Endodontics
Course Review
Enoch Ng, DDS 2014
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Apical diagnosis cannot be distinguished solely by radiographic interpretation
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Metastatic cancer, periapical cemento-osseous dysplasia, periapical cyst/granuloma all look the same
Only PA cyst/granuloma requires RCT (should provide no response to testing)
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Interpretation of radiographs often misleading
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47-73% agree between observers
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75-83% agree for the same observer seen at different times
Working Radiographs
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Radiographs for monitoring treatment procedures
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For orientation on access – use bitewings to gauge depth of the pulp
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Displays relationship between endodontic instruments/materials to apical portion of root
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If you need to change working length >1mm, take new radiograph
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Locating canals – a root will always have a canal
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Canals may be small and difficult/impossible to locate
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If single canal, will be positioned in center of the root
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If canal is skewed off center, another canal is usually present
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Evaluating cleaning and shaping, obturation
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MAF – largest file cleaned to, placed in canal for radiographic film
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Evaluating healing
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Restitution of normal tissue structures
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Disease can persist in the absence of signs/symptoms – radiographs essential for evaluating apical
response to treatment
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SLOB rule – the canal that is closer to the side of the radiograph corresponding to the same off angle shot is the
lingual canal, and vice versa
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Still requires direct straight shot for comparison as off angle shots have distortion
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Maxilla (SMM)
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Anteriors – straight shot
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Premolars – mesial shot 20
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Molars – mesial shot 20
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4 canal molar – mesial shot separates MB1 and MB2, straight and distal shots superimpose them
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Mandible (DMD)
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Incisors – distal 20
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Canines and Premolars – mesial 20
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Molars – distal 20
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