Friday, June 7, 2013

ENDODONTIC DIAGNOSIS

                                            ENDODONTIC DIAGNOSIS

                    Accurate and efficient diagnosis is the cornerstone of endodontic therapy. Patient’s chief complaint and history of illness are the first, and arguably the most, important pieces of the diagnostic puzzle. Some investigators view history of moderate-to-severe pain as a good indicator of irreversible pulpal pathosis. Nonetheless, clinical signs and symptoms alone are not accurate predictors of pulp and periradicular diseases. Thermal (cold and heat) and electrical pulp testing (EPT) are simple tests but are not completely reliable. Heat as a pulp test has a relatively high sensitivity but is the least accurate overall of the three common pulp tests owing to low specificity. Cold testing with tetraflouroethane, ethyl chloride or carbon dioxide (CO2) snow is relatively reliable and generally more accurate than heat. Cold testing is presumed to be more reliable than EPT in teeth with incomplete root formation. Since thermal tests are not 100 percent accurate, EPT is especially useful for confirming a questionable pulpal diagnosis.
                            A major limitation of thermal testing and EPT is that these tests measure only pulpal nerve response, not pulpal blood flow. Since the true measure of pulp vitality is blood flow, laser Doppler flowmetry (LDF) and pulse oximetry devices have been adapted for experimental use in assessing pulp vitality. These devices seem particularly well-suited for evaluating the vitality of traumatized teeth and for evaluating teeth in areas that may require orthognathic surgery.
                          Some investigators have attempted to identify biological factors that may determine the health status of the pulp tissue more accurately. Identification of the 20,000 to 25,000 genes of the human genome has paved the way for association of specific genes with known pathological findings. Microarray technology has enabled researchers to identify and study a large array of Genes and proteins those are affected during disease formation and healing.

Commonly used methods of endodontis diagnosis :
1) VISUAL AND TACTILE AND INSPECTION
2) PERCUSSION
3) PALPATION
4) MOBI L ITY AND DEPRESSIBILITY TESTS
5) PERIODONTAL TESTS
6) THERMAL TESTS
7) ANAESTHETIC TESTS
8) TEST CAVITY
9) TRANSILLUMINATION
10) BITING
11) STAINING
12) GUTTA-PERCHA POINT TRACING
13) ELECTRIC PULP TESTING
14) RADIOGRAPHS

Recent methods of endodontic diagnosis
  1. LASER DOPPLER FLOWMETRY
  2. HEAT STIMULATION BY LASER INSTEAD OF HOT GUTTA-PERCHA
  3. PULSE OXIMETERS
  4. HUGHES PROBEYE CAMERA / INFRA RED THERMOGRAPHY
  5. ELECTRONIC THERMOGRAPHY
  6. LIQUID CRYSTAL TESTING
  7. ELECTRIC PULP TESTERS
  8. TRANSMITTED-LIGHT PHOTPLETHYSMOGRAPHY
  9. FOTI    
  10. DIGITAL RADIOGRAPHY (RVG)
  11. DIGITAL SUBTRACTION RADIOGRAPHY
  12. COMPUTERISED TOMOGRAPHY
  13. TACT
  14. COMPUTERIZED EXPERT SYSTEM
  15. TACT
  16. ULTRASONOGRAPHY (echography).
  17. XENON-133 WITH RADIOLABELLED MICROSPHERES.
  18. DUAL WAVE LENGTH SPECTROPHOTOMETRY.
  19. ELECTROMAGNETIC FLOWMETRY
  20. DETECTION OF INTERLEUKIN-1 BETA IN HUMAN PERIAPICAL LESION.
  21. MICROBIOLOGICAL DIAGNOSIS
    • TRADITIONAL
    • CULTURE
    • MICROSCOPY
    • IMMUNOLOGIC METHODS
    • RECENT
               1) MOLECULAR GENETIC METHODS