Endodoncia

Review Article

Identify and Define All Diagnostic Terms for Periapical/ Periradicular Health and Disease States
James L. Gutmann, DDS,* J. Craig Baumgartner, DDS, MS, PhD,† Alan H. Gluskin, DDS,‡ Gary R. Hartwell, DDS, MS,§ and Richard E. Walton, DMD, MSjj
Abstract
Introduction: The purpose of this in-depth investigation was to identify, clarify, and substantiate clinical terminologyrelative to apical/periapical/periradicular diagnostic states, which is used routinely in the provision of endodontic care. Furthermore, the information gleaned from this investigation was used to link diagnostic categories to symptoms, pathogenesis, treatment, and prognosis wherever possible, along with establishing the basis for the metrics used in this diagnostic process. Materials and Methods:Diagnostic terminologies and their relevance to clinical situations were procured from extensive historic and electronic searches and correlated with contemporary concepts in disease processes, clinical assessments, histologic findings (if appropriate), and standardized definitions that have been promulgated and promoted for use in the last 25 years in educational programs and test constructions and forthird-party concerns. Results: In general, clinical terminology that is used routinely in the practice of endodontics is not based on the findings of scientific investigations. The diagnostic terms are based on assumptions by correlating certain signs, symptoms, and radiographic findings with what is presumed (not proven) to be the underlying disease process of a given clinical state. There were nostudies that specifically tried to assess the accuracy of the metrics used contemporarily for the classification of clinical disease states. Conclusion: A succinct diagnostic scheme that could be described thoroughly, agreed on unanimously, coded succinctly for easy electronic input, and ultimately used for follow-up analysis would not only drive treatment modalities more accurately, but would alsoallow for future outcomes assessment and validation. (J Endod 2009;35:1658–1674)

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Key Words
Apical, periapical and periradicular disease, diagnostic categories, diagnostic terms

From *Baylor College of Dentistry, Dallas, TX; †Oregon Health & Science University, Portland, Oregon; ‡Department of Endodontics, University of the Pacific, San Francisco, California; §Naval Postgraduate DentalSchool, Bethesda, Fairfax, Virginia; and jjDepartment of Endodontics, University of Iowa College of Dentistry, Iowa City, Iowa. Address correspondence to James L. Gutmann, DDS, 1416 Spenwick Terrace, Dallas, TX 75204-5529. E-mail address: jlgutmann@earthlink.net. 0099-2399/$0 - see front matter Copyright ª 2009 American Association of Endodontists. doi:10.1016/j.joen.2009.09.028

ne of thehallmarks of any profession is its distinct lexicon; this is no different with the dental specialties. Within this framework of the lexicon, there should exist clarity, succinctness, and specificity that are based on sound biological principles and understandings, clinical realities, and daily usages. Even in a global society in which differences may exist, there must be a commonality of thought, adistinct explicitness of meaning, and a rational basis for the choice of terminology and its routine application, as opposed to personalized, empiric bias that is used to exaggerate an individual’s thought process or perceived and unsupported interpretation. Oftentimes, the latter is identified as colloquial and bears little resemblance to the actual issue, event, or procedure at hand. Within thediscipline of endodontics, this latter type of lexicon has been proffered in contemporary times regardless of the historic framework on which it has evolved. On the other hand, the clinical discipline of endodontics and its scientific counterpart, endodontology, have been using a terminology in which biological concepts are commingled with that of the clinical, often leaving the reader or clinician...