Clinical Endodontics (eBook)

Brooke Blicher, Rebekah Lucier Pryles, Jarshen Lin, Alice Li (Autoren)

eBook Download: EPUB

2024 | 1. Auflage
244 Seiten
Quintessence Publishing Co Inc USA (Verlag)
978-1-64724-185-8 (ISBN)

Infos

This straightforward clinical manual covers everything dentists need to know about basic endodontics. The essentials of endodontic examination and diagnosis, pharmacology, surgical and nonsurgical treatment, vital pulp therapy, emergency treatment, complication management, and more are all reviewed here. The quick guide accompanying the main text is an invaluable reference tool, providing step-by-step instructions for performing procedures and lists of required materials to ensure a well-stocked clinic.

Brooke Blicher, DMD Dr Brooke Blicher received her BA in chemistry from Colgate University, where she graduated Magna Cum Laude and Phi Beta Kappa; was awarded her DMD from Harvard School of Dental Medicine, where she graduated with honors in research; and earned her certificate in endodontics from Tufts University School of Dental Medicine. Dr Blicher is a Diplomate of the American Board of Endodontics and a Fellow in both the American College of dentistry and the international College of Dentistry. She continues to be involved in teaching, research, and mentorship, and holds faculty appointments at the dental schools at both Harvard and Tufts. She is involved in organized dentistry and is a member of several committees for the American Association of Endodontists and local and state dental societies. Dr Blicher continues to pursue her academic interests while providing state-of-the-art specialty care at her private practice in White River Junction, Vermont. She authored the chapter 'Diagnosis and Treatment Planning' in the sixth edition of Endodontics: Principles and Practice, edited by Mahmoud Torabinejad, Ashraf Fouad, and Shakrokh Shabahang, and coauthored the textbook Endodontics: A Review, now in its second edition. She has published extensively, including in the Journal of Dental Research, General Dentistry, Inside Dentistry, and Compendium. Dr Blicher has lectured locally and internationally on endodontic diagnosis, nonodontogenic pain, fractures, trauma, resorption, the treatment of immature teeth, and CBCTs in endodontics, as well as on restorative care following endodontic treatment. Rebekah Lucier Pryles, DMD Dr Rebekah Lucier Pryles received her DMD and her certificate in endodontics from Tufts University School of Dental Medicine. She continues to be involved in teaching and research and holds a faculty appointment at her alma mater as well as at the Harvard School of Dental Medicine. She is a Diplomate of the American Board of Endodontics and a fellow in both the American and International College of Dentistry. She was awarded the ADA's 10 Under 10 Award for 2020. Dr Lucier Pryles is involved in organized dentistry, and is the former President of the Vermont State Dental Society. While providing state of the art specialty care in her private practice in White River Junction, Vermont, she continues to pursue her academic interests. Dr Lucier Pryles co-wrote Endodontics: A Review, with Dr Brooke Blicher and Dr Jarshen Lin. She has published extensively, including in Inside Dentistry and The Journal of Periodontics. Along with Dr Brooke Blicher, Dr Lucier Pryles has lectured locally and internationally on endodontic diagnosis, nonodontogenic pain, fractures, trauma, resorption, treatment of immature teeth, and CBCT in endodontics, as well as on ideal restorative care following endodontic treatment. Alice Li, DMD Dr Alice Li earned her DMD degree from Harvard School of Dental Medicine in 2023. As a student, she helped create My Dental Key, an online platform that aims to enhance dental education worldwide. Dr Li combined her interest in endodontics with her artistic skills to illustrate for this textbook, and she is currently pursuing her certificate in endodontics at Harvard School of Dental Medicine. In her free time, Dr Li enjoys hiking, camping, playing board games, finding new creative hobbies, and trying different cuisines in and around Boston.

Inhalt

Examination Protocols Part 1. Establishing a Diagnosis
Chapter 01. Examination Protocols
Chapter 02. The Definitive Diagnosis

Part 2. Management of Endodontic Pathology
Chapter 03. Diagnosis-Driven Treatment Planning
Chapter 04. Pharmacology
Chapter 05. Nonsurgical Endodontics
Chapter 06. Nonsurgical Retreatment
Chapter 07. Apical Microsurgery
Chapter 08. Vital Pulp Therapy
Chapter 09. Treatment of Immature Necrotic Teeth
Chapter 10. Emergency Treatment and Complication Management

Part 3. Adjunctive Endodontic: Diagnosis and Treatments
Chapter 11. Fractures
Chapter 12. Resorption
Chapter 13. Periodontal-Endodontic Infections
Chapter 14. Traumatic Dental Injuries
Glossary
Index

Textauszug

2 The Definitive Diagnosis

The data collected from the subjective and objective examinations is what directly facilitates the development of a definitive diagnosis. While the great majority of pain and infection in the orofacial region relates to endodontic pathology, clinicians must also be aware of nonendodontic diseases that may present similarly. This chapter reviews the diagnosis of endodontic pathology and its adjuncts, as well as common differential diagnoses.

Diagnosis of Endodontic Pathology

Every endodontic diagnosis consists of two parts: the pulpal diagnosis and the periapical diagnosis (Fig 2-1).1 These diagnoses are developed based on the results of the clinical and radiographic examinations. The diagnostic terminology for both the pulpal and periapical diagnosis is defined in the glossary of this book, and the clinical test results used to establish these diagnoses are organized in Tables 2-1 and 2-2. The pulpal and periapical diagnoses are separate but related entities. Certain pulpal diagnoses correlate with certain periapical diagnoses (Fig 2-2), and typical patterns emerge in diagnosis.

Fig 2-1 Pulpal and periapical diagnoses.1

Table 2-1 Subjective and objective findings corresponding to pulpal diagnostic categories

Pulpal diagnosis	Chief complaint	Thermal testing	Electric pulp testing	Radiographic findings (apex)

Normal

NA

+

+

Normal

Reversible pulpitis

Cold sensitivity

++

+

Normal

Asymptomatic irreversible pulpitis

NA

+ or ++

+

Normal or widened PDL

Symptomatic irreversible pulpitis

Cold and/or heat sensitivity, spontaneous pain, radiating pain

++ with lingering pain

+

Normal, widened PDL, or PARL

Pulp necrosis

Variable

–

–

Normal, widened PDL, or PARL

Previously treated

Variable

– (potential + if untreated anatomy present)

–

Normal, widened PDL, or PARL

Previously initiated

Variable

– (potential + if untreated anatomy present)

–

Normal, widened PDL, or PARL

+ = response similar to controls; ++ = heightened response; – = no response; PDL = periodontal ligament; PARL = periapical radiolucency.

Table 2-2 Subjective and objective findings corresponding to periapical diagnostic categories

Periapical diagnosis	Chief complaint	Percussion	Palpation	Radiographic findings (apex)

Normal

NA

–

–

Normal

Symptomatic apical periodontitis

Sensitivity to chewing or pressure

+

+

Normal, widened PDL, or PARL

Asymptomatic apical periodontitis

NA

–

–

Widened PDL or PARL

Chronic apical abscess

Intermittent discharge of pus through sinus tract, minimal discomfort

–

–

PARL

Acute apical abscess

Swelling, rapid onset of pain

+

+

Widened PDL or PARL

Condensing osteitis (rare)

Variable

+/–

+/–

Apical radiopacity

+ = greater sensitivity than controls; – = similar to control responses; PARL = periapical radiolucency; PDL = periodontal ligament.

Fig 2-2 Common combinations of pulpal and periapical diagnoses.

Though diagnosis-specific clinical and radiographic findings are generally well defined, the chief complaint may be variable, particularly for teeth with necrotic pulps or teeth that were previously endodontically treated or where endodontic treatment was initiated. For example, a previously treated tooth containing untreated anatomy may present with a history of heat sensitivity as well as biting tenderness (Fig 2-3). Teeth with vital pulp tissue can similarly present in a myriad of symptomatic and asymptomatic states. Additionally, radiographic findings may be limited by anatomical noise when 2D imaging is used,2 though CBCT imaging will overcome these limitations to showcase apical pathology whenever present.3 For example, although periapical radiolucencies in the posterior maxilla are difficult to visualize with periapical imaging due to overlap with the maxillary sinus, CBCT removes this obstruction4 (Fig 2-4).

Fig 2-3 Heat sensitivity may develop in previously endodontically treated teeth with untreated canals. (a) This patient presented with a chief complaint of heat sensitivity in the right maxilla that was localized to the maxillary right first molar during testing. (b) Preoperative CBCT imaging revealed an untreated second mesiobuccal canal. (c) Retreatment of the tooth resolved symptoms.

Fig 2-4 Periapical pathology is often much more apparent on CBCT imaging than periapical imaging due to anatomical noise, particularly in the posterior maxilla. In this case, periapical pathology was suspected only in the maxillary right first molar when studied with periapical imaging (a) but confirmed to extend also to the second molar in the sagittal section of CBCT imaging (b).

Adjunctive endodontic diagnoses

Beyond the pulpal and periapical diagnoses defined for each endodontically involved tooth, certain teeth have comorbid conditions either causing the endodontic pathology or increasing its complexity. These adjunctive diagnoses include fractures, resorption, periodontal-endodontic infections, and traumatic dental injuries, described in detail in part III. It is important for the diagnosing clinician to understand and define these conditions because they greatly impact management strategies. Each condition involves its own nuanced diagnostic methodology and criteria and management strategy.

Maxillary sinusitis of endodontic origin

Not only can nonodontogenic sinus pathology produce dental symptoms including thermal sensitivity and pressure discomfort, but dental pathology also has the ability to produce unilateral sinus disease. The latter effect has long been recognized by the medical community. Otolaryngologists often refer patients with unilateral sinusitis for dental evaluation.5,6 This pathologic extension of endodontic disease into the maxillary sinus, referred to as maxillary sinusitis of endodontic origin (MSEO), should be considered in the context of adjunctive endodontic pathology.7

Whenever sinus pathology is present secondary to endodontic disease, patients will often volunteer a history of symptoms including low-grade nasal drainage, congestion, or headaches. Although 2D images rarely depict obvious signs of MSEO given the limitations of this modality in visualizing the sinus,2 CBCT images readily depict sinus pathology.4 The earliest and most common sign of MSEO is periapical mucositis, a thickening of the sinus mucosa greater than 2 mm often creating a dome-shaped appearance adjacent to the apex of an infected tooth.8,9 Later stages of MSEO present with periapical osteoperiostitis, an osteogenic reaction that elevates the sinus periosteum into the sinus. This creates a corticated border superior to the periapical lesion that may close around the lesion or open and drain into the adjacent sinus cavity. MSEO may also present as unilateral opacification of the entire maxillary sinus adjacent to the diseased tooth (Fig 2-5).

Fig 2-5 (a) Endodontic pathology in the posterior maxilla is often associated with periapical mucositis, even before pulp necrosis develops and apical radiolucencies are apparent. (b) Late stage MSEO is associated with periapical osteoperiostitis. (c) Severe MSEO is associated with unilateral opacification of the sinus. (d) Air bubbles may also be noted in the mucosa, suggestive of MSEO.

Endodontic treatment represents first line therapy for MSEO. It will typically resolve both mild sinonasal symptoms and radiographic sinus pathology7 (Fig 2-6). If symptoms remain or radiographic findings persist at follow-up, referral to otolaryngology specialists is advised. Patients with severe or chronic sinonasal symptoms or disease should be informed of the potential need for concomitant medical management of sinus disease, usually by way of saline irrigation and topical corticosteroids10 and possibly surgical interventions to facilitate...

Produkt-Details

• Erscheint lt. Verlag: 28.8.2024
• Verlagsort: Batavia
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin
• Schlagworte: Adjunctive Endodontic • Apical Microsurgery • Endodontics • Fractures • Immature Necrotic Teeth • Nonsurgical • Pathology • Periodontal-Endodontic Infections • pharmacology • traumatic dental injuries • Vital Pulp Therapy
• ISBN-10: 1-64724-185-5 / 1647241855
• ISBN-13: 978-1-64724-185-8 / 9781647241858