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Clinical Diagnosis and Treatment Planning

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Common Complications in Endodontics

Abstract

Establishing an accurate diagnosis (both pulpal and periapical) is the most important step in determining the appropriate treatment [1, 2]. If an incorrect diagnosis/assessment of the clinical findings is made, improper management may result often leading to confusion, for example, performing endodontic treatment when it is not needed or providing some other treatment when root canal treatment is indicated. Tooth pain is usually considered the worst and least tolerable kind of pain. It usually originates in dentine, pulp, or periapical tissue and is thus considered of endodontic origin. Therefore, 90% of all patients with orofacial pain require a thorough endodontic assessment and diagnosis, and 60% of them may require endodontic treatment. A proper diagnosis is only possible following the subjective description of complaints by the patient coupled with objective clinical findings. Identification of a coronal or radicular fracture is also important. Although this is not specifically a pulpal or periradicular diagnosis, but it is important to note that fractures may change the proposed treatment plan. Temporomandibular joint (TMJ) dysfunctions may also present as dental pain, so we should keep in mind the clinical presentation of patients with those symptoms as well.

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References

  1. Berman LH, Hartwell GR. Diagnosis. In: Cohen S, Hargreaves KM, editors. Pathways of the pulp. 11th ed. St. Louis: Mosby/Elsevier; 2011. p. 2–39.

    Chapter  Google Scholar 

  2. Schweitzer JL. The endodontic diagnostic puzzle. Gen Dent. 2009;57(6):560–7.

    PubMed  Google Scholar 

  3. Glickman GN. AAE consensus conference on diagnostic terminology: background and perspectives. J Endod. 2009;35:1619.

    Article  Google Scholar 

  4. AAE Consensus Conference. Recommended diagnostic terminology. J Endod. 2009;35:1634.

    Article  Google Scholar 

  5. American Association of Endodontists. Glossary of endodontic terms. 8. 2012. AAE Chicago.

    Google Scholar 

  6. Glickman GN, Bakland LK, Fouad AF, Hargreaves KM, Schwartz SA. Diagnostic terminology: report of an online survey. J Endod. 2009;35:1625.

    Article  Google Scholar 

  7. Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part 1: general information and thermal tests. Int Endod J. 2010;43:738–62.

    Article  Google Scholar 

  8. Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part II: electric pulp tests and test cavities. Int Endod J. 2010;43:945–58.

    Article  Google Scholar 

  9. Newton CW, Hoen MM, Goodis HE, Johnson BR, McClanahan SB. Identify and determine the metrics, hierarchy, and predictive value of all the parameters and/or methods used during endodontic diagnosis. J Endod. 2009;35:1635.

    Article  Google Scholar 

  10. Levin LG, Law AS, Holland GR, Abbot PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. J Endod. 2009;35:1645.

    Article  Google Scholar 

  11. Gutmann JL, Baumgartner JC, Gluskin AH, Hartwell GR, Walton RE. Identify and define all diagnostic terms for periapical/periradicular health and disease states. J Endod. 2009;35:1658.

    Article  Google Scholar 

  12. Rosenberg PA, Schindler WG, Krell KV, Hicks ML, Davis SB. Identify the endodontic treatment modalities. J Endod. 2009;35:1675.

    Article  Google Scholar 

  13. Sindet-Pedersen S, Petersen JK, Gotzsche PC. Incidence of pain conditions in dental practice in a Danish county. Community Dent Oral Epidemiol. 1985;13:244–6.

    Article  Google Scholar 

  14. McCarthy PJ, McClanahan S, Hodges J, Bowles WR. Frequency of localization of the painful tooth by patients presenting for an endodontic emergency. J Endod. 2010;36(5):801.

    Article  Google Scholar 

  15. American Association of Endodontists. AAE consensus conference recommended diagnostic terminology. J Endod. 2009;35:1634.

    Article  Google Scholar 

  16. Iqbal M, Kim S, Yoon F. An investigation into differential diagnosis of pulp and periapical pain: a PennEndo database study. J Endod. 2007;33:548–51.

    Article  Google Scholar 

  17. Zero DT, Zandona AF, Vail MM, Spolnik KJ. Dental caries and pulpal disease. Dent Clin N Am. 2011;55:29–46.

    Article  Google Scholar 

  18. Carrotte P. Endodontics: part 3. Treatment of endodontic emergencies. Br Dent J. 2004;197:299–305.

    Article  Google Scholar 

  19. Nalliah RP, Allareddy V, Elangovan S, Karimbux N, Lee MK, Gajendrareddy P, et al. Hospital emergency department visits attributed to pulpal and periapical disease in the United States in 2006. J Endod. 2011;37:6–9.

    Article  Google Scholar 

  20. Asgary S, Eghbal MJ. The effect of pulpotomy using a calcium-enriched mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: a randomized clinical trial. Odontology. 2010;98:126–33.

    Article  Google Scholar 

  21. Friedman S, Mor C. The success of endodontic therapy—healing and functionality. J Calif Dent Assoc. 2004;32:493–503.

    PubMed  Google Scholar 

  22. Montgomery S, Ferguson CD. Endodontics. Diagnostic, treatment planning, and prognostic considerations. Dent Clin N Am. 1986;30:533–48.

    PubMed  Google Scholar 

  23. Rosenberg P. Case selection and treatment planning. In: Cohen S, Burns R, editors. Pathways of the pulp. 8th ed. St Louis: Mosby; 2002. p. 91–102.

    Google Scholar 

  24. Wagnild GW, Mueller K. Restoration of the endodontically treated tooth. In: Cohen S, Burns R, editors. Pathways of the pulp. 8th ed. St Louis: Mosby; 2002. p. 765–95.

    Google Scholar 

  25. Marshall FJ. Planning endodontic treatment. Dent Clin N Am. 1979;23:495–518.

    PubMed  Google Scholar 

  26. Messer HH. Clinical judgement and decision making in endodontics. Aust Endod J. 1999;25:124–32.

    Article  Google Scholar 

  27. Pothukuchi K. Case assessment and treatment planning: what governs your decision to treat, refer or replace a tooth that potentially requires endodontic treatment? Aust Endod J. 2006;32:79–84.

    Article  Google Scholar 

  28. Kidd EAM, Smith BGN. Making clinical decisions. In: Kidd EAM, Smith BGN, editors. Pickard’s manual of operative dentistry. Oxford: Oxford University Press; 1998. p. 28–49.

    Google Scholar 

  29. Libman WJ, Nicholls JI. Load fatigue of teeth restored with cast posts and cores and complete crowns. Int J Prosthodont. 1995;8(2):155–61.

    PubMed  Google Scholar 

  30. Tan PL, Aquilino SA, Gratton DG, et al. In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations. J Prosthet Dent. 2005;93:331–6.

    Article  Google Scholar 

  31. Torabinejad M, Lemon RR. Procedural accidents. In: Walton R, Torabinjad M, editors. Principles and practice of endodontics. 3rd ed. Philadelphia: Saunders; 2002. p. 310–30.

    Google Scholar 

  32. Ingle JI, Simon JH, Machtou P, Bogaerts P. Outcome of endodontic treatment and re-treatment. In: Ingle JI, Bakland LK, editors. Endodontics. 5th ed. London: Decker; 2002. p. 748–57.

    Google Scholar 

  33. Kvinnsland I, Oswald RJ, Halse A, Gronningsaeter AG. A clinical and roentgenological study of 55 cases of root perforation. Int Endod J. 1989;22(2):75–84.

    Article  Google Scholar 

  34. Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto study. Phases I and II—orthograde retreatment. J Endod. 2004;30:627–33.

    Article  Google Scholar 

  35. Stewart T. Diagnosis and treatment planning are essential prior to commencing endodontic treatment: discuss this statement as it relates to clinical endodontic management. Aust Endod J. 2005;31:29–34.

    Article  Google Scholar 

  36. Vire D. Failure of endodontically treated teeth. J Endod. 1991;17:338–42.

    Article  Google Scholar 

  37. Friedman S. Considerations and concepts of case selection in the management of post-treatment endodontic disease (treatment failure). Endod Top. 2002;1:54–78.

    Article  Google Scholar 

  38. Heling I, Gorfil C, Slutzky H, Kopolovic K, Zalkind M, Slutzky-Goldberg I. Endodontic failure caused by inadequate restorative procedures: review and treatment recommendations. J Prosthet Dent. 2002;87:674–8.

    Article  Google Scholar 

  39. Kirkevang LL, Hörsted Bindslev P. Technical aspects of treatment in relation to treatment outcome. Endod Top. 2002;2:89–102.

    Article  Google Scholar 

  40. Gutmann JL. Clinical, radiographic, and histologic perspectives on success and failure in endodontics. Dent Clin N Am. 1992;36:379–92.

    PubMed  Google Scholar 

  41. American Association of Endodontists; American Academy of Oral and Maxillofacial Radiology. Use of cone-beam computed tomography in endodontics joint position statement of the American Association of Endodontists and the American Academy of oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:234–7.

    Article  Google Scholar 

  42. Patersson SS, Mitchell DF. Calciic metamorphosis of the dental pulp. Oral Surg Oral Med Oral Pathol. 1965;20(1):94–101.

    Article  Google Scholar 

  43. Oginni AO, Adekoya-Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dent Traumatol. 2009;25(6):620–5.

    Article  Google Scholar 

  44. Amir FA, Gutmann JL, Witherspoon DE. Calciic metamorphosis: a challenge in endodontic diagnosis and treatment. Quintessence Int. 2001;32(6):447–55.

    PubMed  Google Scholar 

  45. Tavares WLF, Lopes RCP, Menezes GB, Henriques LCF. Ribeiro- Sobrinho AP. Non-surgical treatment of pulp canal obliteration using contemporary endodontic techniques: case series. Dental Press Endod. 2012;2(1):52–8.

    Google Scholar 

  46. McCabe PS, Dummer PM. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J. 2012;45:177–97.

    Article  Google Scholar 

  47. American Association of Endodontics. Case difficulty assessment form and guidelines B. Chicago: American Association of Endodontists; 2006.

    Google Scholar 

  48. Krasner P, Rankow HJ. Anatomy of the pulp chamber floor. J Endod. 2004;30:5–16.

    Article  Google Scholar 

  49. Selden HS. The role of the dental operating microscope in improved non surgical treatment of calcified canals. Oral Surg Oral Med Oral Pathol. 1989;68:93–8.

    Article  Google Scholar 

  50. Johnson BR. Endodontic access. Gen Dent. 2009;57:570–7.

    PubMed  Google Scholar 

  51. Ngeow WC, Thong YL. Gaining access through a calcified pulp chamber: a clinical challenge. Int Endod J. 1998;31:367–71.

    Article  Google Scholar 

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Correspondence to Priyanka Jain M.Sc., M.D.S., B.D.S. .

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Jain, P. (2018). Clinical Diagnosis and Treatment Planning. In: Jain, P. (eds) Common Complications in Endodontics. Springer, Cham. https://doi.org/10.1007/978-3-319-60997-3_1

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  • DOI: https://doi.org/10.1007/978-3-319-60997-3_1

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