Endodontics
Course Review
Enoch Ng, DDS 2014
Diagnostic Procedures – order doesn’t matter, consistency does
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Radiographic examination – state of pulp tissue, even if necrotic, cannot be determined radiographically
o
Caries
o
Past vital pulp therapy – direct and indirect pulp caps
o
Extensive restorations
o
Previous RCT – pulpotomy, pulpectomy, nonsurgical RCT, surgical RCT
o
Root canal calcifications – calcified canals, pulp canal obliteration (calcific metamorphosis), pulp stones
o
Lesions of endodontic origins
o
Internal (circular, continuous) vs external (non-uniform, irregular) resorption
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Clinical examination
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Visual Extraoral
Swellings, Lymph node exam, Sinus tracts
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Visual Intraoral
Hard tissues – caries, discoloration, fractures, cracked teeth, vertical root fractures, occlusion
Soft tissues – swellings, sinus tracts, periodontal status
o
Diagnostic tests – (S = positive, NS = negative)
Percussion – apical inflammation
Test by digital (finger), then instrument handle
Horizontal and vertical vectors
Palpation – apical inflammation, swelling
Periodontal probings
I – furcation not open
II – can feel furcation, can’t go through it
III – can go through furcation
IV – can see through furcation
Vitality tests – electric pulp test, temperature tests
o
Aδ – sharp pain, low threshold, EPT and cold test
Not fully formed until 5y after tooth eruption
o
C – dull pain, high threshold, heat tests
True nociceptive nerves, resistant to necrosis
EPT – set rate no higher than 4, test on “normal” tooth first
Thermal tests – differentiate between reversible and irreversible pulpitis
Cold tests – test response (S, NS) and lingering (L, NL)
Lingers for ??? considered irreversible
o
Ice stick – 0
o
C, Not for full coverage teeth
Melting ice on adjacent areas may give false positive
o
Endo ice – -26.2
o
C, Tests 3-4 teeth per application
Spray for 3s from 5.0mm distance, shake off excess
Hot tests
o
Burlew wheel, Hot gutta-percha, Hot ball burnisher
Problems with these 3
Temperature can be raised 20
o
in 20s
Increases >20
o
can cause pulpal damage
Temperature no greater than 140
0
F to prevent irreversible pulpal injury
o
Elements/system B – system of choice for “hot” testing