Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H....

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Endodontic Assessments in a Differential Diagnosis The Endodontic-Restorative Continuum Alan H. Gluskin DDS Alan H. Gluskin DDS Professor and Chair Professor and Chair Department of Endodontics Department of Endodontics

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Transcript of Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H....

Page 1: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Assessmentsin a Differential Diagnosis

The Endodontic-Restorative Continuum

Alan H. Gluskin DDSAlan H. Gluskin DDSProfessor and ChairProfessor and Chair

Department of EndodonticsDepartment of Endodontics

Page 2: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 3: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 4: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

The Role of Endodontic Vitality Testing

in aDifferential Diagnosis

Page 5: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 6: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 7: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Differential DiagnosisMedical / DentalMedical / Dental

Extraoral ExaminationExtraoral Examination

Intraoral ExaminationIntraoral Examination

Tactile ExamTactile Exam

Definitive DiagnosisDefinitive Diagnosis

Vitality TestsVitality Tests

RadiographsRadiographs

Page 8: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Extraoral Visual Examinations

Facial Facial Asymmetry Asymmetry

??Yes / NoYes / No

Aggressive Aggressive SwellingSwelling

??Yes / NoYes / No

Facial Facial InjuriesInjuries

??Yes / NoYes / No

Purulent Purulent DrainageDrainage

??Yes / NoYes / No

Page 9: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Intraoral Visual Examination

PalpationPalpation

RadiographsRadiographs

ProbingsProbings PercussionPercussionMobilityMobility

Page 10: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 11: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Palpation / Digital ExaminationPalpation ExaminationPalpation Examination

Light Digital PressureLight Digital Pressure

Soft TissuesSoft Tissues

LocationLocation

Indurated, Swollen Indurated, Swollen FluctuantFluctuant

Pain IntensityPain Intensity

No Pain, Tender, No Pain, Tender, Acute PainAcute Pain

Page 12: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 13: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 14: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 15: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Intraoral Visual Examination

Page 16: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 17: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 18: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 19: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

OopsOops

Page 20: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 21: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Assessmentsin a Differential Diagnosis

The Endodontic-Restorative Continuum

Alan H. Gluskin DDSAlan H. Gluskin DDSProfessor and ChairProfessor and Chair

Department of EndodonticsDepartment of Endodontics

Page 22: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Vitality Assessment & Tools

Thermal Thermal Cold HeatCold Heat

Vital Test Vital Test CavityCavity

Electric Electric Pulp Pulp

TesterTester

Selective Selective AnesthesiaAnesthesia

Tooth Tooth Slooth™Slooth™

Fiber Fiber Optic Optic LightLight

Tentative DiagnosisTentative Diagnosis

Page 23: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Establish A Point of Reference

Challenge Challenge Adjacent/ Adjacent/

Contralateral Contralateral ToothTooth

Challenge Challenge Opposing Opposing Tooth or Tooth or

ArchArch

Challenge Challenge Tooth in Tooth in QuestionQuestion

Challenge Challenge QuadrantQuadrant

Page 24: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Vitality Assessment & Tools

Thermal Thermal Cold HeatCold Heat

Vital Test Vital Test CavityCavity

Electric Electric Pulp Pulp

TesterTester

Selective Selective AnesthesiaAnesthesia

Tooth Tooth Slooth™Slooth™

Fiber Fiber Optic Optic LightLight

RadiographsRadiographs

Page 25: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Tooth Responses

Hypo Hypo ResponsiveResponsive

W.N.L. W.N.L. Hyper Hyper ResponsiveResponsive

Responses Responses From ToothFrom Tooth

(-)(-) (-) / (+)(-) / (+) (+ +) , (+ + +)(+ +) , (+ + +)

MomentaryMomentary LingersLingers SpontaneousSpontaneous

Page 26: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Differential DiagnosisMedical / DentalMedical / Dental

Extraoral ExaminationExtraoral Examination

Intraoral ExaminationIntraoral Examination

Tactile ExamTactile Exam

Definitive DiagnosisDefinitive Diagnosis

Vitality TestsVitality Tests

RadiographsRadiographs

Page 27: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Dental History - The Science

•Recognize

•Understanding

•Interpreting

Page 28: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Dental History - The Art

•Asking the RIGHT questions

•ACTIVE listening

Page 29: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Dental Emergencies

Tooth Tooth TraumaTrauma

ToothacheToothacheNon-Pulpal Non-Pulpal

InvolvementInvolvement

Tooth Tooth Knocked Knocked

OutOut

Loose Loose ToothTooth

Fractured Fractured ToothTooth

Chipped Chipped ToothToothConcussionConcussion

Page 30: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Diagnosing Oro-facial Pain

•Dental

•Non-Dental

Page 31: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Interpreting the Language of Pain

Subjective Subjective ColoringColoring AcuteAcute ChronicChronic

Low Low Grade Grade PainPain

Hx of Hx of PainPainIntenseIntenseSharpSharpSpon-Spon-

taneoustaneousDeep, Deep,

GnawingGnawing

Page 32: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Understanding the Language of Pain

SignsSigns SymptomsSymptoms

DentalDentalNon-DentalNon-DentalDentalDental Non-DentalNon-Dental

++

Page 33: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Inflammation• Cellular

• Neurologic

• Vascular

• Humoral

Page 34: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Language of Pulp PainDental PulpDental Pulp

Pulpal InflammationPulpal Inflammation

AsymptomaticAsymptomatic SymptomaticSymptomatic

AcuteAcute ChronicChronic

Page 35: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Physiology of Pulpal Pain

A-Delta A-Delta FibersFibers

PainPain

Human Human Dental PulpDental Pulp

Afferent Afferent ImpulsesImpulses

C-FibersC-Fibers

Page 36: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Physiology of Pulpal Pain

• A-delta Fibers:–Located in Pulp-Dentin Interface

–Myelinated–Large Diameter

Page 37: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

A-delta Fibers – Cold / HeatThermoreceptor for Pain

•Quick

•Sharp

•Short

Page 38: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Physiology of Pulpal Pain

• C- Fibers:

·Located Centrally in the Pulp

·Unmyelinated

·Small Diameter

Page 39: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

C-Fibers - HeatThermoreceptor for Pain

• Steady

• Dull / Gnawing

• Prolonged / Spontaneous

Page 40: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Acute Pulpal OriginAcute Pulpal Acute Pulpal PainPain

Temporary Temporary PainPain

Short Short DurationDuration

ColdCold

AbscessAbscessSpontaneousSpontaneous

ConstantConstant Pres-Pres-suresure

Swell-Swell-inging FeverFever

HeatHeat IncreaIncrea-sing-sing

Cold Cold HotHot

ThrobThrob-bing-bing

Cold Cold ReliefRelief

DiffuseDiffuse LocalizedLocalized

Page 41: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Chronic Pulpal OriginChronicChronicPulpal PainPulpal Pain

DullDull IntermittentIntermittent RecurrentRecurrent

DeepDeep

AcuteAcute

TolerableTolerable

AcuteAcute

AcuteAcute

AcuteAcute

Page 42: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Assessmentsin a Differential Diagnosis

The Endodontic-Restorative Continuum

Alan H. Gluskin DDSAlan H. Gluskin DDSProfessor and ChairProfessor and Chair

Department of EndodonticsDepartment of Endodontics

Page 43: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 44: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 45: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 46: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 47: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 48: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 49: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 50: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 51: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 52: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 53: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 54: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Mobility - DepressibilityExamination

Integrity

of the

Attachment Apparatus

Page 55: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Tooth Mobility EvaluationMobility Mobility

ExaminationExamination

Light Lateral Light Lateral PressuresPressures

Adjacent TeethAdjacent Teeth

Suspect TeethSuspect Teeth

Class IClass I Class IIClass II Class IIIClass III

Page 56: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 57: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 58: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 59: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Periodontal Ligament Reaction

Page 60: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

TraumaTrauma

Vital PulpVital PulpNecrotic Necrotic

PulpPulp

P.D.L. P.D.L. ReactionReaction

HealthyHealthy SickSickEgressing Egressing

OutOut

Perio Perio DiseaseDisease

Egressing Egressing OutOut

Page 61: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 62: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 63: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 64: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 65: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 66: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Thermal Responses

Page 67: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Cold Stimulus ChallengeCold Cold TestTest

ToothTooth

Ethyl ChlorideEthyl ChlorideRefrigerantsRefrigerants IceIce

Hyper Hyper ResponseResponse

CarbonCarbonIceIce

W.N.L.W.N.L. Hypo Hypo ResponseResponse ReliefRelief

Page 68: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 69: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 70: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 71: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Cold Test

Page 72: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 73: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Heat Challenge

Page 74: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 75: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 76: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Heat Stimulus ChallengeHeat Heat TestTest

ToothTooth

Warm Gutta Warm Gutta PerchaPercha

Hot Tap Hot Tap WaterWater

Hyper Hyper ResponseResponse

Rubber Disc Rubber Disc FrictionFriction

W.N.L.W.N.L. No No ResponseResponse

Delayed Delayed ResponseResponse

Page 77: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

EarlyEarly

Pulpal InjuryPulpal Injury

Thermal Thermal ChallengeChallenge

Normal PulpNormal Pulp Inflamed Inflamed PulpPulp Aged PulpAged Pulp

LateLate

Page 78: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Neural Responses

Page 79: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Electric Response AssessmentElectric Pulp Electric Pulp

TesterTester

Adjacent ToothAdjacent Tooth

Suspect ToothSuspect Tooth

Contralateral Contralateral ToothTooth

Hyper Hyper ResponseResponse W.N.L.W.N.L. Hypo Hypo

Response Response No No

ResponseResponse

Page 80: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 81: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 82: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 83: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 84: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Neuron Neuron ActivityActivity

Neural Neural ResponsesResponses

Vital PulpVital Pulp Necrotic Necrotic PulpPulp

Total Total NecrosisNecrosis

Partial Partial NecrosisNecrosis

Aged Aged TissuesTissues

Trauma Trauma to Pulpto Pulp

Young Young TissuesTissues

Page 85: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 86: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Sensory Pathways

Page 87: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 88: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Identifies Identifies Source of Source of

Tooth PainTooth Pain

Sensory Sensory PathwaysPathways

Identifies Identifies Referred Referred

Pain From Pain From ToothTooth

Identifies Identifies Non - Tooth Non - Tooth

PainPain

Page 89: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Anesthetic DiagnosisSelective Selective

AnesthesiaAnesthesia

Ligamental Ligamental InjectionsInjections Local AnesthesiaLocal Anesthesia

Relieves Relieves Suspect Suspect

ToothTooth

Regional Regional BlocksBlocks

Reveals Reveals Referral Referral

PainPain

Reveals Reveals Trigger Trigger SitesSites

Reveals Reveals Referral Referral

PainPain

Page 90: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 91: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 92: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Test Cavity Challenge

Page 93: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Test Cavity ChallengeTest CavityTest Cavity

No Anesthetic No Anesthetic

Prepare Shallow Prepare Shallow AccessAccess

Penetrate Into Penetrate Into Dentin / ChamberDentin / Chamber

No ResponseNo Response Slight ResponseSlight Response Acute ResponseAcute Response

Pulpal NecrosisPulpal Necrosis Degenerating PulpDegenerating Pulp Vital PulpVital Pulp

Page 94: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

100% 100% HealthyHealthy

Extent of Extent of Pulp VitalityPulp Vitality

Test CavityTest Cavity

Vital PulpVital Pulp

Endodontic Endodontic AccessAccess

NecroticNecrotic

DegeneratingDegenerating

Page 95: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 96: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 97: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 98: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 99: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Fractured Tooth AssessmentTooth Tooth Slooth™Slooth™

Bite & ReleaseBite & Release

Sharp PainSharp Pain

Engage Cusp TipEngage Cusp Tip

Shallow Shallow FxFx Cuspal FxCuspal Fx Vertical Vertical

FxFxHorizontal Horizontal

FxFx

No PainNo Pain

Page 100: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Occlusal Provocation

Page 101: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Occlusal Occlusal ProvocationProvocation

Vital Vital ToothTooth

Damage Damage to Crownto Crown

NecroticNecroticToothTooth

Damage Damage to Rootto Root

Damage Damage to Rootto Root

Damage Damage to Socketto Socket

Page 102: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Crack Detection

Page 103: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 104: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Tooth Slooth™Tooth Slooth™

Page 105: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 106: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 107: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 108: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Checking for crack/fracture

Page 109: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Crack MB cusp

Page 110: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Deep isolated pocket

Page 111: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 112: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 113: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Transillumination

Page 114: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 115: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

TransilluminationFiber Optic Fiber Optic Light ExamLight Exam

Thru Cervical Thru Cervical LineLine

Light Light ConductanceConductance

Through & Through & ThroughThrough

Abrupt Abrupt StoppageStoppage

Surface Surface CrazingCrazing

Thru Line Thru Line AnglesAngles

Thru Cusps Thru Cusps TipsTips

Page 116: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Superficial Superficial CracksCracks

TransilluminationTransillumination

Hard Tissue Hard Tissue IntegrityIntegrity

Deep Deep FracturesFractures

Moderate Moderate CrazingCrazing

Page 117: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Acute Crack

Page 118: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

MisdiagnosisMisdiagnosis

Page 119: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 120: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

The Endodontic-Restorative Continuum

Page 121: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Decision Making

Diagnosis Prognosis

Treatment

Page 122: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Decision Making

Diagnosis Prognosis

Treatment

Host ResistanceEndo - PerioPatient Dental I.Q.Operator Limitations

How Critical is Tooth? Cost EffectivenessTreatment Alternatives Sequence of Treatment Use of Specialist

HistoryEtiologyEndo and / or Perio

Page 123: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Determination of Prognosis

• Periodontal Prognosis

• Endodontic Prognosis

• Restorative Prognosis

Page 124: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Periodontal Prognosis

• Bone loss

• Pocketing

• Health of Periodontium

Page 125: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Periodontal Concerns

• General periodontal status

• Isolated periodontal defect

Page 126: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Prognosis

• Vitality

• Periapical area

• Canals negotiable?

• Posts present?

Page 127: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Endodontic Diagnosis Vital Tooth

•Reversible•Irreversible

Page 128: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Electric Pulp Tester

Page 129: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 130: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Cold Test

Page 131: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 132: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Cold Test

Page 133: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Tooth Restorability • Caries

• Chip in enamel

• Chip into dentin

• Cusp fracture

• Tooth fracture

• Root amputation

Page 134: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Restorative Prognosis determined by…

Structural IntegrityStructural Integrity

Page 135: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 136: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 137: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 138: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 139: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 140: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Treatment AlternativesRestore as is...

Restore as is... and extract

Extract–No further treatment–Fixed partial denture–Removable partial denture–Implant

and hopeand hope

Page 141: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Financial Considerations

•At UOP

•In Private Practice

Page 142: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Ferrule Effect

• What is it?

• Facial/Lingual vs Mesial/Distal

• Anterior Tooth

• Posterior Tooth

• How wide / thick?

Page 143: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

How to achieve the ferrule

• Prep into sulcus

• Crown lengthening

• Extrusion

Page 144: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

FerruleFerrule• 11.5 -2 mm long.5 -2 mm long

• Parallel wallsParallel walls

• Totally encircle toothTotally encircle tooth

• End on sound tooth surfaceEnd on sound tooth surface

• Not invade attachment Not invade attachment apparatusapparatus

Page 145: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

CoreCore• Replaces missing Replaces missing

tooth structuretooth structure

• Supports rehabilitationSupports rehabilitation

Page 146: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Core MaterialsCore Materials

• Cast metalCast metal

• AmalgamAmalgam

• Composite resinComposite resin

• Glass Ionomer / Glass Glass Ionomer / Glass Ionomer Silver materialsIonomer Silver materials

Page 147: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Fractured Cusp into Furcation

Page 148: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Crown/restorative disassembly

Page 149: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Tooth isolated for endodontics

Page 150: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Resin syringe

Page 151: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Build-up matrixed

Page 152: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Crown lengthening

Page 153: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Post-op crown lengthening

Page 154: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

Post-op crown lengthening

Page 155: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 156: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 157: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 158: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 159: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 160: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 161: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 162: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 163: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 164: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 165: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.
Page 166: Endodontic Assessments in a Differential Diagnosis The Endodontic- Restorative Continuum Alan H. Gluskin DDS Professor and Chair Department of Endodontics.

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