endo diagnosis
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SO FAR WE HAVE EMPHASIZEDHOW TO PERFORM A ROOT CANAL
How to ACCESS
How to CLEAN AND SHAPE
How to OBTURATE
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BUT HOW ABOUT WHY?
Why do we ACCESS?
Why do we CLEAN AND SHAPE?
Why do we OBTURATE?
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WE TOLD YOU THAT THE
REASON WHY WE PERFORM AROOT CANAL
TO PREVENT APICALPERIODONTITIS
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BUT WHAT DOES THIS MEAN?In other words,
we want to prevent inflammation (infection) of thetissues surrounding the apex of a tooth.
This infection may lead to destruction of theperiodontal tissues.
The infection may spread.
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THE MOUTH IS FILLED WITHPOTENTIAL PATHOGENS
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The pulp canalmay act as apath for
pathogens toenter thesurroundintissues andspreadthroughout thebody
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EXTRA-ORAL DRAINAGE THROUGHCHIN
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LUDWIGS ANGINA
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SO IN ROOT CANAL THERAPYWE WANT TO:
(1) CLEAN OUT THE TOOTH OFALL PULP TISSUE (A SOURCE OF
NUTRITION FOR BACTERIA)
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AND
(2) FILL THE CANAL SPACE SO
WITHIN THE TOOTH AND CANNOT MIGRATE INTO THE
PERIAPICAL TISSUES
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BUT BEFORE BEGINNING ANY
ENDODONTIC PROCEDURE,2 DIAGNOSES ARE REQUIRED:
1. PULPAL
2. APICAL (PERIAPICAL)
AND THE TOOTH MUST BERESTORABLE!!!
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PULPAL DIAGNOSES
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THE PULP WILL BE ALIVE(VITAL)
OR
THE PULP WILL BE DEAD
(NECROTIC)
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THINK OF THIS AS VITAL
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VITAL PULP CLASSIFICATIONS:
NORMAL PULPREVERSIBLE PULPITIS
IRREVERSIBLE PULPITISPULP NECROSIS
PREVIOUSLY INITIATED THERAPYPREVIOUSLY TREATED
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NORMAL PULP
A clinical diagnostic category in
which the pulp is symptom freeand normally response to vitality
testing
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NORMAL PULP
+HEAT +
EPT (Electrical pulp testing) +
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REVERSIBLE PULPITIS
A clinical diagnosis based upon
indicating that the inflammationshould resolve and the pulp return
to normal
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REVERSIBLE PULPITIS
Possible Signs and Symptoms
Cold ++ (Does not linger)Heat ++ (Does not linger)
+No spontaneous painInitiate appropriate restorative
treatment as long as the tooth isrestorable
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IRREVERSIBLE PULPITIS(Symptomatic or Asymptomatic)
subjective and objective findingsindicating that the vital inflamed
pulp is incapable of healing
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SYMPTOMATIC IRREVERSIBLE
PULPITIS
Lingering thermal pain,
spontaneous pain, referred pain
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SYMPTOMATIC IRREVERSIBLE
PULPITIS
Possible Signs and SymptomsCold +++ (Lingers)
Spontaneous Pain
EPT +May not allow patient to sleep
Initiate endodontic treatment as long
as the tooth is restorable
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VISUAL ANALOG SCALETO RATE PAIN
TO 10 BEING THE WORST PAINEVER
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BUT THERE MAY BE SOMETHINGABOVE LEVEL 10 PAIN
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BEYOND 10 PAIN
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BUT SERIOUSLY, IF YOU CANPREPARE A REVERSE CROWN,
YOU CAN PREP ANYTHING!!!
STRENGTHEN YOUR CLINICALSKILLS AND ENHANCE YOUR
PATIENT CARE
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ENDODONTICS RELIES UPON FIXED
PROSTHODONTICS ESPECIALLY FORPOSTERIOR TEETH
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ASYMPTOMATIC IRREVERSIBLEPULPITIS
No clinical symptoms but
inflammation produced by caries,caries excavation, trauma, etc.
Initiate endodontic treatment aslong as the tooth is restorable.
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PULP NECROSIS
A clinical diagnostic category indicating.
non-responsive to vitality testing.Initiate endodontic treatment as long
as the tooth is restorable.
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PREVIOUSLY INITIATED THERAPY
A clinical diagnostic category
previously treated by partialendodontic therapy (e.g.pulpotomy, pulpectomy)
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PREVIOUSLY INITIATED THERAPY
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PREVIOUSLY TREATED
A clinical diagnostic categoryindicating that the tooth has been
endodontically treated and thecanals are obturated with various
filling materials, other thanintracanal medicaments
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PREVIOUSLY TREATED
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APICAL (PERIAPICAL) DIAGNOSES
Normal apical tissues
Asymptomatic apical periodontitisAcute apical abscess
Chronic apical abscess
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NORMAL APICAL TISSUES
Teeth with normal periradicular tissuesthat will not be abnormally sensitive to
percussion or palpation testing. Thelamina dura surrounding the root isintact and the periodontal ligament
space is uniform
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SYMPTOMATIC APICALPERIODONTITIS
Inflammation, usually of the apicalperiodontium, producing clinical
symptoms including painful responseto biting and pain/tenderness to
percussion . It may or may not beassociated with an apical radiolucentarea
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ASYMPTOMATIC APICALPERIODONTITIS
Inflammation and destruction of apical,
appears as an apical radiolucent areaand does not produce clinical
symptoms. No abnormal tendernessto percussion.
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CHRONIC APICAL ABSCESS
An inflammatory reaction to pulpalinfection and necrosis
,little or no discomfort (to
percussion) and the intermittentdischarge of pus through an
associated sinus tract
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RADIOLUCENCIES ARE INDICATIVE OFBONE DESTRUCTION
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SINUS TRACT WITH PUS(Dipping sauce for the shrimp sushi)
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SINUS TRACT WITH GUTTA-PERCHA
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After the completion of this,
performed on a patient
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CONCLUSION
THANK YOU!!!
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LABORATORYSUGGESTIONS
March 2, 2009
Brett Nagatani
M i l/Di l R di h
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Mesial/Distal RadiographsAlternative Method With Plastic Box
LABORATORY AND WREB
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LABORATORY AND WREB
MESIAL/DISTAL RADIOGRAPH
BUCCAL/LINGUAL RADIOGRAPH
DO NOT SUBMIT THESE RADIOGRAPHSWITH THE REQUIRED RADIOGRAPHS!!!
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Where is the pulp chamber?Bur has passed chamber Bur not centered
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Where is the pulp chamber?Angle Bur Towards Long Axis Angle Bur Centrally
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GATES-GLIDDEN FORMULA
(GG)(20) + 30 = GG Size
(2GG)(20) + 30 = 70(3GG)(20) + 30 = 90
(4GG)(20) + 30 = 110