1

Kassara P Dec 1st , 2009

Pulpal diagnosis 1.1 Healthy 1.2 Reversible pulpitis 1.3 Irreversible pulpitis - Symptomatic Vital - Asymptomatic Non-Vital 1.4 Pulp necrosis 1.5 Previously treated 1.6 Previously initial therapy Periapical diagnosis 2.1 Normal apical tissue 2.2 Symptomatic apical periodontitis (AAP) 2.3 Asymptomatic apical periodontitis (CAP) 2.4 Acute apical abscess (AAA) 2.5 Chronic apical abscess (CAA) 2.6 Condensing osteitis (CO)

3
(1) Tooth structure CLINICAL FINDINGS RADIOGRAPHIC FINDINGS Normal PDL space ENDODONTIC TREATEMENT ASSUMING TOOTH IS RESTORABLE No endodontic treatment Non-surgical root canal treatment for prosthetic or periodontal reasons

PULPAL DIAGNOSIS
Normal pulp Pulp is vital Patient is asymptomatic Gingival retraction: may cause symptoms due to fluid movement inside dentinal tubules

Reversible pulpitis

Pulp is vital with some degree of inflammation Symptoms: from none to intense Pain: Mainly to cold Pain subsides after stimulus is removed No carious pulp exposure Pulp is vital with severe degree of inflammation Symptoms: from none to intense Pain: may be spontaneous, poorly localized Pain to hot and/or to cold In some cases, cold relives pain Pain lingers for several seconds after stimulus is removed May present with pain to percussion May present with carious pulp exposure Normal PDL space Removal of the etiologic factor, normally caries, and placement of restoration or sedative filling Non-surgical root canal treatment for prosthetic or periodontal reasons Emergency treatment may be required Non-surgical root canal treatment Emergency treatment is required

Irreversible pulpitis - Symptomatic -Asymptomatic

Normal PDL space Some cases may present with thickened PDL space

4
Necrotic pulp Pulp is non-vital Symptoms: from none to intense Pain: Present when inducing periradicular disease May or may not present with periradicular lesion Non-surgical root canal treatment Emergency treatment may be required

Previously initial therapy

Previous endodontic

emergency treatment Symptoms: from none to intense Pain: present when inducing periradicular disease

Radiographi finding show temporary filling in access cavity

Non-surgical root canal treatment Emergency treatment may be required

Previously treated

Previous endodontic treatment detectable radiographically Symptoms: from none to intense Normally, no sensitivity to thermal stimuli Pain: present when inducing periradicular disease May or may not present with bone resorption Non-surgical root canal retreatment Surgical root canal treatment Emergency treatment may be required

5 (2)
PERIRADICULAR DIAGNOSIS Normal apical tissues Periradicular tissue structure CLINICAL FINDINGS

RADIOGRAPHIC FINDINGS
Lamina dura surrounding the root is intact periodontal ligament space is uniform

Normally sensitive to percussion Normally sensitive palpation testing.

Symptomatic apical periodontitis

Inflammation, usually of the apical periodontium Painful response to biting and percussion It may or may not be associated with an apical radiolucent area. (This category includes what many of us previously called a Acute Apical Periodontitis)

6
Asymptomatic apical periodontitis Inflammation and destruction of apical periodontium does not produce clinical symptoms Negative response to biting or percussion Appears as an apical radiolucent area (This is what many of us have previously called a Chronic Apical Periodontitis)

Acute apical abscess (AAA)

An inflammatory reaction to pulpal infection and necrosis Characterized by rapid onset Spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues. Appears as a rarefied area of periapical tissue (not well defined radiolucent area)

Chronic apical abscess (CAA)

An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset. Little or no discomfort Intermittent discharge of pus through an associated sinus tract. Appears as a well defined radiolucent area of periapical tissue