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Afkhami F, Wright PP, Chien PYH, Xu C, Walsh LJ, Peters OA. Exploring approaches to pulp vitality assessment: A scoping review of nontraditional methods. Int Endod J 2024; 57:1065-1098. [PMID: 38661046 DOI: 10.1111/iej.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
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.
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Affiliation(s)
- Farzaneh Afkhami
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | | | - Philip Yuan-Ho Chien
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Chun Xu
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Laurence James Walsh
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Ove Andreas Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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Abdellatif D, Iandolo A, De Benedetto G, Giordano F, Mancino D, Euvrard E, Pisano M. Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:458-484. [PMID: 38939542 PMCID: PMC11205167 DOI: 10.4103/jcde.jcde_140_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 06/29/2024]
Abstract
Background and Objectives The present systematic review aims to assess the success rate of the pulp regeneration treatment, according to the American Association of Endodontists (AAE) criteria, using different bioactive materials in permanent teeth of pediatric subjects (6-17 years of age). Materials and Methods The study protocol was registered on PROSPERO and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The question formulation was accomplished using the PICO model, and an electronic search was carried out on Scopus, MEDLINE/PubMed, Web of Science, and Cochrane databases till April 1, 2023. A total of 30 studies were established to fulfill the inclusion criteria of this systematic review. Results A total of 273 teeth have been treated with pulp regeneration treatment. By comparing different biomaterials and the success criteria defined by the AAE, the material associated with a higher success rate was found to be the white mineral trioxide aggregate. However, the overall success rate of pulp regeneration treatment was reported for 248 out of 273 teeth (91.20%). Conclusions Data obtained support the potential that regenerative endodontics aids in continuing root development in permanent immature teeth. Further studies are needed for a more extensive evaluation of the use of different biomaterials and the success rate in regenerative endodontics.
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Affiliation(s)
- Dina Abdellatif
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfredo Iandolo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Francesco Giordano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Davide Mancino
- Faculty of Dental Surgery, Federation of Medicine Translational of Strasbourg and Federation of Materials and Nanoscience of Alsace, University of Strasbourg, Strasbourg, CHU Besançon, France
| | - Edouard Euvrard
- Service of Maxillofacial Surgery, Stomatology and Hospital Odontology, CHU Besançon, France
- Laboratoire Sinergies EA 4662, University of Franche-Comté, Besançon, France
| | - Massimo Pisano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Kim D, Ko HS, Park SY, Ryu SY, Park SH. The effects of gingival blood flow on pulpal blood flow detection using ultrasound Doppler flowmetry: animal study. Restor Dent Endod 2023; 48:e9. [PMID: 36875807 PMCID: PMC9982237 DOI: 10.5395/rde.2023.48.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 02/10/2023] Open
Abstract
Objectives This study evaluated the effect of adjacent gingival blood flow on detection of pulpal blood flow (PBF) using ultrasound Doppler flowmetry (UDF) through animal study. Materials and Methods The study included 36 right and left maxillary the third incisors and canines in 9 experimental dogs. The study included 2 main steps: In the first step, the pulse sound level (PSL) was recorded on the cervical part of each tooth without flap elevation (Group 1), with flap elevation (Group 2), and after it was repositioned in place (Group 3). In the second step, the PSL was recorded on the cervical part of each tooth (Group 4), after pulpotomy (Group 5), after partial pulp extirpation (Group 6), after complete extirpation (Group 7), and after canal filling (Group 8). In Groups 5-8, the study was performed with and without flap elevation in the left and right teeth, respectively. The PSL was graded as follows: 0, inaudible; 1, heard faintly; and 2, heard well. The difference between each group was analyzed using Friedman's test with Wilcoxon signed-rank tests (α = 0.05). Results In step 1, the PSL results were Group 1 > 2 and 3. In step 2, there was no significant difference between the groups when the flap was not elevated, while PSL results were Group 4 > 5 ≥ 6 and 7 ≥ 8 when the flap was elevated. Conclusions PBF is affected by gingival blood flow when measured with UDF. UDF measurements require isolation of gingiva from the tooth.
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Affiliation(s)
- Dohyun Kim
- Department of Conservative Dentistry, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyoung-Seok Ko
- Department of Conservative Dentistry, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Soo-Yeon Park
- Department of Conservative Dentistry, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seung-Yeon Ryu
- Department of Conservative Dentistry, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Ho Park
- Department of Conservative Dentistry, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
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Qu T, Lai Y, Luo Y, Pan W, Liu C, Cao Y, Hua C. Prognosis of second molars with external root resorption caused by adjacent embedded third molars. J Endod 2022; 48:1113-1120. [DOI: 10.1016/j.joen.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
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Parab P, Khandeparker R. Xylanolytic enzyme consortia from Bacillus sp. NIORKP76 for improved biobleaching of kraft pulp. Bioprocess Biosyst Eng 2021; 44:2513-2524. [PMID: 34402971 DOI: 10.1007/s00449-021-02623-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
A cellulase-free xylanolytic enzyme consortia consisting of a xylanase, arabinofuranosidase, and acetyl xylan esterase produced by Bacillus sp. NIORKP76 isolate under solid-state fermentation was assessed for its bio-bleaching ability on kraft pulp. In the biobleaching analysis, the xylanase dose of 5 Ug-1 dry pulp denoted the optimum bleaching of pulp at 40 °C and pH 8.0 after 2 h of treatment. The reduction in kappa number of pre-treated hardwood pulp using xylanolytic enzyme consortium (XEC) was found to be ~ 55%, while solo xylanase could reduce the kappa number to 44-46%. In the case of chemical bagasse pulp, a reduction of ~ 27.5% and 19-20% was seen in kappa number using XEC and solo xylanase, respectively. Enzyme-treated pulp (HW and CB) showed a 50% reduction in hypochlorite consumption during the chlorine treatment. The current study results reveal the significant potential of xylanolytic enzyme consortium from Bacillus sp. NIORKP76 on the environmentally friendly bio-bleaching process.
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Affiliation(s)
- Pankaj Parab
- Biological Oceanography Division, CSIR-National Institute of Oceanography, Dona Paula, Goa, 403004, India.,Department of Microbiology, Goa University, Taleigao Plateau, Goa, 403206, India
| | - Rakhee Khandeparker
- Biological Oceanography Division, CSIR-National Institute of Oceanography, Dona Paula, Goa, 403004, India.
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Dabiri D, Harper DE, Kapila Y, Kruger GH, Clauw DJ, Harte S. Applications of sensory and physiological measurement in oral-facial dental pain. SPECIAL CARE IN DENTISTRY 2018; 38:395-404. [PMID: 30194771 PMCID: PMC6282998 DOI: 10.1111/scd.12323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 12/01/2022]
Abstract
Dentists regularly employ a variety of self‐report and sensory techniques to aid in the diagnosis and treatment of tooth‐related disease. Many of these techniques leverage principles borrowed from psychophysics, the quantitative measurement of the relationship between stimuli and evoked sensations, which falls under the larger umbrella of quantitative sensory testing (QST). However, most clinicians fail to meet the bar for what could be considered quantitative sensory testing, and instead focus on qualitative and dichotomous “yes/no” aspects of sensory experience. With our current subjective measurements for pain assessments, diagnosis and treatment of dental pain in young children and individuals (any age) with severe cognitive impairment rely extensively on third‐party observations. Consequently, the limitation of inadequate pain diagnosis can lead to poor pain management. In this review, it discusses mechanisms that underlie acute and chronic dental pain. It details the measurement of somatosensory responses and pulpal blood flow as objective measures of tooth health and pain. It proposes that bridging these varied methodologies will significantly improve diagnosis and treatment of orofacial pain and pathology. It concludes that improving the precision of sensory measurements could yield important improvements in diagnostic challenges in pulpal pathology for noncommunicative and cognitively impaired individuals.
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Affiliation(s)
- Darya Dabiri
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
| | - Daniel E Harper
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
| | - Yvonne Kapila
- Division of Periodontology, Department of Orofacial Sciences, University of California San Francisco, San Francisco, California
| | - Grant H Kruger
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
| | - Steven Harte
- Chronic Pain & Fatigue Research Center, Department of Anesthesiology, University of Michigan Medicine, Ann Arbor, Michigan
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Estrela C, Oliveira KS, Alencar AHG, Barletta FB, Estrela CR, Felippe WT. Oxygen Saturation in the Dental Pulp of Maxillary and Mandibular Molars - Part 2. Braz Dent J 2018; 28:704-709. [PMID: 29211125 DOI: 10.1590/0103-6440201701447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/10/2017] [Indexed: 11/21/2022] Open
Abstract
This study determined the oxygen saturation (SaO2) in dental pulp of healthy maxillary and mandibular molars. Mean of SaO2 was evaluated in 112 maxillary and mandibular molars using pulse oximetry. Quantitative variables were described by mean and standard deviation. Variables with symmetric distribution were compared by Student t test and Mann-Whitney test. Pearson's correlation coefficient was used to correlate quantitative variables. Analysis of variance was used to assess differences in SaO2 levels between the molar groups, followed by post-hoc Tukey. The significance level established at p<0.05. Mean of oxygen saturation for the 112 molar dental pulps was 85.09%. There was no significant correlation (r=-0.007; p=0.977) between the mean of SaO2 of molar pulps with patient´s indicator finger (92.89%). There was a significant difference (p=0.037) between the mean of SaO2 of the first (85.76%) and second maxillary molars (81.87%), and it was not significant (p=0.1775) between the first and second mandibular molars. Maxillary molars had lower pulpal SaO2 (83.59%) than mandibular molars (86.89%) (p=0.018). The mean of the patient's response time to the cold stimulus was 1.12 s (maxillary molars 1.25 s and mandibular molars 0.99 s)(p=0.052). There was no significant correlation between the time response of the patient to the cold stimulus and the SaO2 for molars. The mean oxygen saturation level was 85.09%. The mandibular molars presented higher SaO2 level than maxillary molars.
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Affiliation(s)
- Carlos Estrela
- Dental School, UFGO - Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Keila Sa Oliveira
- Dental School, UFGO - Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | | | | | - Wilson T Felippe
- Dental School, UFSC - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Abstract
AIM To evaluate the effects of maxillary canine retraction on pulpal blood flow (PBF) in humans as recorded by laser Doppler flowmetry (LDF). METHODS Maxillary canines of 24 participants were divided into two groups (n = 12 each). Teeth in the study group underwent maxillary canine retraction using mini-implants as anchorage for approximately 4 months, with 100 g of force applied via coil springs. Subjects in the control group received no orthodontic treatment. LDF measurements were recorded at baseline (T0); during retraction, at 24 hours (T1), 3 days (T2), 7 days (T3) and 1 month (T4); and at the end of retraction (T5) in the study group and at similar time-points in control subjects. Data were analyzed using the Friedman, Wilcoxon signed rank and Mann-Whitney U tests, with the significance level set at 0.05. RESULTS No significant changes in PBF perfusion units (PU) were observed in the control group over the course of the study. However, PBF in the study group increased significantly from T0 (3.6 ± 0.2 PU) to T1 (3.7 ± 0.2 PU, p < 0.001) and decreased severely from T1 to T2 (3.3 ± 0.1, p < 0.001). PBF in the study group was still significantly lower at T3 (3.4 ± 0.1 PU, p < 0.001) in comparison to T0; however, at T4 and T5, PBF was found to have returned to pre-retraction levels. CONCLUSION The fact that PBF values returned to initial levels within one month of the initiation of retraction despite short-term, hyperaemic, regressive changes demonstrates that the changes observed in PBF during canine retraction are reversible.
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Affiliation(s)
- Fidan Alakus Sabuncuoglu
- a Department of Orthodontics, Center for Dental Sciences , Gulhane School of Medicine, Ankara , Turkey
| | - Seyda Ersahan
- b Department of Endodontics, Faculty of Dentistry , Bezmialem Vakıf University , Istanbul , Turkey
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Riehl J, Hetzel SJ, Snyder CJ, Soukup JW. Detection of Pulpal Blood Flow In Vivo with Pulse Oximetry in Dogs. Front Vet Sci 2016; 3:36. [PMID: 27243024 PMCID: PMC4873511 DOI: 10.3389/fvets.2016.00036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/20/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of the present study was to investigate the ability of pulse oximetry to detect blood flow within the canine tooth of dogs. Materials and methods Dogs aged 18–138 months presenting for oral treatment and meeting the inclusion criteria underwent pulse oximetry evaluation of at least one canine tooth. Oxygen saturation (SpO2) and pulse rate values were acquired from vital canine teeth of 38 clinical patients (representing 40 total teeth) with a handheld pulse oximeter and compared to a control area. SpO2 values from the tooth and control area were recorded every 5 s for three 60-s intervals. The sensors were repositioned after each 60-s interval. Results The vital teeth consistently recorded SpO2 values significantly lower than the control area. The mean vital tooth SpO2 was 85.9% (median = 87%; SD = 8.6), and the mean control area SpO2 was 97.7% (median = 98%; SD = 1.8). An age-related significant difference was noted in vital tooth SpO2 values. Conclusion In conclusion, the present data support the possible use of pulse oximetry to detect blood flow in canine teeth. However, there was no significant correlation between SpO2 values in the vital tooth and in the control areas. Additionally, the results were not definitive, and validation of the modality with additional studies of non-vital canine teeth is needed before clinical use can be recommended.
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Affiliation(s)
- Jessica Riehl
- Dentistry and Oral Surgery Section, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison , Madison, WI , USA
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison , Madison, WI , USA
| | - Christopher J Snyder
- Dentistry and Oral Surgery Section, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison , Madison, WI , USA
| | - Jason W Soukup
- Dentistry and Oral Surgery Section, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison , Madison, WI , USA
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Bargrizan M, Ashari MA, Ahmadi M, Ramezani J. The use of pulse oximetry in evaluation of pulp vitality in immature permanent teeth. Dent Traumatol 2015; 32:43-7. [PMID: 26358664 DOI: 10.1111/edt.12215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The current methods of pulp vitality assessment, either electric or thermal, are of limited use in children. Recently, traumatized and immature teeth may not respond to such methods and because such methods require subjective responses, it may not provide accurate results particularly in children. Pulse oximetry, an atraumatic approach, is used to measure oxygen saturation in vascular system. The aim of this study was to investigate the use of pulse oximetry to evaluate pulp vitality status in immature permanent teeth. METHODS AND MATERIALS The study was conducted on 329 maxillary central and lateral incisors in children. The negative control group consisted of 10 root filled teeth. Systemic oxygen saturation was first measured on the thumb of the individual using a custom-made sensor. Oxygen saturation values of the teeth were then evaluated. The correlation between oxygen saturation measurement obtained from finger and tooth, and the correlation between oxygen saturation values and stage of root development were analyzed. A further comparison was made between the teeth with open and closed apex. RESULTS Mean oxygen values recorded in the patient's finger were 97.17%, and mean oxygen values in the maxillary central and lateral incisors were 86.77% and 83/92%, respectively. There was no significant correlation between blood oxygen levels in the finger and in the teeth. (P > 0.05) There was a significant negative correlation between the stage of root development and the blood oxygen levels in the patients' teeth. (P < 0.05) Mean oxygen values in the teeth with open apex were significantly higher than the teeth with closed apex. (P < 0.001). CONCLUSION Vital teeth provided consistent oxygen saturation readings, and non-vital teeth recorded no oxygen saturation values. During tooth development, the oxygen saturation values decreased. These findings confirm that the pulse oximetry is capable of detecting the pulpal blood flow and oxygen saturation.
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Affiliation(s)
- Majid Bargrizan
- Department of Pediatric Dentistry, Dental School, Shahid Beheshti Medical University (SBMU), Tehran, Iran
| | - Mohammad Asna Ashari
- Department of Endodontics, Dental School, Shahid Beheshti Medical University (SBMU), Tehran, Iran
| | - Mohsen Ahmadi
- Department of Medical Engineering, Shahid Beheshti Medical University (SBMU), Tehran, Iran
| | - Jamileh Ramezani
- Department of Pediatric Dentistry, Dental School, Golestan University of Medical Sciences, Gorgan, Iran
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Levin LG. Pulp and periradicular testing. J Endod 2014; 39:S13-9. [PMID: 23439039 DOI: 10.1016/j.joen.2012.11.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 11/21/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
Pulp and periradicular testing is crucial to the initial trauma evaluation and to subsequent monitoring of the traumatized teeth and supporting structures. An accurate diagnosis serves as the basis for therapeutic intervention and helps to ensure that destruction of the dental structures will be minimized and function will be regained. The purpose of this review is to present the current best evidence for accurate diagnostic testing of the pulp and periapex of traumatized teeth. Five databases were searched for literature pertaining to pulpal testing and trauma. Widely recognized textbooks were also consulted. Currently used pulp vitality testing is constrained by its subjective character and by the fact that it is a measure of neuronal status and not true pulpal viability. Tests that measure tissue perfusion more accurately reflect pulpal vitality, but they are not available commercially. This review discusses the specificity, sensitivity, and accuracy of commonly used tests, with emphasis on the applicability of certain tests to specific patient presentations in trauma. Factors that influence test selection are discussed, and specific recommendations are made on the basis of best evidence. Although differences exist between the various studies as to the accuracy of commonly used pulpal and periradicular tests, most of these have acceptable predictive value. Pulpal and periradicular tests in the trauma patient should be used in conjunction with clinical and radiographic observations to arrive at a diagnosis and treatment plan.
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Affiliation(s)
- Linda Gibson Levin
- University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA.
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Abstract
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.
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Pozzobon MH, de Sousa Vieira R, Alves AMH, Reyes-Carmona J, Teixeira CS, de Souza BDM, Felippe WT. Assessment of pulp blood flow in primary and permanent teeth using pulse oximetry. Dent Traumatol 2011; 27:184-8. [PMID: 21342436 DOI: 10.1111/j.1600-9657.2011.00976.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulse oximetry (PO) is a well-accepted non-invasive method for assessing vascular health, based on oxygen saturation (SaO(2) ) measurements. The objectives of this study were to design and build a custom-made PO dental sensor holder, to evaluate the effectiveness of PO in determining pulp blood flow in primary and permanent teeth, and to compare the SaO(2) levels obtained in teeth and on the little finger of patients. The PO sensor adapted to the custom-made sensor holder is termed as a device to position and hold the PO sensor. This study evaluated SaO(2) readings obtained in the pulp of 123 teeth of 84 children aged 4-13years. The teeth were divided into three groups: group I - primary teeth: 23 central incisors and 28 canines; group II - permanent teeth: 25 central incisors and 28 canines; and group III - endodontically treated teeth (control): 12 permanent central incisors and seven primary central incisors. The pulp blood flow and SaO(2) were measured and were compared with readings of the patient's finger. Data were analyzed by paired t-tests and Pearson's analysis method. The PO was able to identify all the clinically normal pulps contained in the sample, and all the endodontically treated teeth (controls) showed no response. The mean SaO(2) values were 85.27% in the teeth and 92.85% in the fingers. In conclusion, PO readings were effective in determining pulp blood flow in primary and permanent teeth. However, there was no correlation between the SaO(2) values in the fingers and in the teeth of the patients (P<0.05).
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Affiliation(s)
- Maria Helena Pozzobon
- Department of Endodontics, School of Dentistry, Universidade Federal de Santa Catarina Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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Abstract
Dental pulp testing is a useful and essential diagnostic aid in endodontics. Pulp sensibility tests include thermal and electric tests, which extrapolate pulp health from sensory response. Whilst pulp sensibility tests are the most commonly used in clinical practice, they are not without limitations and shortcomings. Pulp vitality tests attempt to examine the presence of pulp blood flow, as this is viewed as a better measure of true health than sensibility. Laser Doppler flowmetry and pulse oximetry are examples of vitality tests. Whilst the prospect is promising, there are still many practical issues that need to be addressed before vitality tests can replace sensibility tests as the standard clinical pulp diagnostic test. With all pulp tests, the results need to be carefully interpreted and closely scrutinised as false results can lead to misdiagnosis which can then lead to incorrect, inappropriate, or unnecessary treatment.
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Jafarzadeh H, Rosenberg PA. Pulse Oximetry: Review of a Potential Aid in Endodontic Diagnosis. J Endod 2009; 35:329-33. [DOI: 10.1016/j.joen.2008.12.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 12/16/2008] [Accepted: 12/23/2008] [Indexed: 11/27/2022]
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The Application of Tooth Temperature Measurement in Endodontic Diagnosis: A Review. J Endod 2008; 34:1435-40. [DOI: 10.1016/j.joen.2008.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 09/10/2008] [Accepted: 09/16/2008] [Indexed: 11/30/2022]
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Gopikrishna V, Tinagupta K, Kandaswamy D. Comparison of Electrical, Thermal, and Pulse Oximetry Methods for Assessing Pulp Vitality in Recently Traumatized Teeth. J Endod 2007; 33:531-5. [PMID: 17437866 DOI: 10.1016/j.joen.2007.01.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 01/10/2007] [Accepted: 01/16/2007] [Indexed: 11/29/2022]
Abstract
Pulse oximeter is a well-established and noninvasive method for measuring vascular health by evaluating oxygen saturation. This study compared the efficacy of a custom-made pulse oximeter dental probe with the electric pulp testing and thermal testing for measuring pulp vitality status of recently traumatized permanent teeth. Readings for pulp vitality for 17 recently traumatized maxillary incisors were taken with custom-made pulse oximeter dental probe (group 1), electrical pulp tester (group 2), and thermal testing (group 3) over a 6-month period. The proportion of recently traumatized teeth showing a positive responsiveness in thermal/electric pulp tests increased from no teeth showing responsiveness on day 0 to 29.4% teeth on the 28th day, 82.35% of teeth at 2 months, and 94.11% teeth at 3 months. However, pulse oximeter gave positive vitality readings that remained constant over the study period from day 0 to 6 months in all patients.
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Affiliation(s)
- Velayutham Gopikrishna
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, India.
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Gopikrishna V, Tinagupta K, Kandaswamy D. Evaluation of Efficacy of a New Custom-Made Pulse Oximeter Dental Probe in Comparison With the Electrical and Thermal Tests for Assessing Pulp Vitality. J Endod 2007; 33:411-4. [PMID: 17368329 DOI: 10.1016/j.joen.2006.12.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 11/21/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
Pulse oximetry is a noninvasive method of measuring vascular health by evaluating oxygen saturation. This study evaluated the efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. Sensitivity, specificity, negative predictive value, and positive predictive value for each test were calculated by comparing the test results with the actual pulpal status, as evaluated by direct visual inspection. The sensitivity of the pulse oximeter was found to be 1.00, as compared to 0.81 with the cold test and 0.71 with the electrical test. The specificity of the pulse oximeter was 0.95, as compared to 0.92 with the cold and electrical pulp tests. Thus, the custom-made pulse oximeter dental probe is an effective, accurate, and objective method of evaluating pulp vitality.
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Affiliation(s)
- Velayutham Gopikrishna
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Alapakkam Main Road, Maduravoyal, Chennai 600 095, India.
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21
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Rotstein I, Simon JHS. Diagnosis, prognosis and decision-making in the treatment of combined periodontal-endodontic lesions. Periodontol 2000 2004; 34:165-203. [PMID: 14717862 DOI: 10.1046/j.0906-6713.2003.003431.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ilan Rotstein
- Continuing Oral Health Professional Education, University of Southern California, School of Dentistry, Los Angeles, California, USA
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22
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Abstract
Transient apical breakdown is a sequelae of certain dental traumatic injuries where the injured tissues undergo a spontaneous process of repair with no permanent damage to the pulp. Misdiagnosis of this condition may result in unnecessary endodontic treatment. Presented is a case of transient apical breakdown following a subluxation injury of a maxillary central incisor in a 15-year-old girl. Four months after injury, coronal discoloration, periapical radiolucency as well as negative pulp responses to cold and electric tests were still recorded. Subsequently, the tooth spontaneously regained its original shade and the pulp responded normally to pulp sensitivity tests. Methods for early diagnosis of transient apical breakdown are discussed.
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Affiliation(s)
- Nestor Cohenca
- Department of Endodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel.
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Kells BE, Kennedy JG, Biagioni PA, Lamey PJ. Computerized infrared thermographic imaging and pulpal blood flow: Part 1. A protocol for thermal imaging of human teeth. Int Endod J 2000; 33:442-7. [PMID: 11307463 DOI: 10.1046/j.1365-2591.2000.00257.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To observe the thermographic appearance of teeth and to develop a suitable protocol for imaging teeth in human subjects using modern thermographic imaging (TI) equipment in a thermologically controlled environment. METHODOLOGY The emissivity of enamel was investigated using an extracted incisor tooth. A total of 12 unrestored maxillary lateral incisors in six healthy patients were then imaged under rubber dam after a 20-min equilibration period and the thermographic data analysed using a dedicated software package. Recordings were made from standardized gingival and incisal sites on each tooth and the temperature gradient established for each tooth. Subsequently, a sequence of images of both maxillary central incisors in one patient was stored every 30 s during a 20-min equilibration period with and without an air-conditioning unit in operation. RESULTS For the lateral incisors there was a consistent temperature gradient (mean 1.28 degrees C) from gingival area to incisal area and there were no statistically significant differences between right and left sides for the gingival site (t = 0.34, NS) or the incisal site (t = 0.62, NS). The air-conditioning unit had a rapid and profound cooling effect. With the air-conditioning disabled there was a mean tooth surface temperature increase of 1.1 degrees C from 0 to 5 min of the equilibration period and 0.3 degree C from 15 to 20 min. CONCLUSIONS There was no significant difference in gingival or incisal temperatures between pairs of contralateral maxillary lateral incisors and a consistent temperature gradient existed from gingival to incisal areas of healthy maxillary lateral incisor teeth. The protocol described is suitable for TI of vital teeth. However, TI measured tooth surface temperature only which was extremely sensitive to air currents. A 15-min acclimatization period under rubber dam was adequate to allow stable tooth surface temperature measurement.
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Affiliation(s)
- B E Kells
- School of Dentistry, Queen's University of Belfast, Belfast, UK
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Musselwhite JM, Klitzman B, Maixner W, Burkes EJ. Laser Doppler flowmetry: a clinical test of pulpal vitality. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:411-9. [PMID: 9347507 DOI: 10.1016/s1079-2104(97)90041-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PROBLEM A rapid, accurate, noninvasive method of determining pulpal blood flow would be helpful in determining pulpal vitality. OBJECTIVE The purpose of this study was to determine if laser Doppler flowmetry can measure induced changes in pulpal blood flow. STUDY DESIGN Two percent lidocaine with epinephrine 1:100,000 was infiltrated into the labial vestibule to anesthetize five anterior teeth in healthy human volunteers. Stents were placed on the teeth to stabilize the laser Doppler probes. Measurements of pulpal blood flow were made along with electrocardiograms to record the cardiac cycle. RESULTS Laser Doppler flowmetry demonstrated pulpal blood flow and pulse amplitude decreases under test conditions. These decreases were most significant at 10 minutes after the injection of anesthetic with vasoconstrictor. CONCLUSIONS Laser Doppler flowmetry was able to measure pulpal blood flow and record changes in blood flow that occurred when epinephrine was used with infiltration anesthesia. The pulse width and the mean flow were dramatically affected as was synchronization with the cardiac cycle.
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Affiliation(s)
- J M Musselwhite
- Division of Plastic Surgery, Duke University Medical Center, Durham, N.C., USA
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26
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Oikarinen KS, Kainulainen V, Särkelä V, Alaniska K, Kopola H. Information of circulation from soft tissue and dental pulp by means of pulsatile reflected light: further development of optical pulp vitalometry. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:315-20. [PMID: 9377198 DOI: 10.1016/s1079-2104(97)90350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- K S Oikarinen
- Department of Oral and Maxillofacial Surgery, Oulu University Hospital, Finland
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27
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Oikarinen K, Kopola H, Mäkiniemi M, Herrala E. Detection of pulse in oral mucosa and dental pulp by means of optical reflection method. ENDODONTICS & DENTAL TRAUMATOLOGY 1996; 12:54-9. [PMID: 9028197 DOI: 10.1111/j.1600-9657.1996.tb00097.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- K Oikarinen
- Department of Oral and Maxillofacial Surgery, University of Oulu, Finland
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Kahan RS, Gulabivala K, Snook M, Setchell DJ. Evaluation of a pulse oximeter and customized probe for pulp vitality testing. J Endod 1996; 22:105-9. [PMID: 8618088 DOI: 10.1016/s0099-2399(96)80283-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Current routine methods for assessment of pulp vitality rely on stimulation of A-delta nerve fibers and give no direct indication of blood flow within the pulp. Recent papers have suggested that pulse oximeters may be used to diagnose pulp vitality by detection of blood flow. In this study, an optimized pulse oximeter probe for teeth was designed, built and tested using the Biox 3740 Oximeter (Ohmeda, Louisville, CO). Following preliminary in vitro tests, the probe was tested clinically. Pulse waveforms from maxillary and mandibular anterior teeth were noted. Simultaneous readings from the subjects' finger were used as controls. Pulse wave readings from the teeth were found to be synchronous with the finger probe, but not consistently. It was easier to maintain continuous readings from mandibular incisors than from maxillary incisors. The average percentage synchronization with the pulse was 28.95% for maxillary incisors and 50.28% for mandibular incisors. This difference was significant (p = 0.05). The overall accuracy of the commercial instrument was disappointing, and in its present form it was not considered to have clinical value.
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Affiliation(s)
- R S Kahan
- Department of Conservative Dentistry, Eastman Dental Institute, London, UK
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Noblett WC, Wilcox LR, Scamman F, Johnson WT, Diaz-Arnold A. Detection of pulpal circulation in vitro by pulse oximetry. J Endod 1996; 22:1-5. [PMID: 8618078 DOI: 10.1016/s0099-2399(96)80226-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Evaluation of pulse oximetry as a potential method of determining pulp vitality was the subject of this research. An in vitro model of pulpal circulation was fabricated to test the design for a dental pulse oximetry sensor. Blood samples equilibrated with hypoxic gas mixtures were circulated through the model by a peristaltic pump. A pulse was simulated by introduction of gas bubbles into the blood circulation. Pulse oximeter readings for saturation were recorded and compared with blood gas analysis results. Statistical analysis revealed no difference between pulse oximetry and blood gas analysis with a highly significant correlation coefficient. Clinical evaluation of this application is currently in progress.
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Affiliation(s)
- W C Noblett
- Department of Endodontics, University of Iowa College of Dentistry, Iowa City 52240, USA
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30
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Abstract
An in vitro, flow-through optical system was designed to measure hemoglobin (Hb) concentrations in the pulp space. The system included light-emitting diodes and a silicon photodetector positioned on opposing surfaces of human teeth. A syringe pump allowed a controlled flow of blood through the pulp chamber. The Hb concentration was computed as a nonlinear function of transmitted light intensity. Transmitted light intensities were also used as indicators of oxygenation level. Optical measurements correlated with Hb values measured by the conventional cyanmethemoglobin method (r=0.993). The mean percentage error was 5.8%, and the standard error of prediction was 0.77 g/dl for Hb concentrations ranging from 4 to 20 g/dl. Deoxygenated blood exhibited up to 31% lower transmitted intensity. Light transmission through teeth may be useful in the assessment of total Hb and blood oxygenation within the pulp chamber.
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Affiliation(s)
- A M Diaz-Arnold
- Department of Family Dentistry, College of Dentistry, University of Iowa, Iowa City 52242, USA
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Abstract
An optical system to assess blood within the pulpal cavity was developed. The system included a light-emitting diode source, human incisor teeth, and a silicon photodiode detector. An automated syringe pump was used to flow bovine blood lengthwise through the teeth. Transmitted light intensities were recorded at a collection frequency of 20 reading/min and apparent absorbance units were calculated. The effects of blood concentration, blood flow rate, and pulp chamber size were investigated. It was found that changes in blood flow rate did not cause significant changes in transmitted light intensity. Increases in blood concentration and pulp chamber size resulted in larger absorbance values. These results suggest that photoplethysmography measurements may be sensitive to the amount of blood in the pulp chamber as it reflects the pulsatile-related expansion and contraction of capillaries within the pulp tissue.
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Affiliation(s)
- A M Diaz-Arnold
- Department of Family Dentistry, College of Dentistry, University of Iowa, Iowa City
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