Contemporary endodontic evaluation and diagnosis: implications for evidence-based endodontic care.

Endodontics has evolved as a truly scientific procedure and, when correctly diagnosed and performed, its research-reinforced statistics corroborate its high success rates. In order for a correct diagnosis to be made, a number of steps and tests are required. These include ascertaining the source of the patient’s chief complaint, understanding the patient’s dental history and performing pulp tests that are integral to the diagnosis. In addition, the possibility of cracked teeth and periodontal involvement must be considered and assessed during the diagnostic phase. Only after a complete examination has been performed and a definitive diagnosis obtained is it possible to create a treatment plan for successful endodontic treatment. Introduction Endodontics remains a cornerstone in the foundation for dental restorative care in the 21st century. Without successful endodontics, we are unable to provide many patients with two of their most important facets – their ability to smile while displaying their natural teeth and their ability to use their natural teeth to eat with pain-free function. A recent study by the American Association of Endodontists highlighted this, with a third of participants stating that they would not sell their front teeth for any amount of money.1 Endodontics has evolved as a truly scientific procedure, and when correctly diagnosed and performed, its researchreinforced statistics corroborate its high success rates.2 This is ultimately reflected by the high patient satisfaction with the procedure. Eighty-five percent of patients who have had endodontic treatment performed by an endodontist would return to him or her for future work. This serves to reinforce the concept that endodontic procedures are valuable treatment modalities for the person who we ultimately serve, the patient. There are many myths and misconceptions in endodontics, and many of these have been addressed by the resurgence in endodontic research. This article provides the reader with a contemporary, evidence-based perspective on endodontic diagnosis that will enable clinicians to be secure and confident in the knowledge that they are striving to provide quality endodontic care that follows guidelines and principles established from the latest endodontic research. Endodontic Diagnosis To perform successful endodontic treatment, it is first necessary to correctly diagnose the affected tooth or teeth. This diagnosis can often be simple where there is a large carious cavity and there are healthy, restoration-free adjacent teeth (Figure 1), or it can be extremely complex where the symptoms are less defined and there have been multiple endodontic procedures on numerous teeth (Figure 2). Irrespective of the details of the case, the same protocol of examination and testing should be employed in each instance in order to obtain the most precise response and establish an accurate diagnosis. Figure 1. Periapical radiograph displaying a large carious cavity on tooth #3 This was identified as the symptomatic tooth by pulp testing. The adjacent teeth have no restorations, and there is no peri-radicular pathology evident with them. Figure 2. Periapical radiograph with existing RCT of satisfactory technical status on teeth #2, #3 and #4, and coronal restorations The Patient’s Chief Complaint An examination should always be initiated by obtaining the patient’s chief complaint. This is critical, as it will provide information as to what symptoms or pathology our subse-