Endodontic Diagnostic Terminology-3.pdf

Endodontic Diagnostic Terminology W C R A I G N O B LETT , D D S , M S D I P LO MAT E, A ME R I CAN B O A R D O F E N D ODONTI C S D I V I S ION O F E N D O DONTI C S U N I VER SI TY O F MI N N ESOTA S C H O OL O F D E N T IST RY Vocabulary is Important Consensus Conference on Endodontic Diagnostic...

Endodontic Diagnostic Terminology W C R A I G N O B LETT , D D S , M S D I P LO MAT E, A ME R I CAN B O A R D O F E N D ODONTI C S D I V I S ION O F E N D O DONTI C S U N I VER SI TY O F MI N N ESOTA S C H O OL O F D E N T IST RY Vocabulary is Important Consensus Conference on Endodontic Diagnostic Terminology October 2008 in Chicago Convened to agree on terminology so that we would all be “speaking the same language” Most would agree it was moderately successful Apical vs. Periapical vs. Periradicular All three terms appear in the literature and are used interchangeably in Endodontic culture, but Apical is the agreed upon term Two-part Diagnosis For each endodontic diagnosis, there are two parts: Pulpal Diagnosis Describes the status of the pulp based upon diagnostic testing Apical Diagnosis Describes the status of the apical tissues beyond the apical foramen, also based on diagnostic testing as well as radiographic interpretation Pulpal Diagnosis Normal Pulp Reversible Pulpitis Symptomatic Irreversible Pulpitis Asymptomatic Irreversible Pulpitis Pulp Necrosis Previously Treated Previously Initiated Therapy (Treatment) Apical Diagnosis Normal Apical Tissues Symptomatic Apical Periodontitis Asymptomatic Apical Periodontitis Acute Apical Abscess Chronic Apical Abscess Condensing Osteitis Pulpal Diagnosis Normal Pulp Chief Complaint: Normally none Radiographs: Normal dental/osseous structures EPT: Responsive Thermal Tests: Responsive without lingering discomfort Reversible Pulpitis Chief Complaint: Hot &/or cold sensitivity Radiographs: Normal EPT: Responsive Thermal Pulp Tests: Exaggerated & non-lingering Other Factors: Caries, cracks, restorative procedures, trauma Symptomatic Irreversible Pulpitis Chief Complaint: Lingering cold/occasional heat sensitivity History: Possible spontaneous pain Radiographs: Normal to widened PDL Occasionally apical radiolucency EPT: Responsive Thermal Tests: Exaggerated and lingering response Other factors: Cracks, caries, restorative procedures Symptomatic Irreversible Pulpitis Asymptomatic Irreversible Pulpitis Chief Complaint: Usually none Radiographs: Caries with Normal apical tissues, widened PDL or radiolucency EPT: Responsive Thermal Tests: Responsive without lingering sensitivity Other Factors: Caries in close proximity to the pulp Pulp is not likely to recover from insult Asymptomatic Irreversible Pulpitis Pulp Necrosis Chief Complaint: Variable Radiographs: Normal to widened PDL to Apical Radiolucency EPT: Non-responsive Thermal Tests: Non-responsive Other factors: Caries, cracks, restorative procedures, trauma Pulp Necrosis Pulp Necrosis Always remember the tooth is NEVER necrotic Only the pulp is necrotic If you mix them up: Previously Treated Chief Complaint: Variable History: Tooth that has been endodontically treated with canals obturated Radiographs: Normal, Widened PDL, or Radiolucency EPT: Generally non-responsive Thermal Tests: Generally non-responsive Previously Treated Previously Initiated Therapy Chief Complaint: Variable History: Tooth that has had treatment started but not completed Radiographs: Normal, Widened PDL, or Radiolucency EPT: Generally non-responsive Thermal Tests: Generally non-responsive Questions? Apical Diagnosis Normal Apical Tissues Chief Complaint: None Radiographs: uniform Lamina dura intact, PDL Percussion: Non-tender Palpation: Non-tender Mobility: Physiologic Normal Apical Tissues Symptomatic Apical Periodontitis Chief Complaint: Discomfort on biting or chewing History: Possible recent restoration Radiographs: Normal, Widened PDL, Radiolucency Percussion: Tender Palpation: Tender or non-tender Mobility: Normal to Class I Other factors: Occlusal trauma Asymptomatic Apical Periodontitis Chief Complaint: None History: Asymptomatic Radiographs: Apical radiolucency Percussion: Non-tender Palpation: Non-tender Other factors: Pulp necrosis or previously treated Asymptomatic Apical Periodontitis Asymptomatic Apical Periodontitis Acute Apical Abscess Chief Complaint: Pain and swelling History: Usually rapid onset, spontaneous pain, tenderness to touch the tooth, swelling of adjacent tissues Radiographs: Normal, Widened PDL, Radiolucency Percussion: Often extremely tender Palpation: Tender Mobility: Possibly Other Factors: Pulp necrosis or previously treated Acute Apical Abscess Chronic Apical Abscess Chief Complaint: Bad taste or “gum boil” Radiographs: Radiolucency usually Percussion: Non-tender Palpation: Non-tender Mobility: Usually physiologic to Class I Other Factors: Pulp necrosis or previously treated with sinus tract present Chronic Apical Abscess Sinus Tract A draining tract from an area of inflammation to a mucosal or epidermal surface A fistula is an artificial communication between two normal anatomical spaces If you mix them up: Condensing Osteitis Chief Complaint: Usually asymptomatic History: Tooth with extensive restorative history or a crack Radiographs: Increased radiodensity/opacity EPT/Thermal tests: Responsive or non-responsive Percussion: Non-tender Palpation: Non-tender Mobility: Physiologic Differential Diagnosis of a Radiolucency Granuloma COF Cyst KOT Apical scar Metastatic disease Abscess Lymphoma Cholesteoma Ameloblastoma Cementoma Myxoma Giant Cell Granuloma Multiple Myeloma Questions? 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