of pulpal origin,
appears as an apical radiolucent area
and does not produce clinical
symptoms. No abnormal tenderness
to percussion.
 ACUTE APICAL ABSCESS

An inflammatory reaction to pulpal

infection and necrosis characterized by
rapid onset, spontaneous pain,
tenderness of the tooth to pressure,
pus formation and swelling of
associated tissues. Pain/tenderness
to percussion.
 CHRONIC APICAL ABSCESS

An inflammatory reaction to pulpal

infection and necrosis
characterized by gradual onset,
little or no discomfort (to
percussion) and the intermittent
discharge of pus through an
associated sinus tract
RADIOLUCENCIES ARE INDICATIVE OF
BONE DESTRUCTION
 SINUS TRACT WITH PUS
(Dipping sauce for the shrimp sushi)
SINUS TRACT WITH GUTTA-PERCHA
 After the completion of this
course, your next root canal will be
performed on a patient
CONCLUSION

THANK YOU!!!
LABORATORY
SUGGESTIONS

March 2, 2009

Brett Nagatani
 Mesial/Distal Radiographs
Alternative Method With Plastic Box
 LABORATORY AND WREB

MESIAL/DISTAL RADIOGRAPH
BUCCAL/LINGUAL RADIOGRAPH

FOR ACCESS ORIENTATION

DO NOT SUBMIT THESE RADIOGRAPHS

WITH THE REQUIRED RADIOGRAPHS!!!
 Where is the pulp chamber?
Bur has passed chamber Bur not centered
 Where is the pulp chamber?
Angle Bur Towards Long Axis Angle Bur Centrally
GATES-GLIDDEN FORMULA

(GG)(20) + 30 = GG Size

(2GG)(20) + 30 = 70
(3GG)(20) + 30 = 90
(4GG)(20) + 30 = 110