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Diagnosis and treatment planningin Root Canal Therapy

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Examination ProcedureGeneral medical history

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C/O-

H/O/C

Currant symptoms, past & recent treatment

Pain – location,nature,duration,stimuli,relief,referred

Clinical examination- swelling, facial asymmetry, periodontaldisease, discharging sinuous, caries, restoration, fracture, attrition,abrasion, erosion, and abfraction

Diagnosis tests – percussion, palpation, mobility, pocket

Pulp sensibility test – electric, cold, heat

Radiographic test - IOPA, tube sift, bite wing, panoramic

Other test – biting on individual cusp, trans-illumination, localanaesthesia test, test cavity

Investigations –removal of caries of restoration, trans- illuminationof cavity.

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History

• All the problems be determined diagnosismaid, appropriate treatment discussed andinformed consent should be obtained.

• Demographic, medical and dental historyshould be recorded

• Radiograph is Mandatory. early stages ofpulpitis are not evident

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Patient selection limitations

Medically compromised patient

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Very old patientPoor oral hygieneRetain rootsCalculiCarious teethRestricted mouth openingPatient’s attitudePatient’s complianceCost

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Patents requiring antibiotic cover

Hisory of infective endodarditisVentricular septal defectDuctus arteriosusCoarctation of the aortaProsthetic heart valveDegenerative valve diseaseRheumatic heart diseasePersistent heart murmurAtrial septal defect repaired with apatch

10. Chronic debilitating disease

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Pain

How long have you had the painDo you know which tooth it isWhat initiate the painHow would you describe the painSharp or dull, throbbing mile or severe, localizeor radiation

• How long does the pain last• Does it pain most during the day or night• Does anything relieve the pain

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Examination

Standard oral HygieneAmount and quality of Restorative workPrevalence of cariesMissing and unopposed teethGeneral medical conditionPresence of soft or hard swellingPresence of any sinus tractsDiscolored teethTooth wear and facets

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Intra--oral Swelling

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Extra--oral Swelling

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Extra--oral Swelling

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Facial asymmetry

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Periodontal disease

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Intra--oral discharging sinuous

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Extra--oral discharging sinuous

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Caries

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Heavily restored teeth

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Fractured teeth

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Pulp Testing

• Moribund pulp may give possitive results, multirooted teeth give complicated results. Ideal wayof measuring vitality leiser dopler flowmetermessure blood flow to the pulp

• Electronic gives false possitive reading due tostimulation of PDL

• Thermol pulp test• Heat guttapercha sticks• Cold ethil chloride• ice sticks

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Palpation

• Palpation the sight andsize of any soft or hardswelling – examine forfluctuation and crepitus

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Percussion

• Percussion –gentle tapping withfinger – bothlateral and vertical

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Mobility

• Mobility – slightmoderate andextensive – lateraland vertical

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Pockets depth

• Standard oralHygiene

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Biting on individual cusp

•Wooden stick test

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Mouth opening

• restrictedmouthopening

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• Local aneasthetics• Intra ligamental injection• Fibro-optic light trans illumination teeth to

show inter-proximal caries, fracture,opacity or discoloration

• Cutting a test cavity

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Indication for root canal treatment

• Post space insufficient tooth substance fornormal restoration

• Over denture

• Teeth with doubtful pulp

• Periodontal disease

• Pulpal sclerosis following trauma

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5.6.67.

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Tooth selection limitations

Unrestorable tooth

Insufficient periodontal support3.4.

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10.

Root fractureBizarre anatomyNon-strategic toothExternal/external resorptionProcedural accidentCalcified canalPost retained crownsOpen apex

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Anatomical complications

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Non--functional tooth

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External / Internal resorption

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Anatomical defects

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Anatomical defects

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Procedural accident

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Procedural accident - zip perporation

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Obstruction of canal – foreign body

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Obstruction of canal – fractured instrument

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Obstruction of canal – calcified canal

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Open apex

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Contra indication (general)

• Inadequate access –

Restricted mouth opening

• Poor oral hygiene – patient should be able tomaintain a healthy mouth

Patients general medical condition –

• Chronic debilitating disease or very old age

• Patients attitude –

Patient should be sufficiently educated andmotivated

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Contra indication (Local)

• Tooth non restorable supra-gingival and supra-crestal

• Insufficient periodontal support• Non strategic tooth• Root fracture• Internal or external resorption• Bizarre anatomy – exceptionally curved tooth,

dilacerated teeth, congenital palatal roots,unusual anatomy

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Indication for re-treatment

Signs of infected root canalSigns of periapical pathologyTechnically inadequate RCFDislodge of post retain crownBroken down crown restorations

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• 90-95% success – noperiapical lesion

• 80--85%success – preoperativeperiapical lesion

• 60-65% success – re rootfilling

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