[Diagnosis & Pulp Classification](https://endo-guide.app/diagnosis) Quick Reference # Endodontic Diagnosis Chart Pulpal and periapical diagnostic categories at a glance — key findings and the typical treatment direction for each, aligned with AAE terminology. AAE-aligned terminology Two-axis diagnosis 26 August 2026 Reviewed by[Uzm. Dt. Levent Yüksel](https://endo-guide.app/about)DDS · Endodontist ## 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 | Category | Key Features | Treatment Direction | | --- | --- | --- | | Normal Pulp | Asymptomatic, normal response to sensibility testing, no radiographic changes | No endodontic treatment indicated | | Reversible Pulpitis | Sharp, transient pain to thermal stimuli; pain resolves quickly after stimulus removal | Address cause (caries, restoration); pulp may recover | | Symptomatic Irreversible Pulpitis | Spontaneous, lingering pain (often >30 s after thermal); may be positional; sleep-disturbing | RCT or vital pulp therapy may be considered | | Asymptomatic Irreversible Pulpitis | No symptoms; exposure from caries/trauma; pulp unlikely to recover | RCT or vital pulp therapy may be considered | | Pulp Necrosis | No response to sensibility testing; may have discoloration | Consider RCT after clinical and radiographic correlation | | Previously Treated | Endodontically treated tooth | Evaluate for retreatment if periapical pathology present | | Previously Initiated Therapy | Treatment started but not completed | 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 | Category | Key Features | Clinical Significance | | --- | --- | --- | | Normal Apical Tissues | No symptoms on percussion/palpation; intact lamina dura; uniform PDL space | No periapical pathology | | Symptomatic Apical Periodontitis | Pain on biting/percussion; may have localized swelling; radiolucency may or may not be present | Suggests pulpal pathology extending to periapex | | Asymptomatic Apical Periodontitis | No symptoms; radiolucency present at apex | Suggests chronic pulpal pathology | | Acute Apical Abscess | Rapid onset; pain, swelling, purulence; may have systemic signs (fever, lymphadenopathy) | Urgent care: drainage and endodontic source control; antibiotics if systemic | | Chronic Apical Abscess | Intermittent drainage via sinus tract; minimal discomfort; radiolucency present | Endodontic treatment is indicated; trace sinus tract with GP cone | | Condensing Osteitis | Diffuse radiopaque area at apex; associated with a vital or necrotic pulp | 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](https://endo-guide.app/diagnosis) ## Related guides [Endodontic Emergencies→](https://endo-guide.app/emergencies)[Pain After Root Canal→](https://endo-guide.app/post-root-canal-pain)[Cracked Tooth & VRF→](https://endo-guide.app/cracked-tooth-vertical-root-fracture)[Failed Root Canal→](https://endo-guide.app/failed-root-canal-retreatment)[Endodontic Surgery→](https://endo-guide.app/endodontic-surgery)[Regenerative Endodontics→](https://endo-guide.app/regenerative-endodontics)[Apexification & Apexogenesis→](https://endo-guide.app/apexification-apexogenesis)[Dental Trauma→](https://endo-guide.app/dental-trauma)[Tooth Resorption→](https://endo-guide.app/tooth-resorption)[Diagnosis & Pulp Classification→](https://endo-guide.app/diagnosis)[Root Canal Treatment Steps→](https://endo-guide.app/treatment-steps)[Canal Preparation→](https://endo-guide.app/canal-preparation)[Working Length Determination→](https://endo-guide.app/working-length)[Irrigation Protocols→](https://endo-guide.app/irrigation)[Intracanal Medicaments→](https://endo-guide.app/medicaments)[Obturation Techniques→](https://endo-guide.app/obturation)[Vital Pulp Therapy→](https://endo-guide.app/vital-pulp-therapy)[Complications→](https://endo-guide.app/complications)[Local Anesthesia→](https://endo-guide.app/local-anesthesia)[Rubber Dam & Isolation→](https://endo-guide.app/rubber-dam-isolation)[Imaging & CBCT→](https://endo-guide.app/endodontic-imaging)[Restoration After Root Canal→](https://endo-guide.app/restoration-after-root-canal) ## References 1. [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](https://pubmed.ncbi.nlm.nih.gov/19932339/) 2. [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](https://pmc.ncbi.nlm.nih.gov/articles/PMC11991915/) 3. [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](https://doi.org/10.1111/iej.13974) 4. [American Association of Endodontists. Updating Diagnostic Terminology in Endodontics — living web resource published July 2025, last updated March 2026](https://www.aae.org/specialty/diagnostic-terminology-stakeholder-input/) 5. [Glickman GN. "AAE Consensus Conference on Diagnostic Terminology: background and perspectives." — J Endod (2009);35(12):1619-1620. PMID 19932336](https://pubmed.ncbi.nlm.nih.gov/19932336/) 6. [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](https://pubmed.ncbi.nlm.nih.gov/20609022/) 7. [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](https://pubmed.ncbi.nlm.nih.gov/20726917/) 8. [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](https://pubmed.ncbi.nlm.nih.gov/41407481/) 9. [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](https://doi.org/10.1016/j.joen.2018.01.021) 10. [International Classification of Orofacial Pain, 1st edition (ICOP) — Cephalalgia (2020);40:129-221. DOI 10.1177/0333102419893823](https://doi.org/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. ![Uzm. Dt. Levent Yüksel](https://endo-guide.app/images/levent-yuksel.jpg) 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. 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