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Yang J, Liu Z, Chen Z, Yang G, Yuan G. Application of Oxygen Saturation Test after Replantation of Avulsed Immature Permanent Teeth: A Prospective Observational Study. J Endod 2024; 50:954-961. [PMID: 38604473 DOI: 10.1016/j.joen.2024.04.003] [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: 12/19/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION The evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth. METHODS A prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit. RESULTS Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged. CONCLUSIONS The oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation.
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Affiliation(s)
- Jinghui Yang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhengyan Liu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhi Chen
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China
| | - Guobin Yang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; General and Emergency Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Guohua Yuan
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Wuhan University, Wuhan, China; Department of Pediatric Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Frontier Science Center for Immunology and Metabolism, Wuhan University, Wuhan, China.
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Çağırır Dindaroğlu F, Özay Güngör N. Comparison of the vitality test with sensitivity tests in mature and immature teeth: clinical trial. BMC Oral Health 2024; 24:613. [PMID: 38802767 PMCID: PMC11131178 DOI: 10.1186/s12903-024-04317-3] [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: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND One of the most important steps in deciding on the treatment of a tooth is to determine the vitality and health status of the pulp. Since immature teeth innervation is not completed, the response to sensitivity tests may not yield definite results. Pulse oximetry (PO) which is considered as a vitality test, measures the arterial oxygen saturation (SpO2). This study aims to compare PO, electric pulp test (EPT) and cold test in mature and immature permanent teeth. METHODS 20 immature and 20 mature permanent incisors of 6-12-year-old ASA1 children who did not use any analgesics, were included in the study. Pulp vitality of the teeth was determined by EPT, cold test and PO. An infant probe of PO device (CMS60D, Contec Medical Systems Co. Ltd, China) was used to determine the SpO2 of the teeth. The SpO2 level is controlled on the patient's finger by a children's probe and an infant probe of PO. Shapiro-Wilk, Spearman rank correlation test and Kruskal-Wallis test/Dunn post-hoc analysis were used for statistical comparisons. RESULTS There was no significant correlation between finger SpO2 and the mature/immature teeth SpO2 (r=-0.026, r = 0.253). Arterial oxygen saturation values in the immature teeth were significantly higher than in the mature teeth (p = 0.002). There was a high correlation between the vitality response of the EPT, cold test and PO. CONCLUSIONS Pulse oximetry can be used as an effective vitality test compared to sensitivity tests in both immature and mature permanent incisors.
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Affiliation(s)
- Funda Çağırır Dindaroğlu
- Faculty of Dentistry, Department of Pediatric Dentistry, İzmir Katip Çelebi University, İzmir, Turkey.
| | - Narin Özay Güngör
- Faculty of Dentistry, Department of Pediatric Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
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Saikiran KV, Gurunathan D, Gayathri E, Nuvvula S. Identification of the Ideal Reference Site and Pain Threshold Values for the Placement of Electric Pulp Testers in Permanent Upper and Lower Anterior Teeth: A Cross-Sectional Study. Cureus 2024; 16:e58156. [PMID: 38741880 PMCID: PMC11089269 DOI: 10.7759/cureus.58156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Electric pulp testers (EPTs) are widely used diagnostic tools for diagnosing traumatized teeth. Several factors can affect the result of an electric pulp test. One such factor that will affect the diagnosis is the electrode tip placement. Hence, the current study aims to identify the most painful site and response time threshold in healthy anterior teeth. METHODS A total of 90 individuals, 48 male and 42 female, aged 19 to 25 years, were recruited. An EPT was placed on three different sites: the cervical, middle, and incisal third of the labial surface of both upper and lower anterior teeth (central incisor, lateral incisor, and canine) with an appropriate electrolyte as a conducting medium. Later, the threshold values were recorded, and pain assessment was done using the Memojis pain scale (MPS). Finally, the data was analyzed statistically using the Mann-Whitney U test. RESULTS Mean and standard deviation values of reaction time were collected from 540 EPT readings (three sites from 180 teeth). Among the three sites tested, the difference between the upper and lower central incisors was statistically insignificant (p > 0.05). Similarly, when upper and lower lateral incisors and canines were compared, a statistically significant difference was observed among the three sites (p<0.05). There was a significant difference (p<0.05) in the pain scores only on the incisal and cervical thirds of the upper and lower central incisors. Only the incisal third showed a statistically significant difference (p<0.05) between the pain scores in the upper and lateral incisors. At the same time, a statistically significant difference in the pain scores was observed among the three tested sites between the upper and lower canines (p<0.05). Conclusion: Lower threshold values were appreciated at the incisal third of all the upper and lower anterior teeth for placing the EPT. Most individuals have experienced a score of 2 (hurts little bit) for the perceived pain using EPTs for both the upper and lower anterior teeth.
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Affiliation(s)
- Kanamarlapudi V Saikiran
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Deepa Gurunathan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Esha Gayathri
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sivakumar Nuvvula
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Kanumuru KR, Solomon N, Ramkumar H, Paulindraraj S, Jayakaran TG, Dakshinamoorthy S. Assessment of Pulpal Oxygen Saturation in Caries-free and Carious Maxillary Primary Central Incisors Using a Customized Dental Pulse Oximeter. Int J Clin Pediatr Dent 2023; 16:560-564. [PMID: 37731798 PMCID: PMC10507304 DOI: 10.5005/jp-journals-10005-2582] [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] [Indexed: 09/22/2023] Open
Abstract
Introduction Pulpal status is best determined by assessing the pulp vitality, which proves to be important yet sceptical with the use of conventional thermal and electrical testing methods. The use of pulse oximetry helps to arrive at a definitive diagnosis by detecting the pulpal oxygen saturation. Aim To assess and compare the pulpal oxygen saturation in caries-free and carious maxillary primary central incisors using a customized dental pulse oximeter sensor probe. Materials and methods A total of 225 maxillary primary central incisors were selected from children aged 3-6 years. Teeth were categorized into group I-caries-free teeth, group II-deep caries lesion, and group III-pulpectomized teeth (n =75 in each group). Pulpal oxygen levels were assessed using a three-dimensionally (3D) designed custom-made probe, and the readings were tabulated. The values were subjected to statistical analysis using paired t-test, analysis of variance (ANOVA), and Tukey's HSD post hoc test. Results The mean oxygen saturation levels of teeth in group I (92.03%) were statistically significantly high compared to group II (64.36%), that was statistically significant. Readings noted from group III, which was kept as control, was 0%. Conclusion The obtained results showed that the caries-free group exhibited higher saturation compared to the carious group. 3D designed customized pulse oximeter can be used as an adjunct to assess the pulp vitality in primary teeth. How to cite this article Kanumuru KR, Solomon N, Ramkumar H, et al. Assessment of Pulpal Oxygen Saturation in Caries-free and Carious Maxillary Primary Central Incisors using a Customized Dental Pulse Oximeter. Int J Clin Pediatr Dent 2023;16(4):560-564.
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Affiliation(s)
- Kranthi Reddy Kanumuru
- Department of Pediatric and Preventive Dentistry, KGR Multi Specialty Dental Hospital & Trauma Centre, Nellore, Andhra Pradesh, India
| | - Nancy Solomon
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, Chennai, Tamil Nadu, India
| | - Hemalatha Ramkumar
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, Chennai, Tamil Nadu, India
| | - Shankar Paulindraraj
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, Chennai, Tamil Nadu, India
| | | | - Senthil Dakshinamoorthy
- Department of Pedodontics and Preventive Dentistry, SRM Dental College, Chennai, Tamil Nadu, India
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Mohamed Khazin S, Abdullah D, Liew AKC, Soo E, Ahmad Tarib N. Pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study. AUST ENDOD J 2022; 48:8-19. [PMID: 34609035 DOI: 10.1111/aej.12567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 01/20/2023]
Abstract
This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; 'crowned' and 'untreated' groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy.
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Affiliation(s)
- Sobrina Mohamed Khazin
- Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Malaysia
| | - Dalia Abdullah
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amy Kia Cheen Liew
- Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Eason Soo
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Natasya Ahmad Tarib
- KPJ KL Dental Specialist Centre, KPJ Tawakkal Health Centre, Kuala Lumpur, Malaysia
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Proulx C, Dumais Y, Beauchamp G, Steagall P. Reliability of Electric Pulp Test, Cold Pulp Test or Tooth Transillumination to Assess Pulpal Health in Permanent Dog Teeth. J Vet Dent 2022; 39:133-141. [PMID: 35257623 PMCID: PMC9109579 DOI: 10.1177/08987564221076363] [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] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the reliability of electric pulp test (EPT), cold pulp test (CPT) and tooth transillumination (TTI) in the assessment of pulpal health in dog teeth. Forty-five client-owned dogs requiring tooth extraction or pulpectomy were included. For each patient, one affected and two control healthy teeth were evaluated with EPT, followed by CPT and TTI. Direct pulp inspection was used as a gold standard. The real pulpal health (vital or necrotic) was determined by the presence or absence of bleeding after creating access to the pulp chamber. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EPT, CPT and TTI were obtained for each pulp test using the binomial Clopper-Pearson exact method to establish confidence intervals. Forty-five affected teeth were tested. Forty-three were tested with EPT, CPT, and TTI, and two were tested solely with EPT and CPT. All dogs tested with EPT and TTI were included in the study whereas 21 out of 45 (47%) dogs tested with CPT were excluded. The sensitivity, specificity, PPV, NPV and accuracy were respectively 0.96, 1.00, 1.00, 0.96 and 0.98 for EPT; 1.00, 0.89, 0.92, 1.00 and 0.95 for CPT; and 0.59, 0.95, 0.94, 0.67 and 0.76 for TTI. This study concluded that EPT is a highly reliable diagnostic test to evaluate pulpal health in dogs. The high accuracy of CPT is conditional on the patient's responsiveness to stimulation applied to its control healthy teeth. TTI was the least reliable test in the study.
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Affiliation(s)
- Caroline Proulx
- Centre hospitalier universitaire vétérinaire, Faculty of Veterinary Medicine, 70354Université de Montréal, , St-Hyacinthe, QC, Canada
| | - Yvan Dumais
- Centre hospitalier universitaire vétérinaire, Faculty of Veterinary Medicine, 70354Université de Montréal, , St-Hyacinthe, QC, Canada
| | - Guy Beauchamp
- 5622Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC Canada
| | - Paulo Steagall
- Clinical Sciences Department, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC, Canada
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Saklecha P, Kishan KV, Shroff MG. Comparison of pulp sensibility test responses in normotensive and hypertensive individuals: A clinical study. J Conserv Dent 2022; 25:526-530. [PMID: 36506632 PMCID: PMC9733552 DOI: 10.4103/jcd.jcd_105_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background Pulp sensibility testing is an essential part of the diagnostic process in the assessment of pulpal health. Several lines of evidence suggest an interaction between control of blood pressure and pain regulatory mechanisms. Aim The aim of the study is to compare pulp sensibility test responses in normotensive and hypertensive individuals. Materials and Methods Ninety-eight patients participated in the study, with 49 individuals each in the hypertensive and normotensive groups. A minimum of 4 and maximum of 8 sound teeth were included in the study each from the anterior, premolar, and molar, i.e., 4 teeth from either arch. A total of 832 teeth were tested. The value and time when the responses evoked for electric pulp test (EPT) and cold test were recorded respectively. Statistical Analysis For intergroup and intragroup analyses, independent t-test and paired t-test were utilized. Results A statistically significant difference was noted in values for EPT as well as cold test responses when both the groups were compared (P < 0.01). Higher values were obtained with the hypertensive group. Conclusion Patients with established hypertension showed an increased threshold to electric pulp testing and cold stimulus as compared to normal healthy individuals.
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Affiliation(s)
- Purnima Saklecha
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Karkala Venkappa Kishan
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India,Address for correspondence: Dr. Karkala Venkappa Kishan, Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Pipariya, Waghodia, Vadodara - 391 760, Gujarat, India. E-mail:
| | - Manan Gaurang Shroff
- Department of Conservative Dentistry and Endodontics, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
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Juerchott A, Jelinek C, Kronsteiner D, Jende JME, Kurz FT, Bendszus M, Heiland S, Hilgenfeld T. Quantitative assessment of contrast-enhancement patterns of the healthy dental pulp by magnetic resonance imaging: A prospective in vivo study. Int Endod J 2021; 55:252-262. [PMID: 34767640 DOI: 10.1111/iej.13662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
AIM This prospective in vivo study aimed to optimize the assessment of pulpal contrast-enhancement (PCE) on dental magnetic resonance imaging (dMRI) and investigate physiological PCE patterns. METHODOLOGY In 70 study participants, 1585 healthy teeth were examined using 3-Tesla dMRI before and after contrast agent administration. For all teeth, the quotient of post- and pre-contrast pulp signal intensity (Q-PSI) was calculated to quantify PCE. First, pulp chambers were analysed in 10 participants to compare the coefficient of variation of mean versus maximum Q-PSI values (Q-PSImean versus Q-PSImax ). Second, dynamic PCE was evaluated in 10 subjects to optimize the time interval between contrast agent application and image acquisition. Finally, 50 participants (age groups: 20-29, 30-39, 40-49, 50-59 and 60-69 years) were examined to analyse age, gender, tooth types and maxilla versus mandible as independent factors of PCE. Statistical analysis was performed using Wilcoxon signed rank test and linear mixed models. RESULTS PCE assessment based on Q-PSImax was associated with a significantly smaller coefficient of variation compared with Q-PSImean , with median values of 0.17 versus 0.21 (p = .002). Analysis of dynamic PCE revealed an optimal timing interval for image acquisition 4 min after contrast media application. No significant differences in PCE were observed by comparing age groups, female versus male participants and maxillary versus mandibular teeth (p > .05). Differences between tooth types were small (median Q-PSImax values of 2.52/2.32/2.30/2.20 for molars/premolars/canines/incisors) but significant (p < .05), except for the comparison of canines versus premolars (p = .80). CONCLUSIONS PCE in dMRI was a stable intra-individual marker with only minor differences between different tooth types, thus forming an important basis for intra-individual controls when assessing teeth with suspected endodontic pathosis. Furthermore, it was demonstrated that PCE is independent of age, gender and jaw type. These findings indicate that dMRI-based PCE analysis could be a valuable diagnostic tool for the identification of various pulp diseases in future patient studies.
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Affiliation(s)
- Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Dorothea Kronsteiner
- Institute of Medical Biometry, Heidelberg University Hospital, Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Assessment of Electrosensitivity of the Pulp of the Mandibular Second Molar after Surgical Removal of an Impacted Mandibular Third Molar. J Clin Med 2021; 10:jcm10163614. [PMID: 34441910 PMCID: PMC8397152 DOI: 10.3390/jcm10163614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 02/06/2023] Open
Abstract
Despite the frequent discussion of complications associated with surgical removal of wisdom teeth in the scientific literature, increased mobility of the second molar, which can affect the clinical status of the pulp, is often downplayed or overlooked. This study aimed to evaluate surgical removal of an impacted third molar on the change in the electrosensitivity of the pulp of the mandibular second molar. Sixty patients consecutively presenting to the Department of Oral Surgery to remove an impacted mandibular third molar were included in the study. Clinical examinations of pulp sensitivity of second molars in both the study and control groups were evaluated before the procedure, seven days after the procedure, and eight weeks after the procedure. The surgical removal of an impacted mandibular third molar significantly affected the pulp sensitivity of the second molar.
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Farughi A, Rouhani A, Shahmohammadi R, Jafarzadeh H. Clinical comparison of sensitivity and specificity between sensibility and vitality tests in determining the pulp vitality of mandibular premolars. AUST ENDOD J 2021; 47:474-479. [PMID: 33829611 DOI: 10.1111/aej.12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
This clinical study was designed to compare cold pulp testing (CPT), heat pulp testing (HPT) and electric pulp test (EPT) with pulse oximetry (PO), flowmetry (FM) and thermometry (TM) in terms of sensitivity and specificity. Twenty premolar teeth in need of root canal treatment were included in the study. Pulp sensibility tests (CPT, HPT and EPT) along with vitality tests (PO, FM and TM) were performed. As the gold standard, the teeth were endodontically treated and pulp vitality was determined by direct visual observation. Sensitivity, specificity and accuracy values for each test were as follows: HPT 1, 1, 100%; CPT 1, 0.818, 90%; EPT 1, 0.909, 95%; PO 1, 0.545, 75%; TM 0.111, 0.272, 20%; and FM 0.444, 0.272, 35%, respectively. The most accurate test among all was HPT. PO was the most accurate vitality test.
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Affiliation(s)
- Aidin Farughi
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Armita Rouhani
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Shahmohammadi
- Department of Endodontics, Faculty of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Hamid Jafarzadeh
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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11
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Pulse Oximetry as a Diagnostic Tool to Determine Pulp Vitality: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11062747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulse oximetry (PO) can be used as a technique to assess vascularization. Although it is commonly used in the field of medicine, it still has limited use in dentistry. The aim of this study is to evaluate, by means of a systematic review, if pulse oximetry is a viable and effective system to determine pulp vitality and assess the clinical criteria for its use. A literature search was performed in Medline, Scopus, Embase, and Web of Science databases. Clinical studies using pulse oximetry as a tool to determine pulp vitality in permanent teeth were eligible. Quality assessment of the included studies was performed following the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2) guidelines. A total of 24 articles were included in the review. The subjective test most compared to PO was the cold test. PO has shown a good sensibility and specificity, and it has been used in different clinical situations. Pulse oximetry has a high potential as a tool for the diagnosis of pulp vitality. However, the absence of a specific pulse oximeter for a dental practice, among other limitations, added to the lack of evidence on how different systemic and oral pathologies may affect the pulp’s oxygen saturation levels, which hinders its clinical use.
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Hazard ML, Wicker C, Qian F, Williamson AE, Teixeira FB. Accuracy of cold sensibility testing on teeth with full-coverage restorations: a clinical study. Int Endod J 2021; 54:1008-1015. [PMID: 33550601 DOI: 10.1111/iej.13490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 02/03/2021] [Indexed: 01/19/2023]
Abstract
AIM This clinical study evaluated the reliability of the 1,1,1,2-tetrafluoroethane (Endo Ice) cold test to determine the pulpal diagnosis of teeth with full-coverage restorations (FCR). The effect of several variables on its reliability was also investigated. METHODOLOGY Data collected from 825 patients treated in the Advanced Education Program in Endodontics at the University of Iowa, USA were analysed. The experimental group included 425 teeth with FCR, whilst the control group consisted of 400 teeth with natural crowns (NC). The pulp sensibility test results, tooth type, tooth number, type of crown, age, gender, presence or absence of caries and recent use of analgesics were recorded. Bivariate analyses were performed to assess the variables associated with the accuracy of dental pulp sensibility tests for either teeth with crowns or teeth without crowns using chi-square tests, Fisher's exact tests, Cochran-Mantel-Haenszel tests, and the Wilcoxon rank-sum tests. A P-value of less than 0.05 was used as a criterion for statistical significance, and a P-value in 0.05 < P < 0.10 was used as a criterion for marginal relevance. RESULTS The sensibility test results for FCR teeth had an accuracy of 0.866; sensitivity of 0.835; specificity of 0.879; a positive predictive value of 0.746; and a negative predictive value of 0.926. The data indicated a significant difference in the accuracy of pulp sensibility test results between the experimental and control groups (P < 0.001). Although the cold test in FCR teeth still had high accuracy, teeth with NC were significantly more likely to have true-positive and true-negative results (91.5% NC vs. 86.6% FCR, P = 0.024). No significant differences between FCR and NC were found concerning gender, tooth type, type of crown, the presence of abutment and recent use of analgesic (P > 0.05). CONCLUSION Pulp sensibility cold testing with 1,1,1,2-tetrafluoroethane (TFE) on teeth with FCR was less accurate than on teeth without full-coverage crowns. However, the use of TFE cold testing is still a relevant and reliable diagnostic tool, particularly for teeth with a pulpal diagnosis of symptomatic irreversible pulpitis. Clinicians should routinely carry out cold pulp sensibility testing on teeth when making a pulpal diagnosis.
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Affiliation(s)
- M L Hazard
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - C Wicker
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - F Qian
- Division of Biostatistics and Computational Biology, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - A E Williamson
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - F B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
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Pinheiro CR, de Castro Pinto L, Mateo-Castillo JF, Siqueira VDS, Garib D. Response to Pulp Vitality Tests in Teeth Submitted to Orthodontic Movement, Adjacent to the Cleft Area. Cleft Palate Craniofac J 2021; 59:72-78. [PMID: 33622061 DOI: 10.1177/1055665621996115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the pulp vitality in teeth adjacent to the cleft area submitted to orthodontic movement into the alveolar graft area in individuals with complete unilateral cleft lip and palate (CUCLP). DESIGN Cold sensitivity, vertical, and horizontal percussion tests were conducted on the teeth adjacent to the cleft and the contralateral teeth. SETTING Endodontics Sector in the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). PATIENTS One hundred patients with CUCLP and hypodontia of the upper lateral incisor in orthodontic movement and after successful alveolar bone graft in the cleft area. MAIN OUTCOME MEASURES The cleft study group (SG) was composed of 200 teeth, adjacent to the cleft area. The control group (CG) consisted of 200 contralateral teeth. Statistical analysis was performed using the chi-square test for comparisons between groups (P < .05). RESULTS In the SG, 82.0% of teeth presented positive response to the cold sensitivity testing, 13.5% had negative response, and 4.5% had marked response, with statistically significant difference in relation to the CG. The vertical and horizontal percussion tests on teeth in the SG revealed the same results, in which 95.0% presented negative response and 5.0% responded positively, without significant difference compared to teeth in the CG, for both tests. CONCLUSIONS Teeth adjacent to the cleft area presented changes in the physiological conditions of the pulp, which were observed by reduction of positive response to the cold sensitivity testing or presence of pulp hypersensitivity in cases of marked response.
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Affiliation(s)
- Claudia Ramos Pinheiro
- Dentistry Department, Specialization in Endodontics, Post Graduation Center in Dentistry, CPO Uningá, Bauru, São Paulo, Brazil
| | - Lidiane de Castro Pinto
- Dentistry Department, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil
| | - José Francisco Mateo-Castillo
- Dentistry Department, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil
| | - Viviane da Silva Siqueira
- Dentistry Department, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil
| | - Daniela Garib
- Department of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP) and Bauru School of Dentistry, University of São Paulo (FOB/USP), Brazil
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Different Approaches to the Regeneration of Dental Tissues in Regenerative Endodontics. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
(1) Background: The regenerative procedure has established a new approach to root canal therapy, to preserve the vital pulp of the tooth. This present review aimed to describe and sum up the different approaches to regenerative endodontic treatment conducted in the last 10 years; (2) Methods: A literature search was performed in the PubMed and Cochrane Library electronic databases, supplemented by a manual search. The search strategy included the following terms: “regenerative endodontic protocol”, “regenerative endodontic treatment”, and “regenerative endodontics” combined with “pulp revascularization”. Only studies on humans, published in the last 10 years and written in English were included; (3) Results: Three hundred and eighty-six potentially significant articles were identified. After exclusion of duplicates, and meticulous analysis, 36 case reports were selected; (4) Conclusions: The pulp revascularization procedure may bring a favorable outcome, however, the prognosis of regenerative endodontics (RET) is unpredictable. Permanent immature teeth showed greater potential for positive outcomes after the regenerative procedure. Further controlled clinical studies are required to fully understand the process of the dentin–pulp complex regeneration, and the predictability of the procedure.
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Kayaoglu G, Ekici M, Altunkaynak B. Mechanical Allodynia in Healthy Teeth Adjacent and Contralateral to Endodontically Diseased Teeth: A Clinical Study. J Endod 2020; 46:611-618. [DOI: 10.1016/j.joen.2020.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 11/26/2022]
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Vitality Tests for Pulp Diagnosis of Traumatized Teeth: A Systematic Review. J Endod 2019; 45:490-499. [DOI: 10.1016/j.joen.2019.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/21/2022]
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17
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Detection of pulsed blood flow through a molar pulp chamber and surrounding tissue in vitro. Clin Oral Investig 2018; 23:1121-1132. [DOI: 10.1007/s00784-018-2530-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/19/2018] [Indexed: 01/12/2023]
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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] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/25/2022]
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Mladenovic I, Krunic J, Supic G, Kozomara R, Bokonjic D, Stojanovic N, Magic Z. Pulp Sensitivity: Influence of Sex, Psychosocial Variables, COMT Gene, and Chronic Facial Pain. J Endod 2018; 44:717-721.e1. [DOI: 10.1016/j.joen.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/27/2018] [Accepted: 02/01/2018] [Indexed: 01/28/2023]
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Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis. Pain Res Manag 2017; 2017:3108940. [PMID: 28694714 PMCID: PMC5488488 DOI: 10.1155/2017/3108940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/24/2017] [Accepted: 05/21/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). METHODOLOGY A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. RESULTS IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). CONCLUSION None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.
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Hirsch V, Wolgin M, Mitronin AV, Kielbassa AM. Inflammatory cytokines in normal and irreversibly inflamed pulps: A systematic review. Arch Oral Biol 2017; 82:38-46. [PMID: 28600966 DOI: 10.1016/j.archoralbio.2017.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/14/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To review the available literature in regard to the inflammatory process and pulpitis. Setting forth to evaluate if differences in the levels of various cytokines (TNF-α, IL-1β, IL-2, IL-6 and IL-8) can be observed in clinically diagnosed normal and irreversibly inflamed pulps that could serve as possible markers and/or diagnostic tools to predict and differentiate between certain states of inflammation. Methods used to measure and assess levels of cytokines have been limited to two protein quantification methods ELISA and/or Multiplex Array. DESIGN The databases PubMed, EMBASE/Ovid, The Cochrane Central Register of Controlled Trials, Cochrane Reviews and Scopus were consulted for the electronic literature search. Screening of titles and abstracts followed the PRISMA guidelines while data extraction and the assessment of the full texts were carried out in accordance to the GRADES assessment. RESULTS The review showed that significant increases in levels of IL-1β, IL-2, IL-6, IL-8 and TNF-α in irreversible pulpitis samples exist, in comparison to normal pulp samples which serve as a good basis for potential markers. Due to larger discrepancies in available literature, IL-2 seems rather unsuitable at the moment, while IL-6 and TNF alpha seem to be more promising. CONCLUSION It may be concluded that even by combining two protein quantification methods inconsistencies between studies exist. At the moment it is difficult to select just one specific cytokine suitable for testing, rather it supports the rationale that further high-quality clinical studies are needed.
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Affiliation(s)
- Vivian Hirsch
- Centre for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstrasse 124, 3500 Krems, Austria
| | - Michael Wolgin
- Centre for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstrasse 124, 3500 Krems, Austria.
| | - Aleksandr V Mitronin
- Department of Cariology and Endodontology, Moscow State University of Medicine and Dentistry (MSMSU), ul. Delegatskaya 20/1, 127473 Moscow, Russia
| | - Andrej M Kielbassa
- Centre for Operative Dentistry, Periodontology, and Endodontology, University of Dental Medicine and Oral Health, Danube Private University (DPU), Steiner Landstrasse 124, 3500 Krems, Austria
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Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, Matsushita K. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther 2017; 8:61. [PMID: 28279187 PMCID: PMC5345141 DOI: 10.1186/s13287-017-0506-5] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/05/2017] [Accepted: 02/10/2017] [Indexed: 02/06/2023] Open
Abstract
Background Experiments have previously demonstrated the therapeutic potential of mobilized dental pulp stem cells (MDPSCs) for complete pulp regeneration. The aim of the present pilot clinical study is to assess the safety, potential efficacy, and feasibility of autologous transplantation of MDPSCs in pulpectomized teeth. Methods Five patients with irreversible pulpitis were enrolled and monitored for up to 24 weeks following MDPSC transplantation. The MDPSCs were isolated from discarded teeth and expanded based on good manufacturing practice (GMP). The quality of the MDPSCs at passages 9 or 10 was ascertained by karyotype analyses. The MDPSCs were transplanted with granulocyte colony-stimulating factor (G-CSF) in atelocollagen into pulpectomized teeth. Results The clinical and laboratory evaluations demonstrated no adverse events or toxicity. The electric pulp test (EPT) of the pulp at 4 weeks demonstrated a robust positive response. The signal intensity of magnetic resonance imaging (MRI) of the regenerated tissue in the root canal after 24 weeks was similar to that of normal dental pulp in the untreated control. Finally, cone beam computed tomography demonstrated functional dentin formation in three of the five patients. Conclusions Human MDPSCs are safe and efficacious for complete pulp regeneration in humans in this pilot clinical study.
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Affiliation(s)
- Misako Nakashima
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Koichiro Iohara
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masashi Murakami
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroshi Nakamura
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yayoi Sato
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kenji Matsushita
- Department of Dental and Oral Infrastructure Development, Center of Advanced Medicine for Dental and Oral Diseases, National Center for Geriatrics and Gerontology, Obu, Japan
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Caldeira CL, Barletta FB, Ilha MC, Abrão CV, Gavini G. Pulse oximetry: a useful test for evaluating pulp vitality in traumatized teeth. Dent Traumatol 2016; 32:385-9. [DOI: 10.1111/edt.12279] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | | | - Giulio Gavini
- School of Dentistry; University of São Paulo; Sao Paulo Brazil
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Wall A, Bueno E, Pomahac B, Treister N. Intraoral features and considerations in face transplantation. Oral Dis 2015; 22:93-103. [DOI: 10.1111/odi.12301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A Wall
- Department of Oral Medicine and Dentistry; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - E Bueno
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - B Pomahac
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - N Treister
- Department of Oral Medicine and Dentistry; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Oral Medicine, Infection and Immunity; Harvard School of Dental Medicine; Boston MA USA
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Fowler S, Fullmer S, Drum M, Reader A. Does Acetaminophen/Hydrocodone Affect Cold Pulpal Testing in Patients with Symptomatic Irreversible Pulpitis? A Prospective, Randomized, Double-blind, Placebo-controlled Study. J Endod 2014; 40:1958-60. [DOI: 10.1016/j.joen.2014.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/03/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022]
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Jespersen JJ, Hellstein J, Williamson A, Johnson WT, Qian F. Evaluation of Dental Pulp Sensibility Tests in a Clinical Setting. J Endod 2014; 40:351-4. [DOI: 10.1016/j.joen.2013.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/31/2013] [Accepted: 11/03/2013] [Indexed: 12/14/2022]
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