Comparative evaluation of dental pulp tests in pulpal status diagnostics / Evaluación comparativa de pruebas de pulpa dental en el diagnóstico del estado pulpar

Introduction: The purpose of this study was to evaluate the effectiveness and compare the accuracy of pulp tests in the diagnosis of teeth pulpal health. Material and Methods: Traumatized (n=71) and non-traumatized (n=71) teeth from 42 patients were evaluated. Each tooth underwent cold, heat, electric and oximetry tests, followed by radiographic examination and calculation of the sensitivity, specificity, PPV, NPV and accuracy. Results: Clinical and radiographic examination showed no alteration for the 71 teeth from the intact contralateral group. From the traumatized group, 29 teeth presented complete endodontic treatment, 17 presented periapical alterations that required endodontic treatment and 25 teeth did not present conclusive radiographic alteration. The cold test showed a significantly higher proportion of correct results, while the electric test showed a significantly lower proportion. The data showed higher accuracy for the cold, followed by oximeter and heat tests, while the electric test presented the lowest accuracy. Cold and oximeter tests proved superior over the electric and heat tests, while the electric test showed better parameters when diagnosing diseased pulp. Conclusion: Combining two pulp tests seems reasonable for improving the pulp diagnoses using both oximeter and cold or oximeter and heat tests to detect healthy pulp; or cold and electric tests to define diseased pulp.

Introducción: El propósito de este estudio fue evaluar la efectividad y comparar la precisión de las pruebas pulpares en el diagnóstico de la salud pulpar de los dientes. Material y Métodos: Se evaluaron dientes traumatizados (n=71) y no traumatizados (n=71) de 42 pacientes. Cada diente se sometió a pruebas de frío, calor, eléctricas y de oximetría, seguidas de examen radiográfico y cálculo de la sensibilidad, especificidad, VPP, VPN y precisión. Resultados: El examen clínico y radiográfico no mostró alteración en los 71 dientes del grupo contralateral intacto. Del grupo traumatizado, 29 dientes presentaron tratamiento endodóntico completo, 17 presentaron alteraciones peri-apicales que requirieron tratamiento endodóntico y 25 dientes no presentaron alteración radiográfica concluyente. La prueba en frío mostró una proporción significativamente mayor de resultados correctos, mientras que la prueba eléctrica mostró una proporción significativamente menor. Los datos mostraron mayor precisión para la prueba de frío, seguida de las pruebas de oxímetro y calor, mientras que la prueba eléctrica presentó la menor precisión. Las pruebas de frío y oxímetro demostraron ser superiores a las pruebas eléctricas y de calor, mientras que la prueba eléctrica mostró mejores parámetros al momento de diagnosticar pulpa enferma. Conclusión: La combinación de dos pruebas pulpares parece razonable para mejorar los diagnósticos pulpares utilizando tanto el oxímetro como las pruebas de frío u oxímetro y calor para detectar una pulpa sana; o pruebas de frío y eléctricas para definir pulpa enferma.

Effect of a bonding resin layer associated with a self-etching adhesive system on the bond strength of indirect restorations.

The aim of this study was to evaluate the influence of a low-viscosity bonding resin applied over a self-etching adhesive system on the microtensile bond strength (microTBS) of indirect restorations. Comparisons were made using One Up Bond F (OB) self-etching adhesive system, Single Bond (SB) one-bottle adhesive system and Scotchbond Multi Purpose Plus (SMP) bonding component. Thirty bovine incisors were extracted and decoronated at the cementoenamel junction. The labial surfaces were ground so that superficial dentin and deep dentin were exposed. The specimens were randomized to three groups (n=10): G1- OB; G2- OB + SMP; G3- SB. In G2, a layer of the SMP bonding was applied over the OB adhesive system. Indirect composite restorations were bonded using dual-cure cement under 500 g load for 5 min. The specimens were serially sectioned with a bonding area of +/- 1.0 mm(2) in 3 regions: enamel (E), superficial dentin (SD) and deep dentin (DD). The sticks were fixed with cyanoacrylate adhesive and submitted to microTBS test at a crosshead speed of 0.5 mm/min in a mechanical testing machine (EMIC DL 2000). The fractured specimens were examined under scanning electron microscopy to determine the failure mode. Data were analyzed by one-way ANOVA followed by Tukey's test (p<0.05). microTBS means (in MPa) were: G1/E: 15.5 +/- 3.5b; G1/SD: 22.7 +/- 7.6a; G1/DD: 19.4 +/- 9.4a; G2/E: 15.9 +/- 5.8b; G2/SD: 19.9 +/- 6.9a; G2/DD: 15.3 +/- 4.9a; G3/E: 23.2 +/- 7.3a; G3/SD: 20.4 +/- 8.2a; G3/DD: 19.1 +/- 8.7a. The results showed that the use of a low viscosity bonding resin did not affect the microTBS means when associated with a self-etching adhesive system. The self-etching adhesive system was significantly more efficient in dentin than in enamel, while the one-bottle system was significantly more efficient in enamel when compared to the self-etching adhesive system.