Titulo
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
O
Introduction: The purpose of this in-depth investigationwas to identify, clarify, and substantiate clinical terminology
relative to apical/periapical/periradicular diagnostic states,
which is used routinely in the provision of endodontic
care. Furthermore, the information gleaned from this inves-
tigation was used to link diagnostic categories to symp-
toms, pathogenesis, treatment, and prognosis wherever
possible, along with establishing the basis for the metricsused in this diagnostic process. Materials and Methods:
Diagnostic terminologies and their relevance to clinical
situations were procured from extensive historic and elec-
tronic searches and correlated with contemporary concepts
in disease processes, clinical assessments, histologic find-
ings (if appropriate), and standardized definitions that
have been promulgated and promoted for use in the last25 years in educational programs and test constructions
and for third-party concerns. Results: In general, clinical
terminology that is used routinely in the practice of
endodontics is not based on the findings of scientific inves-
tigations. The diagnostic terms are based on assumptions
by correlating certain signs, symptoms, and radiographicfindings with what is presumed (not proven) to be the
underlying disease process of a given clinical state. There
were no studies that specifically tried to assess the accu-
racy of the metrics used contemporarily for the classifica-
tion of clinical disease states. Conclusion: A succinct
diagnostic scheme that could be described thoroughly,
agreed on unanimously, coded succinctly for easy elec-tronic input, and ultimately used for follow-up analysis
would not only drive treatment modalities more accurately,
but would also allow for future outcomes assessment and
validation. (J Endod 2009;35:1658–1674)
Key Words
Apical, periapical and periradicular disease, diagnostic
categories, diagnostic terms
From *Baylor College of Dentistry, Dallas, TX; †OregonHealth & Science University, Portland, Oregon; ‡Department
of Endodontics, University of the Pacific, San Francisco, Califor-
nia; §Naval Postgraduate Dental School, Bethesda, Fairfax, Vir-
ginia; and jjDepartment of Endodontics, University of Iowa
College of Dentistry, Iowa City, Iowa.
Address correspondence to James L. Gutmann, DDS, 1416Spenwick 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 the hallmarks of any profession is its distinct lexicon; this is no different with
the dental specialties. Within this framework of the lexicon, there should existclarity, 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, a distinct 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’sthought 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 the discipline of endodontics, this latter type of lexicon
has been proffered in contemporary times regardless of the historic framework on
which it has evolved....
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