Resolving the Pluzzle of Diagnosis in Endodontics

ABSTRACT
The diagnostic approach to pulpal and periapical disease is usually a complex process, that requires combination analysis of symptoms and radiographic findings. Endodontic diagnosis is similar to a jigsaw puzzle, as it cannot be made from a single isolated piece of information. The clinician must systematically gather all of the necessary information to make a “probable” diagnosis. The clinical and radiographic examinations in combination with a thorough periodontal evaluation and clinical testing (pulp and periapical tests) are prerequisite in order to confirm the preliminary diagnosis. In some cases, the clinical and radiographic examinations give conflicting results specific diagnoses cannot be made. Treatment should not be rendered without a diagnosis and in these situations, we may have to wait and be reassessed at a later date. In particular, the diagnosis is based on data obtained from medical and dental history, responses to pulp sensibility tests and radiographic interpretation. Clinical examination and modern imaging techniques contribute significantly to the aforementioned goals. As part of this presentation, a brief reference to symptoms and signs of pulpal and periapical diseases and presentation of the modern classification of those diseases will be done. Well-defined radiolucent lesions surrounding teeth may present difficulties in differential diagnosis and in determining treatment strategies. There are some lesions that appear in periapical regions mimicking an endodontic lesion due to pulp necrosis. Most of them are developmental cysts, or odontogenic tumours, such as ameloblastoma or malignant lesions may also be found. Volume tomography with CBCT, when used in accordance with the current European Commission guidelines, is recommended for complex endodontic problems. In this webinar we will analyze step by step the diagnostic procedure in endodontics, as well as complex diagnostic cases. We will also learn which medical conditions may present with dental or orofacial pain, and how we can reach to the right diagnosis and treatment.