Difference between Pulpal & PeriApical Diagnosis

1. Pulpal & PeriApical
Diagnosis
PRESENTED BY: DR FARYAL AFZAL

2. Endodontic Diagnosis
For every single tooth whether Dead or Alive has two Endodontic Diagnosis, which are;
• Pulpal Diagnosis
• Periapical Diagnosis

3. Pulpal Diagnosis
•Normal Pulp
•Reversible Pulpitis
•Symptomatic Irreversible Pulpitis
•Asymptomatic Irreversible Pulpitis
•Pulp Necrosis
•Previously treated Pulp

4. Normal Pulp
•Asymptomatic
•And when we test it in a certain way it has Mild to moderate transient response to thermal
and electrical stimuli
•* By transient it mean it subsides when the stimulus is removed & it’s a momentary response
•* Thermal And Electrical This means its referring to the pulp, those fibers in the pulp are
stimulated with thermal and electrical stimuli and these are conveniently tested with:
•Cold Test & Electric Pulp Test respectively.
• These are the diagnostic tools for Pulpal Diagnosis.

5. Cold Test
Endo Ice = Dichlorodifluoromethane, -30degree C
•Chilled pallet is applied immediately to middle third of facial surface of crown for 5 seconds
•Intensity and duration of response provide information about pulpal diagnosis

6. Electrical Pulp Test (EPT)
•Least reliable pulp vitality testing method
•Indicates if there are vital sensory fibers present in the pulp, but does not provide any
information about vascular supply to the pulp
•False positives & negatives results
•Contraindicated if pt has cardiac pacemaker

7. Reversible Pulpitis
•Symptomatic
•Thermal (usually cold) stimulus causes quick, sharp, hypersensitive, transient response
•No complaints of spontaneous response
•Caused by an irritant that affects the pulp, so irritants can be caries, deep cleaning, deep
restorations without a proper liner or base, but if the irritant is removed the pulp reverts to and
uninflamed state hence why it is called irreversible.
•Technically it is a Symptom, not a disease.

8. Symptomatic Irreversible Pulpitis
•Symptomatic
•Pulp has been irreversibly damaged beyond repair; even with removal of the irritant it will not
fully heal
•Characterized by spontaneous intermittent or continuous pain
•Thermal (often cold) stimulus causes lingering pain
•Postural changes like bending over or lying down increases blood pressure to the head and may
exacerbate dental pain
•Radiograph are generally insufficient; EPT is of little value for diagnosis so we are really relying a
lot on pt History, their explanation of their dental pain and the cold test resuts.

9. Asymptomatic Irreversible Pulpitis
•Asymptomatic (* asymptomatic means that nerves are responding rather normally and the pulp
is basically like a normal pulp in terms of response but microscopically, histologically and
physiologically the pulp has been irreversibly damaged and requires treatment)
•Microscopically similar to previous stage being symptomatic irreversible pulpitis, but no clinical
symptoms

10. Pulp Necrosis
•Usually Asymptomatic but not always
•Can be partial or total necrosis
•Due to long term interruption of blood supply to the pulp
•Crown discoloration may accompany pulp necrosis in anterior teeth

11. Periapical Diagnosis
•Normal Apical tissues
•Symptomatic Apical Periodontitis
•Asymptomatic Apical Periodontitis
•Acute Apical Abscess
•Chronic Apical Abscess

12. Normal Apical Tissue
•Asymptomatic
•No pain on percussion or palpation
•* Percussion or palpation and X-rays Are the Main Diagnostic tools for Apical Diagnosis.

13. Percussion & Palpation
Percussion = tapping on teeth with a mirror handle tap in a vertical direction along the lon
axis of the tooth
Palpation= feeling of a gloved finger on gums around apex of the root

14. Symptomatic Apical Periodontitis
•Painful inflammation around the apex
•Characterized by painful percussion and intense throbbing pain
•This is due to Localized inflammatory infiltrate within the PDL

15. Asymptomatic Apical Periodontitis
•Asymptomatic
•Apical radiolucency
•Confirmation of pulpal necrosis

16. Acute Apical Abscess
•Rapid swelling
•Severe pain
•Purulent exudate ( liquefaction necrosis) around apex
•It is easy to diagnose due to these cardinal features.

17. Chronic Apical Abscess
•Draining Sinus Tract usually without discomfort
•In this example above, of what appears to be a kind of smaller abscess not so much of swelling
theres actually a tract that communicates with the oral cavity & source of infection associated
with one of these teeth, now we insert a Gutta Percha Cone through the sinus tract stop when
you feel resistance & then with it in place expose a PA radiograph and find the path and source
of sinus tract, as in the above Xray, you can trace it to the premolar.

18. THANKYOU!