Optical characteristics of human extracted teeth and the possible application of photoplethysmography to the human pulp

Exploring approaches to pulp vitality assessment: A scoping review of nontraditional methods

INTRODUCTION

Diagnostic procedures for pulp vitality assessment are a crucial aspect of routine dental practice. This review aims to provide a comprehensive overview of nontraditional techniques and methodologies for assessing pulp vitality, specifically exploring promising approaches that are currently not used in dental practice.

METHODS

The study protocol was registered a priori (https://osf.io/3m97z/). An extensive electronic search was conducted across multiple databases, including MEDLINE via PubMed, Scopus, Web of Science, and Embase. Inclusion criteria were guided by the research question based on the PCC model as follows: "What are the potential nontraditional techniques (Concept) for assessing pulp vitality (Population) in the field of endodontics or clinical practice (Context)?" Studies were included that explored possible approaches to pulp vitality assessment, utilizing a range of techniques, whilst any studies using traditional pulp tests (cold, heat, and electric stimulation) or well-known methods (pulse oximetry and laser Doppler flowmetry) were excluded. Reviewers independently screened articles and extracted data. A patent search was also performed.

RESULTS

Of 3062 studies, 65 were included that described nontraditional approaches for assessing pulp vitality. These included a range of optical diagnostic methods, ultrasound Doppler flowmetry (UDF), magnetic resonance imaging (MRI), terahertz imaging, tooth temperature measurements, as well as invasive methodologies, including 133xenon washout, radioisotope-labelled tracers, hydrogen gas desaturation, intravital microscopy and fluorescent microspheres isotope clearance. The patent search included artificial intelligence and biomarkers methods.

CONCLUSIONS

This review provides details for potential innovative tests that may directly describe pulp vitality. Importantly, these methods range from clinically impractical through to promising methods that may transform clinical practice. Several nontraditional techniques have the potential to enhance diagnostic accuracy and could provide valuable insights into the assessment of pulp vitality in challenging clinical scenarios.

Transmitted-light plethysmography detects changes in human pulpal blood flow elicited by innocuous tooth cooling and foot heating

OBJECTIVES

The present study aimed firstly, to investigate whether pulpal circulatory changes elicited by innocuous tooth cooling and foot heating can be monitored with transmitted-light plethysmography (TLP), which detects pulpal blood volume changes, and secondly, to assess the effect of autonomic nervous control on TLP values.

DESIGN

Thirty sound permanent maxillary incisors in 30 healthy volunteers (age: 25-35 years) were examined. The photodiode and 525-nm light-emitting diode of a prototype TLP system (J. Morita) were fixed onto the palatal and labial side, respectively, of each tooth with a custom-made acrylic cap. The subjects were stimulated for 10 min by cold (0 °C) water application to the experimental tooth or 30 min by foot heating with a footbath (43 °C). TLP and finger plethysmography were simultaneously recorded before (baseline), during and after stimulation. TLP values and autonomic nerve activity were statistically analyzed using a repeated measures one-way ANOVA followed by Tukey post-hoc test and partial correlation analysis.

RESULTS

TLP values decreased significantly after both innocuous stimuli (P < 0.05), and returned to their baseline levels shortly after the removal of the stimuli. There was no significant serial correlation between the autonomic nervous activity and TLP values (P > 0.05).

CONCLUSION

TLP was able to monitor the pulpal circulatory changes evoked by innocuous stimuli. Systemic autonomic nervous control mechanisms were not associated with the pulpal circulatory changes, suggesting the involvement of other mechanisms, such as somatosensory-sympathetic nervous control.

Human pulpal blood flow in different root formation stages measured with transmitted-light plethysmography

OBJECTIVES

To determine the pulp vitality after traumatic injury, dentists often use pulp sensitivity tests, which can be ambiguous in young permanent teeth with incomplete root formation. Transmitted-light plethysmography (TLP) is a non-invasive objective method that uses a 525-nm LED to detect blood volume change in the pulp. The present study aimed (1) to investigate pulpal blood flow with TLP and optical characteristics in healthy permanent maxillary incisors in different root formation stages, and (2) to assess the influences of body growth of the children and tooth color on the TLP amplitude.

DESIGN

Seventy-eight fully erupted maxillary central incisors were divided into four groups, according to the root formation stages. Group 1: root with wide-open apex, Group 2: root completed in length with open apex, Group 3: root with half-closed apex, Group 4: root with complete formation. The TLP amplitude, optical density, electric pulp testing, and cervical tooth color measurements of each group were compared using a one-way analysis of variance followed by the Bonferroni method. The correlation between the weights/heights of children and TLP amplitudes was analyzed using Pearson coefficient.

RESULTS

The TLP amplitude was significantly higher in Group 3 than in the other groups. The amplitude was correlated with the weights/heights of children, but not with the tooth color. Optical density and electric sensitivity increased with tooth maturation.

CONCLUSION

The amplitude of TLP and optical density may be affected by growth and development in children and indicate changes in the vascular dynamics of the pulp and hard tissue maturation during root formation stages.

Optical Measurement of Blood Oxygen Saturation of Dental Pulp

The applicability of arterial pulse oximetry to dental pulp was demonstrated using in vitro and in vivo measurements. First, porcine blood of known oxygen saturation (SO2) was circulated through extracted human upper incisors, while transmitted-light plethysmography was performed using three different visible wavelengths. From the light intensity waveforms measured in vitro, a parameter that is statistically correlated to SO2 was calculated using the pulsatile/nonpulsatile component ratios of two wavelengths for different SO2. Then, values were measured in vivo for living incisors, and the corresponding SO2 values were calculated using the results of in vitro measurements. The estimated SO2 values of the upper central incisors measured in vivo were from 71.0 to 92.7%. This study showed the potential to measure the oxygen saturation changes to identify the sign of pulpal inflammation.

Absolute transmitted light plethysmography for assessment of dental pulp vitality through quantification of pulp chamber hematocrit by a three-layer model

After confirming that the gingival circulation had little effect on transmitted light plethysmography measurement in the upper central incisor in both in vivo experiments and numerical Monte Carlo simulation studies, a three-layer model comprising of a pulp chamber sandwiched between two dentin layers has been introduced to quantify the pulp chamber hematocrit (Hctp) from the measured optical density. Two-flux theory was utilized to derive a mathematical equation for transmitted intensity in terms of tooth dimensions, Hctp, and light-source wavelength. Each layer was assumed homogeneous so as to represent its optical properties by the bulk absorption and scattering constants. The mean error between the Hctp estimate based on the three-layer-model equation and the Hctp actual in the extracted model tooth was -0.00115 with standard deviation (SD) of 0.00733 at 522 nm wavelength, while for 810 nm +0.09157 and 0.02493. The Hctp estimate of the upper central incisor in 10 young volunteers at 522 nm using the three-layer model ranged from 0.002 to 0.061 with the mean of 0.032. The Hctp change reflects blood volume shift in the pulp microcirculation to possibly indicate dental pulp vitality.

The effect of short-term tooth intrusion on human pulpal blood flow measured by laser Doppler flowmetry

The purpose was to examine the effect of brief intrusive forces on human pulpal blood flow (PBF). Laser Doppler flowmetric measurements were made from 17 vital upper left central incisors of 17 participants who had clinically healthy tooth crowns and periodontal tissues. Brief intrusive forces (0.5,1,5 N; duration 20 s) were applied to the incisal edges of the examined teeth, and apical displacement of the teeth and the PBF were measured simultaneously. Recordings were made with and without an opaque rubber dam applied to the examined teeth. Intrusive force significantly reduced PBF flux both with and without the dam (P<0.05, Friedman analysis). The results indicate that transient apical displacement can reduce PBF.

Scattering of laser light directed onto the labial surface of extracted human upper central incisors

The purpose of this study was to evaluate the scatter of light through human teeth with laser Doppler flowmetry. An optical probe (probe 1), which mounted two optical fibers (one for light illumination and another for the measurement of backscattered light intensity) was placed on the labial surface of the extracted teeth. Another optical probe (probe 2) for the measurement of transmitted-light intensity was placed either on the mesial, distal, or palatal surface or in the canal of the teeth. The light intensity at probe 1 was stable, irrespective of the location of probe 2, whereas the transmitted light intensity at probe 2 tended to increase as probe 2 moved to more incisal positions on the mesial, distal, and palatal tooth surfaces. The results indicate that the light scatters to a wide area outside the tooth and provides information regarding the surrounding tissue blood flow.

Information of circulation from soft tissue and dental pulp by means of pulsatile reflected light: further development of optical pulp vitalometry

OBJECTIVES

To show experimentally and clinically that information of blood circulation patterns can be obtained through dentin and enamel by means of reflected light.

STUDY DESIGN

Several different experimental techniques were developed in vitro leading up to in vivo tests.

RESULTS

Pulsatile information of back-scattered light at 560 nm was obtained in an experiment in which a thread with white and red sections was pulled through the empty pulp cavum. The pulsatile information of back-scattered light of 560 nm wavelength was detected from a forefinger of a volunteer through dental hard tissue plates. There was a difference in the radiant flux of back-scattered light in extracted teeth filled with various materials. Photoplethysmograms obtained from the vital pulp of a 24-year-old woman were analyzed with Fast Fourier Transformation (FFT). The analyzed data showed a dominant amplitude of heart rate near 1 Hz.

CONCLUSIONS

Tests indicated that reliable information of circulation can be obtained from the dental pulp chamber by means of the optical reflection method. This could serve as a model for a new type of pulp vitalometer.

Detection of pulse in oral mucosa and dental pulp by means of optical reflection method

This paper describes a new system in which optical reflectance is used to test the pulse and vitality of oral mucosa or dental pulp. Radiation at red (660 nm) and near infra-red (850 nm) wavelengths are directed through a thin probe. The beam is directed into tissue and reflected back. Plethysmography is used to measure the pulse rate from the right forefinger. Reflected radiation is related to plethysmogram using a computer. Preliminary findings relating to the lips and gingiva in 9 healthy volunteers were promising. Preliminary tests showed that vital and nonvital pulps reflected the radiation differently. Pulpal pulse did not always correspond to plethysmogram from the right forefinger.