pulpal and apical diagnosis Flashcards

Question

PIT (Previously Initiated Treatment)

Answer 1

PIT (Previously Initiated Treatment) – Tooth has been previously treated by partial endodontic therapy, i.e. pulp cap, pulpotomy/pulpectomy. RCT NOT completed

Answer 2

Always remember everything in DX is continually CHANGING A pain which is diffuse today may be localized tomorrow A severe cold sensitivity may abate overnight The same tooth may become newly sensitive to bite next day as pulp vitality succumbs to challenge.

Answer 3

Both seriously Inflamed and Infected Pulpitis cases will ultimately lead to a Necrotic pulp if left untreated long enough.

Answer 4

• RARELY do we see APICAL RADIOGRAPHIC CHANGES in cases of pure pulpitis or even EARLY necrotic pulp *** • Advanced pulpal disease or necrosis of the pulp is generally required to allow infection to affect the apical tissues.

Answer 5

We must use EVIDENCE gained from CLINICAL EXAMINATION & CLINICAL TESTING along with our knowledge and experience: 1. Medical & Dental History 2. CC + Signs & Symptoms 3. Clinical examination 4. Clinical testing 5. Radiological indications

Answer 6

• Never attempt to make a Dx fromradiographs alone *** • Many unrelated non-odontogenic entities can mimic “Lesions of Endodontic Origin” (LEO)s radiographically but in factbe something entirely different* • Don’tskip any steps* • Document ALL TESTING andEXAMINATION DONE.

Answer 7

must prove it is a LEO with testing

Answer 8

• Do you see any damage to the tooth? • Caries, Restoration, Fracture, Extreme/Rapid Wear? • Trauma of any sort? Ask more than once! Check 4 Crack • Discoloration of the crown?

Answer 9

• The disease process rapidly extends peri-apically. • The tooth often will become percussion + &/or spontaneous pain may appear BEFORE radiographic evidence is clear.

Answer 10

occurs but takes time to develop – 100% OF THE MEDULLARY BONE CAN BE DESTROYED & no PARL may show on the standard radiograph. – A Visible PARL is ONLY VISABLE when 40% of the Cortical Bone has been destroyed.

Answer 11

PERCUSSION.

Answer 12

PERCUSSION

Answer 13

• Mechanoreceptors (Proprioceptors) are present in PDL not in Pulp • It means that inflammation/infection from the pulp has already reached the P/Apical tissues and we are dealing with an Apical DX of some type. • The offending tooth will now be sensitive to percussion but a lesion may NOT yet show on XR* • (Recent or chronic occlusal trauma –possible exception)

Answer 14

condesing osteitis

Answer 15

Teeth not sensitive to percussion or palpation. Lamina dura is intact and the PDL is uniform and unbroken.

Answer 16

Inflammation of the periodontium producing a painful response to biting/percussion/maybe palpation.

Answer 17

Inflammation and destruction of the periodontium that is of pulpal origin appearing as a radiolucent area with no clinical symptoms.

Answer 18

Inflammatory reaction to pulpal infection with rapid onset, spontaneous pain, tooth tender to pressure, pus formation and SWELLING & FEVER

Answer 19

Inflammatory reaction to pulpal infection with gradual onset, little or no discomfort and DRAINING SINUS TRACT.

Answer 20

Diffuse radiopaque lesion representing a localized boney reaction to a low-grade inflammatory stimulus.

Answer 21

Rapid Development Swelling (often Severe) Elevated Temp./Fever can occur with AAA, requires I and D

Answer 22

usually not, typically no pain

Answer 23

Always trace out a Draining Sinus Tract (DST) with Gutta Percha cone & Radiograph ... sometimes you can be fooled!!!!

Answer 24

CO (Condensing Osteitis) ➢ Radio-opaque formative or reactive bone ➢ Asymptomatic and no apparent pathology = NO TREATMENT (Continue to monitor) ➢ Treatment of CO is based upon symptoms ➢ Develops in response to a mild or “sub clinical” inflammation or infection where bone is actually formed instead of being resorbed or destroyed Differential DX: Sclerotic Bone which is a non-pathology & requires no TX. (no DAMAGE

Answer 25

• Everything that follows an inaccurate DX is . . . WRONG ! • You cannot do ANY Treatment for the patient until you have a supported DX* • If you cannot make a definitive DX today, support the patient with appropriate supportive medications and follow up or...refer

Answer 26

• Craze Lines (Confined to enamel) • Fractured Cusp (Oblique shearing FX ) Facial-Lingual • Cracked Tooth (Incomplete “Greenstick” FX) • Split Tooth • Vertical Root Fracture***

Answer 27

Common & Generally Unimportant (don’t stop light)

Answer 28

Often involves undermined cusp, may be restorable

Answer 29

– M-D FX involving 1 or both marginal ridges – May or may Not involve the pulp – May be confined to crown or extend to root

Answer 30

– Involves Crown, Root & generally Pulp – Must remove FX segment & determine restorability

Answer 31

Begins INTERNALLY (at root apex or from crown) – Primarily in axial plane may be F-L or M-D* – Often occur in RCT teeth

Answer 32

Horizontal Fractures are also important but are generally easily seen and are usually associated with known traumatic events.

Answer 33

always do all necessary DX testing. Determine condition of pulp. If vital and restorable, anesthetize and remove the fractured portion and restore if possible.

Answer 34

Normal procedure is to remove the fractured cusp and see if the remaining tooth structure will support a restoration (intra-coronal or extra-coronal).

Answer 35

Anything from simple intracoronal restoration to endodontic intervention to extraction of the tooth may ensue in this highly variable injury.

Answer 36

crown lengthening may help so little tooth structure remains that RCT + post, build-up and crown will be necessary to properly restore.

Answer 37

Most common site of cracked tooth is mandibular 2nd or 1st molar followed by maxillary premolars.

Answer 38

Often seen in teeth without caries or restoration. May follow bruxism or clenching habit or other trauma

Answer 39

Difficult to see if covered by MOD amalgam or even composite. May need to remove restorations, stain & trans-illuminate to diagnose.

Answer 40

A Cracked Tooth is most often discovered following patient complaint of acute, sharp, momentary pain upon biting or release of biting pressure. An old crack may often be seen as stained.

Answer 41

Generally pulp is vital in early stages & may remain so for some time.

Answer 42

Often, the untreated patient may learn to avoid biting on the tooth and the pulp may survive for a time in this manner before eventually succumbing to the bacterial challenge &/or extension of the crack at which point the pulp becomes necrotic & the previous pain stops because the pulp is now necrotic and can no longer respond. Later SAP will develop as infection invades the peri-radicular tissues.

Answer 43

When a cracked tooth with a vital pulp is bitten upon in a manner to wedge open the crack, air & saliva enter the defect. When biting pressure is released, typically the wedged crack moves rapidly toward closure forcing a change in the fluid gradient in the dentinal tubules producing the characteristic acute & sharp, momentary pulpal pain as long as the pulp remains vital.

Answer 44

At this point, the tooth is generally NOT sensitive to percussion and if the crack is confined to the crown & the pulp remains healthy, it may be possible to protect & preserve the pulp and stabilize the crack by extra-coronal restoration to achieve stability of the crack. RCT may become necessary nevertheless if pain continues or the pulp succumbs. It is important to note that the crack may extend to the root even with the stabilization. RCT or Extraction may become necessary depending upon the extent of extension of the crack ( if the crack extends to the pulpal floor or a canal, RCT will not be successful).

Answer 45

-Transillumination -Staining (Sable Seek) -P. Probing (drop-off Pocket) -B/W XR why? (restorability) -Angular crestal -Bite Stick: "Frac Finder” and “Tooth Slooth”

Answer 46

A “Drop-Off” Periodontal Pocket in an otherwise healthy periodontal mouth may be a tip-off that a longitudinal (axial) crack may extend into the root and therefore create a guarded or hopeless prognosis. A drop-off pocket is when you measure 3-3-3-3-8-3. It is a NARROW pocket and often indicate the extension of a crown fracture into the root. May signal a non-restorable tooth A VRF on a PT RCT case after success for several years now shows a “J” Shaped Lesion Chances are good that a VRF fracture may have occurred.

Answer 47

Look for J-Shaped (HALO) apical boney lesion Probe for Drop-off Pocket VRF difficult to confirm radiographically –UNLESS . . . separation of segments occurs

Answer 48

This is simply a drainage path of a CAA along the PDL as evidenced by the sealer extrusion from the lateral accessory canals along this path. No angular crestal bone loss, no drop-off pocket, unable to transilluminate due to crown.

Answer 49

expose it surgically and demonstrate the fracture using stain and a possibly a microscope* or wait for it to separate?

Answer 50

thickened PDL can be caused by occlusal trauma with high restoratiosn

pulpal and apical diagnosis Flashcards

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