Hi, guys.
This week, I am trying to study/finish endo section.
I have gone thru Mosby's review couple of times but I wasn't able to answer any of the diagnosis and treatment planning questions I found in dental deck/released exams.
For example, if a question gives us a pt with age, what happened to the tooth, vitality...etc and tell me what I should do with options such as pulpotomy, pulpectomy, root canal, don't do anything...etc. I don't know how to approach this type of questions😕
Here are some examples and I would appreciate it if you can explain how you approached to come up with answers.
1. 4 mandibular incisors were traumatized 3 yrs ago. x ray shows bone rarefaction i the region of the apices of the incisors.
Answer = test the pulp vitality and perform RCT only in those that don't respond to pulp testing.
2. Pt has severe, throrrinb pain, aggrevated by heat, biting, and touching.
answer = RCT
3. permanent tooth crown got fractured, creating 1mm pulp exposure for 30 min
answer = direct pulp capping with calcium hydroxide.
4. 4 yr old w/ frequent spontaneous pain in primary mandibular 2nd molar. Necrotic pulp
answer = pulpectomy
5. 5 yr old child has a carious lesion in her primary mandibular 2nd molar. No mobility but small draining sinus tract adjacent to the tooth
answer = pulpectomy
6. 8 year old has exposed vital but inflamed coronal pulp in #14
answer = pulpotomy
7. 7 year old patient has fractured #8, 3 hrs ago, 2mm exposure of a bleeding pulp.
answer = pulpotomy w/ calcium hydroxide.
8. 6 yr old pt, tx choice for necrotic pulp on permanent first molar
answer = apexification
9. 34 yr old black woman. Asymptomatic. No decay or destruction. Slight perio disease. Periapical radioluencies on two mandibular central incisors. positive pulptal test.
answer = no treatment necessary at this time.
10. A patient experienced a blow to the mouth. Horizontal mid-root fracture of a maxillary central incisor. No mobility. Asymtomatic. negative pulp test. No radiographic lesion.
answer = render no treatment at this time and periodically recheck clinically and radiographically.
Thanks in advance.
1) if pulp is vital no need for RCT if pulp is not vital RCT .
2) severe throbbing pain, aggregated by heat ,irreversible pulpitis ,do RCT.
) permanent tooth with pulp exposure , diagnosis depend on the age ,if pt is old do RCT if its a kid and apex is not fully closed pulp capping.
4) 4 yr old primary tooth , necrotic pulp do pulpectomy ,Remember it's. primary tooth.,if its a permanent tooth might need apexification .
5) 5 yr old with carious lesion ,draining sinus tract mean pulp is necrotic so do pulpectomy .
8)6 yr old ,necrotic pulp permanent tooth do apexification . Coz apex is not closed yet.
9) 34 yr old , asymptomatic, pulp vital no endo treatment required periapical radiolucencies could be perio issue.
10) pt with horizontal mid root fracture , don't do the pulp test right away it could be negative even if pulp is vital.so wait for some time do the pulp test again and make diagnosis.most tooth with vertical root fracture has poor prognosis.prognosis in horizontal fracture depend upon extent of the fracture .
6)8 yr old with vital but inflamed coronal pulp,remove coronal pulp put ca ( oh)2. Root of #14 close around 10 yr. so need that pulp for apex formation if the whole pulp is infected or necrotic do apexification.
7) same explanation as above.
