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Describe the anatomical features, structures, and their clinical significance. | C O H E N ’ S
P A T H W A Y S of the
PULP
E L E V E N T H E D I T I O N
EDITORS
KENNETH M. HARGREAVES, DDS, PhD, FICD, FACD
Professor and Chair
Department of Endodontics
Professor
Departments of Pharmacology, Physiology (Graduate School), and Surgery (Medical School)
President’s Council Endowed Chair in Research
Univer... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | 3251 Riverport Lane
St. Louis, Missouri 63043
COHEN’S PATHWAYS OF THE PULP, Eleventh Edition
ISBN 978-0-323-09635-5
Copyright © 2016, Elsevier Inc. All Rights Reserved.
Previous editions copyrighted 2011, 2006, 2002, 1998, 1994, 1991, 1987, 1984, 1980, 1976.
All rights reserved. No part of this publication may be repr... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | v
About the Authors
KENNETH M. HARGREAVES
Dr. Hargreaves is Professor and Chair of the Department of Endodontics at the University
of Texas Health Science Center at San Antonio. He is a Diplomate of the American Board
of Endodontics and maintains a private practice limited to endodontics. He is an active
researcher,... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | vii
The field of endodontics would be difficult to imagine without
Pathways of the Pulp. In speaking with colleagues across North
America and around the world, it becomes clear that Pathways
has had an immense, ubiquitous, and persistent impact on
endodontics. This enduring contribution to our specialty is
due to th... | |
Provide a comprehensive explanation of the following dental concept. | viii
Contributors
Frederic Barnett, DMD
Chairman
Dental Endodontics
Albert Einstein Medical Center
Philadelphia, Pennsylvania
Bettina Basrani, DDS, PhD
Specialist in Endodontics
Associate Professor
Endodontics
University of Toronto
Toronto, Ontario, Canada
Ellen Berggreen, PhD
Speciality in Endodontics
Professor
Biomed... | |
Provide a comprehensive explanation of the following dental concept. | CONTRIBUTORS
ix
James L. Gutmann, DDS, Cert Endo,
PhD (honoris causa), FACD, FICD, FADI
Professor Emeritus
Department of Restorative Sciences
Baylor College of Dentistry
Texas A&M University System, Health
Science Center
Dallas, Texas
Diplomate of the American Board
of Endodontics
Honorary Professor, School of Stomat... | |
Explain the pathophysiology, microbiology, and management of the infectious process. | x
CONTRIBUTORS
Al Reader, BS, DDS, MS
Professor and Program Director
Advanced Endodontics Program
College of Dentistry
The Ohio State University
Columbus, Ohio
Domenico Ricucci, MD, DDS
Private Practice
Cetraro, Italy
Isabela N. Rôças, DDS, MSc, PhD
Professor
Department of Endodontics
Head
Molecular Microbiology Labo... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | xi
New to This Edition
EIGHT NEW CHAPTERS
Chapter 2: Radiographic Interpretation covers imaging
modalities, diagnostic tasks in endodontics, three-dimensional
imaging, cone beam computed tomography, intraoperative or
postoperative assessment of endodontic treatment complica-
tions, and more!
Chapter 4: Pain Control ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | xii
Introduction
ENDODONTICS: A VIEW OF THE FUTURE
The Editors have had the privilege of “standing on the
shoulders” of our generous contributors, enabling us to “look
over the horizon” to gain a glimpse at our endodontic future.
As we advance into the years ahead, we will incorporate even
more refined and accurate ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | xiii
Contents
PART I: THE CORE SCIENCE OF
ENDODONTICS, 1
1
Diagnosis, 2
Louis H. Berman and Ilan Rotstein
2
Radiographic Interpretation, 33
Madhu K. Nair, Martin D. Levin,
and Umadevi P. Nair
3
Case Selection and Treatment Planning, 71
Paul A. Rosenberg and Matthew Malek
4
Pain Control, 90
Al Reader, John Nusstein... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | xiv
CONTENTS
26
Effects of Age and Systemic Health on
Endodontics, e62
Carl W. Newton and Jeffrey M. Coil
27
Bleaching Procedures, e96
Frank Setzer
28
Understanding and Managing the Fearful
Dental Patient, e114
Henrietta L. Logan and Ellen B. Byrne
29
Endodontic Records and Legal
Responsibilities, e124
Edwin J. ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 1
The Core Science
of Endodontics
CHAPTER 1
Diagnosis
CHAPTER 2
Radiographic Interpretation
CHAPTER 3
Case Selection and Treatment Planning
CHAPTER 4
Pain Control
CHAPTER 5
Tooth Morphology, Isolation, and Access
CHAPTER 6
Cleaning and Shaping the Root Canal System
CHAPTER 7
Obturation of the Cleaned and Shaped Root
... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 2
judgment. The clinician must be able to approach the problem
by crafting what questions to ask the patient and how to ask
these pertinent questions. Careful listening is paramount to
begin painting the picture that details the patient’s complaint.
These subjective findings combined with results of diagnostic
test... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | FIG. 1-1 Dental history form that also allows the patient to record pain experience in an organized and descrip-
tive manner.
TELL US ABOUT YOUR SYMPTOMS
LAST NAME
FIRST NAME
1. Are you experiencing any pain at this time? If not, please go to question 6.
2. If yes, can you locate the tooth that is causing the pain?
3... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | FIG. 1-2 Succinct, comprehensive medical history form designed to provide insight into systemic conditions
that could produce or affect the patient’s symptoms, mandate alterations in treatment modality, or change the
treatment plan.
TELL US ABOUT YOUR HEALTH
LAST NAME
FIRST NAME
How would you rate your health?
Plea... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
5
medical condition rather than to the condition itself. More
common examples of medication side effects are stomatitis,
xerostomia, petechiae, ecchymoses, lichenoid mucosal lesions,
and bleeding of the oral soft tissues.80
When developing a dental diagnosis, a clinician must also be
aware that ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 6
PART I
The Core Science of Endodontics
the diagnosis of dental pathosis; this issue is discussed in more
detail in subsequent chapters.
If, at the completion of a thorough dental examination,
the subjective, objective, clinical testing and radiographic find-
ings do not result in a diagnosis with an obvious dental o... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
7
FIG. 1-3 When taking a dental history and performing a diagnostic examination, often a premade form can
facilitate complete and accurate documentation. (Courtesy Dr. Ravi Koka, San Francisco, CA.) | |
Provide a comprehensive explanation of the following dental concept. | 8
PART I
The Core Science of Endodontics
FIG. 1-4 Several practice management software packages have features for charting endodontic diagnoses
using user-defined drop-down menus and areas for specific notations. Note that for legal purposes, it is desirable
that all recorded documentation have the ability to be locke... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
9
A subtle visual change such as loss of definition of the
nasolabial fold on one side of the nose may be the earliest sign
of a canine space infection (Fig. 1-5). Pulpal necrosis and
periradicular disease associated with a maxillary canine should
be suspected as the source of the problem. Extrem... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | 10
PART I
The Core Science of Endodontics
would be involved. For infections associated with these teeth,
the root apices of the maxillary teeth must lie superior to the
attachment of the buccinator muscle to the maxilla, and the
apices of the mandibular teeth must be inferior to the buccina-
tor muscle attachment to... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
11
attempts to heal the extraoral stoma. In these particular cases,
after multiple treatment failures, the patients may finally be
referred to a dental clinician to determine whether there is a
dental cause. Raising the awareness of physicians to such cases
will aid in more accurate diagnosis and... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 12
PART I
The Core Science of Endodontics
Intraoral Sinus Tracts
On occasion, a chronic endodontic infection will drain through
an intraoral communication to the gingival surface and is
known as a sinus tract.12 This pathway, which is sometimes
lined with epithelium, extends directly from the source of the
infectio... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
13
epithelium that extended from the oral mucosa surface to the
periradicular lesion.12 The presence or absence of an epithelial
lining does not seem to prevent closure of the tract as long as
the source of the problem is properly diagnosed and adequately
treated and the endodontic lesion has hea... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 14
PART I
The Core Science of Endodontics
FIG. 1-15 Percussion testing of a tooth, using the back end of a mirror
handle.
FIG. 1-14 A, To locate the source of an infection, the sinus tract can be
traced by threading the stoma with a gutta-percha point. B, Radiograph of
the area shows an old root canal in a maxill... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
15
1-mm increments. Periodontal bone loss that is wide, as deter-
mined by a wide span of deep periodontal probings, is gener-
ally considered to be of periodontal origin and is typically more
generalized in other areas of the mouth. However, isolated
areas of vertical bone loss may be of an endod... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 16
PART I
The Core Science of Endodontics
resulting CO2 stick is applied to the facial surface of either the
natural tooth structure or crown. Several teeth can be tested
with a single CO2 stick. The teeth should be isolated and the
oral soft tissues should be protected with a 2-by-2-inch gauze
or cotton roll so th... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
17
Another method for heat testing is to apply heated gutta-
percha or compound stick to the surface of the tooth. If this
method is used, a light layer of lubricant should be placed onto
the tooth surface before applying the heated material to prevent
the hot gutta-percha or compound from adheri... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 18
PART I
The Core Science of Endodontics
advances are being made with regard to determining the vital-
ity of the pulp on the basis of the blood supply, this technology
has not been perfected enough at this time to be used on a
routine basis in a clinical setting.
The electric pulp tester has some limitations in pro... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
19
obstruction from restorations, which can sometimes limit the
usefulness of pulse oximetry to test pulp vitality.
Custom-made sensors have been developed and were found
to be more accurate than electric and thermal pulp tests.31,54
This sensor has been especially useful in evaluating teeth that
... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 20
PART I
The Core Science of Endodontics
FIG. 1-22 To determine which tooth, or tooth part, is sensitive to mastica-
tion, having the patient bite on a specially designed bite stick is often helpful.
be used as controls so that the patient is aware of the “normal”
response to these tests. The small cupped-out area ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
21
FIG. 1-23 Sometimes there is no clear indication of why a tooth is symptomatic. This radiograph shows a
mandibular second molar with a moderately deep restoration (A); the pulp tests nonvital. Without any transillu-
mination, a fracture cannot be detected (B). However, by placing a high-intensi... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 22
PART I
The Core Science of Endodontics
Two-dimensional dental radiography has two basic short-
comings: the lack of early detection of pathosis in the cancel-
lous bone, because of the density of the cortical plates, and the
influence of the superimposition of anatomic structures. Vari-
ability in the radiographic e... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
23
radiographic beam is directed to the target area with a recip-
rocating capturing sensor on the opposite side (Fig. 1-27).
The resulting information is digitally reconstructed and inter-
preted to create an interface whereby the clinician can three-
dimensionally interpret “slices” of the patien... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 24
PART I
The Core Science of Endodontics
FIG. 1-29 Cone-beam volumetric tomography has the advantage of being
able to detect pathosis in the bone or associated with the teeth without the
obstruction of anatomic structures. The planes of vision may be axial, sagittal,
or coronal. (Courtesy J. Morita USA, Irvine, CA... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
25
Craze lines are merely cracks in the enamel that do not
extend into the dentin and either occur naturally or develop
after trauma. They are more prevalent in adult teeth and
usually occur more in the posterior teeth. If light is transillu-
minated through the crown of such a tooth, these craze... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 26
PART I
The Core Science of Endodontics
terminology of cracked tooth syndrome22,108 should be avoided.6
The subjective and objective factors seen in cases of fractured
teeth will generally be diverse; therefore, a tentative diagnosis
of a fractured tooth will most likely be more of a prediction.
Once this predict... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
27
FIG. 1-33 Poorly fitting intracoronal restorations can place stresses within the tooth that can cause a vertical
root fracture. A, This radiograph of a mandibular second premolar (with a gold inlay) reveals extensive periapical
and periradicular bone loss, especially on the distal aspect. B, Th... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 28
PART I
The Core Science of Endodontics
Reversible Pulpitis
This is a clinical diagnosis based on subjective and objective
findings indicating that the inflammation should resolve and
the pulp return to normal.6 When the pulp within the tooth is
irritated so that the stimulation is uncomfortable to the patient
but ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
29
it may give a positive response. The tooth may also exhibit
symptoms of symptomatic irreversible pulpitis. Pulp necrosis,
in the absence of restorations, caries, or luxation injuries, is
likely caused by a longitudinal fracture extending from the
occlusal surface and into the pulp.19
After th... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 30
PART I
The Core Science of Endodontics
only 79.5% of the time, illustrating that patients may have a
difficult time discriminating the exact location of pulpal pain.44
Referred pain from a tooth is usually provoked by an intense
stimulation of pulpal C fibers, the slow conducting nerves that
when stimulated cause a... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 1
Diagnosis
31
REFERENCES
1. Abella F, Patel S, Duran-Sindreu F, et al: Evaluating the
periapical status of teeth with irreversible pulpitis by using
cone-beam computed tomography scanning and
periapical radiographs, J Endod 38:1588, 2012.
2. Abuabara A, Zielak JC, Schramm CA, Baratto-Filho F:
Dental infe... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 2010.
20. Bierma MK, McClanahan S, Baisden MK, Bowles WR:
Comparison of heat-testing methodology, J Endod
38:1106, 2012.
21. Bornstein MM, Lauber R, Sendi P, von Arx T: Comparison
of periapical radiography and limited cone-beam
computed tomography in mandibular molars for analysis
of anatomical landmarks before ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | of digital dental x-ray
systems with self-developing film and manual processing
for endodontic file length determination, J Endod 26:65,
2000.
40. Evans D, Reid J, Strang R, Stirrups D: A comparison of
laser Doppler flowmetry with other methods of assessing
the vitality of traumatized anterior teeth, Endod Dent
Trau... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 1269, 2012.
60. Ingolfsson AER, Tronstad L, Riva CE: Reliability of laser
Doppler flowmetry in testing vitality of human teeth,
Endod Dent Traumatol 10:185, 1994.
61. Ingram TA, Peters DD: Evaluation of the effects of carbon
dioxide used as a pulp test. Part 2: in vivo effect on
canine enamel and pulpal tissues, J... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 32
PART I
The Core Science of Endodontics
70. Kataoka SH, Setzer FC, Gondim-Junior E, et al: Pulp
vitality in patients with intraoral and oropharyngeal
malignant tumors undergoing radiation therapy assessed
by pulse oximetry, J Endod 37:1197, 2011.
71. Katz J, Chaushu G, Rotstein I: Stafne’s bone cavity in
the a... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | the problem, J Am Dent
Assoc 132:1570, 2001.
89. Morsani JM, Aminoshariae A, Han YW: Genetic
predisposition to persistent apical periodontitis, J Endod
37:455, 2011.
90. Mozzo P, Proccacci A, et al: A new volumetric CT
machine for dental imaging based on the cone-beam
technique: preliminary results, Eur Radiol 8... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | Dent 47:36,
1982.
109. Rotstein I, Engel G: Conservative management of a
combined endodontic-orthodontic lesion, Endod Dent
Traumatol 7:266, 1991.
110. Rotstein I, Moshonov J, Cohenca N: Endodontic therapy
for a fused mandibular molar, Endod Dent Traumatol,
13:149, 1997.
111. Rotstein I, Simon HS: Diagnosis, progno... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | Steinbacher DM, Glick M: The dental patient with asthma:
an update and oral health considerations, J Am Dent
Assoc 132:1229, 2001.
130. Stroblitt H, Gojer G, Norer B, Emshoff R: Assessing
revascularization of avulsed permanent maxillary incisors
by laser Doppler flowmetry, J Am Dent Assoc 134:1597,
2003.
131. Sue... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 33
Radiographic Interpretation
Imaging Modalities
Image Characteristics and Processing
Digital Imaging and Communications in Medicine (DICOM)
Diagnostic Tasks in Endodontics
Working Length Determination
Diagnosis and Healing
Three-Dimensional Imaging
Principles of Cone Beam Computed Tomography
Voxels and Voxel Sizes
Fi... | |
Describe the anatomical features, structures, and their clinical significance. | 34
PART I
The Core Science of Endodontics
FIG. 2-2 A and B, High-resolution complementary metal oxide semiconductor (CMOS) sensors are available
from many manufacturers. Note that Figure B shows wireless CMOS sensors transmit images to the
chairside workstation by 2.4 GHz radio frequency. (Courtesy SIR... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
35
Modified from the National Council on Radiation Protection and Measurements:
Radiation protection in dentistry, Report #145, Bethesda, Md, 2003. Available at:
www.ncrppublications.org/Reports/145.
BOX 2-1
Recommendations of the National Council on
Radiation Protection... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 36
PART I
The Core Science of Endodontics
enhancement is a must for all images, so as to delineate
signals of interest through manipulation of the grayscale. Most
endodontic tasks require a high contrast and thus a shorter
grayscale.
Digital radiographs can be saved in different file formats.
Several file formats are... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
37
available in CBCT, such as the ability to change the vertical or
horizontal angulation of the image in real time, in addition to
thin-slice, grayscale data of varying thicknesses, will never be
available for conventional or even digital radiography. Further-
more, the use of ... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | 38
PART I
The Core Science of Endodontics
Voxels and Voxel Sizes
Voxels are cuboidal elements that constitute a 3D volume,
unlike pixels, which are 2D. Data are acquired and represented
in three dimensions using voxels. Unlike with medical com-
puted tomography (MDCT), cone beam units acquire x-ray
information using... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
39
the patient. A typical CBCT examination would expose the
patient to only about 20 to 500 µSv in a single study, whereas
a typical medical examination of the head would approach
2100 µSv2 because the image data are gathered one section at
a time. Therefore, soft tissue imagin... | |
Describe the anatomical features, structures, and their clinical significance. | 40
PART I
The Core Science of Endodontics
FIG. 2-7 A, CS 9000 3D and CS 8100 Extraoral imaging systems. B, Morita Accu-i-tomo 170. (A Courtesy
Carestream Dental LLC, Atlanta, GA; B Courtesy J Morita, Irvine, CA.)
A
B
FIG. 2-8 Left, Drawing represents a pixel (picture element), the image capture and display element o... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
41
FIG. 2-9 Multiplanar and 3D color reconstructed views of the mandibular
quadrant taken on a CBCT machine with a volume size of 37 × 50 mm. (Data
acquired and reformatted at 0.076 mm voxel size using a CS 9000 3D unit
[Carestream Dental, Atlanta, Ga].)
FIG. 2-10 Image of ent... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | 42
PART I
The Core Science of Endodontics
clinician owns a cone beam machine does not mean that every
patient should be exposed to a cone beam study.119 If previous
studies are available, they need to be evaluated first in a recall
patient. Use of imaging in children must be minimized. Cone
beam machines with smalle... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
43
IMAGING TASKS IMPROVED OR
SIMPLIFIED BY CONE BEAM VOLUMETRIC
COMPUTED TOMOGRAPHY
The Executive Opinion of the American Academy of Oral and
Maxillofacial Radiology and, later, the position paper on the
use of CBCT in endodontics jointly developed by the American
Association ... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 44
PART I
The Core Science of Endodontics
Pigg et al.146a conducted a study of 20 patients with AO. All of
the patients had at least one tooth in the region of discomfort
that had undergone invasive treatment; 21 of 30 teeth had
undergone endodontic treatment. These researchers found that
60% had no periapical lesi... | |
Provide a comprehensive explanation of the following dental concept. | Carestream Dental, LLC, Atlanta, GA].)
A
B
C
*References 28, 54, 56, 81, 130, 143, 151, and 152. | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
45
slices also improved detection of VRFs.76 Continued improve-
ment of sensor technology, including the use of FPDs, has
resulted in enhanced resolution. Voxel dimensions are smaller
in these units. Detection of vertical root fractures with thick-
ness ranging from 0.2 to 0.4 mm... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 46
PART I
The Core Science of Endodontics
INTRAOPERATIVE OR POSTOPERATIVE
ASSESSMENT OF ENDODONTIC
TREATMENT COMPLICATIONS
Materials Extending Beyond
the Root Canal
CBCT scans provide the opportunity to map endodontic
treatment complications through the examination of 3D rep-
resentations of the teeth and supportin... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
47
side in the same patient; an average distance of 1.51 to 3.43 mm
in adults.97 Procedures involving the mandibular second molar
were most likely to cause nerve damage.106 Further research is
required to clarify the risks and benefits of CBCT when end-
odontic treatment is contem... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 48
PART I
The Core Science of Endodontics
ionizing radiation. Receiver coils are being developed to
enhance the image quality of maxillofacial and dental magnetic
resonance studies.
The accidental introduction of root canal instruments, irri-
gating solutions, obturation material, and root tips into the
maxillary si... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
49
possible in only 47.7% of cases if the instrument is not visible
(Fig. 2-22).127 When a separated instrument is lodged in the
apical third of a root canal, the chances of retrieval are the
lowest, but the apical terminus may be adequately sealed by
treatment of an anastomosi... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 50
PART I
The Core Science of Endodontics
and ethnic origin.163 CBCT can be an important adjunct to
magnification and illumination in these cases.
Perforations
A perforation is defined as a “mechanical or pathologic com-
munication between the root canal system and external tooth
surface”6; it is usually associated wit... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | CHAPTER 2
Radiographic Interpretation
51
size of the perforations and that the method of obturation did
not favor extravasation of obturation material.166 CBCT images
suffer from beam hardening artifact resulting from root canal
obturation and restorative materials (e.g., gutta-percha, posts,
and perforation repair... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 52
PART I
The Core Science of Endodontics
by Andreasen et al.11 This study showed that the type of healing
(e.g., hard tissue fusion, PDL interposition with and without
bone) and the location of the fracture on the root had the most
influence on tooth loss. CBCT should be considered when
placement of individual PA r... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
53
FIG. 2-24 Horizontal root fractures resulting from trauma (A) were evident in this 22-year-old male patient,
who was referred with a contemporaneous film–based PA radiograph (B) for evaluation and possible treatment
9 months after trauma to his maxillary lateral and central in... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 54
PART I
The Core Science of Endodontics
multiple scans would be difficult to justify. ERR can be classi-
fied as surface resorption, external inflammatory resorption,
external replacement resorption, external cervical resorption,
and transient apical breakdown (Fig. 2-25).141 These lesions
are always associated with ... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | CHAPTER 2
Radiographic Interpretation
55
resolved with cone beam imaging. Multiplanar views allow the
clinician to see the defect and suspected causes from the axial,
sagittal, and coronal aspects; 3D grayscale or color imaging
helps the clinician visualize the entire defect before the inci-
sion is made. This is an... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 56
PART I
The Core Science of Endodontics
F
Superior genial canal
Inferior genial canal
Panoramic reformation
Extraction defect
Crestal bone loss
Mandibular tori
Fracture
Extraction defect
J
G
H
I
this relationship can best be assessed using CBCT.93 A potential
difference in the location of the mandibular canal with r... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
57
K
Buccal cortical plate
Maxillary sinus with mucositis
Oro-antral
communication
Extraction defect
Nasal septum
Deviation of nasal septum
Nasal fossa
Lateral wall of nasal fossa
Maxillary sinus with mucositis
Nasal septum
Incisive canal
Inferior nasal conch
Maxillary sinus
Mucosi... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 58
PART I
The Core Science of Endodontics
negative diagnosis of AP using CBCT scans occurred in 92%
of cases.
Determination of healing or nonhealing in individual cases
should depend on the clinical and radiographic findings,
adjusted for risk factors for the patient, radiation dose, and
cost (Fig. 2-27). For patien... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | CHAPTER 2
Radiographic Interpretation
59
FIG. 2-27 This series of radiographs shows a maxillary left central incisor several months after a bicycle
accident. The patient complained of significant discomfort and mobility with slight swelling in the periapical region.
The preoperative PA radiograph (A, le... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 60
PART I
The Core Science of Endodontics
moderately reduced ambient lighting, ranging from 25 to
40 lux.110a
FUTURE OF CBCT
The first decade of the twenty-first century saw the develop-
ment of a wide range of CBCT applications, especially in den-
tistry. Lower radiation dose, higher spatial resolution, smaller
FOV, a... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | CHAPTER 2
Radiographic Interpretation
61
instantaneous image capture, and therefore are recommended
for endodontic applications. Careful and appropriate image
processing further helps tease out the signal of interest. In
an enterprise-wide setting or in larger private practices that
have multiple specialty areas, P... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 62
PART I
The Core Science of Endodontics
When the clinician works with different vendor products,
it is important to have a quality assurance program in place.
This is not being done currently. Additionally, accreditation of
stand-alone imaging laboratories is now a requirement for
reimbursement of medical and den... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
63
Joint Position Statement of the
American Association of Endodontists
and the American Academy of Oral
and Maxillofacial Radiology on the
Use of Cone Beam Computed
Tomography in Endodontics:
2015 Update
This statement was prepared by the Special Committee to
Revise the Joi... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 64
PART I
The Core Science of Endodontics
non-specific clinical signs and symptoms associated
with untreated or previously endodontically-treated
teeth.
Rationale:
◆ In some cases, the clinical and planar radiographic exami-
nations are inconclusive. Inability to confidently determine
the etiology of endodontic patho... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | CHAPTER 2
Radiographic Interpretation
65
identified with periapical radiographs and CBCT were eval-
uated by Liang et al.22 The results showed that periapical
radiographs detected periapical lesions in 18 roots (12%) as
compared to 37 on CBCT scans (25%). 80% of apparently
short root fillings based on intraoral radiog... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | 66
PART I
The Core Science of Endodontics
REFERENCES
1. 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 Maxillofa... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | a better understanding.
Rev Pain 2011;5(4):18-27.
15. Pigg M, List T, Petersson K, Lindh C, Petersson A.
Diagnostic yield of conventional radiographic and
cone-beam computed tomographic images in patients
with atypical odontalgia. Int Endod J 2011;44(12):
1365-2591.
16. Blattner TC, Goerge N, Lee CC, Kumar V, Ye... | |
Describe the anatomical features, structures, and their clinical significance. | beam computed tomography. Pediatric Dentistry
2013;35:120-4.
28. Estrela C, Bueno MR, De Alencar AH, Mattar R,
Valladares Neto J, Azevedo BC, De Araújo Estrela CR.
Method to evaluate Inflammatory Root Resorption by
using Cone Beam computed tomography. J Endod
2009;35(11):1491-7.
29. Durack C, Patel S, Davies J, W... | |
Provide a comprehensive explanation of the following dental concept. | �of cone beam computed
tomography, J Endod 39:548, 2013. | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | CHAPTER 2
Radiographic Interpretation
67
16a. Beck-Mannagetta J, Necek D, Grasserbauer M: Solitary
aspergillosis of maxillary sinus: a complication of dental
treatment, Lancet 2:1260, 1983.
17. Benavides E, Rios HF, Ganz SD, et al: Use of cone beam
computed tomography in implant dentistry: the
International Congr... | |
Describe the anatomical features, structures, and their clinical significance. | �in studies of association
between apical periodontitis and systemic health, Endod
Topic 8:15, 2008.
34. Special Committee to Revise the Joint AAE/AAOMR
Position Statement on Use of CBCT in Endodontics: Joint
position statement of the American Association of
Endodontists and the American Academy of Oral and
Maxi... | |
Describe the recommended treatment procedure, techniques, and clinical rationale. | �film and manual processing
for endodontic file length determination, J Endod 26:65,
2000.
50. Eraso FE, Analoui M, Watson AB, Rebeschini R: Impact of
lossy compression on diagnostic accuracy of radiographs
for periapical lesions, Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 93:621, 2002.
51. Escoda-Francoli J... | |
Explain the diagnostic approach and clinical evaluation for the following dental condition. | �Dreyer C: Radiographic
assessment of simulated external root resorption cavities in
maxillary incisors, Endod Dent Traumatol 14:133, 1998.
67. Gomes AP, de Araujo EA, Goncalves SE, Kraft R:
Treatment of traumatized permanent incisors with crown
and root fractures: a case report, Dent Traumatol 17:236,
2001.
68. ... |
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