2. Examination Procedure
a) General medical history
b) C/O- Currant symptoms, past & recent treatment
c) H/O/C Pain – location,nature,duration,stimuli,relief,referred
d) Clinical examination- swelling, facial asymmetry, periodontal
disease, discharging sinuous, caries, restoration, fracture, attrition,
abrasion, erosion, and abfraction
e) Diagnosis tests – percussion, palpation, mobility, pocket
f) Pulp sensibility test – electric, cold, heat
g) Radiographic test - IOPA, tube sift, bite wing, panoramic
h) Other test – biting on individual cusp, trans-illumination, local
anaesthesia test, test cavity
i) Investigations –removal of caries of restoration, trans- illumination
of cavity.
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3. History
• All the problems be determined diagnosis
maid, appropriate treatment discussed and
informed consent should be obtained.
• Demographic, medical and dental history
should be recorded
• Radiograph is Mandatory. early stages of
pulpitis are not evident
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6. Pain
• How long have you had the pain
• Do you know which tooth it is
• What initiate the pain
• How would you describe the pain
• Sharp or dull, throbbing mile or severe, localize
or 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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7. Examination
• Standard oral Hygiene
• Amount and quality of Restorative work
• Prevalence of caries
• Missing and unopposed teeth
• General medical condition
• Presence of soft or hard swelling
• Presence of any sinus tracts
• Discolored teeth
• Tooth wear and facets
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18. Pulp Testing
• Moribund pulp may give possitive results, multi
rooted teeth give complicated results. Ideal way
of measuring vitality leiser dopler flowmeter
messure blood flow to the pulp
• Electronic gives false possitive reading due to
stimulation of PDL
• Thermol pulp test
• Heat guttapercha sticks
• Cold ethil chloride
• ice sticks
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19. Palpation
• Palpation the sight and
size of any soft or hard
swelling – examine for
fluctuation and crepitus
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20. Percussion
• Percussion –
gentle tapping with
finger – both
lateral and vertical
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21. Mobility
• Mobility – slight
moderate and
extensive – lateral
and vertical
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25. • 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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26. Indication for root canal treatment
• Post space insufficient tooth substance for
normal restoration
• Over denture
• Teeth with doubtful pulp
• Periodontal disease
• Pulpal sclerosis following trauma
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39. Contra indication (general)
• Inadequate access –
Restricted mouth opening
• Poor oral hygiene – patient should be able to
maintain a healthy mouth
Patients general medical condition –
• Chronic debilitating disease or very old age
• Patients attitude –
Patient should be sufficiently educated and
motivated
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40. 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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41. Indication for re-treatment
1. Signs of infected root canal
2
2. Signs of periapical pathology
3. Technically inadequate RCF
4
4. Dislodge of post retain crown
5. Broken down crown restorations
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