Diagnostic accuracy of dental pulse oximeter with customized sensor holder, thermal test and electric pulp test for the evaluation of pulp vitality: an in vivo study / Precisão diagnóstica do oxímetro de pulso odontológico com suporte de sensor personalizado, teste térmico e teste elétrico da polpa para avaliação da vitalidade pulpar: um estudo in vivo

Background: the efficiency of the diagnostic aids plays an important role in the treatment plan. This study aims to assess the diagnostic accuracy of dental pulse oximeter with a customized sensor holder, thermal test and electric pulp tester in assessing the actual pulp status and to evaluate the oxygen saturation level in control healthy teeth, non-vital and teeth with irreversible pulpitis. Material and methods: thirty-seven single canal teeth requiring endodontic therapy were included in the study. The selected teeth were tested with dental pulse oximeter, electric pulp test, cold spray, and heated gutta percha stick. Between each test a time lag of 2 minutes was allowed for the central sensitization to occur. Three blinded operators were involved in the study. The actual status of the pulp was evaluated after the initiation of endodontic treatment, by direct visual examination of the accessed cavity. The data was statistically analysed using (ANOVA) Analysis of Variance and Post-hoc Tukey test. Results: sensitivity of pulse oximeter, heat test, cold and electric pulp test, was 100, 25, 50, and 12, respectively. The specificity of these tests was 100, 72 81, and 77, respectively. The ANOVA showed that there was statistical difference between all the groups (p=0.0005). Post-Hoc Tukey revealed that there was statistical difference among all the groups, nonvital group (p=0.0005), control group (p=0.01) and for irreversible pulpitis (p=0.01). The overall diagnostic accuracy of pulse oximeter was 100% followed by cold test 66%, heat test to be 49% and electric pulp test to be 45%. Conclusion: the custom-made holder used in the present study aided in providing accurate response for pulp vitality testing. In this study the diagnostic accuracy was high with dental pulse oximeter followed by cold, heat and the least was electric pulp tester in different pulpal conditions. (AU)

Fundamentação: a eficiência dos meios de diagnóstico desempenha um papel importante no plano de tratamento. Este estudo tem como objetivo avaliar a precisão diagnóstica do oxímetro de pulso odontológico com um suporte de sensor personalizado, teste térmico e testador de polpa elétrico na avaliação da condição pulpar e na avaliação do nível de saturação de oxigênio em dentes controle saudáveis, não vitais e dentes com pulpite irreversível. Material e métodos: trinta e sete dentes de canal único que necessitavam de terapia endodôntica foram incluídos no estudo. Os dentes selecionados foram testados com oxímetro de pulso, teste pulpar elétrico, spray frio e bastão de guta-percha aquecido. Entre cada teste, foi permitido um intervalo de tempo de 2 minutos para a sensibilização central ocorrer. Três operadores cegos foram envolvidos no estudo. A condição real da polpa foi avaliada após o início do tratamento endodôntico, por meio de exame visual direto da cavidade de acesso. Os dados foram analisados estatisticamente pelo teste de Análise de Variância (ANOVA) e pelo teste Post-hoc de Tukey. Resultados: a sensibilidade do oxímetro de pulso, teste de calor, de frio e teste pulpar elétrico foi de 100, 25, 50 e 12, respectivamente. A especificidade desses testes foi de 100, 72 81 e 77, respectivamente. O teste de ANOVA mostrou que houve diferença estatística entre todos os grupos (p = 0,0005). O teste Post-Hoc de Tukey revelou que houve diferença estatística entre todos os grupos, grupo não-vital (p = 0,0005), grupo controle (p = 0,01) e pulpite irreversível (p = 0,01). A precisão diagnóstica geral do oxímetro de pulso foi de 100%, seguida pelo teste a frio de 66%, o teste de calor a 49% e o teste pulpar elétrico a 45%. Conclusão: o suporte personalizado utilizado no presente estudo ajudou a fornecer uma resposta precisa para o teste de vitalidade pulpar. Neste estudo, a precisão diagnóstica foi alta com o oxímetro de pulso dental, seguido do teste com frio e calor, sendo o teste elétrico o menos eficaz nas diferentes condições pulpares testadas.(AU)

Identification of the Most Appropriate Site for the Cold Test in Molar Teeth / Identificación del sitio más apropiado para la prueba de frío en dientes molares

Abstract A test frequently used to complement endodontic diagnoses is the cold test; however, in the last 20 years, authors have reported incorrect results within pulp sensitivity tests. Specifically, a high frequency of false results in posterior teeth, were found. The aim of this study was to identify the most appropriate site for the cold test in molar teeth with a need for endodontic treatment, calculating predictive values, accuracy and reproducibility. A cross-sectional study was performed, evaluating 390 subjects. A total of 152 subjects of both genders from the ages of 15-65 years old participated. The ideal standard was established by direct pulp inspection, and the cold test agent used was 1,1,1,2-tetrafluoroethane. The patients were divided into four groups in relation to the molar tooth: (1) mandibular first molar, (2) mandibular second molar, (3) maxillary first molar, and (4) maxillary second molar. 169 teeth and 676 sites were studied. (a) The most appropriate sites for cold test were the middle third of the buccal surface and cervical third of the buccal surface in the mandibular molars with the following results: Middle third of the first molar: Accuracy 0.93, positive predictive value 0.90 and negative predictive value 0.96. Middle third of the second molar: Accuracy 0.93, positive predictive value 1.00 and negative predictive value 0.90. In relation to third cervical the results were: First molar: Accuracy 0.93, positive predictive value 0.89 and negative predictive value 0.97 y second molar: Accuracy 0.93, positive predictive value 1.00 and negative predictive value 0.90. (b) The highest reproducibility was observed in the middle third of the buccal surface with cervical third of the buccal surface in the mandibular second molar (1.00). The most appropriate site and reproducibility of the sites are auxiliary to complement endodontic diagnose with the cold test.

Resumen Una prueba frecuentemente utilizada para complementar los diagnósticos endodónticos es la prueba de frío. Sin embargo, en los últimos 20 años, los autores han reportado resultados incorrectos con las pruebas de sensibilidad pulpar. Específicamente, se ha observado una alta frecuencia de resultados falsos en dientes posteriores. El objetivo del estudio fue identificar el sitio más adecuado para la prueba de frío en dientes molares con necesidad de tratamiento endodóntico, calculando valores predictivos, exactitud y reproducibilidad. Se realizó un estudio transversal donde se evaluaron a 390 sujetos. 152 sujetos de ambos sexos de 15 a 65 años cumplieron con los criterios de inclusión. El estándar ideal que se utilizó en el estudio fue la inspección directa de pulpa en la cámara pulpar y la prueba de frío utilizada fue el 1,1,1,2-tetrafluoroetano. Los pacientes fueron divididos en cuatro grupos en relación al diente molar: (1) primer molar mandibular, (2) segundo molar mandibular, (3) primer molar maxilar, y (4) segundo molar maxilar. En el estudio se evaluaron 169 dientes con 676 sitios. (a) Los sitios más adecuados para la prueba de frío fueron el tercio medio y el tercio cervical de la superficie bucal en los molares mandibulares con los siguientes resultados: Tercio medio del primer molar: Exactitud 0.93, valor predictivo positivo 0.90 y valor predictivo negativo 0.96. Tercio medio del segundo molar: Exactitud 0.93, valor predictivo positivo 1.00 y valor predictivo negativo 0.90. En relación al tercio cervical los resultados fueron: Primer molar: Exactitud 0.93, valor predictivo positivo 0.89 y valor predictivo negativo 0,97 y segundo molar: Exactitud 0.93, valor predictivo positivo 1.00 y valor predictivo negativo 0.90. (b) La más alta reproducibilidad (1.00) se observó entre el tercio medio con el tercio cervical de la superficie bucal en el segundo molar inferior. El sitio más apropiado y la reproducibilidad de los sitios son auxiliares para complementar el diagnóstico endodóntico con la prueba de frío.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

OBJECTIVES: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. MATERIALS AND METHODS: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. RESULTS: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. CONCLUSIONS: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

OBJECTIVES: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. MATERIALS AND METHODS: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. RESULTS: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. CONCLUSIONS: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Comparação entre métodos para a avaliação do vigor de lotes de sementes de triticale / Comparison of methods for assessing the vigor of seed lots of triticale

Dentro de um programa de controle de qualidade, a avaliação do vigor de sementes é fundamental e necessária para o sucesso da produção. Este trabalho teve como objetivo avaliar a eficiência de diferentes testes de vigor na avaliação da qualidade fisiológica de sementes de triticale (X. triticosecale Wittmack), buscando a diferenciação de lotes. Cinco lotes da cultivar 'IPR 111' foram submetidos ao teste de germinação, primeira contagem, teste de frio, condutividade elétrica (50 sementes 50mL-1 de água; 25°C 24h-1), lixiviação de potássio (50 sementes 75mL-1 de água; 25°C 3h-1), envelhecimento acelerado (43°C 48h-1) e teor de água. O teste de condutividade elétrica e lixiviação de potássio são eficientes na diferenciação do vigor de lotes de sementes de triticale.

In a program of seed quality assurance, the evaluation of seed vigor is fundamental and necessary to the global production process outcome. The objective of this experiment was to verify the efficiency of different vigor tests for evaluation of triticale seeds (X. triticosecale Wittmack) seeking the lots differentiation. Five lots of triticale seeds (cv. IPR 111) were submitted to the following evaluations: germination, first counting of germination test, cold test, electrical conductivity test (50 seeds into 50ml of water, at 25°C for 24 hours), accelerated aging test (43°C 48h-1) in distilled water (100 percent RH), and also seed water content. The test of electrical conductivity and potassium leaching was efficient to distinguish vigor of triticale.

Testes de vigor utilizados na avaliação da qualidade fisiológica de lotes de sementes de milho-doce (sh2) / Vigor tests for selection of sweet corn (sh2) seeds lot

Dentro de um programa de controle de qualidade, a avaliação do vigor de sementes é fundamental e necessária para o sucesso da produção. Com o objetivo de avaliar a eficiência de diferentes testes de vigor na avaliação da qualidade fisiológica de sementes de milho-doce na tentativa de diferenciação de lotes quanto ao nível de vigor e previsão de emergência de plântulas em campo e ao potencial de armazenamento, 10 lotes do híbrido DO-04 shrunken-2 (sh-2) foram submetidos a teste de germinação, primeira contagem, precocidade de emissão de raiz primária (32, 48, 56 e 72h), teste de frio, condutividade elétrica (50 sementes 75mL-1 de água; 25°C/4, 6, 8 e 24h), envelhecimento acelerado (42°C) em água destilada (100 por centoUR), solução saturada de cloreto de potássio (87 por centoUR) e solução saturada de cloreto de sódio (76 por cento UR), avaliando-se quatro períodos de exposição (24, 48, 72 e 96h), teor de água, emergência de plântulas em campo e germinação após armazenamento das sementes (10°C e 40 por centoUR), avaliada quadrimestralmente por 16 meses. A condutividade elétrica (por 6, 8 e 24h) foi o único teste eficiente na diferenciação do vigor de lotes de sementes de milho-doce (sh2); no entanto, não apresentou correlação com a emergência de plântulas em campo ou armazenamento.

In a program of seed quality assurance, the evaluation of seed vigor is fundamental and necessary to the global production process outcome. The objective of this experiment was to verify the efficiency of different vigor tests for evaluation of sweet corn seeds quality towards lots differentiation and prevision of seedling emergence and storage capacity of those. Ten lots of DO-04 shrunken-2 (sh2) hybrid sweet corn seeds were submitted to the following evaluations: germination, first counting of germination test, earliness of primary root emission (32, 48, 56 and 72 hours), cold test, electrical conductivity test (50 seeds into 75ml of water, at 25°C for 4, 6, 8 and 24 hours), accelerated aging test (42°C) in distilled water (100 percent RH), potassium chloride saturated solution (87 percent RH) and sodium chloride saturated solution (76 percent RH). Four exposition periods (24, 48, 72 and 96 hours) were evaluated and also seed water content, field seedlings emergence and germination after seeds storage (10°C and 40 percentRH) during sixteen months. The electrical conductivity test (for 6, 8 and 24 hours) was the unique test efficient to distinguish vigor of sweet corn (sh2) seeds lots, but it did not present correlation with field seedlings emergence or storage capacity.