João Miguel dos Santos

Establishing a differential diagnosis in endodontics requires a unique blend of knowledge, skills, and the ability to interpret and interact with a patient in real time.

The accuracy of a pulp diagnosis relies on a combination of data obtained from clinical examination, corroborated with radiographic findings, results of pulp testing, and reported dental history.

The diagnostic process is also influenced to some degree by the clinician’s experience in the field. Dental pulp testing is a useful and essential diagnostic aid widely used in endodontics.

There are multiple methods of testing the pulp status: either by assessing the neural component of the pulp (triggering a sensory response through mechanical or sensibility tests) or by assessing the vascular component (through vitality tests).

Nowadays, the endodontic treatment paradigm is shifting towards techniques aimed at maintaining pulp vitality, allowing the tooth to heal, and for that reason, an accurate diagnosis of the pulp status prior to the treatment is essential.

Moreover, traditional classification of irreversible pulpitis has been challenged and a new classification for pulp diagnosis has been proposed and is now under clinical assessment.

Therefore, it is mandatory to develop advanced preoperative and intraoperative diagnostic packages, including biomarkers.

Endodontic diagnosis must always include periapical evaluation, relying in signs and symptoms and enhanced by the use of two-dimensional radiography and in selected cases even three-dimensional imaging to inform treatment planning and decision-making.