牙体牙髓病诊断学.pptxVIP

牙体牙髓病诊断学会计学DIAGNOSIS第1页/共60页 Diagnosis is an art. It involves learning skills of evaluation and knowing how to interpret the responses that the clinician receives from the patient. Even for the finest clinician, there will be times when the diagnosis is in doubt. In those instances, it is best to postpone initiating treatment. Symptoms will usually localize.OBJECTIVES OF A DIAGNOSIS第2页/共60页To determine need for appropriate treatment (does this require endo, perio intervention etc.)To determine those cases deemed to be too complex for the level of training , experience and expertise of the practitionerTo determine if it is necessary to consult or refer to other health professionals第3页/共60页DIAGNOSTIC TESTSThermal testElectric Pulp TestSinus Tract TracingRadiographsSelective anesthesiaPercussionPalpationPeriodontal probing第4页/共60页SYSTEM OF DIAGNOSISRadiographic examinationperiapical changesperiodontaladjacent teethCariesDetermine pathosis and potential etiology REVIEW ONE STRUCTURE AT A TIME第5页/共60页DIAGNOSISRADIOGRAPHIC EVALUATIONKnow normal structuresIf pulp tests vital, PA lesion could be normal landmark or other type of pathologyMultiple films from different anglesPA lesion should remain at apex regardless of angleDIAGNOSIS RADIOGRAPHS第6页/共60页Brynolf, Swed Dent J, 1970Correct diagnosis from single x-ray: 74% of casesCorrect diagnosis from 3 x-rays at different angles: 90% of casesA good quality radiographic image is essential RADIOGRAPHS第7页/共60页Bender, Seltzer, JADA, 1961Lesions in cancellous bone cannot be detected radiographically. The lesion can be detected when there is erosion or perforation of inner cortical bone Pulp can be necrotic with no PA lesionEarly stagesCortical bone must be involved to be visible第8页/共60页RADIOGRAPHIC EVALUATIONPulp can be necrotic with no PA lesionInner Cortical bone must be involved for a lesion to be visible Know normal structuresIf pulp tests vital, PA lesion could be normal landmark or other type of pathologyMultiple films f