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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
diagnosis CE article | 13roots1 2016 apices.Diagnosis:Pulpnecrosis;symptomaticapical periodontitis with condensing osteitis. Non-surgical endodontic treatment is indicated followed by a build-up and crown. Over time the condensing oste itis should regress partially or totally.15 Following the placement of a full gold crown on the maxillary right second molar, a patient com plained of sensitivity to both hot and cold liquids; now the discomfort is spontaneous (Fig. 2). Upon application of Endo-Ice® on this tooth, the patient experienced pain and upon removal of the stimulus, the discomfort lingered for 12 seconds. Responses to both percussion and palpation were normal; ra diographically, there was no evidence of osseous changes.Diagnosis:Symptomaticirreversiblepulpi tis; normal apical tissues. Non-surgical endodontic treatment is indicated; access is to be repaired with a permanent restoration. Note that the maxillary second premolar has severe distal caries; following evaluation,thetoothwasdiagnosedwithsymptom atic irreversible pulpitis (hypersensitive to cold, lin gering eight seconds); symptomatic apical peri odontitis (pain to percussion). A maxillary left first molar has occlusal-mesial caries and the patient has been complaining of sen sitivity to sweets and to cold liquids (Fig. 3). There is no discomfort to biting or percussion. The tooth is hyper-responsivetoEndo-Ice®withnolingeringpain. Diagnosis: reversible pulpitis; normal apical tissues. Treatment would be excavation of the caries fol lowed by placement of a permanent restoration. If the pulp is exposed, treatment would be non-surgi cal endodontic treatment followed by a permanent restoration such as a crown. A mandibular right lateral incisor has an apical radiolucency that was discovered during a routine examination (Fig. 4). There was a history of trauma more than 10 years ago and the tooth was slightly discolored. The tooth did not respond to Endo-Ice® ortotheEPT;theadjacentteethrespondednormally to pulp testing. There was no tenderness to percus sion or palpation in the region. Diagnosis: pulp ne crosis;asymptomaticapicalperiodontitis.Treatment is non-surgical endodontic treatment followed by bleaching and permanent restoration. A mandibular left first molar demonstrates a rela tively large apical radiolucency encompassing both the mesial and distal roots along with furcation in volvement (Fig. 5). Periodontal probing depths were all within normal limits. The tooth did not respond to thermal(cold)testingandbothpercussionandpalpa tion elicited normal responses. There was a draining sinus tract on the mid-facial of the attached gingiva whichwastracedwithagutta-perchacone.Therewas recurrentcariesaroundthedistalmarginofthecrown. Diagnosis:pulpnecrosis;chronicapicalabscess.Treat ment is crown removal, non-surgical endodontic treatment and placement of a new crown. A maxillary left first molar was endodontically treated more than 10 years ago (Fig. 6). The patient is complaining of pain to biting over the past three months. There appear to be apical radiolucencies aroundallthreeroots.Thetoothwastendertoboth percussionandtotheToothSlooth.Diagnosis:pre viously treated; symptomatic apical periodontitis. Treatment is non-surgical endodontic retreatment followed by permanent restoration of the access cavity. Fig.4 Fig.5