Acute periapical cyst and acute periodontal cyst are differentiated by:
a- Vitality test.***
b- Radiograph.
c- Clinical examination.
--------------------------
Pulp vitality tests:
Pulp vitality tests are procedures that are part of the endodontic diagnosis and serve to guide the presence or not of pulp vitality.
Unquestionably, to obtain a correct diagnosis, a series of tests and exams must be carried out that, together with scientific knowledge, intuition, common sense and experience, make the diagnosis as accurate as possible and that the treatment be optimized.
The Oxford Compact English Dictionary in its second edition (1993) defines the diagnosis as: "the determination of the nature and condition of the disease".
Cohen and Burns believe that the diagnosis "consists in recognizing the patient, determining the disease and diagnosing it in order to carry out an effective treatment".
At present there are sophisticated means to perform pulp vitality tests that try to give an accurate diagnosis, although the concept that there is a poor correlation between clinical symptoms and pulp histopathology cannot be forgotten.
Pulp vitality tests that various authors call pulp sensitivity only serve to detect whether or not there is vitality.
They are part, as stated above, of a series of exams and tests such as: medical history, dental history, the main complaint that is usually presented as pain, percussion tests, palpation, mobility, radiographic analysis, periodontal examination, transillumination tests, selective anesthesia and many more.
The Glossary of the American Association of Endodontists of 1998 notes that pulp vitality tests are diagnostic procedures that determine the response of the dental pulp when an electrical, thermal or mechanical stimulus is applied.
Thermal conduction tests are based on dentistry sensitivity theories:
1- Nerve conduction is carried out by the presence of nerve fibers within the dentinal canaliculi.
2- The nerve conduction is performed because the odontoblast acts directly as a nerve transmitter.
3- The hydrodynamic theory of Brämmströn and Aström, of 1963, talks about the presence of fluids inside the dentinal canaliculi, which when compressed or expanded stimulate the nerve fibers in the Rashkow plexus.
Cold test:
It is a test that is applied more regularly and consists of placing cold on the teeth to be examined. It can be done with different sources of cold, such as: ice, cold water, carbon dioxide (CO2), ethyl chloride (volatile liquid) dichlorodifluromethane (DDM), known as Endo Ice®.
Currently, DDM is the most reliable, since it reaches a temperature between –26 ºC and –50 ºC, without affecting the pulp. In addition, it can be applied with relative insulation
and does not damage the ozone layer.
The individual must be informed before this test is done; relative or total isolation should also be maintained and contralateral control teeth chosen to differentiate the type of positive reaction.
or negative, which may be different for each patient.
This test can give false positives or false negatives; If this happens, it should be complemented with other tests for added security.
The presence of pulp calcifications, teeth with open or immature apex, apprehensive or medicated patients, extensive restorations can be sources of altered test.
Heat test:
It is the least used and least reliable test, usually the patient expresses that heat is the cause that causes pain or discomfort; This is carried out by applying different sources of heat by using a gutta-percha bar, hot water or using a rubber cup for polishing with a prophylactic medium.
These last two are not used frequently; In addition, the person must be informed and have contralateral control teeth.
The use of a gutta-percha bar heated and applied in the middle third of the vestibular face of the tooth or teeth to be examined, previously isolated with petroleum jelly so that they do not adhere, is the most used method.
Like cold tests, they can give false positives or false negatives that can make us doubt the result, so they must be corroborated by other complementary tests.
a- Vitality test.***
b- Radiograph.
c- Clinical examination.
--------------------------
Pulp vitality tests:
Pulp vitality tests are procedures that are part of the endodontic diagnosis and serve to guide the presence or not of pulp vitality.
Unquestionably, to obtain a correct diagnosis, a series of tests and exams must be carried out that, together with scientific knowledge, intuition, common sense and experience, make the diagnosis as accurate as possible and that the treatment be optimized.
The Oxford Compact English Dictionary in its second edition (1993) defines the diagnosis as: "the determination of the nature and condition of the disease".
Cohen and Burns believe that the diagnosis "consists in recognizing the patient, determining the disease and diagnosing it in order to carry out an effective treatment".
At present there are sophisticated means to perform pulp vitality tests that try to give an accurate diagnosis, although the concept that there is a poor correlation between clinical symptoms and pulp histopathology cannot be forgotten.
Pulp vitality tests that various authors call pulp sensitivity only serve to detect whether or not there is vitality.
They are part, as stated above, of a series of exams and tests such as: medical history, dental history, the main complaint that is usually presented as pain, percussion tests, palpation, mobility, radiographic analysis, periodontal examination, transillumination tests, selective anesthesia and many more.
The Glossary of the American Association of Endodontists of 1998 notes that pulp vitality tests are diagnostic procedures that determine the response of the dental pulp when an electrical, thermal or mechanical stimulus is applied.
Thermal conduction tests are based on dentistry sensitivity theories:
1- Nerve conduction is carried out by the presence of nerve fibers within the dentinal canaliculi.
2- The nerve conduction is performed because the odontoblast acts directly as a nerve transmitter.
3- The hydrodynamic theory of Brämmströn and Aström, of 1963, talks about the presence of fluids inside the dentinal canaliculi, which when compressed or expanded stimulate the nerve fibers in the Rashkow plexus.
Cold test:
It is a test that is applied more regularly and consists of placing cold on the teeth to be examined. It can be done with different sources of cold, such as: ice, cold water, carbon dioxide (CO2), ethyl chloride (volatile liquid) dichlorodifluromethane (DDM), known as Endo Ice®.
Currently, DDM is the most reliable, since it reaches a temperature between –26 ºC and –50 ºC, without affecting the pulp. In addition, it can be applied with relative insulation
and does not damage the ozone layer.
The individual must be informed before this test is done; relative or total isolation should also be maintained and contralateral control teeth chosen to differentiate the type of positive reaction.
or negative, which may be different for each patient.
This test can give false positives or false negatives; If this happens, it should be complemented with other tests for added security.
The presence of pulp calcifications, teeth with open or immature apex, apprehensive or medicated patients, extensive restorations can be sources of altered test.
Heat test:
It is the least used and least reliable test, usually the patient expresses that heat is the cause that causes pain or discomfort; This is carried out by applying different sources of heat by using a gutta-percha bar, hot water or using a rubber cup for polishing with a prophylactic medium.
These last two are not used frequently; In addition, the person must be informed and have contralateral control teeth.
The use of a gutta-percha bar heated and applied in the middle third of the vestibular face of the tooth or teeth to be examined, previously isolated with petroleum jelly so that they do not adhere, is the most used method.
Like cold tests, they can give false positives or false negatives that can make us doubt the result, so they must be corroborated by other complementary tests.
Electrical test:
The electrical test is based on the special conductivity conditions of the tooth tissues.
The electrical test by means of the pulpometer is performed to stimulate pulp sensory fibers, specifically those of fast or myelinic conduction (A delta) in the pulpodentinary junction by means of electrical excitation.
The unmyelinated fibers, fibers C), may or may not respond to this test. It is important to note that the patient's response to the electrical test does not suggest that the pulp is healthy and whole; on the contrary, this reaction simply indicates that there are sensory fibers present in the pulp.
Likewise, this test does not provide any information about the pulp vascular supply, which is the true variable to indicate pulp vitality.
However, the usefulness of this test becomes necessary when the rest of the tests performed have been inconclusive.
The main resource used by the clinician to perform this test is the pulpometer or pulpovitalometer; This device uses a high frequency electric current and in its body has a digital reader that indicates the intensity of current generated by it.
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