Endodontic Diagnosis and Treatment Planning
Endodontic Diagnosis and Treatment Planning tests whether you can convert a complaint into separate pulpal and periapical diagnoses, then justify a plan against restorability, periodontal status, medical risk, and strategic value.
Core rules
- Pulp sensibility tests such as cold and EPT assess nerve response, not blood supply; a negative response suggests necrosis but is unreliable in immature teeth or heavily calcified canals.
- Record pulpal and apical diagnoses separately, for example necrotic pulp with asymptomatic apical periodontitis.
- Use percussion and palpation for apical status, probing for periodontal communication, and a sinus tract trace to locate the source.
- Radiographs are adjuncts: they may be normal in early disease and do not measure pulp vitality.
- Treatment planning weighs restorability, crown-root ratio, furcation, caries, periodontal support, strategic value, patient preference, and operator skill.
Worked example
A 45-year-old has a discoloured maxillary premolar, no pain, no swelling, a negative cold test, and a 4-mm periapical radiolucency. Probing is normal and the tooth is restorable. Diagnosis: necrotic pulp with asymptomatic apical periodontitis. Plan: root canal treatment and coronal restoration; extraction is not indicated merely because a lesion is present.
Traps that cost marks
Diagnosing from a single test; using EPT as a vitality test; missing a sinus tract that points to another tooth; calling a deep periodontal pocket a periapical sinus tract; and planning treatment before checking restorability and periodontal support.