Saudi Endodontic Journal

 

 Saudi Endodontic Journal “SEJ” (ISSN - 1658-5984), a publication of Saudi Endodontic Society, is a peer-reviewed online journal with 3 Issues print on demand compilation of issues published. The journal’s full text is available online at http://www.saudiendodj.com . The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. The journal does not charge for submission, processing or publication of manuscripts and even for color reproduction of photographs. SEJ aims to be one of the foremost worldwide periodical on Endodontics, dedicated to the promotion of research, post-graduate training and further education in Endodontics.

 

http://www.aae.org/Dental_Professionals/Considerations_for_Regenerative_Procedures.aspx

 

 

Use of Cone BeamComputed Tomography in Endodontics

The ability to assess an area of interest in 3 dimensions might benefit both novice and experienced clinicians alike. High-resolution limited cone-beam volumetric tomography (CBVT) has been designed for dental applications. As opposed to sliced-image data of conventional computed tomography (CT) imaging, CBVT captures a cylindrical volume of data in one acquisition and thus offers distinct advantages over conventional medical CT. These advantages include increased accuracy, higher resolution, scan-time reduction, and dose reduction. Specific endodontic applications of CBVT are being identified as the technology becomes more prevalent. CBVT has great potential to become a valuable tool in the modern endodontic practice. 

Read more by clicking this site:

http://www.carestreamdental.com/~/media/files/digital%20imaging%20systems/cbct%20in%20endo.ashx

 

 

AAE and AAOMR Joint Position Statement

Use of Cone-Beam-Computed Tomography in Endodontics

Introduction

The American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology have jointly developed this position statement. It is intended to provide scientifically based guidance to clinicians regarding the use of cone-beam-computed tomography in endodontic treatment as an adjunct to planar imaging. This document will be periodically revised to reflect new evidence.

Endodontic disease adversely affects quality of life and can produce significant morbidity in afflicted patients. Radiography is essential for the successful diagnosis of odontogenic and nonodontogenic pathoses, treatment of the pulp chamber and canals of a compromised tooth, biomechanical instrumentation, evaluation of final canal obturation and assessment of healing.

Until recently, radiographic assessments in endodontic treatment have been limited to intraoral and panoramic radiography. These radiographic technologies provide two-dimensional representations of three-dimensional tissues. If any element of the geometric configuration is compromised, the image can demonstrate errors.1 In more complex cases, radiographic projections with different beam angulations can allow parallax localization. However, complex anatomy and surrounding structures can make interpretation of planar “shadows” difficult.

Cone-Beam-Computed Tomography

The advent of CBCT has made it possible to visualize the dentition, the maxillofacial skeleton and the relationship of anatomic structures in three dimensions.2 Significantly increased use of CBCT is evidenced by a recent Web-based survey of active AAE members in the United States and Canada, which found that 34.2% of 3,844 respondents indicated that they were utilizing CBCT. The most frequent use of CBCT among the respondents was for diagnosis of pathosis, preparation for endodontic treatment or endodontic surgery, and for assistance in the diagnosis of trauma-related injuries.3

CBCT, as with any technology, has known limitations. There are also numerous CBCT equipment manufacturers and models available. In general, CBCT can be categorized into large-, medium- and limited-volume units based on the size of their “field of view.”

Volume Size(s)

The size of the “field of view,” or FOV, describes the scan volume of CBCT machines and is dependent on the detector size and shape, beam projection geometry and the ability to collimate the beam. Beam collimation limits the x-radiation exposure to the region of interest and ensures that an optimal FOV can be selected based on disease presentation. Smaller scan volumes generally produce higher resolution images, and since endodontics relies on detecting disruptions in the periodontal ligament space measuring approximately 200μm, optimal resolution is necessary.4

The principal limitation of large FOV cone-beam imaging is the size of the field irradiated. Unless the smallest voxel size is selected in these larger FOV machines, there is also reduced resolution compared to intraoral radiographs or 

limited-volume CBCT machines with inherent small voxel sizes. The limited-volume CBCT imaging in endodontics is advantageous, but by irradiating only one site or area, projections acquired may not contain the entire region of interest. Reconstructed images may suffer from truncation artifacts5 when comparing medical CT with CBCT reconstructed images; medical CT scans provide the most suitable images for tumor-derived alterations due to their capacity for soft tissue visualization.6

For most endodontic applications, limited-volume CBCT is preferred over large-volume CBCT for the following reasons:

1. Increased spatial resolution to improve the accuracy of endodontic-specific tasks such as the visualization of small features including accessory canals, root fractures, apical deltas, calcifications, etc.

2. Highest possible spatial resolution that provides a diagnostically acceptable signal-to-noise ratio for the task at hand.

3. Decreased radiation exposure to the patient.

4. Time savings due to smaller volume to be interpreted.

Dose Considerations

Every effort should be made to reduce the effective radiation dose to the patient for endodontic-specific tasks. Using the smallest possible FOV, the smallest voxel size, the lowest mA setting and the shortest exposure time in conjunction with a pulsed exposure mode of acquisition is recommended. If extension of pathology beyond the area surrounding the tooth apices or a multifocal lesion with possible systemic etiology is suspected, and/or a nonendodontic cause for devitalization of the tooth is established clinically, appropriate larger field of view protocols may be employed on a case-by-case basis. Interpretation of the entire acquired volume will be essential to justify the use of task-specific modification of acquisition protocol in such cases.

CBCT has a significant advantage over medical grade CT as radiation doses from commonly used CBCT acquisition protocols are lower by an order of magnitude.7 Selection of the most appropriate imaging protocol for the diagnostic task at hand is paramount.

Patient Selection Criteria

CBCT must not be used routinely for endodontic diagnosis or for screening purposes in the absence of clinical signs and symptoms. The patient’s history and clinical examination must justify the use of CBCT by demonstrating that the benefits to the patient outweigh the potential risks. Clinicians should use CBCT only when the need for imaging cannot be answered adequately by lower dose conventional dental radiography or alternate imaging modalities.

Patient Consent

Significant risks, benefits and alternatives of special importance should be explained by disclosure and patient education, and then documented in a patient’s record. The use of CBCT will expose the patient to ionizing radiation that may pose elevated risks to some patients (e.g., cases of pregnancy, previous treatment with ionizing radiation and younger patients). Patients should be informed that CBCT volumes cannot be relied upon to show soft-tissue lesions unless they have caused changes in hard tissues (teeth and bone), and some of the images may contain artifacts that can make interpretation difficult.

A patient may understand the relevant facts and implications of not following a recommended diagnostic or therapeutic action and still refuse the proposed intervention. This is known as the medico-legal concept of “informed refusal” and is recognized in certain state laws and court decisions.8 Should a patient be incapable of understanding or responding to an informed consent presentation or be a minor, the informed consent or informed refusal should be documented in the patient’s record and signed by an individual legally responsible for the patient.

Interpretation

Clinicians ordering a CBCT are responsible for interpreting the entire image volume, just as they are for any other radiographic image. Any radiograph may demonstrate findings that are significant to the health of the patient. There is no informed consent process that allows the clinician to interpret only a specific area of an image volume. Therefore, the clinician can be liable for a missed diagnosis, even if it is outside his/her area of practice.9 Any questions by the practitioner regarding image data interpretation should promptly be referred to a specialist in oral and maxillofacial radiology.

Protection of Patients and Office Personnel

At this time, all CBCT equipment produce dose levels and beam energies that are higher than conventional dental radiography, requiring extra practical protection measures for office personnel. Appropriate qualified experts should be consulted prior to and after installation to meet state and federal requirements, and manufacturer’s recommended calibration routines should be conducted at the recommended intervals.

Recommendations

The decision to order a CBCT scan must be based on the patient’s history and clinical examination, and justified on an individual basis by demonstrating that the benefits to the patient outweigh the potential risks of exposure to X-rays, especially in the case of children or young adults. CBCT should only be used when the question for which imaging is required cannot be answered adequately by lower dose conventional dental radiography or alternate imaging modalities. Initial studies regarding the use of CBCT for a variety of endodontic related imaging tasks have demonstrated the effectiveness and comparability of CBCT to conventional radiography.10-16 In general, the use of CBCT in endodontics should be limited to the assessment and treatment of complex endodontic conditions such as:

• Identification of potential accessory canals in teeth with suspected complex morphology based on conventional imaging.

• Identification of root canal system anomalies and determination of root curvature.

• Diagnosis of dental periapical pathosis in patients who present with contradictory or nonspecific clinical signs and symptoms, who have poorly localized symptoms associated with an untreated or previously endodontically treated tooth with no evidence of pathosis identified by conventional imaging, and in cases where anatomic superimposition of roots or areas of the maxillofacial skeleton is required to perform task-specific procedures.

• Diagnosis of nonendodontic origin pathosis in order to determine the extent of the lesion and its effect on surrounding structures.

• Intra- or postoperative assessment of endodontic treatment complications, such as overextended root canal obturation material, separated endodontic instruments, calcified canal identification and localization of perforations.

• Diagnosis and management of dentoalveolar trauma, especially root fractures, luxation and/or displacement of teeth, and alveolar fractures.

• Localization and differentiation of external from internal root resorption or invasive cervical resorption from other conditions, and the determination of appropriate treatment and prognosis.

• Presurgical case planning to determine the exact location of root apex/apices and to evaluate the proximity of adjacent anatomical structures.

• Dental implant case planning when cross-sectional imaging is deemed essential based on the clinical evaluation of the edentulous ridge.

Summary

All radiographic examinations must be justified on an individual needs basis whereby the benefits to the patient of each exposure must outweigh the risks. In no case may the exposure of patients to X-rays be considered “routine,” and certainly CBCT examinations should not be done without initially obtaining a thorough medical history and clinical examination. CBCT should be considered an adjunct to two-dimensional imaging in dentistry. Limited field of view CBCT systems can provide images of several teeth from approximately the same radiation dose as two periapical radiographs, and they may provide a dose savings over multiple traditional images in complex cases.

References

1. Grondahl HG, Huumonen S. Radiographic manifestations of periapical inflammatory lesions. Endodontic Topics. 2004; 8:55-67.

2. Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarament DP. Accuracy of three-dimensional measure-ments using CBCT. Dentomaxilllofac Radiol. 2006; 35:410.

3. Dailey B, Mines P, Anderson A, Sweet M. The use of cone beam computer tomography in endodontics: Results of a questionnaire. 2010. AAE Annual Session abstract presentation.

4. Scarfe WC, Levin MD, Gane D Farman AG. Use of cone beam computed tomography in endodontics. Int J Dent. 2009; DOI:1155/2009/634567.

5. Katsumata A, Hirukawa A, Noujeim M, Okumura S, Naitoh M, Fujishita M, et al. Image artifact in dental-cone beam CT. Oral Surg Oral Med Oral Path Oral Radiol Endod. 2006;101(5):652-7.

6. Schulze D, Heiland M, Thurmann H, Adam G. Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography. Dentomaxillofac Radiol 2004;33:83–6.

7. Chau ACM and Fung K: Comparison of radiation dose for implant imaging using conventional spiral tomography, computed tomography and cone-beam computed tomography. Oral Surg Oral Med Oral Path Oral Radiol Endod. 2009;107(4)559-65.

8. Goodman JM. Protect yourself! Make a plan to obtain informed refusal. OBG Management. 2007; 3:45-50.

9. AAOMR executive opinion statement on performing and interpreting diagnostic cone beam technology. 2008

10. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography. J Endod. 2007; 33(9):1121-32.

11. Lofthag-Hansen S, Huumogen S, Grondahl K, Grondahl HG. Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Path Oral Radiol Endod. 2007;103(1):114-9.

12. Cohenca N, Simon JH, Mathur A, Malfaz JM. Clinical indications for digital imaging in dentoalveolar trauma. Part 2: root resorption. Dent Traumatol. 2007; 23(2):105-13.

13. Nair MK, Nair UP. Digital and advanced imaging in endodontics: a review. J Endod. 2007; 33(1):1-6.

14. Low KMT, Dula K, Bürgin W, von Arx T. Comparison of periapical radiography and limited cone-beam tomography in posterior maxillary teeth referred for apical surgery. J Endod. 2008; 34(5):557-62.

15. Noujeim M, Prihoda TJ, Langlais R, Nummikoski P. Evaluation of high-resolution cone beam computed tomography in the detection of simulated interradicular bone lesions. Dentomaxillofac Radiol. 2009; 38:156-62.

16. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesslink PR. Detection of vertical root fractures in endodontically treated teeth by cone beam computed tomography scan. J Endod. 2009; 35(5):719-22.

http://www.aae.org/uploadedFiles/Publications_and_Research/Guidelines_and_Position_Statements/conebeamstatement.pdf  

 

 

The First Plastic Endodontic Rotary Finishing File

How it works

 No matter which endodontic file system a clinician chooses to incorporate into their conventional endodontic treatment in conjunction with sodium hypochlorite (NaOCL) and EDTA (ethylenediaminetetracitic acid) usage, there will always be some canal debris left on the dentinal walls. The main reasons for this are first, NiTi files stay centered in the canal and thus will not contact walls that have various invaginations or irregularities. Secondly, canal morphology can be complex making it difficult for the chemical-mechanical canal preparation to be effective in removing all the canal debris.

Although the use of sonic or ultrasonic instrumentation is effective in removing residual canal debris that rotary endodontic files and irrigation solutions are often unable to remove during endodontic treatment, many clinicians still do not incorporate it in their endodontic instrument armamentarium. The common reasons given for the not using sonic or ultrasonic filing are:  

1.  It can be time consuming to set up.

2.  A dentist is unwilling to incur the cost of the equipment.

3.  A clinician is not aware of the benefits to this final instrumentation step in endodontic treatment.

It is for these reasons that a new endodontic polymer-based rotary finishing file was developed. This new, single-use, plastic rotary file has a unique file design with a diamond abrasive embedded into a non-toxic polymer. The F® File will remove dentinal wall debris and agitate the sodium hypochlorite without further enlarging the canal.

Additional Uses of the F® File

• Removal of calcium hydroxide dressing
• Placement of sealer
• Removal of canal debris after post preparation
• Placement of post cements

http://www.plasticendo.com/f_file.html

 

 

Regenerative Endodontics: Teeth of the Future, Today

In recent years, regenerative therapies have been identified as a key opportunity for endodontics. Research departments at many universities are increasingly focused on regenerative endodontic practices and innovations.

Dr. Peter E. Murray, an associate professor of endodontics and postgraduate research administrator at Nova Southeastern University, recently penned an article for the South Florida Sun Sentinel called "The Tooth Harvest." The article explained, in clear but scientific terms, the many effects regenerative therapies could have on dentistry and the research processes universities have undertaken to spur this initiative. In the article, he writes, “replacement teeth and dental tissues [could] be grown in the lab and implanted into patients.”

“The public reaction to knowing this research is underway to give practitioners the technology to regenerate functional teeth and gums has been fantastic,” Dr. Murray commented of the response to the article.

To make this treatment a reality for patients, the AAE is committed to encouraging innovative research and assisting endodontists in utilizing new techniques as soon as they are available. To that end, the AAE Web site currently features a Regenerative Endodontics Database, where members can submit information related to revascularization cases. This data will be used in endodontic research, assisting in establishing a best practice for treatment and clarifying future research initiatives for these cutting-edge therapies. The database also collects follow-up submissions, allowing a breadth of notes on a patient to be shared.

The database is being managed by the Regenerative Endodontics Committee, which is working to enhance the AAE’s participation in a variety of arenas. The Committee has supported the AAE’s sponsorship of a symposium on regenerative endodontics to follow the International Association of Dental Research meeting in Geneva, Switzerland, in July 2010. The symposium will cover regenerative biology, scaffold technology, the effects of inflammation and infection, and other topics related to regenerative endodontics. To continue fostering research in the area, the Committee is also in the beginning stages of developing a Request for Proposals for a clinical research project.

Dr. Alan S. Law, committee chair, spoke at the 2009 American Dental Association Annual Session about regenerative dentistry, presenting a course titled,It's Alive: Revascularization of Necrotic Pulp Tissue in Immature Teeth. Regenerative dentistry will also be a cornerstone of the educational course offerings at the next Fall Conference, which will be themed Future Endodontics—It’s Not That Far Away!

The AAE will continue to work on regenerative opportunities as part of its Strategic Plan, ensuring that endodontists secure a leadership position in this exciting field. If you have any questions about the database or the committee activities, please contact Debby Rice, assistant executive director for development at drice@aae.org, or by calling 800/872-3636 (North America) or 312/266-7255 (International), ext. 3017.

http://www.aae.org/welcome/pulparchive/PULP1109.htm#2

 

 

AAE Responds to Bold Statement on Implants

On August 27, the American Academy of Implant Dentistry distributed a press release that included a number of bold attacks on endodontic treatment, including the recommendation that "patients should forego prolonged dental heroics to save failing teeth and replace them with long-lasting dental implants." The AAE responded quickly to the Academy’s remarks, releasing an immediate rebuttal that cited accurate information on endodontic and implant success rates, advocated for the rights of the patient and emphasized the retention of teeth as a core goal of all dental health professionals.

The AAE rebuttal worked to counter some factual inaccuracies in the AAID release, which stated in part that "endodontic surgical retreatments, according to published studies, have success rates ranging from 37 to 87 percent." To challenge this misleading claim, the AAE cited a 2007 consensus report published by the Academy of Osseointegration in its International Journal of Oral and Maxillofacial Implants and studies published in the Journal of Endodontics, which demonstrate that the success rates for endodontically treated teeth are the same as those for single-tooth implants, and better than implants over the long term.

AAE President Gerald N. Glickman, in a letter to the AAID president, also observed: "It is interesting to note that while implant data available today are from carefully controlled clinical studies with intensive maintenance, the endodontic numbers discussed here are retention data from average, non specialized dentists."

Apart from these clarifications, the AAE response hammered home the message that treatment decisions should be based on what is in the best interest of the patient, with the patient's full knowledge of all available options. AAE Secretary James C. Kulild commented on the disturbing eagerness with which some dentists extract teeth in an interview with DrBicuspid.com by saying, "Once you lose a tooth, you can't grow another one."

This controversy is familiar to many endodontists, who often face the challenge of addressing similar claims with referring and specialist colleagues. To assist, the AAE has made it a high priority to offer current and comprehensive resources about dental implants. These resources are multifaceted and include an AAE position statement on implants, tools for outreach to dental professionals, educational material for patients, and a large list of references to help bolster knowledge-based discussion on the issue.

For more information, contact Harriet Bogdanowicz, assistant executive director for communications, at hbogdanowicz@aae.org, or call 800/872-3636 (North America) or 312/266-7255 (International), ext. 3032.

http://www.aae.org/welcome/pulparchive/PULP0909.htm#1

 

 

Stem Cells and Regenerative Endodontics: Its Your Future Whether You Know It or Not By Peter E. Murray B.Sc.(Hons), Ph.D.

By way of introducing the fascinating and promising area of regenerative endodontics, Peter E. Murray of Nova Southeastern University, answered a few basic questions. In the coming months, Dentalcompare will cover this treatment philosophy with information on specific research and clinical applications. But here're the basics..... Can you give the 30,000-foot overview of regenerative endodontics? Regenerative endodontics is expected to become the next big treatment revolution. It is the creation and delivery of tissues to replace a diseased, missing, and traumatized pulp-dentin complex, in addition to tooth-supporting tissues. Some research is focused on accomplishing the regeneration of host-tissues, while others create replacement tissue in the laboratory for transplantation. How did it originate? Who is doing most of the research? Regenerative endodontics originated as part of research that is aimed at unlocking the therapeutic potential of stem cells, growth factors, molecular biology and the human genome. The first paper describing regenerative endodontics was published in the Journal of Endodontics in 2007 by Murray, Garcia-Godoy, and Hargreaves. Dr. Peter Murray and Dr. Franklin Garcia-Godoy are from Nova Southeastern University College of Dental Medicine, Fort Lauderdale, FL. Dr Ken Hargreaves is from the University of Texas Health Science Center at San Antonio, TX. Are any of the techniques/protocol in clinical use yet? What's the timetable? In 2007, the Directors of the American Association of Endodontists (AAE) created a committee to investigate and provide guidelines concerning Regenerative Endodontics. In May 2008, the committee launched a database to collect case-reports of the outcomes of regenerative endodontic treatments. In coming years, once enough cases have been collected to provide a reliable guide: The AAE hopes to provide guidelines that will optimize the success of the regenerative treatments.  What are the implications for patient care? In the coming decades unparalleled advances in endodontics, dentistry, and medicine are set to take place with the availability of artificial oral tissues, including; teeth, oral mucosa, bone, muscle, glands, and skin. Although current treatment modalities offers high levels of success for many conditions, an ideal form of therapy might consist of a regenerative procedure, in which diseased pulp tissues are removed and replaced with healthy pulp tissue in order to revitalize teeth.  Are there other potential applications for dental pulp stem cells? There is some controversy among researchers about the origin, source, and usefulness of dental pulp stem cells. It seems these cells have the potential to be used to create tissues which are hard, soft, mineralizing, and have neuronal properties. These discoveries mean that these cells have the potential to create many types of tissues in the body. By the same token, other types of stem cells have demonstrated some potential to regenerate tooth tissues. I recently reviewed an article submitted to a stem cell journal that used stem cells taken from hair follicles to regenerate tooth tissues. Many predict a bright future for dental pulp stem cells, several companies have established dental pulp stem cell banks in the hope of capitalizing on the potential therapeutic applications of these cells.  What are some good resources for dentists who want to learn more right now? Courses? Web sites? Literature? The most valuable resource for dentists will be the AAE guidelines, the best evidence-base are the limited number of articles published in peer-reviewed dental journals.  Refrences: Tissue engineering in endodontics. Aust Endod J Jan 05, 2006 Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: A case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Volume 108, Issue 2, Pages e62-e65 A paradigm shift in endodontic management of immature teeth: Conservation of stem cells for regeneration. J Dent Apr 18, 2008 The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering.  J Endod. 2008 Jun;34(6):645-51  Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009 Feb;35(2):160-4.

 

New Endodontic Diagnosis Terminology

Endodontic diagnostic terminology is based on clinical signs & symptoms, radiographic appearance & presence or lack of swelling or drainage. It is easily understood how confusing this can be with so many variables. The following is the new terminology recommended by the ABE:

PULPAL DIAGNOSIS	PERIAPICAL DIAGNOSIS
Normal pulp – A clinical diagnostic category in which the pulp is symptom free and normally responsive to vitality testing.	Normal apical tissues – Teeth with normal periradicular tissues that will not be abnormally sensitive to percussion or palpation testing. The lamina dura surrounding the root is intact and the periodontal ligament space is uniform.
Reversible pulpitis – A clinical diagnosis based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal.	Symptomatic apical periodontitis – Inflammation, usually of the apical periodontium, producing clinical symptoms including painful response to biting and percussion. It may or may not be associated with an apical radiolucent area. (This category includes what many of us call Acute Apical Periodontitis & Phoenix Abscess)
Irreversible pulpitis (IP)  – A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing.   Additional descriptions: Symptomatic IP– Lingering thermal pain, spontaneous pain, referred pain Asymptomatic IP – No clinical symptoms but inflammation produced by caries, caries excavation, trauma, etc.	Asymptomatic apical periodontitis – Inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms. (This is what many of us have previously called a Chronic Apical Periodontitis)
Pulp necrosis – A clinical diagnostic category indicating death of the dental pulp. The pulp is non-responsive to vitality testing.	Acute apical abscess – An inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.
Previously Treated – A clinical diagnostic category indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials, other that intracanal medicaments.	Chronic apical abscess – An inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort and the intermittent discharge of pus through an associated sinus tract.
Previously Initiated Therapy – A clinical diagnostic category indicating that the tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy, pulpectomy).	Condensing osteitis  - Diffuse radiopaque lesion representing a localized bony reaction to a low-grade inflammatory stimulus, usually seen at apex of tooth.

 

The American Board of Endodontics (ABE),     JOE — Volume 35, Number 12, December 2009

Source: www.aae.org/certboard