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Diagnostic aids in endodontics

Contents
Introduction Case history Clinical examination Diagnostic tests Visual and tactile inspection Palpation Percussion Mobility and depressibility test Electric pulp testing Thermal test Anesthetic test Test cavity Transillumination Staining Wedging Radiographs

Advances

Xeroradiography RVG Digital subtraction radiography TACT Pulse oximetry LDF Liquid cholesterol method Infrared thermography (Hughes Probeye camera) Computed tomography MRI

References conclusion

INTRODUCTION

Diagnosis can be defined as : The translation of data gathered by clinical and Radiographic examination in to an organized, classified definition of the conditions present.

Diagnostic sequence

Demographic information with respect to name, age, sex etc Chief complaint and history of present illness Medical and dental history Clinical examination Radiographic findings

Other tests, laboratory values or consultations if required

Provisional diagnosis / diagnosis

Treatment plan

Presenting Symptoms; Subjective symptoms

Objective symptoms

Pathway to correct clinical diagnosis;

Case history Clinical examination Diagnostic tests \ investigations

Dental history
PAIN: Type of pain Duration of pain Localization of pain

Clinical examination:

Extraoral examination Intraoral examination

DIAGNOSTIC TESTS :

visual & tactile inspection:soft tissue:

colour contour consistency

Hard tissue:
Colour Contour consistency

Palpation : Percussion :

Mobility and depressibility test: as classified by:

Grossman & Cohen Miller

Electric pulp testing (EPT)

Advantages Comfortable for patients Digital display

Disadvantages Interferes with cardiac pacemakers Teeth with immature apex Recently traumatized teeth No indication about vascular supply

Pulp tester classification: Monopolar Bipolar False positive response False negative response

Commercially available pulp testers Digilog pulp tester Parkell pulp tester Analytic technique tester Pelton crane system Greenwood pulp tester Neosono ultima EZ-apex locator + pulp tester

Thermal tests

Heat testWarm stick temporary stopping Hot water bath Hot air Hot burnisher

Cold testIce sticks Compressed gases CO2 snow Ethyl chloride

Anesthetic testing:

Test cavity

Transillumination:

Staining

Wedging

Radiography

Advances

Xeroradiography Based on electrostatic process Types: Medical 125 system Dental 110 system

Radiovisiography 3 components of RVG

Advantages

Elimination of x-ray film

Reduction in exposure time Instant image display

Digital subtraction radiography

Can detect 0.12 mm change in thickness of cortical bone Useful in: Evaluating osseous healing Accurate detection of active disease

TACT
consists of:

Standard radiographic unit Digital image acquisition device TACT software Uses visualization of canals Detection of secondary caries Diagnosis of external root resorption

Pulse oximetry
Probe sensor consists of: Two LED red light ( 640 nm) infrared light (960 nm) Photo detector
Avg value O2saturation 94% ( tooth ) PR = 72 / min

Laser Doppler flowmetry

Used to assess blood flow HeNe or diode lasers used

Liquid cholesteric crystal method

Introduced by Howell (1970) inference

Vital
blue-green

Non Vital
red

Red-green
green

yellow
yellow-red

Infrared Thermography

(Hughes probeye camera)

Can detect temperature changes as small as 0.10 C .

Consists of :

Thermal video system

Silicon close-up lens

Spiral CT

Micro CT

Magnetic resonance imaging

Advantages of MRI
It offers the best resolution of tissues of low inherent contrast. No ionizing radiation is involved with MRI Direct multiplanar image is possible without reorienting the patient.

Disadvantages:

Long imaging time.

Potential hazard imposed by the presence of ferromagnetic metals in the vicinity of the imaging magnet.

References
1. Pulse oximetry as a diagnostic tool of pulp vitality .JOE,1991 vol 17 ,488-90 2. Pulpal blood flow assessed by laser Doppler flowmetry in a tooth with horizontal root fracture. Oral surgery oral med oral path,feb 1996,vol 81, 229-33 3. Three dimensional quantization of periradicular bone destruction by micro-computed tomography. JOE,2003 vol 29 , 252-56

Conclusion