Dr Busch Endodontic Diagnosis.pdf

Endodontic Diagnosis     Leigh R. Busch, D.D.S. Director, Predoctoral Endodontics 2006-2021 New York University College of Dentistry Former Chief of Endodontics, Metropolitan Hospital Center September 5,2001 If you can’t diagnosis it properly you can’t treat it properly  Approach for Di...

Endodontic Diagnosis     Leigh R. Busch, D.D.S. Director, Predoctoral Endodontics 2006-2021 New York University College of Dentistry Former Chief of Endodontics, Metropolitan Hospital Center September 5,2001 If you can’t diagnosis it properly you can’t treat it properly  Approach for Diagnosis You must have a step by step sequenced examination and testing approach  Don’t skip your procedures  Diagnostic Procedures Speak to Your Patient  Ask Pertinent Questions  Determine What Tests To Do   Know How to Relate Answers and Test Findings to a Proper Diagnosis Diagnostic Tests         Radiographs—PA and BW, Why? Vitality Testing—EPT, Cold—Meaning? Percussion—Does it Tell Vitality? Tracing Sinus Tract Palpation Heat Anesthesia Test Cavity Why I Always Take a PA and a Bite Wing More Angles Help Vitality Testing Reversible Pulpitis VITAL TOOTH  Thermal Sensitivity—Not lingering  Frequently Post Treatment  No Treatment Indicated  Irreversible Pulpitis      VITAL TOOTH Classic Symptom: Lingering Pain to Cold May Or May Not Be Sensitive To Percussion Some Cases Pain With Heat Relieved By Cold RCT Required Percussion Palpation  Two Stomas Present  Perio or Endo Problem?  Always Trace the Sinus Tract  Both GP Points Traced to Mid Root  No GP in Apical Third of Canal Yet no PAP External Sinus Tract Sinus Tract Healed Heat Radiolucent Areas Apices of #s 29 & 30 Non Surgical RCT #29&30 Again Proper Dx =Proper Tx PAP or PCD? Chronic Apical Periodontitis Non Vital—No Response To Thermal Stimuli Or EPT  Asymptomatic  Periradicular Radiolucency Present  No Pain To Percussion  RCT Indicated  Acute Apical Periodontitis Tender To Percussion  May Be Vital Or Non Vital  May Or May Not Require RCT  Many Reasons For Tenderness To Percussion  Chronic Suppurative Periodontitis AKA Chronic Apical Abscess  Non Vital—Necrotic Pulp  Draining Sinus Tract or Fistula  Usually Asymptomatic Due To Drainage  Requires RCT  Acute Apical Abscess Non Vital—Necrotic Pulp  Spontaneous Pain  May Or May Not Be Swelling  Pain To Percussion & Palpation  May Or May Not Be PAP  Perio Abscess Diagnostic Tests         Radiographs—PA and BW, Why? Vitality Testing—EPT, Cold—Meaning? Percussion—Does it Tell Vitality? Tracing Sinus Tract Palpation Heat Anesthesia Test Cavity