Comparison of the Efficacy and Safety of Pulp Sensitivity Testing Results Using a New Pulp Testing Device versus Some Commonly Used Methods: A Crossover Study.

INTRODUCTION: The efficacy and safety of a single novel electronic pulp sensitivity tester with a transilluminator (PSTT) capable of providing 4 different tests was compared with gold standard (GS) pulp testing methods. METHODS: Four hundred eighty teeth, including 3 from each quadrant and their contralateral and opposing teeth, were randomly assessed using the PSTT or GS methods. Seven days later, the same teeth were assessed using the method not used earlier so that all teeth were evaluated using both methods. Sixty previously root canal-treated teeth, serving as negative controls, were assessed identically to the experimental groups. Results were analyzed using IBM SPSS software (IBM Corp, Armonk, NY) (P < .05). RESULTS: A higher percentage of teeth responded to cold and electricity using GS methods compared with the PSTT (99.4 vs 93.1 and 99.6 vs 97.3, respectively). A lower percentage of teeth responded to heat using the GS method compared with the PSTT (50.0 vs 68.1). Chi-square tests determined differences in the proportion of sensitivity to temperature, and electric testing methods were statistically significant (P < .001 and P = .004, respectively). No difference in the proportion of sensitivity was observed for transillumination. The Wilcoxon signed rank test determined significantly shorter cold testing times using the GS method (P = .024). Shorter testing times were observed using the PSTT for heat (P < .001), electric pulp testing (P = .048), and transillumination (P = .001). The overall PSTT testing time was significantly shorter than the GS testing time (P = .03). Tissue injury was not observed. CONCLUSIONS: The PSTT efficiently and safely provided heat and transillumination for pulpal diagnosis. Improvements are needed to enhance the cold and electric stimulus efficacy.

Success of Pulpal Anesthesia Following Buccal Infiltration of the Maxillary First Molar With 1.8 mL and 3.6 mL of 4% Articaine With 1:100,000 Epinephrine: A Prospective, Randomized Crossover Study.

OBJECTIVE: The purpose of this prospective, randomized crossover study was to compare the peak incidence of success, onset, and incidence over time of pulpal anesthesia in maxillary first molars following a buccal infiltration of 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine. METHODS: A total of 118 adults received 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine via buccal infiltration of the maxillary first molar at 2 separate appointments. Electric pulp testing (EPT) of the maxillary first molar was performed over 68 minutes. RESULTS: There was no significant difference in the peak incidence of anesthetic success (85% and 92%, respectively) in the maxillary first molar between 1.8 mL and 3.6 mL. The difference in onset times (4.5 min for 1.8 mL vs 4.4 min for 3.6 mL) was not statistically significant. However, the 3.6-mL volume did produce a significantly higher incidence of pulpal anesthesia from minutes 48 to 68 compared with the 1.8-mL volume. CONCLUSION: There was no significant difference in peak incidence or onset of pulpal anesthesia in the maxillary first molar between 1.8 mL and 3.6 mL of articaine with epinephrine. The incidence of pulpal anesthesia was significantly higher with 3.6 mL of articaine at 48 minutes and beyond, but neither volume provided complete pulpal anesthesia for all subjects that lasted at least 60 minutes.

A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Local Anesthetic Efficacy in Marijuana Users and Nonusers: A Pilot Study.

OBJECTIVE: Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers. METHODS: Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals. RESULTS: A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia. CONCLUSION: No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study.

OBJECTIVE: This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. METHODOLOGY: A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. RESULTS: Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. CONCLUSIONS: RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.

'Cold is gold'? The diagnostic accuracy of sensibility and vitality testing techniques.

Data sources Medline, Web of Science and the Cochrane Central Register of Controlled Trials databases along with Google Scholar, Greylist and OpenGrey were systematically searched (up to December 2020).Study selection In vivo observational studies and clinical trials assessing the diagnostic accuracy of pulp vitality tests and sensibility tests in adult human teeth were screened. Exclusion criteria included non-English articles, deciduous teeth, case reports and in vitro studies.Data extraction and synthesis Data extracted included basic study location, sample size, age of participants, pathology of teeth, type of teeth and the vitality (pulse oximetry or Laser Doppler flowmetry) or sensibility test (cold, hot and electric pulp testing) used. Measures of diagnostic accuracy were synthesised (sensitivity, sensibility, predictive values, and likelihood ratios). Meta-analysis was performed using a bivariate random-effects model producing summary values for sensitivity and specificity. Results were presented as a ROC curve. Risk of bias and the quality of the studies were assessed using the QUADAS-2 tool.Results A total of ten studies were included in the review, of which five were included in the meta-analysis. Overall risk of bias was unclear. Pulse oximetry showed higher diagnostic accuracy than electric pulp testing and thermal testing. Insufficient data precluded quantitative analysis for Laser Doppler flowmetry.Conclusions Pulse oximetry demonstrates greater diagnostic accuracy when compared to sensibility testing. Limited sample size and heterogeneity among the included studies limits their applicability.

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.

Making sense of sensibility: part 2.

To reach an accurate endodontic diagnosis, it is important for clinicians to understand how to undertake pulpal sensibility tests correctly, how to interpret their results and how to understand their limitations. Part one of this series defined different terms relevant to pulp testing and detailed the diagnostic uses and diagnostic accuracy of pulp testing methods. This section describes clinical techniques for commonly used pulp tests and highlights their limitations and correct interpretation of their results. Applying these principles and techniques will enable accurate endodontic diagnosis in different clinical scenarios.

Evaluation of electric pulp test thresholds and correct probe tip placement site in developing incisors: a clinical study in 1200 teeth.

PURPOSE: Although electric pulp tests (EPT) may play a valuable diagnostic role in traumatized immature permanent teeth, the EPT threshold values which can be used as reference are not known. The aim of this study was to determine the average range of EPT threshold values in healthy permanent incisors according to their stage of root development. METHODS: A total of 1200 permanent incisors were examined in 273 children (142 girls, 131 boys) aged 6-12 years. Panoramic radiographs were used to group teeth according to the stage of root development. A digitest II pulp vitality tester (Parkell, Inc, Edgewood, NY) was used along with toothpaste as the conducting medium to determine sensibility on three different sites (incisal, middle and cervical third). RESULTS: In all teeth, mean EPT values showed a tendency to decrease along with advanced root development. Irrespective of the stage of root development, the lowest EPT values were obtained when measurements were made on the incisal third of the crown (p < 0.001). Mandibular incisors had lower mean response thresholds than their maxillary counterparts. CONCLUSION: The present findings provide reference EPT threshold values according to stage of tooth development to monitor the post traumatic pulp status of permanent incisors.

Reliability of Electric Pulp Test, Cold Pulp Test or Tooth Transillumination to Assess Pulpal Health in Permanent Dog Teeth.

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.

An evaluation of the repeatability of electric pulp sensibility tests.

The accuracy, reliability and reproducibility of electric pulp tests (EPT) have been investigated but there is conflicting information about their repeatability. The aim of this study was to investigate whether EPT are repeatable over time. EPT results from 180 healthy teeth in 39 patients with 2-10 readings per tooth (total 692 readings) were analysed. Single measures intraclass correlation coefficients (ICC) ranged from 0.776 to 0.845 in teeth with 2-7 repeated measures (P < 0.001), indicating good repeatability. With eight or more measures per tooth, the ICC was low, indicating poor repeatability over longer follow-up times, but only seven teeth in two subjects were included in this analysis. The Pearson correlation showed no statistically significant correlation for 2-7 readings but when all readings were included, there was a statistically significant negative correlation. Hence, EPT has good repeatability.

In Vitro Cytotoxicity Analysis of Bioceramic Root Canal Sealers on Human Gingival Fibroblast Cells

ABSTRACT@#This study evaluated the cytotoxicity of four bioceramic root canal sealers (bioceramic sealers): GuttaFlow Bioseal (GB), MTA Fillapex, CeraSeal Bioceramic root canal sealer (CS), and iRoot SP root canal sealer (iRSP). The viability of human gingival fibroblast (HGF) cells was used to evaluate the cytotoxicity of these bioceramic sealers. HGF cells were cultured and exposed to bioceramic sealer extracts for 24 hours, 48 hours and 72 hours at 37°C in an incubator humidified with 5% CO2. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide or MTT assay was conducted to determine cell viability at each incubation period and compared among all bioceramic sealers. The Kruskal-Wallis test revealed statistically significant differences between the positive control group and MTA Fillapex, MTA Fillapex and GB, and between GB and iRSP with p < 0.05. However, no statistical differences were found in cell viability for each material across all the incubation periods. GB was the least cytotoxic bioceramic sealer with cell viability exceeding 90% throughout the 72-hour incubation followed by CS, iRSP, and MTA Fillapex with non-cytotoxicity after 72-hour incubation, mild cytotoxicity after 72-hour incubation, and mild cytotoxicity after 72-hour incubation, respectively. However, iRSP showed moderate cytotoxicity, and MTA Fillapex was severely cytotoxic (< 30% cell viability) after 24-hour incubation.

[Comparative analysis of 2% and 4% articaine solution efficacy and safety for the local anesthesia]. / Sravnitel'nyi analiz primeneniya 2% i 4% rastvora artikaina pri in"ektsionnoi mestnoi anestezii.

AIM: To determine the functional diagnostics criteria for predicting the effectiveness of using 2% and 4% solutions articaine without vasoconstrictor and with epinephrine content of 1:200.000. MATERIAL AND METHODS: The study involved 357 patients (193 women and 164 men) aged 20 to 35 years. with the presence of intact single-rooted and multi-rooted teeth without periodontal pathology without pronounced general somatic pathology, and with a low level of situational anxiety according to the Spielberger-Khanin scale. All the patients received injection anesthesia by the infiltration method of 2% and 4% articaine solution without vasoconstrictor or with epinephrine concentration of 1:200.000. The effectiveness of local anesthesia was assessed by recording functional parameters (electrosensitivity threshold test and hemomicrocirculation) of the pulp of intact single-root and multi-root teeth before anesthesia, 5, 10, 15, 30, and 60 minutes after local anesthesia. The safety of the anesthesia was determined by continuous monitoring of the patient's hemodynamic parameters: blood pressure, heart rate, blood oxygen saturation before anesthesia and within 60 minutes after. RESULTS: Articaine solution 2% with epinephrine concentration of 1:200.000 used for infiltration or modified periodontal anesthesia resulted in pulp electrosensitivity threshold growth by 95.93% and 93.58%, respectively. There were no statistically significant differences in hemodynamic values between both study groups. CONCLUSION: Analysis of the data obtained showed the effectiveness and safe anesthesia with drugs based on 2% articaine with an epinephrine concentration of 1:200.000.

Associations between Pain Severity, Clinical Findings, and Endodontic Disease: A Cross-Sectional Study.

INTRODUCTION: Thorough pain assessment and thermal and mechanical testing are the primary diagnostic tools used to assess the status of pulp and periapical tissues in teeth with potential endodontic pathology. This study evaluated predictors of acute odontogenic pain to better understand the relationship between endodontic pain, clinical testing, endodontic disease, and diagnoses. METHODS: Participants (N = 228) presenting with acute odontogenic pain underwent standardized clinical testing and reported their pain intensity. Univariate and multiple regression analyses were performed to evaluate the predictors of acute endodontic pain. Chi-square tests with Bonferroni adjustments were conducted to measure the frequency of endodontic diagnostic test findings and clinical observations in patients with different pulpal diagnoses. RESULTS: A negative response to cold stimulation on the causative tooth and percussion hypersensitivity on the healthy adjacent tooth were the strongest predictors of higher levels of acute endodontic pain. Percussion hypersensitivity on the healthy adjacent tooth was present in a quarter of the cohort and was reported with equal frequency in teeth diagnosed with irreversible pulpitis, necrotic pulp, and previously initiated/treated teeth. Although painful percussion on the causative tooth was more frequently reported in teeth diagnosed with necrotic pulp, painful palpation was more frequently reported on teeth diagnosed with previously initiated/treated teeth. CONCLUSIONS: Percussion hypersensitivity on the healthy adjacent tooth may reveal a lowered pain threshold and heightened pain sensitization. It is also possible that the 2 commonly performed mechanical sensory tests, percussion and palpation hypersensitivity, may detect different aspects of endodontic pathophysiology and pain processing.

Relationship between the difference in electric pulp test values and the diagnostic type of pulpitis.

BACKGROUND: According to the diagnosis criteria of the American Association of Endodontists (AAE), sensitive responses to cold and/or heat tests of suspected teeth compared with those of control teeth can be used for the diagnosis of pulpitis, but the role of electric pulp test (EPT) is not mentioned. It is believed that EPT has some limitations in determining the vitality of the pulp. The aim of this study was to explore the association between the difference in EPT values and the differential diagnoses of reversible pulpitis (RP) and symptomatic irreversible pulpitis (SIRP) caused by dental caries. METHODS: A total of 203 cases with pulpitis caused by dental caries were included. A diagnosis of pulpitis was made on the basis of the diagnostic criteria of AAE. Patient demographic and clinical examination data were collected. The EPT values of the suspected teeth and control teeth were measured, and the differences between them were calculated. The correlation between the difference in the EPT values and diagnosis of pulpitis was analyzed using univariate and multivariate logistic regression. RESULTS: In the 203 cases (78 males and 125 females; 115 cases of RP, 88 cases of SIRP; 9 anterior teeth, 59 premolars, and 135 molars), the mean patient age was 34.04 ± 13.02 (standard deviation) years. The unadjusted (crude) model, model 1 (adjusted for age), model 2 (adjusted for age and sex), and model 3 (adjusted for age, sex, and tooth type) were established for the statistical analyses. In model 3 [odds ratio (OR) = 1.025; 95% confidence interval (CI) 1.002-1.050; P = 0.035], the difference in EPT values between RP and SIRP was statistically significant. However, the areas under the curve of predictive probability of the crude model, model 1, model 2, and model 3 were 0.565, 0.570, 0.585, and 0.617, respectively, showing that the model accuracy was low. The P-value for the trend in differences between the EPT values as a categorical variable showed that the differences in the EPT values, comparing RP and SIRP, were not statistically significant. CONCLUSIONS: Based on the present data, the difference in EPT values was not sufficient to differentiate RP from SIRP.

Oximetría de pulso y su eficacia para diagnosticar vitalidad pulpar / Pulse oximetry and its use in diagnosing pulp vitality

Objetivo: Identificar y analizar en la literatura científica reciente el uso de la oximetría de pulso como método diagnóstico de vitalidad pulpar. Metodología: En este trabajo se llevó a cabo una revisión de la literatura en las plataformas de PubMed y Google Académico, en la cual se analizó el uso de la oximetría de pulso en el diagnóstico y monitoreo odontológico del estado pulpar. Resultados: Después de una exhaustiva revisión, y de acuerdo con los criterios de inclusión y exclusión, se analizaron 21 artículos. La mayoría de los trabajos consideran la oximetría de pulso un método alternativo de diagnóstico indoloro, seguro y eficaz; sin embargo, la adaptación de un instrumento de uso exclusivo odontológico es necesaria para una medición exacta de la saturación de oxígeno en la pulpa dental. Los avances tecnológicos en el campo clínico de la odontología nos han llevado a la búsqueda de nuevas técnicas diagnósticas clínicas para mejorar la atención y los tratamientos de los pacientes que acuden día con día a recibir una consulta odontológica. Conclusiones: En los últimos años la oximetría de pulso ha demostrado ser una herramienta de diagnóstico eficaz para el diagnóstico de la vitalidad pulpar. El análisis de los artículos incluidos en esta revisión concluye que la oximetría de pulso es una técnica innovadora que puede ser utilizada como una herramienta diagnóstica adyuvante en el diagnóstico de la vitalidad pulpar (AU)

Objective: To identify and analyze in the recent scientific literature the use of pulse oximetry as a diagnostic method for pulp vitality. Methodology: In this work, a literature review was carried out on the PubMed and Google Scholar platforms in which the use of pulse oximetry in the dental diagnosis and monitoring of pulp status was analyzed. Results: After an exhaustive review and in accordance with the inclusion and exclusion criteria, 21 articles were analyzed. Most of the studies consider pulse oximetry an alternative method of painless, safe and effective diagnosis, however, the adaptation of an instrument for exclusive dental use is necessary for an exact measurement of the oxygen saturation in the dental pulp. Technological advances in the clinical field of dentistry have led us to search for new clinical diagnostic techniques to improve the care and treatment of patients who come every day to receive a dental consultation. Conclusions: In recent years, pulse oximetry has proven to be an effective diagnostic tool for the diagnosis of pulp vitality. The analysis of the articles included in this review concludes that pulse oximetry is an innovative technique that can be used as an adjunct diagnostic tool in the diagnosis of pulp vitality (AU)

[Evaluation of the effectiveness of the compression method for infiltration anesthesia of the mandibular molars]. / Otsenka effektivnosti primeneniya kompressionnogo metoda pri infil'tratsionnoi anestezii dlya obezbolivaniya zhevatel'nykh zubov na nizhnei chelyusti.

AIM: To study the depth of analgesia and the electrical excitability dynamics of the pulp of the tooth under local anesthesia without and with compression on the depot of local anesthetics. MATERIALS AND METHODS: 87 men and 93 women took part in the study, the average age of men was 36.8±5.02 and the average age of women was 30.43±2.14. According to the indications, local anesthesia of infiltration type with and without compression at the depot of local anesthetics was performed. The injection was carried out with a solution of 4% articaine with epinephrine1:100000 or 1:200000. Patients were divided into 2 groups depending on the used concentration of the vasoconstrictor with 4% articaine. The target area thermometry and electroodontometry (EOD) of the first mandibular molar were performed. The criterion for the onset of pulp analgesia was the value from 92 to 100 mA. RESULTS: Dynamics of change in pulp electrical excitability of the first molar with the use of 4% articaine with epinephrine 1:200000 without a compress showed that in the latter case the reduction of pulp electrical excitability to 96.6 µA, which is optimal for painless treatment, was developed by the 5th minute of the study and remained at the limit of 92.2-92.1 µA for 20 minutes. When using 4% articaine 1:100 000 it was noted that also the compression technique allowed to reach the necessary reduction of EOD indices to 93.5 µA by the 5th minute of the study, and to 97.2 µA by the 10th minute. Increased hypothermia in the injection depot area was noted thermographically, especially when high concentrations of epinephrine were used. CONCLUSION: Our own studies reflect the dynamics of change in the electrical excitability of the pulp of the first molar with the use of 4% articaine by compression method more intensively reduces the electrical reacrivity of the dental pulp depending on the concentration of the epinephrine: with the use of 1:100000, the advantage of the pressure technique is 19.3% and 1:200000 - 21.8%.

Does dental fluorosis affect electric pulp test response and/or optimum probe placement site?

The placement site of electric pulp tester (EPT) probe on the tooth affects the threshold values obtained. The aim of this study was to determine and compare threshold levels and appropriate placement sites for EPT probe on fluorotic and normal teeth. Equal numbers of fluorotic and non-fluorotic maxillary central incisors of 40 subjects were assessed. The mean of three threshold readings from an EPT was taken from the labial surface at the incisal edge, incisal third, middle third and cervical third. Kruskal-Wallis and Friedman ANOVA followed by post hoc tests were used to compare threshold scores. Significantly higher thresholds were recorded for fluorotic teeth at the incisal edge and incisal third. The lowest thresholds were obtained for the incisal edge in both fluorotic and non-fluorotic teeth when compared to the cervical third. There was no statistically significant difference among corresponding test sites between the genders and age groups.

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

Pulp Vitality of Maxillary Canines After Alveolar Cleft Bone Grafting: Pulse Oximetry Versus Electric Pulp Test Versus Cold Test.

OBJECTIVES: Assessment of pulp vitality is necessary prior to any dental treatment. The purpose of this study was to assess pulp vitality of bilateral canines in unilateral cleft patients following alveolar bone graft surgery using pulse oximetry, electrical pulp test, and cold test. METHODS: This analytical, cross-sectional study was conducted on canines of 20 unilateral cleft patients who had alveolar bone graft surgery. Pulp vitality of canines was evaluated postoperatively by pulse oximetry, electrical pulp test, and cold test. Data were analyzed using t test, Mann-Whitney test, and χ2 test. P ≤0.05 was considered statistically significant. RESULTS: The mean pulp SpO2 was significantly lower in canines at the cleft side compared with the normal side (85.04 ±â€Š4.65 versus 87.78 ±â€Š4.01, P = 0.05). The response to cold test was not significantly different (P = 0.056). The mean response to electrical pulp was not significantly different between the 2 sides either (P = 0.62). CONCLUSION: The mean SpO2 of canines was lower at the cleft side than normal side but both sides had adequate blood supply and were vital.