The Variability of Electric Pulp Response Threshold in Premolars: A Clinical Study

Determination of the Ideal Tooth Surface and Pain Threshold to Improve the Efficacy of an Electric Pulp Tester in the Diagnosis of Pulp Sensitivity and Vitality in Premolar and Molar Teeth: A Cross-Sectional Study

Introduction The electric pulp tester (EPT) is an extensively used diagnostic tool in endodontics. However, several factors, especially the location and thickness of the tooth structures, such as enamel and dentine, can affect the result of an electric pulp test. Further, these factors also alter the pain threshold, which may lead to an inaccurate diagnosis. Hence, it is crucial to ascertain the optimal tooth surface that requires minimal time to elicit a response and pain threshold to enhance the effectiveness of the electric pulp tester for diagnosing the status of the pulp. Methods Fifty volunteers (36 males and 14 females) aged 18 to 32 years without any prior experience with the EPT were recruited. The EPT was placed on the seven premolar sites, and molar teeth with an appropriate electrolyte as a conducting medium were tested. The pain threshold values were recorded using the stopwatch, whereas pain assessment was carried out using the Memojis pain scale. An independent sample t-test and descriptive statistics were used to analyze the data statistically. Results The buccal occlusal third in males (27.3±8.6 seconds) and the buccal middle third in females (28.5±8.2 seconds) showed lower response times than other sites in premolar teeth. The mesiobuccal cusp showed a lower response time for males (21.3±6.6 seconds) and females (21.5±6.2 seconds) in molar teeth. Of all the various sites tested, the majority of the individuals chose pain scores of 0 (36 in premolars, 84 in molars), two (138 in premolars, 180 in molars), and four (96 in premolars, 42 in molars) in both the premolars and molars. Conclusion The ideal sites for placing the EPT in premolars for males and females are the buccal occlusal third and the buccal middle third. At the same time, the mesiobuccal cusp is the ideal site for molars in both males and females, as it is responded to the quickest by the electric current. Most individuals have experienced a score of two (hurts a little bit) for the perceived pain using EPT for both the molars and premolars.

Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures

OBJECTIVES

This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.

METHODS

This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.

RESULTS

Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.

CONCLUSIONS

Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups.  CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.