Endo note 5   examination
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Endo note 5 examination

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Dr. Özkan ADIGÜZEL

Dr. Özkan ADIGÜZEL

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Endo note 5   examination Endo note 5 examination Presentation Transcript

  • Diagnosis and treatment planning in Root Canal Therapy2/23/2009 Endo 5 1
  • Examination Procedurea) General medical historyb) C/O- Currant symptoms, past & recent treatmentc) H/O/C Pain – location,nature,duration,stimuli,relief,referredd) Clinical examination- swelling, facial asymmetry, periodontal disease, discharging sinuous, caries, restoration, fracture, attrition, abrasion, erosion, and abfractione) Diagnosis tests – percussion, palpation, mobility, pocketf) Pulp sensibility test – electric, cold, heatg) Radiographic test - IOPA, tube sift, bite wing, panoramich) Other test – biting on individual cusp, trans-illumination, local anaesthesia test, test cavityi) Investigations –removal of caries of restoration, trans- illumination of cavity. 2/23/2009 Endo 5 2
  • History• All the problems be determined diagnosis maid, appropriate treatment discussed and informed consent should be obtained.• Demographic, medical and dental history should be recorded• Radiograph is Mandatory. early stages of pulpitis are not evident2/23/2009 Endo 5 3
  • Patient selection limitations 1. Medically compromised patient 2. Very old patient 3. Poor oral hygiene 4. Retain roots 5. Calculi 6. Carious teeth 7. Restricted mouth opening 8. Patient’s attitude 9. Patient’s compliance 10. Cost2/23/2009 Endo 5 4
  • Patents requiring antibiotic cover 1. Hisory of infective endodarditis 2. Ventricular septal defect 3. Ductus arteriosus 4 4. Coarctation of the aorta 5. Prosthetic heart valve 6 6. Degenerative valve disease 7. Rheumatic heart disease 8. Persistent heart murmur 9. Atrial septal defect repaired with a patch 10. Chronic debilitating disease2/23/2009 Endo 5 5
  • Pain• How long have you had the pain• Do you know which tooth it is• What initiate the pain• How would you describe the pain• Sharp or dull, throbbing mile or severe, localize or radiation• How long does the pain last• Does it pain most during the day or night• Does anything relieve the pain2/23/2009 Endo 5 6
  • Examination• Standard oral Hygiene• Amount and quality of Restorative work• Prevalence of caries• Missing and unopposed teeth• General medical condition• Presence of soft or hard swelling• Presence of any sinus tracts• Discolored teeth• Tooth wear and facets2/23/2009 Endo 5 7
  • Intra--oral Swelling2/23/2009 Endo 5 8
  • Extra--oral Swelling2/23/2009 Endo 5 9
  • Extra--oral Swelling2/23/2009 Endo 5 10
  • Facial asymmetry2/23/2009 Endo 5 11
  • Periodontal disease2/23/2009 Endo 5 12
  • Intra--oral discharging sinuous2/23/2009 Endo 5 13
  • Extra--oral discharging sinuous2/23/2009 Endo 5 14
  • Caries2/23/2009 Endo 5 15
  • Heavily restored teeth2/23/2009 Endo 5 16
  • Fractured teeth2/23/2009 Endo 5 17
  • Pulp Testing• Moribund pulp may give possitive results, multi rooted teeth give complicated results. Ideal way of measuring vitality leiser dopler flowmeter messure blood flow to the pulp• Electronic gives false possitive reading due to stimulation of PDL• Thermol pulp test• Heat guttapercha sticks• Cold ethil chloride• ice sticks2/23/2009 Endo 5 18
  • Palpation • Palpation the sight and size of any soft or hard swelling – examine for fluctuation and crepitus2/23/2009 Endo 5 19
  • Percussion • Percussion – gentle tapping with finger – both lateral and vertical2/23/2009 Endo 5 20
  • Mobility • Mobility – slight moderate and extensive – lateral and vertical2/23/2009 Endo 5 21
  • Pockets depth • Standard oral Hygiene2/23/2009 Endo 5 22
  • Biting on individual cusp •Wooden stick test2/23/2009 Endo 5 23
  • Mouth opening • restricted mouth opening2/23/2009 Endo 5 24
  • • Local aneasthetics• Intra ligamental injection• Fibro-optic light trans illumination teeth to show inter-proximal caries, fracture, opacity or discoloration• Cutting a test cavity2/23/2009 Endo 5 25
  • Indication for root canal treatment• Post space insufficient tooth substance for normal restoration• Over denture• Teeth with doubtful pulp• Periodontal disease• Pulpal sclerosis following trauma2/23/2009 Endo 5 26
  • Tooth selection limitations 1. Unrestorable tooth 2 2. Insufficient periodontal support 3. Root fracture 4. Bizarre anatomy 5. Non-strategic tooth 6 6. External/external resorption 7. Procedural accident 8. Calcified canal 9. Post retained crowns 10. Open apex2/23/2009 Endo 5 27
  • Anatomical complications2/23/2009 Endo 5 28
  • Non--functional tooth2/23/2009 Endo 5 29
  • External / Internal resorption2/23/2009 Endo 5 30
  • Anatomical defects2/23/2009 Endo 5 31
  • Anatomical defects2/23/2009 Endo 5 32
  • Procedural accident2/23/2009 Endo 5 33
  • Procedural accident - zip perporation2/23/2009 Endo 5 34
  • Obstruction of canal – foreign body2/23/2009 Endo 5 35
  • Obstruction of canal – fractured instrument 2/23/2009 Endo 5 36
  • Obstruction of canal – calcified canal2/23/2009 Endo 5 37
  • Open apex2/23/2009 Endo 5 38
  • Contra indication (general)• Inadequate access – Restricted mouth opening• Poor oral hygiene – patient should be able to maintain a healthy mouth Patients general medical condition –• Chronic debilitating disease or very old age• Patients attitude – Patient should be sufficiently educated and motivated2/23/2009 Endo 5 39
  • Contra indication (Local)• Tooth non restorable supra-gingival and supra- crestal• Insufficient periodontal support• Non strategic tooth• Root fracture• Internal or external resorption• Bizarre anatomy – exceptionally curved tooth, dilacerated teeth, congenital palatal roots, unusual anatomy2/23/2009 Endo 5 40
  • Indication for re-treatment 1. Signs of infected root canal 2 2. Signs of periapical pathology 3. Technically inadequate RCF 4 4. Dislodge of post retain crown 5. Broken down crown restorations2/23/2009 Endo 5 41
  • • 90-95% success – no periapical lesion• 80--85%success – preoperative periapical lesion• 60-65% success – re root filling2/23/2009 Endo 5 42