Vitality Tests for Pulp Diagnosis of Traumatized Teeth: A Systematic Review

A study on the correlation of Doppler ultrasound in the diagnosis of cervical lymph nodes in patients with laryngeal and hypopharyngeal cancers: An observational study

The objective was to assess the diagnostic efficacy of Doppler ultrasound in detecting cervical lymph nodes in patients diagnosed with laryngeal and hypopharyngeal cancers. Patients undergoing surgery for laryngeal and hypopharyngeal cancers in the Otolaryngology Department from January 2021 to January 2023 were included. Two groups, with equal numbers, underwent ultrasound examination and intensive CT examination in the experimental and control groups, respectively, along with routine cervical lymph node dissection. A resident with over 6 years of clinical experience in the otolaryngology department performed routine bilateral cervical lymph node palpation. Sensitivity, specificity, and validity were compared among different examination methods. The McNemar test assessed specificity and sensitivity between palpation, color Doppler ultrasonography, and enhanced CT, while the Kappa concordance test evaluated the concordance between the 2 examination methods. Data were statistically analyzed using SPSS 23.0. Palpation showed a diagnostic sensitivity (DS) of 52.83% and specificity of 91.11% for all patients with cervical lymph node metastasis. Ultrasonography demonstrated a DS of 77.78% and specificity of 81.82% in patients with cervical lymph node metastasis, while intensive CT had a DS of 75.86% and specificity of 60.00%. Statistical significance (P < .05) was observed in the sensitivity between palpation and ultrasonography, and between palpation and enhanced CT. The specificity between enhanced CT and ultrasonography (P = .021) and between palpation and enhanced CT scan (P = .003) both showed statistical significance (P < .05). Doppler ultrasound yields diagnostic results highly consistent with pathological diagnoses in patients with laryngeal and hypopharyngeal cancers. Utilizing Doppler ultrasound can enhance the accuracy of diagnosing these cancers, aiding physicians in devising more suitable treatment plans for patients.

Application of Oxygen Saturation Test after Replantation of Avulsed Immature Permanent Teeth: A Prospective Observational Study

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.

A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis

AIM

The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors.

METHODOLOGY

Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model.

RESULTS

Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO.

CONCLUSION

Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth.

CLINICAL RELEVANCE

Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control.

CLINICAL TRIAL REGISTRATION

Not applicable.

Pulse oximetry as a dental pulp test: A scoping review to identify barriers hindering the use of oximeters in clinical practice

Background and Objective

Although medical pulse oximeters are considered effective for endodontic diagnoses, the method remains uncommon in current dental practice. The aim of the present scoping review was to investigate clinical factors that exert a negative impact on the use of pulse oximeters in dental practice.

Methods

This study followed the PRISMA-ScR guidelines and the protocol was prospectively registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/3GQCE). A comprehensive search of the MEDLINE (via PubMed), Cochrane Library, and Web of Science databases was performed in December 2022 for articles published in English or Spanish. All types of clinical studies were included, except comments, letters to the editor, and abstracts. Two independent investigators analyzed 45 full-text articles. Data extraction included general characteristics, oxygen saturation levels, and limiting factors/barriers to the use of oximeters as pulp testers.

Results

The search of the databases yielded 1,300 records and 38 were included (quantitative data extraction was performed for 35 and three articles were systematic reviews). Publications were highest in number between 2016 and 2017, with an evident reduction occurring after 2021. The oxygen saturation level for sound/vital maxillary anterior teeth was 84.99% (overall mean). The main limiting factors/barriers were i) the difficulty in maintaining the two light-emitting diodes parallel during pulp tests, ii) infrared light diffraction by enamel/dentin/gingiva, and iii) the diversity of patient ages in studies.

Conclusion

This scoping review encountered noteworthy findings associated with the impracticability of using medical pulse oximeters as dental pulp testers. The recent decrease in the frequency of published studies compared to approximately seven years ago may imply a negative trend in the use of the method.

External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series

INTRODUCTION

External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR.

METHODS

Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months.

RESULTS

Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed.

CONCLUSION

Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition.

Laser Er:YAG-Assisted Debonding May Be a Viable Alternative to the Conventional Method for Monocrystalline Ceramic Brackets

In orthodontic practice, due to the increased interest among patients in smile aesthetics, different types of brackets are now being used, with those most frequently applied being ones made of polycrystalline and monocrystalline ceramic. The aim of this study was to evaluate the laser Er:YAG-assisted debonding technique compared to conventional methods for removing monocrystalline ceramic brackets from human teeth. The study sample included 60 vital teeth (frontals of the upper jaw) from 10 patients who had monocrystalline ceramic brackets and were in the final phase of orthodontic treatment. The debonding procedure was carried out following a split-mouth study design, using either the conventional technique or laser Er:YAG 2940 nm radiation. For each tooth, three variables were evaluated: the patient's sujective tooth sensitivity associated with the debonding, the time required for debonding, and pulp blood flow microdynamics after the debonding. Three evaluation instruments were used to assess and quantify the treatment effects: (i) the Wong-Baker FACES Pain Rating Scale for pain assessment; (ii) a digital stopwatch/timer to measure the time required to remove the bracket; and (iii) laser Doppler flowmetry (LDF) for recording the pulp blood flow evolution. The statistical analysis of the recorded data showed a statistically significant difference between the two debonding methods regarding the tooth sensitivity during the debonding and the time required for the procedure. The subjective tooth sensitivity was reduced from a mean ± standard deviation of 3.07 ± 1.46 to 0.47 ± 0.86 on the Wong-Baker FACES scale (Wilcoxon signed rank, p < 0.001). The necessary time for debonding was reduced by 0.697 ± 0.703 s per tooth (paired t-test, p < 0.001). There was no difference in the blood microdynamics between the two debonding techniques. According to the results of this study, the laser Er:YAG-assisted debonding technique may be a viable alternative to the conventional method for monocrystalline ceramic brackets.

High-Resolution Single Tooth MRI With an Inductively Coupled Intraoral Coil-Can MRI Compete With CBCT?

OBJECTIVES

The aims of this study were to quantify T1/T2-relaxation times of the dental pulp, develop a realistic tooth model, and compare image quality between cone-beam computed tomography (CBCT) and high-resolution magnetic resonance imaging (MRI) of single teeth using a wireless inductively coupled intraoral coil.

METHODS

T1/T2-relaxometry was performed at 3 T in 10 healthy volunteers (283 teeth) to determine relaxation times of healthy dental pulp and develop a realistic tooth model using extracted human teeth. Eight MRI sequences (DESS, CISS, TrueFISP, FLASH, SPACE, TSE, MSVAT-SPACE, and UTE) were optimized for clinically applicable high-resolution imaging of the dental pulp. In model, image quality of all sequences was assessed quantitatively (contrast-to-noise ratio) and qualitatively (visibility of anatomical structures and extent of susceptibility artifacts using a 5-point scoring scale). Cone-beam computed tomography served as the reference modality for qualitative assessment. Statistical analysis was performed using 2-way analysis of variance, Fisher exact test, and Cohen κ.

RESULTS

In vivo, relaxometry of dental pulps revealed T1/T2 relaxation times at 3 T of 738 ± 100/171 ± 36 milliseconds. For all sequences, an isotropic resolution of (0.21 mm) 3 was achieved, with acquisition times ranging from 6:19 to 8:02 minutes. In model, the highest contrast-to-noise ratio values were observed for UTE, followed by TSE and CISS. The best image/artifact quality, however, was found for DESS (mean ± SD: 1.3 ± 0.3/2.2 ± 0.0), FLASH (1.5 ± 0.3/2.4 ± 0.1), and CISS (1.5 ± 0.4/2.5 ± 0.1), at a level comparable to CBCT (1.2 ± 0.3/2.1 ± 0.1).

CONCLUSIONS

Optimized MRI protocols using an intraoral coil at 3 T can achieve an image quality comparable to reference modality CBCT within clinically applicable acquisition times. Overall, DESS revealed the best results, followed by FLASH and CISS.

Effect of dental tissue thickness on the measurement of oxygen saturation by two different pulse oximeters

Abstract This study aimed to evaluate the influence of different dental tissue thickness on the measurement of oxygen saturation (SpO2) levels in high (HP) and low (LP) blood perfusion by comparing the values obtained from two different pulse oximeters (POs) - BCI and Sense 10. Thirty freshly extracted human teeth had their crowns interposed between the POs and an optical simulator, which emulated the SpO2 and heart beats per minute (bpm) at HP (100% SpO2/75 bpm) and LP (86% SpO2/75 bpm) modes. Afterwards, the palatine/lingual surfaces of the dental crowns were worn with diamond drills. The reading of SpO2 was performed again using the POs alternately through the buccal surface of each dental crown. Data were analyzed by the Wilcoxon, Mann-Whitney and Kendall Tau-b tests (α=5%). The results showed significant difference at the HP and LP modes in the SpO2 readouts through the different dental thicknesses with the use of BCI, and at the LP mode with the use of Sense 10, which had a significant linear correlation (p<0.0001) and lower SpO2 readout values in relation to the increase of the dental thickness. Irrespective of tooth thickness, Sense 10 had significantly higher readout values (p<0.0001) than BCI at both perfusion modes. The interposition of different thicknesses of enamel and dentin influenced the POs measurement of SpO2, specially at the low perfusion mode. The POs were more accurate in SpO2 measurement when simulated perfusion levels were higher.

Diagnostic Accuracy of Pulp Vitality Tests and Pulp Sensibility Tests for Assessing Pulpal Health in Permanent Teeth: A Systematic Review and Meta-Analysis

The current systematic review and meta-analysis was carried out to compare the diagnostic accuracy of pulp vitality and pulp sensibility tests in assessing pulpal health. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar and Open Grey databases were searched and after assessing eligibility criteria the data were extracted. True-positive, false-positive, true-negative, false-negative, sensitivity and specificity values were extracted or calculated if not presented. Quality of studies was evaluated based on the QUADAS 2 tool. Meta-analysis was performed in MetaDTA (v2.0; Shinyapps, RStudio PBC, Boston, MA, USA) and Review Manager 5.3 (RevMan web; The Cochrane Collaboration, London, UK). Ten articles were included for qualitative synthesis and five for meta-analysis. The pooled diagnostic odds ratio for pulse oximeter (PO), electric pulp tester (EPT), cold test (CT) and heat test (HT) was 628.5, 10.75, 17.24 and 3.47, respectively. Pairwise comparison demonstrated a higher pooled mean sensitivity and specificity with PO compared with EPT. Comparison between PO and CT and between PO and HT also demonstrated a higher pooled mean sensitivity and specificity for PO. Summary points on receiver operating characteristic curves confirmed the ability of PO to correctly screen negatives in presenting patients as compared to EPT, CT and HT but no study was rated as good on quality assessment. PO can be considered as the most accurate diagnostic method as compared to EPT, CT and HT. This review provides information about the reliability and diagnostic accuracy of using pulp vitality and sensibility tests for assessing pulp status.

Efficacy assessment of laser Doppler imager in diagnosing the pulp vitality after dental trauma

Background/purpose

This is the first paper evaluating the efficacy of laser Doppler imager in diagnosis of pulpal vitality. The purpose of this study was to evaluate and compare the diagnostic benefits of laser Doppler imaging and electric pulp test (EPT) in dental trauma.

Materials and methods

Seven patients were selected for pulp vitality evaluation in Kaohsiung Medical University Hospital between 2018 and 2019. EPT and laser Doppler imager evaluation were performed for patients with traumatic injury to teeth. Statistical methods included the Kappa consistency test and the chi-square test. In addition, the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were used.

Results

There was a significant difference in Doppler flow values between the severe trauma group and the mild trauma group, regardless of patient self-reported symptoms (P = 0.043) or physicians' diagnostic classification (P = 0.018). For an EPT instrument, the Kappa coefficient was 0.67 and 1-year pulpal status findings were highly consistent (P < 0.001). Using a Doppler instrument, the Kappa coefficient was 0.85. According to the ROC curve, the AUC for EPT was 0.94, the AUC for Doppler was 1, and the optimal cut-off value was 31.55, indicating that both were superior diagnostic tools.

Conclusion

Both laser Doppler imager and EPT can be used as tools for diagnosing traumatic pulp necrosis. Doppler imaging instruments allow for a more timely and accurate assessment of pulp vitality in dental trauma. In the future, ongoing research and related training are necessary for interpretation of Doppler data.

A Diagnostic Insight of Dental Pulp Testing Methods in Pediatric Dentistry

The accurate diagnosis of pulpal pathology in pediatric dentistry is essential for the success of vital pulp therapy. Pulp testing is often a challenging task due to understanding and cooperation issues of pediatric patients, as well as the particularities of pulpal physiology encountered in primary and immature permanent teeth. Sensibility tests, although still widely used by dental practitioners, are no longer recommended by pediatric specialists mainly due to their subjective nature. Vitality pulp tests have gained popularity in the last decade in light of some encouraging results of clinical studies. However, their use is not a routine practice yet. This paper is a literature review aimed to guide dental practitioners towards selecting the appropriate pulp testing method for their pediatric cases. It provides an overview on a multitude of pulp testing methods and an update in recommendations for primary and immature permanent teeth.

Regenerative Endodontic Procedures in Immature Permanent Teeth With Dental Trauma: Current Approaches and Challenges

After dental trauma to immature permanent teeth (IPT), there can be pulpitis, necrotic, and periapical periodontitis, which will halt further root development. Traditional endodontic root canal treatments and apexification cannot revitalize the necrotic pulp to revitalize the tooth to promote further root development. As a consequence, IPT with thin dentinal walls can be prone to fracture and if a fracture occurs, the patient will likely suffer the loss of the tooth. In an attempt to save IPT, there has been a growing interest among dentists to use regenerative endodontic procedures (REPs) to revitalize a replace dental pulp to continue root development and strengthen the dentinal walls to help prevent a subsequent loss of the tooth. However, the effectiveness of REPs and the precise methods to successfully accomplish REPs are controversial. Therefore, the objective of this review is to compare the different approaches to REPs in case reports by highlighting their advantages and limitations.

Pulp changes from rapid maxillary expansion: A systematic review

INTRODUCTION

This study aimed to systematically review the current evidence on the occurrence of pulp changes as side effects from orthopaedic rapid maxillary expansion (ORME) or surgically assisted rapid maxillary expansion (SARME).

METHODS

An electronic search was performed in eleven databases. The eligibility criteria included clinical studies assessing vitality, sensibility or dimensions of the pulp chamber of permanent teeth before and after ORME or SARME, without restrictions on publication year or language. The risk of bias was analysed with the NIH 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group' and the 'JBI for quasi-experimental studies' tool. The GRADE tool was used to assess the certainty of evidence.

RESULTS

The initial search resulted in 1,197 records, from which only seven before-after studies were included. There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to 5 days after SARME, which gradually returned after 7 days to 3 months. After ORME, one study observed an increased PBF and one study observed a reduced PBF, which gradually returned after the end of expansion. Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility. Three studies observed a significant reduction in the pulp chamber after ORME or SARME. The outcomes presented a very low certainty of evidence.

CONCLUSIONS

Although limited, the evidence shows that ORME and SARME caused temporary changes in pulp vitality and sensibility, with the possibility of inducing a reduction in pulp chamber dimensions.

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

European Society of Endodontology position statement: endodontic management of traumatized permanent teeth

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the endodontic management of traumatized permanent teeth. A recent comprehensive review with detailed background information provides the basis for this position statement (Krastl et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13508). The statement is based on current scientific evidence as well as the expertise of the committee. Complementing the recently revised guidelines of the International Association of Dental Traumatology, this position statement aims to provide clinical guidance for the choice of the appropriate endodontic approach for traumatized permanent teeth. Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

Dental hypersensitivity in individuals with cleft lip and palate: Origin and therapies

Background. Dental hypersensitivity is due to the exposure of the dentin layer after wear of enamel or cementum, exposing the dentinal tubules and the nerve endings of odontoblasts within these tubules. The present study aimed to assess the factors related to dental hypersensitivity in individuals with cleft lip and palate and the most common therapy received.

Methods. The medical records of 536 patients with cleft lip and/or palate (281 males, 255 females) with a mean age of 18 were analyzed in a single center. The inclusion criterion was patients reporting dental hypersensitivity from May 2015 to October 2019. The origin of dental hypersensitivity was evaluated considering orthodontic movement, periodontal diseases, and reversible and irreversible pulpitis. The therapy indicated by the dental professionals for dental hypersensitivity were recorded. Descriptive statistics were performed.

Results. Of 61 teeth with dental hypersensitivity, 10 were attributed to orthodontic movement, 21 to periodontal problems, 27 to reversible pulpitis, and three to irreversible pulpitis. The most used therapies were the application of fluoride varnish and prophylaxis, dentifrice indication for dental sensitivity, free gingival grafts, pulpectomy, desensitizing agent application, conservative endodontic treatment (direct pulp protection), and restoration of non-carious cervical lesions.

Conclusion. Reversible pulpitis was the most prevalent etiologic factor of dental hypersensitivity in individuals with cleft lip and palate. Dentifrices for dental sensitivity and fluoride varnish application were frequently recommended.

Clinical comparison of sensitivity and specificity between sensibility and vitality tests in determining the pulp vitality of mandibular premolars

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.

Endodontic management of traumatized permanent teeth: a comprehensive review

The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.

Using Laser-Doppler Flowmetry to Evaluate the Therapeutic Response in Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a common medical condition with underreported prevalence and it is difficult to quantify. This study aimed to investigate whether assessing dental pulp vascular micro-dynamics by laser-Doppler flowmetry (LDF) would be functional for therapeutic evaluation, in contrast to a verbal rating scale (VRS). A split-mouth single-blind randomized study was conducted on seven patients and a total of 36 teeth. Two DH therapeutic methods were employed: (i) fluoride gel; (ii) Nd:YAG radiation combined with fluoride gel. For each tooth, five consecutive LDF determinations of pulp blood flow were made (before and immediately after desensitizing treatment, then after 24 h, 7 days, and 1 month), and the VRS was applied each time. Spearman’s correlation was applied for concurrent validation. Two-way (treatment and patient) repeated measures ANOVA full factorial was applied, followed by Tukey’s post-hoc comparisons and Pillai’s trace multivariate statistic. While VRS scores had moderate reliability, LDF could objectively estimate treatment effects. Based on partial eta-squared values, treatment and patient characteristics were estimated to explain about 84% and 50% of the variability, respectively. In conclusion, LDF is an objective technique that can quantitatively assess DH evolution, and it is effective in reliably monitoring oral health therapeutic interventions.

Efficiency of new custom-made pulse oximeter sensor holder in assessment of actual pulp status

Aim

This study aims to assess the diagnostic accuracy of new custom-made pulse oximeter sensor holder in assessment of actual pulp status with three pulp sensibility tests.

Materials and Methods

Seventy-nine single canal teeth requiring endodontic therapy was included in the study. The tooth that was requiring root canal treatment was tested with heat test, cold test, electric pulp test, and pulse oximeter. Between each test, a time period of 2 min was allowed. The response from three pulp sensibility tests and the reading from pulse oximeter were recorded. Following which root canal treatment was performed. The result obtained from four pulp tests were correlated with the clinical finding after access cavity preparation. The data obtained was statistically assessed. Receiver operator characteristic (ROC) curve analysis was performed to assess the efficacy of the pulp tests. In the above statistical tools, the probability value. 05 is considered as significant level.

Results

The overall diagnostic accuracy was found to be significantly higher with pulse oximeter when compared with other three pulp sensibility tests. The ROC curve demonstrates the results obtained from pulse oximeter was found to be more reliable than other pulp tests.

Conclusion

Within the limitation of the study, diagnostic accuracy of pulse oximeter with custom made sensor holder was reliable and accurate in assessment of actual pulp status.

Evidence mapping and quality assessment of systematic reviews in dental traumatology

BACKGROUND/AIMS

Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research.

METHODS

Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed.

RESULTS

The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods.

CONCLUSION

The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSION

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