Endodontic Diagnosis Chart
Pulpal and periapical diagnostic categories at a glance — key findings and the typical treatment direction for each, aligned with AAE terminology.
26 August 2026
One tooth, two diagnoses
Endodontic diagnosis is generally recorded on two axes for the same tooth: a pulpal diagnosis and a periapical (apical) diagnosis. The tables below summarise the diagnostic categories in wide clinical use, with the key findings that typically support each category and the usual treatment direction.
Category names follow the diagnostic terminology adopted by the American Association of Endodontists (AAE, 2009). EndoGuide is an independent reference and is not affiliated with or endorsed by the AAE.
1. Pulp Diagnosis Categories
Current Standard — AAE 2009 Classification
01Normal PulpAsymptomatic, normal response to sensibility testing, no radiographic changes
Key Features
Asymptomatic, normal response to sensibility testing, no radiographic changes
Treatment Direction
No endodontic treatment indicated
02Reversible PulpitisSharp, transient pain to thermal stimuli; pain resolves quickly after stimulus removal
Key Features
Sharp, transient pain to thermal stimuli; pain resolves quickly after stimulus removal
Treatment Direction
Address cause (caries, restoration); pulp may recover
03Symptomatic Irreversible PulpitisSpontaneous, lingering pain (often >30 s after thermal); may be positional; sleep-disturbing
Key Features
Spontaneous, lingering pain (often >30 s after thermal); may be positional; sleep-disturbing
Treatment Direction
RCT or vital pulp therapy may be considered
04Asymptomatic Irreversible PulpitisNo symptoms; exposure from caries/trauma; pulp unlikely to recover
Key Features
No symptoms; exposure from caries/trauma; pulp unlikely to recover
Treatment Direction
RCT or vital pulp therapy may be considered
05Pulp NecrosisNo response to sensibility testing; may have discoloration
Key Features
No response to sensibility testing; may have discoloration
Treatment Direction
Consider RCT after clinical and radiographic correlation
06Previously TreatedEndodontically treated tooth
Key Features
Endodontically treated tooth
Treatment Direction
Evaluate for retreatment if periapical pathology present
07Previously Initiated TherapyTreatment started but not completed
Key Features
Treatment started but not completed
Treatment Direction
Complete treatment based on clinical assessment
Categories are assigned by correlating history, sensibility testing, and radiographic findings — a single test result in isolation is generally not diagnostic.
2. Periapical Diagnosis Categories
AAE 2009 Classification
01Normal Apical TissuesNo symptoms on percussion/palpation; intact lamina dura; uniform PDL space
Key Features
No symptoms on percussion/palpation; intact lamina dura; uniform PDL space
Clinical Significance
No periapical pathology
02Symptomatic Apical PeriodontitisPain on biting/percussion; may have localized swelling; radiolucency may or may not be present
Key Features
Pain on biting/percussion; may have localized swelling; radiolucency may or may not be present
Clinical Significance
Suggests pulpal pathology extending to periapex
03Asymptomatic Apical PeriodontitisNo symptoms; radiolucency present at apex
Key Features
No symptoms; radiolucency present at apex
Clinical Significance
Suggests chronic pulpal pathology
04Acute Apical AbscessRapid onset; pain, swelling, purulence; may have systemic signs (fever, lymphadenopathy)
Key Features
Rapid onset; pain, swelling, purulence; may have systemic signs (fever, lymphadenopathy)
Clinical Significance
Urgent care: drainage and endodontic source control; antibiotics if systemic
05Chronic Apical AbscessIntermittent drainage via sinus tract; minimal discomfort; radiolucency present
Key Features
Intermittent drainage via sinus tract; minimal discomfort; radiolucency present
Clinical Significance
Endodontic treatment is indicated; trace sinus tract with GP cone
06Condensing OsteitisDiffuse radiopaque area at apex; associated with a vital or necrotic pulp
Key Features
Diffuse radiopaque area at apex; associated with a vital or necrotic pulp
Clinical Significance
May resolve after treatment of the associated tooth
Percussion and palpation findings are recorded as tenderness or pain rather than simply positive/negative, and are compared against control teeth.
How to use the chart
- Record one pulpal and one periapical diagnosis for the tooth being examined — the pair together describes the case.
- The treatment direction columns are general orientations; the choice for an individual patient depends on restorability, strategic value, and patient factors.
- When symptoms and findings do not line up cleanly, re-test, compare with control teeth, and re-examine before starting treatment.
For test techniques, decision pathways, golden tips, and the full FAQ, see the complete guide: Diagnosis & Pulp Classification guide
Related guides
References
- Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. "Identify and define all diagnostic terms for pulpal health and disease states." — J Endod (2009);35(12):1645-1657. PMID 19932339
- Duncan HF, El-Karim I. "Endodontic S3-level clinical practice guidelines: the European Society of Endodontology process and recommendations." — Br Dent J (2025);238(7):580-586. PMID 40217051; PMC11991915
- Duncan HF et al. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline — Int Endod J (2023);56 Suppl 3:238-295. DOI 10.1111/iej.13974
- American Association of Endodontists. Updating Diagnostic Terminology in Endodontics — living web resource published July 2025, last updated March 2026
- Glickman GN. "AAE Consensus Conference on Diagnostic Terminology: background and perspectives." — J Endod (2009);35(12):1619-1620. PMID 19932336
- Jafarzadeh H, Abbott PV. "Review of pulp sensibility tests. Part I: general information and thermal tests" — Int Endod J (2010);43:738-762. PMID 20609022
- Jafarzadeh H, Abbott PV. "Review of pulp sensibility tests. Part II: electric pulp tests and test cavities" — Int Endod J (2010);43:945-958. PMID 20726917
- AAE and AAOMR Joint Position Statement: Use of Cone-Beam Computed Tomography in Endodontics 2025 Update — Oral Surg Oral Med Oral Pathol Oral Radiol (2026);141(1):126-135. PMID 41407481
- Mainkar A, Kim SG. "Diagnostic Accuracy of 5 Dental Pulp Tests: A Systematic Review and Meta-analysis" — J Endod (2018);44:694-702. DOI 10.1016/j.joen.2018.01.021
- International Classification of Orofacial Pain, 1st edition (ICOP) — Cephalalgia (2020);40:129-221. DOI 10.1177/0333102419893823
Clinical judgment required
This chart is an educational summary for dental professionals. Diagnostic categories are assigned by correlating history, testing, and imaging for the individual patient; they are not a substitute for clinical judgment.
Reviewed by
Uzm. Dt. Levent Yüksel
DDS · Endodontist
Endodontist — DDS, Hacettepe University; endodontics specialty training, Ankara University. 10+ years of clinical experience. Independently authored and clinically reviewed.