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Endodontic Endodontic diagnosis and diagnosis and
treatment planningtreatment planning
Endodontic Endodontic diagnosis and diagnosis and
treatment planningtreatment planningMohammad HammadMohammad HammadUniversity of JordanUniversity of Jordan
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• Endodontic diagnosis often presents challenges to the practitioner.
• Most oro-facial pain is of pulpal or periradicular origin.
• Specific diagnostic steps have to be followed in order to reach to a definitive diagnosis and formulate a treatment plan.
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Ascertain the chief complaint
• To be properly documented using patients own words.
• Practitioner has to listen carefully, it is usually the first clue to solve the diagnosis riddle!
• Many different dental pathosis might be identified. Treat first the one that is causing the chief complaint.
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Detailed medical and dental history
• A must for every patient seeking treatment.
• A medical condition can alter the manner the dental care is provided or might have oral manifestations or mimic dental pathosis.
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• The chronology of events leading up to the chief complaint.
• Five areas to be investigated; location of pain, commencement of pain, intensity of pain, provocation and relief of pain, duration of pain.
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Examinations and testing
• Extraoral examination; facial swellings, sinus tracts, lymph nodes enlargement, …etc.
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• Intraoral examination, swellings, sinus tracts…etc.
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• Palpation test.
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• Percussion test.
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• Mobility test.
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• Periodontal examination for diagnosis and prognosis.
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Pulp testing
• Vitality or sensibility testing?• Thermal testing; cold and hot.
Suspected tooth and control tooth. • Hot water, heated gutta percha or
compound, ice sticks, chilled water, EndoIce and EndoFrost.
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• Electric pulp test.
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Special tests • Bite test.
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• Test Cavity.• Selective anesthesia. • Radiographs
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Clinical classification of pulpal and periapical
disease
• Pulpal:1) Healthy pulp.2) Reversible pulpitis.3) Irreversible pulpitis; symptomatic
and asymptomatic.4) Necrotic pulp.
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Clinical classification of pulpal and periapical
disease
• Periapical:1) Periapical periodontitis; Acute or
chronic.2) Periapical abscess; acute or
chronic.
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• Periodontal and restorative evaluation should be carried out.
• If tooth is not restorable or periodontally un-savable then the tooth should be extracted, even though RCT can be performed!
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Pain in cold drinks, getting worse with time!
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Pain when chewing getting worse with time!
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Accidental finding, no complaint
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Pain on chewing on the lower right second molar
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Thank youAny questions?