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endo > use and interpretation of EPT and apex locator > Flashcards

use and interpretation of EPT and apex locator Flashcards

1
Q

Sensibility vs. Vitality

A

– Sensibility
* Does the tooth respond to a stimulus
* Example: Hot, Cold, EPT

– Vitality
* Does the tooth have pulpal blood flow
* Example: Laser Doppler Flow, Pulse Oximetery

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2
Q
  • Specificity vs. Sensitivity
A

– Specificity
* Ability of a test to identify people WITHOUT disease

– Sensitivity
* Ability of a test to identify people WITH disease

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3
Q

Anatomy of an EPT

A
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4
Q

Do we use EPT as part of routine
clinical testing?

A
  • EPT is NOT a primary or routine clinical testing instrument.
  • Thermal testing is inconclusive, use the EPT.
  • EPT is an ADJUNCT to thermal sensitivity testing.
    – If we do not get a definitive or reproducible result with thermal testing, incorporate EPT.
    – If thermal testing provides a result in accordance with
    clinical signs and symptoms, do not incorporate EPT.
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5
Q

cold test and EPT used in conjuction

A
  • Dr. Weisleder!
    – Cold test and EPT used in conjunction resulted in a
    more accurate method for diagnostic testing.
    – If tests positive to EPT and cold, 97% chance it is
    vital.
    – If tests negative (=80) to EPT and cold, 90% chance
    it is necrotic.
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6
Q

EPT mechanism

A
  • Deliver current sufficient to stimulate A-delta fibers
    – If sharp sensation felt, some functioning nerve fibers are present in the pulp
    – If no sensation felt, fibers not functioning
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7
Q

EPT current scale

A
  • EPT reveals response of fibers as current increases
    on a scale from 0- 80
  • Do not attempt to differentiate “vitality” based on
    the magnitude of the numbers (20 vs. 40 vs. 60)
  • EPT does not give an accurate indication of the
    histological health or disease state of the pulp.
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8
Q

interpreting EPT result

A

Reading < 80: Tooth likely “vital” (intact nerve fibers
present)
Reading = 80: Tooth likely necrotic (intact nerve fibers
not present)

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9
Q

how to use EPT

A
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10
Q

electrode conductors

A
  • Toothpaste
  • Electrode Gel
  • Water
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11
Q

where to place electrode
* Anteriors:
* Premolars:
* Molars:

A
  • Anteriors: Facial surface or incisal edge
  • Premolars: Buccal cusp tip
  • Molars: Mesiobuccal cusp tip
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12
Q

what wrong

A

no cotton roll

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13
Q

To EPT or no?

  • # 14:Cold: +++ w/ linger
    EPT: Test or not?
  • # 15:Cold: -
A

14= no, already determine pulpitis
15= yes, non-vital result with cold

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14
Q

CC: Doc, it really hurts on my back tooth when I drink cold water… To EPT or no?
* #30
Cold: +++ w/o linger

A

no, osteomylitis and cannot EPT with crown

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15
Q

false positive of EPT?
– isolation?
– Conductor?
– Touched?
– Patient?
– Conduction via?
– Putrescence?

A

– Poor isolation
– Conductor in contact with adjacent teeth
– Touched gingiva
– Patient comprehension
– Patient anxiety
– Conduction via interproximal restorations
– Putrescence of pulp tissue communicating with
adjacent teeth

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16
Q

false negatives of EPT
– Failed to achieve?
– Patient finger?
– pain threshold?
– Battery?
– Machine?
– Sedatives?
– Orthodontics?

A

– Failed to achieve adequate contact with tooth
– Patient finger does not achieve adequate contact
– High pain threshold
– Battery low (at least 70% needed)
– Machine not working
– Sedative medication
– Orthodontic activation

17
Q

when can EPT be unreliable?

A
  • Trauma
    – Loss of normal response for period of time
    – 1-3 months
  • Immature Pulp
    – May yield no response (80)
    – Fewer A-delta fibers
    – Nerves have not reached maximal depth of penetration
18
Q

methods of WL determination

A
  • Electronic apex locator
  • Radiographic determination
  • Paper point
  • Feel
19
Q

Anatomy of an apex locator

A
20
Q

Basic Principles of apex locator
* Human tissues have?
* Dentin and cementum are?
* At apex, what is present?
* Apical constriction approximate location?

A
  • Human tissues have characteristics that can be modelled by a combination of electrical components
  • Dentin and cementum are insulators
  • At apex, conductive fluids are present
  • Apical constriction approximately 1 mm short of root tip
21
Q

apex locator in canal

A
  • Apex locator will display bars as you approach the apex
  • Intermittent “Beep”
  • No red lines
22
Q

apex locator at apex

A
  • Apex locator will display a red bar
  • Constant “Beeeeeeeeep”
  • Red line = patency
23
Q

What does the apex locator tell us?

A

We are in the canal (blue)
We are at the PDL (red)
We use this measurement to determine our working length. Subtract 1 mm from RED length to establish working length

24
Q

What do the numbers 3, 2, and 1
on the apex locator mean?

A

Nothing
The numbers indicate you are within the canal, not the distance from the apex

25
Q

How to Use apex locator

A
  1. Educate patient on procedure and expectations
  2. Assemble, turn on, and check battery meter (70% or >)
  3. Connect lip clip and file holder: If continuous beep present, apex locator is working
  4. Place lip clip on corner of mouth: Do not remove rubber dam
  5. Insert Size 10 file into canal
  6. Clip file holder to file
  7. Slowly negotiate canal to get controlled swing of bars: Proceed until 1st solid tone
  8. Move rubber stopper to reference point or note reference mark on file
  9. Remove clip and file
  10. Measure file length from rubber stopper
  11. Subtract 1 mm to establish WL
  12. Repeat for all canals
26
Q

WL Radiograph

A
  • Use a #15 file– Able to identify tip on radiograph
    – Ensure placed 1 mm short of patency length
    – Do not spend more than 5 minutes (call for faculty if
    not working)
27
Q

detecting perforations

A
  • Perforations happen
  • Early detection and repair, better long-term prognosis
  • Apex locator identifies when we have reached PDL
  • Perforation is direct communication with PDL
  • Apex locator immediately goes to RED upon entrance
    to perforation
28
Q

Root Canals Not Suitable for EAL
* apical foramen?
* Fluid?
* Broken crown?
* access with metallic?
* Caries?

A
  • Exceptionally large apical foramen
  • Fluid overflowing orifice
  • Broken crown w/ gingival intrusion
  • Small access with metallic restoration
  • Caries touching gingiva

endo (22 decks)

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