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30/12/1434
Vitality Tests
Provide an adjunct to determining the state of pulp Results must be interpreted with caution False positive and false negative results are common
Vitality tests
Surrounding and contralateral teeth should also be tested Test should begin on a normal tooth Stimuli should be applied to normal enamel of the crown of the tooth Better results if more than one test is used ( heat and cold, or cold and electrical tests)
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Cold Test
Involves using a refrigerant, such as endo-ice, ethyl chloride spray The middle third of the clinical crown for posterior teeth and the border between the coronal and middle thirds of the clinical crown for anterior teeth
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The use of hot water, administered through an irrigating syringe under rubber dam isolation
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Disadvantages
May be difficult to use on posterior teeth because of limited access Excessive heating may result in pulp damage May result in a lingering pain, therefore heat tests should be applied for no more than 5 seconds Inadequate heating of the gutta-percha stick could result in the stimulus being too weak to elicit a response from the pulp
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Between 0-40, the patient feels ache; vital pulp Between 4080,with abovementioned reaction, partially vital pulp 80, no mentioned reaction, non-vital pulp
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Electrical conducting gel is present between the electrode and the tooth
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False Positive
The test unhealthy tooth responds normally; Occur in anxious or young patients Contact with metal restorations (electric test) Inadequately dried teeth ( electric test) Multi rooted teeth with one vital root canal pulp In a root canal filled with pus or gas In a patient with low pain threshold
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False Negative
Teeth with restorations ( heat and cold test) Teeth with secondary dentine Nerve supply to the pulp is damaged (e.g. trauma) In a patient with a high pain threshold Faulty technique or equipment
Inconclusive Result
All teeth give similar responses: conflictive results If the results of two tests are inconclusive add a third test Consider cutting a diagnostic access cavity without local anaesthesia
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A LDF probe applied to a sectioned tooth showing the passage of light via the enamel prisms and dentinal tubules to the pulp
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A LDF trace showing signals from two teeth; the upper is from a vital tooth while the lower is from a nonvital tooth
Percussion Test
The handle of an examination mirror or other metal handled instrument is used The tooth is tapped to determine tenderness to percussion and the tone of percussion Tenderness to percussion occurs when there has been injury to the periodontal ligament Testing should begin on a healthy tooth Must be conducted with great care
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Mobility
Mobility is the degree of loosening of a tooth in its socket or, in the case of alveolar fractures, the loosening of several teeth Involves the use of two instruments or a finger and an instrument An instrument or finger is placed buccal and an instrument is placed lingual on the tooth Mobility of the tooth is assessed
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Mobility
Horizontal tooth mobility is the ability to move the tooth in a facial-lingual direction in its socket Vertical tooth mobility, the ability to depress the tooth in its socket
Mobility Scale
Class 1: Slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction Class 2: Moderate mobility, greater than 1 mm of horizontal displacement in a facial-lingual direction Class 3: Severe mobility, greater than 1 mm of displacement in a facial-lingual direction combined with vertical displacement (tooth depressible in the socket)
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Abscess or iflammation of PL
Apical periodon titis Acute trauma Occlusal trauma Periodon titis
Bone fracture
disease
Bony cyst
Neoplasm
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calibrated periodontal probe using customized acrylic stent for positioning the measuring probes
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Recall Patient***
With clinical caries or at increased risk for caries: Posterior bitewing exam at 6-18 month intervals if proximal surfaces cannot be examined visually or with a probe Without clinical caries or at increased risk for caries: Posterior bitewing exam at 24-36 month intervals *** These recommendations are subject to clinical judgment and may not apply to every patient
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Radiography
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Needle Aspiration
performed using 2125 G needle and a 20-ml syringe without local anesthetic Is used to evaluate radiolucencies and to exclude vascular lesions
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Keratin:OKC
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http://medind.nic.in/jao/t09/i1/jaot09i1p70.htm
Odontogenic keratocyst. The cyst aspirate may contain cheesy keratin debris
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Transillumination
The light is reflected back to the eye as different colors according to the density and physical properties of the tissues being observed, e.g. muscle and fatty tissue is usually reflected back as a reddish-orange color while the veins and arteries are reflected back as dark purple or black.
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Transillumination
Using a hand held transilluminator or, A composite curing light or, Less satisfactory is reflection of light by a dental mirror
If the entire tooth lights up, but fracture lines are visible, the fractures are generally shallow and require only monitoring. If only one portion of the tooth lights up, there is a deep crack
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Uses of Transillumination
Tooth cracks (produces light and dark shadows at fracture sites) Interproximal caries Maxillary sinusitis??
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Hand-held Transilluminator
Microlux Transilluminator
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Caries Detection
Diagnodent is used as an adjunct for detection and monitoring of early occlusal caries
DIAGNODENT
Healthy tooth structure exhibits little to no fluorescence, if fluorescence is detected, a value will be displayed on the screen, the higher the value, the greater the decay
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Biting
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