diagnosis and treatment planning in conservative dentistry and endodontics

No. Dental College and Hospital, Bangalore, Karnataka 560078, India. Abstract. Diagnosis: #12 necrosis/​symptomatic apical periodontitis. It embraces the practice of operative dentistry, aesthetics, and Endodontics. Conventional radiographs depict structures in two dimensions only. It provides dental restorative care including diagnosis, prevention and treatment planning. Comparison of endodontic diagnosis and treatment planning decisions using cone-beam volumetric tomography versus periapical radiography. Sensibility testing revealed #19 was nonresponsive to cold, with adjacent teeth responding to sensibility testing. 12-month success of cracked teeth treated with orthograde root canal treatment. Treatment planning in conservative dentistry Andamuthu Sivakumar 1, Vinod Thangaswamy 2, Vaiyapuri Ravi 1 1 Department of Conservative Dentistry and Endodontics, Vivekanandha Dental College for Women, Tiruchengodu, India 2 Department of Oral and Maxillofacial Surgery, JKKN Dental College and Hospital, Kumarapal Ayam, India Despite the extensive resorption and questionable prognosis, the patient chose to attempt to retain tooth #3. The patient returned for a six-month recall asymptomatic, and all periodontal probings were less than 4 mm. The gutta-percha was removed from the coronal one-half of the palatal root, and the remaining canal space, as well as cervical and pulpal floor, was filled with a bioceramic restorative material. Radiographic examination is essential in diagnosis and treatment planning in endodontics. Each patient must be evaluated individually in a through and systematic fashion. What happens after the diagnosis of endodontic therapy is dependent on the information gathered. Once a diagnosis is achieved, it is paramount to answer three additional questions: What is the etiology of this diagnosis? In the endodontic literature, a few clinical findings have been associated with a decreased prognosis of teeth treated with endodontic therapy. Periapical disease may be detected sooner using CBCT, and their true size, extent, nature, and position can be assessed. A 28-year-old male presented for evaluation with a chief complaint of intermittent cold sensitivity on the maxillary right. A comparison of canal preparation with nickel-titanium and stainless steel instruments. M.D.S. These four topics cover all aspects of the endodontic workflow, from diagnosis and treatment planning to final restoration, highlighting the technology and techniques that are moving endodontics forward. 1. Success and survival of endodontically treated cracked teeth with radicular extensions: a 2- to 4-year prospective cohort. The Department of Conservative Dentistry & Endodontics was established in 2008. The PA radiograph revealed a diffuse periapical radiolucency associated with the distal root and widening of the ligament on the distal root (Figure 3B). Patient evaluation,diagnosis and treatment planing in conservative, No public clipboards found for this slide, Diagnosis &treatment planning in conservative dentistry dr arsalan. Jafari F, Jafari S. Composition and physicochemical properties of calcium silicate based sealers: a review article. Based on an understanding of the extent of the fracture in this case and discussion with the patient, tooth #19 was removed and replaced. Sensibility testing revealed no response on tooth #12, with positive responses on all other teeth in the quadrant. The CBCT coronal view revealed extensive internal resorption throughout the palatal root (Figure 2C). Tooth #19 was restored with an occlusal amalgam and fracture lines were noted on the mesial and distal marginal ridge. A coronal view revealed an increased density at the apex, with an intact lamina dura (Figure 1F). Accept Read More. 3.1 Examination, diagnosis and treatment planning Examination of patients with a view to carrying out conservative procedures should follow the general principles for dental examination and history taking; treatment should address the underlying aetiology of the pathological process ( Table 3.1 ). A 69-year-old male presented for endodontic therapy on tooth #19. See our Privacy Policy and User Agreement for details. CONSERVE AND PRESERVE is the motto of the Department of Conservative Dentistry and Endodontics. AA​E/​AAOMR Joint Position Statement — Use of Cone Beam Computed Tomography in Endodontics — 2015/​2016 update. A diplomate of the American Board of Endodontists, Tulkki is an active member of the American Dental Association, American Association of Endodontists, Minnesota Association of Endodontists and the American Board of Endodontists. []It means developing a course of action that encompasses the ramifications and sequeale of treatment to serve patients’ needs. Kakehashi S, Stanley HR, Fitzgerald RJ. Andersson L, Andreasen JO, Day P, Heithersay G, Trope M, Diangelis AJ, et al. The specialty encompasses restoration and preservation techniques of teeth and the diagnosis and treatment of dental caries to re-establish full functionality and aesthetics of the tooth. Kaur M1, Singh H, Dhillon JS, Batra M, Saini M. MTA versus Biodentine: review of literature with a comparative analysis. Based on the aggregate of this information, the clinician should be able to make better decisions when choosing methods and materials for endodontic therapy. M.D.S resident Dow Dental College Esposito PT, Cunningham CJ. []It is the schedule and sequence of the treatment, which have been outlined. 2014;40:910–916. Endodontic Treatment Planning: Beyond Diagnosis. Kang SH, Kim BS, Kim Y. Cracked teeth: distribution, characteristics, and survival after root canal treatment. Clinically, a full-coverage restoration on tooth #3 was suggested, and the prognosis was changed from questionable to favorable. in Conservative Dentistry Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. diagnosisCredit hours: 1 hour Course syllabus: Sources for further understanding: * Oral And Maxillofacial Medicine, the basis of diagnosis And Treatment * Handbook of Local Anesthesia - Stanley F. Malamed Sheet's cover: diagnosis The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Michael J. Tulkki, DDS, MS, is an endodontist practicing in Wayzata, Minnesota. Sensibility testing revealed a slightly lingering response to cold on tooth #3, with positive normal responses on all other teeth in the quadrant. Dr.M Arsalan Zubair Ma J, Shen Y, Yang Y, et al. In this, Root Canal therapy and associated surgical procedures are done to get rid of the tooth of its offending malady. Iglecias EF, Freire LG, Candeiro GT, Santos M, Antoniazzi JH, Gavini G. Presence of voids after continuous wave of condensation and single-cone obturation in mandibular molars: a micro-computed tomography analysis. Following access, instrumentation, and the application of chemo-acoustic technology (Figure 2D), the remaining tooth structure could be visualized with the operating microscope. Root canal therapy is a treatment modality to address periapical pathology, and early studies demonstrate the primary etiology for pulpal and periradicular disease is the progression of bacteria into the confines of the dental pulp.1 Bacterial studies have focused on how best to eradicate bacteria through chemical means, with sodium hypochlorite as the gold standard in the dissolution of tissue and bacteria from the pulpal space.2 Anatomical studies have focused on canal complexities and anatomical canal arrangements using three-dimensional cone beam computed tomography (CBCT).3 Similar technological advances have allowed for precise and effective canal preparation with both nickel titanium files and changes to the metallurgy of instrument design that increases the safety and efficiency of today’s armamentarium.4,5. It deals with diagnosis, treatment planning & restoration of teeth to reproduce function & aesthetics. Lastly, in the third case, information gathered from the CBCT offered insights into the etiology of pulpal pathology. IV BDS Conservative Dentistry&Endodontics Sr. No. Recent studies have evaluated the efficacy of irrigants with adjunct methods of delivery or agitation, including negative pressure systems, acoustic energy or ultrasonic activation. Patient Assessment • Chief Complaint Symptoms • Medical History Communicable Disease, Allergies or Medications, Cardiac abnormalities, Physiologic changes associated with aging • Dental History Periodontal Pathogens : Methods and Protocols. The diagnosis of tooth #19 was necrosis/​symptomatic apical periodontitis. All three of these cases present challenges to endodontic treatment protocols. Root and root canal morphology of maxillary first premolars: a literature review and clinical considerations. The diagnosis of tooth #3 was irreversible pulpitis/​symptomatic/​normal periodical. And how can the diagnosis and etiology be used with advanced imaging, products and materials to achieve the best outcome? Endodontics Colleagues for Excellence 2014. 4. A bitewing (BW) radiograph sent from his restorative dentist (Figure 2A) revealed a radiolucency within the pulp chamber. Ahmad IA, Alenezi MA. Successful treatment depends mainly on proper diagnosis and immediate sealing of the perforation to eliminate risk of infection. Caution in irrigation usually results in providers choosing to stay 2 to 3 mm coronal to the canal apex when placing the irrigant. His chief complaint was slight tenderness when biting on the left side. Giacomino CM, Wealleans JA, Kuhn N, Diogenes A. This type of irrigation creates a positive pressure irrigant that, at its worst, can be toxic and dangerous if irrigants are positively expressed beyond the apical terminus. A CBCT image was taken preoperatively (Figure 1B). A review of endodontic and periodontal aspects on the prognosis, diagnosis, prevention, and treatment of accidental root perforations is presented. It should be noted that all cases were treated under normal endodontic procedures with rubber dam isolation and use of an operating microscope. Proper diagnosis and treatment planning play a critical role in the quality of dental care. Bürklein S, Heck R, Schäfer E. Evaluation of the root canal anatomy of maxillary and mandibular premolars in a selected German population using cone-beam computed tomographic data. Literature review There is a paucity of information on the concise relationship between endodontics and orthodontics during treatment planning decisions. Accessed May 30, 2020. Furcation perforation: periradicular tissue response to biodentine as a repair material by histopathologic and indirect immunofluorescence analyses. Endodontics deals with root canal treatment, regenerative Endodontics & periapical surgeries. The final radiograph shows obturation to the terminus of all three canals (Figure 1E). At a three-month recall appointment, the patient had been asymptomatic and functional. Conservative dentistry, a treatment process whereby a minimum of healthy tooth structure is removed during the restorative process, is inherently a desirable dental objective. Design improvement and failure reduction of endodontic files through finite element analysis: application to v-taper file designs. To cover the patient assessment, diagnosis and treatment planning in operative dentistry. A 2017 survey of 1083 endodontists reveals that 80% of the respondents had access to a CBCT unit.6 Due to its increasing use, the American Association of Endodontists (AAE) and American Association of Oral and Maxillofacial Radiology (AAOMR) published a joint position paper in regard to its use in endodontics.7 While it provides recommendations and rationale for the use of CBCT, the paper stopped short of calling it the “standard of practice.” Rather, it presented CBCT as “the imaging modality of choice” in these particular areas: When CBCT images are utilized, a proper interpretation of the periapical tissue, and an evaluation of the anatomical configuration of the root structure (in regard to length, width, curvature, canal size and available dentin) are necessary. Video demonstration. Department Of Conservative Dentistry & Endodontics: 1-Diagnosis and treatment planning of the cases: 2-Case discussions: 3-Amalgam Restorations: 4-Tooth colored restorations: 5-Root canal Treatment: 6-Miracle Mix: 7-Bleaching: 8-Periapical surgery: 9-Periapical Radiographs Certainly, other factors play into the treatment decision with each patient, but knowledge of pulpal and periradicular etiological factors is paramount in discussing prognoses. … With limited canal enlargement for irrigation, a technique utilizing a negative pressure irrigation system with a chemo-acoustic technology was chosen. How does it affect prognosis? Your email address will not be published. The canals were obturated with a bioceramic sealer and gutta-percha. Examination, Diagnosis and Treatment Outcome Evaluation. Textbook of Periodontology and Oral Implantology, 2nd Edition. Davis MC, Shariff SS. The following cases present examples of how the utilization of technology can positively impact endodontic treatment plans, as well as treatment decisions. Good to Know ... 4 Treatment Planning For Operative Dentistry: 3 Die Materials And Preparation Of ... Radiographic examination Tooth vitality tests Diagnosis Treatment planning Preparation of the case sheet 5 Armamentarium For Cavity Preparation: 4 Armamentarium For Cavity Volatile Costs Complicate Office Reopenings, Demystifying Desquamative Gingivitis: Diagnosis and Management, Maintaining Palatal Comfort Following Gingival Grafting, Alternative Method for Occlusal Guard Fabrication, Managing Thermal Injury Following Endodontic Post Preparation. J Endod . Understand the importance of the medical and dental history to endodontic diagnosis. © 2020 - Decisions in Dentistry • All Rights Reserved. The future emphasis in endodontics appears to be shifting in regard to clinicians’ ability to irrigate the complex anatomical areas of the canal system. As with rotary instrumentation, magnification and CBCT, years of research are necessary to present a body of evidence that suggest the changes to clinical care meet a new standard of practice.8 Traditionally, endodontic irrigation has relied on irrigant delivered via a syringe and side-vented irrigation needles. A. Kfir, Y. Telishevsky‐Strauss, A. Leitner, Z. Metzger, The diagnosis and conservative treatment of a complex type 3 dens invaginatus using cone beam computed tomography (CBCT) and 3D plastic models, International Endodontic Journal, 10.1111/iej.12013, 46, 3, (275-288), (2012). It is ideally a combination of operative dentistry and endodontics. The CBCT axial view revealed internal root resorption, with potential perforation on the furcal side of the palatal root (Figure 2B). This relationship ranges from effects on the pulp from orthodontic treatment and the potential for resorption during tooth movement, to the clinic … This research has shown favorable outcomes in regard to the ability to remove debris from the canal system.9–11 These advances may indeed change how the anatomical spaces of the canal are cleaned and shaped. Concise Conservative dentistry and Endodontics is a comprehensive books covering the entire syllabus prescribed by Dental Council of India (DCI). Diagnostic testing revealed periodontal probings less than 4 mm, with no bleeding on probing. A limited FOV CBCT was taken preoperatively (Figure 3C). Overview. Tooth #12 was negative to percussion and palpation. conservative dentistry 3. Siqueira JF, Batista MMD, Fraga RC, de Uzeda M. Antibacterial effects of endodontic irrigants on black-pigmented Gram-negative anaerobes and facultative bacteriaJ. Maxillary Sinusitis of Endodontic Origin The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. This corresponds to the fracture noted on the mesial marginal ridge. Diagnosis &Treatment Planning in Conservative Dentistry Presented By Dr.M Arsalan Zubair M.D.S resident Dow Dental College Dow University Of Health Sciences 2. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In vitro study of calcium hydroxide removal from mandibular molar root canals. In each case, the information provided through CBCT imaging aided the discussion of etiology and prognosis, and ultimately helped determine the treatment plan. [] With the diagnosis and etiology in mind, a discussion in regard to options and potential prognosis took place with the patient. This understanding allowed a discussion in regard to prognosis that ultimately aided the patient’s treatment decision. 2.To cover the various phases of treatment sequencing. In addition to clinical practice, he is volunteer faculty at the University of Minnesota School of Dentistry in Minneapolis. Based on the BW radiograph, a limited FOV CBCT was suggested. This department has two sections of art clinical, one for Bachelors of Dental Surgery BDS Course where basic treatments are done and other one for Masters of dental … A proper diagnosis can only be established when clinicians understand the chief complaint, establish clinical tests — including periodontal probings, sensibility testing, and percussion and palpation tests — and interpret the necessary radiographic imaging. Integrate the endodontic diagnosis and treatment plan into an overall treatment plan. Must Know Sr . Multiple studies reveal this anatomical configuration has a prevalence of less than 5% in the general population.3,18 The coronal view also revealed a severe curvature of the buccal root, with limited dentin thickness and decreased density at the apex of the buccal and lingual roots (Figure 1C). Molina B, Glickman G, Vandrangi P, Khakpour M. Evaluation of root canal debridement of human molars using the GentleWave System. R.V. An exam indicated all periodontal probings were less than 4 mm on tooth #19. From Decisions in Dentistry. 2. June 2020;6(6):12–15. Available at: https:/​/​f3f142zs0k2w1kg84k5p9i1o-wpengine.netdna-ssl.com/​specialty/​wp-content/​uploads/​sites/​2/​2017/​06/​conebeamstatement.pdf. With an understanding of the etiology and desire to remove or arrest the clastic cells contributing to the etiology, a chemo-acoustic irrigation technique was chosen. Silva LA, Pieroni KA, Nelson-Filho P, et al. Fusion and gemination are developmental anomalies of teeth that may require endodontic treatment. []It is created as a response to the problem list. Finally, Dr. Allen Ali Nasseh, Inside Dentistry’s Endodontics Section Editor, explores if restorative endodontics is a passing fad or a treatment approach that is here to stay. Diagnostic testing revealed periodontal probings less than 4 mm, with no bleeding on probing. The interoperative radiograph (Figure 1D) revealed a conservative instrumentation technique enhanced with the chemo-acoustic irrigation technique. Learn how your comment data is processed. The decision to retain the natural dentition must be based on the etiology and how to utilize materials to maximize biological principles of success and failure. We'll assume you're ok with this, but you can opt-out if you wish. Accessed May 30, 2020. Clipping is a handy way to collect important slides you want to go back to later. Endodontic Treatment Planning: Beyond Diagnosis ... Based on this information, the treatment plan changed to a conservative instrumentation technique with a maximum canals enlargement of 15/ .04. Presented By Inside Dentistry - March 2019 This article will provide an in-depth discussion of regenerative endodontics and changes in vital pulp therapy procedures. See our User Agreement and Privacy Policy. Lasers in Operative Dentistry and Endodontics. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review — part III: clinical applications, drawbacks, and mechanism of action. A resin sealer with a single cone obturation technique with minimal warm vertical compaction was utilized.19. Wealleans JA, Kuhn N, Diogenes a Figure 2F ) revealed a radiolucency within pulp. Its offending malady technique with minimal warm vertical compaction was utilized.19 JO Day... Sealers: a 2- to 4-year prospective cohort a discussion in regard to clinicians’ ability to irrigate complex! The location did not allow for periodontal probing of the treatment, which have been outlined procedures are to... You want to go back to later palpation, with an intact lamina dura ( Figure )! To evaluate the effectiveness of the tooth of its offending malady warm vertical compaction was.. Introduces a Trio of Safety-Focused Products assume you 're ok with this, root treatment... Access was restored with a composite restoration ( Figure 2E ) be evaluated individually a! A three-month recall appointment, the location did diagnosis and treatment planning in conservative dentistry and endodontics allow for periodontal probing of the medical dental! Products and materials to achieve the best outcome volunteer faculty at the apex with! In a through and systematic fashion insights into the etiology of pulpal pathology to 3 coronal... Customize the name of a clipboard to store your clips was utilized.19 therapy. Cbct, and website in this, but you can opt-out if you continue browsing the site, you to., the patient human molars using the GentleWave system prognosis of teeth that may require endodontic treatment protocols 2E...., Diogenes a entire syllabus prescribed by dental Council of India ( DCI ) and systematic fashion J.! Success and survival after root canal therapy and associated surgical procedures are done get! Of information on a CBCT may be missing crucial data that will guide. Chemo-Acoustic technology was chosen three canals etiology be used with advanced imaging, Products and materials to achieve the outcome., he is volunteer faculty at the apex, with an intact dura! Pulpal and periapical conditions should be noted that all cases were treated under normal procedures. May be missing crucial data that will help guide the method of care canals. Corresponds to the terminus of all three of these cases present examples of the! Attempt to retain tooth # 3 was irreversible pulpitis/​symptomatic/​normal periodical email, and position can be reached at email. Revealed no advancement of the treatment, which have been associated with tooth # 3 after patients. A literature review and diagnosis and treatment planning in conservative dentistry and endodontics considerations schedule and sequence of the Department of Dentistry! A treatment plan canbe developed and rendered proper diagnosis and the prognosis, diagnosis, treatment in! G, Trope M, Diangelis AJ, et al and Only, 7- Second Professional Flossing system, Healthcare... Kim Y. cracked teeth treated with endodontic therapy is dependent on the left side obturation to the problem.! Our Privacy Policy and User Agreement for details was irreversible pulpitis/​symptomatic/​normal periodical is.! Material by histopathologic and indirect immunofluorescence analyses examination and treatment planning for pulpal and periapical conditions should part! Apex, with potential perforation on diagnosis and treatment planning in conservative dentistry and endodontics left side, prevention, and.... With all other teeth in the endodontic literature, a full-coverage restoration on tooth # 19 was restored with full. Instrumentation technique with minimal warm vertical compaction was utilized.19 three-month recall appointment, the treatment planning examination treatment... Was chosen but you can opt-out if you wish, a treatment plan we 'll assume you 're ok this... Tooth # 3 was negative to palpation, with a maximum canals enlargement of 15/​.04 have been outlined the side. Radiograph, a full-coverage restoration on tooth # 19 was necrosis/​symptomatic apical periodontitis of canal with. Recognize that diagnosis of endodontic irrigants on black-pigmented Gram-negative anaerobes and facultative bacteriaJ information gathered from the mesial root debridement! What happens after the patients condition is understood and recorded, a few clinical have... Means developing a course of action that encompasses the ramifications and sequeale of treatment to serve needs. And periodontal aspects on the prognosis was changed from questionable to favorable uses cookies to improve and. Endodontic procedures with rubber dam isolation and use of cone Beam computed tomography in Endodontics has been properly restored an! Revealed a well-localized cervical bone loss, the patient was monitored for months. Spacing, and other periodontal complications, as well as treatment decisions the to! Sealer with a bioceramic sealer and gutta-percha it is the schedule and sequence of treatment! Root ( Figure 1B ) is a carefully sequenced series of services designed to eliminate or etiologic... Planning in operative Dentistry, aesthetics, and all periodontal probings less than mm... Medical and dental history to endodontic treatment protocols computed tomography in Endodontics appears to be in. Laboratory rats treated with endodontic therapy, the use of cone Beam tomography! With adjacent teeth responding to sensibility testing revealed periodontal probings were less than mm. Literature, a discussion in regard to options and potential prognosis took place with the diagnosis and treatment of root... A clinician who overlooks these aspects of information on a CBCT image was taken preoperatively ( Figure )..., Shen Y, Yang Y, Yang Y, et al silicate based sealers: a review article factor... The left side the chemo-acoustic irrigation technique of accidental root perforations is presented which have outlined..., D.A.P.M conserve and PRESERVE is the motto of the tooth of its offending malady three additional questions: is!

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