Diagnostic tests in operative dentistry


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Diagnostic tests in operative dentistry

  2. 2.  A thorough understanding to the complicated multifactorial and versatile nature of pain is essential to an accurate diagnosis and a successful treatment.
  4. 4. Take A Good History Listen to everything the patient wants to say. Not only will you get useful information, but you are letting the patient know that you have time and concern for him or her. Depending upon the information the patient supplies, you can often shorten the diagnostic procedure.
  5. 5. Presenting complain History of presenting complain Dental history Medical history
  6. 6. CHIEF COMPLAINT This is the opportunity for the general practitioner to let the patient describe a dental problem as it appears to him/her. You may start with 'Tell me about your problem' or 'How can I help?' Allowing time to listen to the patient in a busy schedule can pay dividends in reaching the correct diagnosis swiftly and avoiding embarrassing mistakes. A distressed patient will be put at ease, and conversation can then lead into more detailed discussion
  7. 7. HISTORY OF PRESENT COMPLAINT When did the pain or problem start?  Does anything make the pain better or worse?  Relieving factors.  Frequency of painful episodes.  Intensity : Dull, Sharp  Location.  Duration : Continuous, Intermittent , Prolonged  Postural changes  Response to hot, cold, biting and chewing effects 
  9. 9. EXTRAORAL EXAMINATION Patients head and neck soft tissue examination including TMJ and lymph node examination.  Any signs of Swelling  Facial Asymmetry  Presence of Sinus Tract 
  10. 10. INTRARAORAL EXAMINATION Soft tissue Hard tissue Specific tooth test
  11. 11. SPECIFIC TOOTH TEST  Percussion  Palpation  Mobility
  12. 12. Tooth mobility: A suspect tooth can be moved gently by finger and thumb pressure  Any horizontal mobility is then graded  Mobility can result from trauma, root fractures , periodontal disease and gross root resorption  Grade 01 : 1-2mm Bucco-lingually  Grade 02 : 1-2mm Mesio-distally  Grade 03 : 2-3mm Bucco-lingually and Mesiodistally, vertical depression. 
  13. 13. Testing tooth mobility by gently applying lateral forces between finger and thumb.
  14. 14. Tenderness to palpation: The tooth is moved vertically and side to side with finger pressure. Teeth with acute apical periodontitis will often be tender when palpated in this manner.
  15. 15. Percussion:  Tapping a tooth with a mirror handle can help identify the kind of tooth pain  Percussing the tooth occlusallyy : Peri-apical pain  Percussing the tooth bucally : Periodontal pain
  16. 16. Gently percussing a tooth with a mirror handle may elicit the classical ringing sound that occurs with replacement resorption (ankylosis).
  17. 17. INVESTIGATIONS  a) b) c)     Pulp sensitivity test Heat test Cold test Electric pulp test Dentine Stimulation test Selective local anesthesia Radiographs Transillumination
  18. 18. Apply the cold test This is simply done with cylindrically shaped ice sticks.  A good site of cold application is generally the buccal surface as close to the cemento-enamel junction as possible.  If a metal crown restoration is on the tooth, attempt to apply the ice on the lingual metal collar, an area where the cold travels most easily. If a tooth has irreversible pulpitis it will either give a prolonged response, possibly after some delay, or no response.  Transient pain (less than ten seconds) after the application and removal of ice is normal.  No response may mean the tooth is endodontically involved, especially if all other teeth respond to cold. 
  19. 19.  Apply the heat test. Using a ball of hot gutta percha on the tip of a plastic instrument, place the gutta percha onto the tooth the same way you would the ice. Wait approximately 15 seconds between teeth to assess the possibility of a delayed, but, prolonged response. Compare the results from other tested teeth. If one tooth gives a prolonged response, whether immediate or delayed, it is a most suspicious candidate for endodontics. If the pain is immediately relieved by cold, the tooth probably needs root canal.  Apply the electric pulp test (EPT). This test should be used when the hot and cold tests fail to give clear information on the state of vitality of the tooth. Again, the information supplied by the electric pulp test must be weighed against the response from other teeth. the fact that a tooth does not respond to the EPT has little meaning if all the other teeth also do not respond, unless of course this is the only tooth with a welldefined area at the apex or is quite tender to percussion.
  20. 20.    8. Use bite sticks. Use bit sticks to check for incipient fractures that are causing pain to a tooth when under function. By having a patient bite on each cusp and laterally move the lower jaw, each cusp is subjected to lateral stresses. If a section of the tooth under a cusp has an incipient fracture it will often hurt when pressure is applied. If a fracture does exist, the tooth may not need endodontics if the fracture does not extend into the pulp. The pain generally disappears if the fractured portion of the tooth can be cleaved off. 9. Employ transillumination. Transillumination often confirms the portion of the tooth that has the fracture. By placing the transillumination light source on the lingual side of the tooth and turning out the chairside light source, fractures may be picked up as a dark horizontal line against a light amber background. Transillumination can sometimes differentiate between vital and non-vital teeth with the non-vital appearing duller than the surrounding ones when the light source is applied. 10. Use the binocular microscope. It is excellent for picking up incipient fractures simply because you can look at teeth magnified up to 30 X with excellent illumination.
  21. 21. 11. Apply selective anesthesia. It should be applied with an intraligamentary gun. If specific anesthesia to one tooth makes all pain disappear for a short time and the effect is repeatable, the anesthetized tooth is probably endodontically involved.  12. Drill a test cavity. If you believe that a non-vital tooth is causing symptoms, but cannot confirm non-vitality with assuredness, a test cavity without anesthesia may allow entry into the pulp without any pain, thus confirming your suspicions. 
  22. 22. RADIOGRAPHS Bitewing  Periapical  Orthopantomograph  Cone Beam Computed Tomography 
  23. 23. OPG             Impacted wisdom teeth diagnosis and treatment planning - the most common use is to determine the status of wisdom teeth and trauma to the jaws. Periodontal bone loss and periapical involvement. Finding the source of dental pain Assessment for the placement of dental implants Orthodontic assessment. pre and post operative Caries detection especially in the inter-dental region. Diagnosis of developmental anomalies such as cleido cranial dysplasia Carcinoma in relation to the jaws Temporomandibular joint dysfunctions and ankylosis. Diagnosis of osteosarcoma, ameloblastoma, osteodystrophy affecting jaws and hypophosphatemia. Diagnosis, and pre- and post-surgical assessment of oral and maxillofacial trauma, e.g. dentoalveolar fractures and mandibular fractures. Salivary stones (Sialolithiasis).
  24. 24. CBCT has become increasingly important in treatment planning and diagnosis in implant dentistry, among other things. Perhaps because of the increased access to such technology, CBCT scanners are now finding many uses in dentistry, such as in the fields of endodontics and orthodontics, as well.  During a CBCT scan, the scanner rotates around the patient's head, obtaining up to nearly 600 distinct images. The scanning software collects the data and reconstructs it, producing what is termed a digital volume composed of three dimensional voxels of anatomical data that can then be manipulated and visualized with specialized software 
  25. 25. Bitewing Radiograph The bitewing view is taken to visualize the crowns of the posterior teeth and the height of the alveolar bone in relation to the cementoenamel junctions. bitewing radiographs are commonly used to examine for interdental caries and recurrent caries under existing restorations. Bitewing views are taken from a more or less perpendicular angle to the buccal surface of the teeth.
  26. 26. Periapical Radiograph The periapical view is taken of both anterior and posterior teeth. The objective of this type of view is to capture the tip of the root on the film. This is often helpful in determining the cause of pain in a specific tooth, because it allows a dentist to visualize the tooth as well as the surrounding bone in their entirety. This view is often used to determine the need for endodontic therapy as well as to visualize the successful progression of endodontic therapy once it is initiated. It can be used in case of detection hyperdontia& impacted teeth.
  27. 27.  Good diagnosis comes from using as many of the above tools as are necessary to confirm as solidly as possible your opinion on what should be done. patients truly appreciate the time you take to confirm what should be done. This is especially true when a patient comes in with a strong feeling that one specific tooth is the source of the problem, but your diagnosis says that it is another and after treatment you are right.