Digital Pulp Research Articles

Probe placement during electric pulp-testing procedures

Electrode placement sites during electric pulp-testing procedures on the crown of a tooth were evaluated in a laboratory setting using thirty-one extracted teeth, an oscilloscope, and a new electric pulp tester (Digital Analytical Pulp Tester). This study showed that the lowest resistance occurred on the occlusal two-thirds electrode sites of the labial or buccal surfaces of maxillary incisors and premolars. More specifically, the middle-third electrode sites of the incisors and the occlusal-third electrode sites of the premolars were shown to have the least resistance. The electrode placement area on the crown where the pulp nerve is first excited to threshold must be identified to avoid false-positive stimulation of surrounding periodontal nerves. This will decrease nerve damage and ensure the patient's cooperation and acceptance.

Clinical investigations concerning the digital nerve suture using the microsurgical technique: with special reference to the evaluation of post-operative results

During the four year and three month period between October, 1975 and January, 1980, the author at the Department of Orthopedics, Nippon Medical School studied the post-operative results achieved in patients with digital nerve injuries.Forty-one patients had undergone microsurgical suture in digital nerve injuries, with 57 nerves and 62 digital pulps having been operated on.There are seven methods available for assessing the recovery of sensation after an operation. These are : the von Frey hair test, two-point discrimination test (2PD), moving two-point discrimination test (m2PD), ridge test, letter test, self-assessment test by patient and the finger volume test. With the above methods of evaluation, the results described below were obtained, allowing the following conclusions to be drawn :1) It was possible to measure the 2PD on 50 nerves, but no 2PD measurement was possible on 12 nerves. As far as the cases of sutured nerves were concerned, 15 nerves (62.5%) out of 24 showed 2PD lower than 8 mm.2) All the patients aged 15 years or less showed a complete recovery with a full return to normalcy.3) Concerning those in whom it was possible to measure the 2PD response, it was found that there was a significant correlative relationship between (1) the 2PD results and von Frey hair test, (2) the 2PD results and the ridge test, (3) the 2PD results and the m2PD values, (4) the 2PD results and the finger volume test, respectively.However, including the cases in which it was impossible to measure the 2PD, the von Frey hair test, the ridge test and the letter test were not suitable for assessing post-operative recovery of the digital nerves.4) The finger volume test devised by the author was considered to be the only quantitave evaluation method among the techniques purporting to provide an objective assessment of sensory perception.5) In the 2PD evaluation tests, it was possible to ascertain, though only in a small number of patients, that those patients who had shown favorable 2PD assessment results included a very few with a poor self-assessment of their recovery of sensation.6) It is the author's contention that the recovery of the digital nerves should be assessed on the basis of an evaluation system integrating the following four test procedures : 2PD, m2 PD, patient's self-assessment and the finger volume test.

Toxic lesions of the hand associated with chemotherapy

New agents used in cancer chemotherapy are continually appearing which, in turn, leads to newer patterns of toxicity. This report reviews experience with some upper extremity lesions associated with chemotherapy. Doxorubicin extravasation caused deep soft tissue necrosis that was successfully managed by aggressive excision and delayed coverage with a well-vascularized flap. Bleomycin resulted in palmar swelling, erythema, and digital pulp necrosis, which healed secondarily. Intravenous nitrogen mustard caused an immediate, and alarming, perivenous hyperpigmentation that was painless but long lasting. Bacille Calmette-Guerin immunotherapy was followed by a large, localized skin slough that was indolent, painful, and healed secondarily. 5-Fluorouracil was associated with permanent, dark pigmentation of the hands along with slough of the digital pulps. The myelosuppression resulting from combination therapy may also predispose these patients to fulminant hand infections, which can be lethal.

Rate and extent of functional recovery after flexor tendon grafting with and without silicone rod preparation

Forty-six consecutive patients requiring flexor tendon grafts were evaluated at 4, 6, 8, 10, 12, 16, 20, 22, 24, 28, 34, and 52 weeks after grafting. The patients were divided into two groups: those who did not require a silicone rubber rod prior to tendon grafting (Group I), and those who did require a silicone rubber rod prior to grafting (Group II). Analysis of the rate of functional recovery as measured by total active motion, gross grip strength, and pinch grip strength showed no significant difference between the two groups. Analysis of the extent of functional recovery at one year, as measured by total active motion and distance of digital pulp from distal palmar crease, showed no significant differences between Groups I and II.

The fascia of the distal phalanx

The anatomy of the distal phalanx of the human finger was studied in preserved and fresh specimens and the fascia was related to associated structures as a mechanism for prehension. Particular attention was directed to the lateral interosseous ligaments of the distal phalanx and their possible function during gripping with the digital pulp.

Esophageal carcinoma presenting with cutaneous nodules

Esophageal cancer accounts for 7% of all gastrointestinal cancers but presentation with metastases in the form of cutaneous nodules is a rare occurrence. Majority of esophageal cancers are mainly those of squamous cell type and so are the reported cases of cutaneous metastasis as our own case. Here we report a 55-year old man with cutaneous metastasis from esophageal squamous cell carcinoma presenting as nodules on the face back and digital pulp with associated skeletal metastasis and pathological fractures. Our case represents the third in the reported series of digital pulp metastasis from esophageal squamous cell carcinoma. The nodule may appear before or after the onset of esophageal symptoms such as dysphagia and weight loss, and is a pointer of tumor aggressiveness.

A local neurovascular flap to repair loss of the digital pulp

Summary 1.The anatomical basis for a dorsal neurovascular flap based on the palmar digital vessels is described. 2.Its value in completely resurfacing the digital pulp with intact sensory cover by one operation is discussed. 3.The failure of return to tactile gnosis in grafts is discussed. The value of the introduction of a neurovascular flap is emphasised.

A local neurovascular flap to repair loss of the digital pulp

Summary 1.The anatomical basis for a dorsal neurovascular flap based on the palmar digital vessels is described. 2.Its value in completely resurfacing the digital pulp with intact sensory cover by one operation is discussed. 3.The failure of return to tactile gnosis in grafts is discussed. The value of the introduction of a neurovascular flap is emphasised.

Toe pulp free grafts in finger-tip repair

Summary It is only by the use of skin of identical thickness and texture that the best results can be obtained in finger-tip repair. The digital pulps are sensory end organs and so demand special attention if their function is to be preserved. A method of utilising the pulps of the toes as free grafts of skin and subcutaneous tissue is advocated and has been employed for the past four years with good results. The method is specially indicated in primary repairs of pulp avulsions in young children and in such instances materially helps to support and prevent deformity in the growing nail. In secondary repairs the same technique has been successfully employed to relieve causalgia and to restore normal pulp sensation.

INFECTION OF THE DIGITAL PULP SPACE

INFECTION OF THE DIGITAL PULP SPACE