Pulp Tester Research Articles

The Influence of Endodontic Lesions on The Clinical Evolution of Odontogenic Sinusitis-A Cohort Study.

Endodontic disease with formation of periapical lesions (PALs) is one of the most common causes of chronic odontogenic sinusitis (ODS). It requires close collaboration between otolaryngologists and dentists, but the best sequence of management is still unknown. The aim of the present study is to clarify how radiological characteristics of teeth with PALs and previous root-canal treatment (RCT) influence the clinical evolution of the disease and to define the predictive value of its radiological and endoscopic features in determining the need for further surgical intervention. A total of 68 symptomatic patients with ODS with PALs were included in the study. The evaluation was performed by an otolaryngologist and a dentist based on a medical interview, nasal endoscopy, cold pulp testing and tomography images. Patients were prospectively followed for at least 12 months, during which nasal steroids, saline irrigations and RCT were administered. The criteria of disease improvement were: decrease of symptoms, healed sinonasal mucosa in endoscopy and radiological resolution of periapical radiolucency and sinus inflammation. Results showed that 9 (13%) patients improved after conservative treatment and 59 (87%) required further surgical intervention. Patients who improved after medical treatment and RCT were younger (p = 0.043) and had a greater distance from the top of the periapical lesion to the maxillary sinus' floor (p = 0.003). When expansion of PALs and bone destruction toward the maxillary sinus was observed on radiological imaging (p = 0.041), and when more than one tooth root was affected (p = 0.004), patients were more likely to require surgical intervention. In conclusion, the more roots that are affected and the closer the top of the PAL is to the maxillary sinus' floor, the greater the possibility of medical treatment and RCT failure. When the bone destruction extends into the maxillary sinus, patients eventually require both tooth extraction and FESS in order to resolve ODS completely.

Evaluation of the Effect of Common Analgesics on Pulpal Sensibility Tests: A Clinical Trial

IntroductionAccurate diagnosis is one of the most important steps before endodontic treatment. The aim of this study was to assess the effect of 2 commonly used analgesics namely ibuprofen and acetaminophen on the cold and electric pulp test (EPT) results in participants with symptomatic irreversible pulpitis (SIP). MethodsThis clinical trial evaluated 41 participants with pain due to SIP. The cold test and EPT were performed for teeth with SIP, and also for the corresponding tooth with healthy pulp in the contralateral quadrant. The participants then received 500 mg acetaminophen, 400 mg ibuprofen, or the placebo in the 3 groups. The cold test and EPT were repeated at 20, 40, and 60 minutes after medication intake, and the results were compared with the pretreatment values. ResultsIn the acetaminophen group, the results of cold test significantly decreased 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. In the ibuprofen group, the cold test results significantly decreased at 20 (P < .05), 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. The EPT results were not significantly affected by the studied analgesics at any time point (P > .05). There was no significant difference among the study groups regarding sex (P > .05). ConclusionIt appears that both acetaminophen and ibuprofen can affect the pulpal response to the cold sensibility test. However, the studied medications had no significant effect on the EPT results. Therefore, dental clinicians should be aware of the possible effects of such medications on the cold test response.

Assessment of the Clinical Outcomes of Single Visit Regenerative Endodontic Procedure In Treating Necrotic Mature Teeth with Apical Periodontitis Using Biological Irrigating Solution

Aim: to observe the effect of propolis and its nano counterpart when used as final irrigation materials and compare them to the conventionally used EDTA and saline on the clinical outcomes of necrotic mature anterior teeth with apical periodontitis after treating them using regenerative endodontic procedure.&#x0D; Methodology: 84 patients who fulfilled the inclusion criteria were recruited for the study. Access cavity was prepared, rubber dam isolation was done. Mechanical preparation was performed up to #60 using K-files. Final irrigation procedure was done as follows:&#x0D; Group A (Control ): Final irrigation was done using saline (3ml/min) followed by 17% EDTA solution (20 mL/canal, 5 min).&#x0D; Group B (comparator 1): Final irrigation was done using propolis[1] irrigation (20 mL/canal, 5 min).&#x0D; Group C (comparator 2): Final irrigation was done using Nano-propolis[2] irrigation (20 mL/canal, 5 min).&#x0D; Bleeding was then induced, PRF was placed in the canals, followed by Collacote[3] and Bio-dentine[4] placement. Patients were recalled after 6 and 12 months. Teeth were checked for sensibility using electric pulp tester and thermal tests. All data was analysed using Kruskal Wallis test.&#x0D; Results: All of the 84 patients (100%) within the 3 groups showed both clinical success and survival. Using Kruskal Wallis, there was no statistically significant difference among the three groups (p=1). Two teeth in the nano propolis group responded positively to thermal test at 12 months follow up. None of the teeth in the three tested groups (100%) responded to the&#x0D; electric pulp test at 12 months. There was nostatistically significant difference between the three groups(p=1)&#x0D; Conclusion: within the limitation of the study, single visit regenerative endodontics can be used to treat necrotic mature teeth with apical periodontitis and a periapical lesion.&#x0D; Key words: Regenerative endodontics, single visit regeneration, propolis, Nano-propolis, Platelet-rich fibrin&#x0D; &#x0D; [1] Propolis: Imtinan/Cairo, Egypt&#x0D; [2] Nanopropolis: NanoTech/Cairo/Egypt&#x0D; [3] Collacote: Collacote/Zimmer/Indiana /USA&#x0D; [4] Biodentine: Acrostone/Cairo/Egypt&#x0D;

Assessment of Pulp Vitality in Multirooted Teeth With Advanced Periodontal Disease: A Clinical and Histological Study.

The relationship between endodontic and periodontal lesions remains a controversy. Their diagnosis is often difficult and requires an interdisciplinary approach to rule out the cause and provide appropriate treatment. Periodontitis as an etiology of pulpal necrosis and irreversible pulpitis has been a hypothetical concept. Thus, the aim of this study was to assess the non-carious teeth extracted due to periodontitis both clinically and histologically to understand the possible association between periodontitis and its effect on pulp vitality. The study consisted of 60 teeth, of which 20 were extracted due to orthodontic requirements (control group) and 40 were extracted due to periodontitis (test group), which was further subclassified based on the presence or absence of gingival recession. Clinically, the teeth were categorized as non-vital after testing them with the electronic pulp tester (EPT). Later, these teeth were sectioned, and histopathological analysis was done to detect the presence of lateral or accessory canals. The results showed that there were mild to moderate deteriorative changes in the pulp in the periodontitis group without a gingival recession and moderate to severe changes in the pulp in the periodontitis group with a gingival recession. There exists a possible deteriorative effect on pulp vitality as a consequence of periodontitis, even when the vitality of the pulp remains unaffected by dental caries.

Reliability of the electric pulp tester as an indicator of pulpal anesthesia in primary maxillary posterior teeth to assess the need for supplemental injections: An observational clinical study.

The primary maxillary molars occasionally remain sensitive during operative procedures even post the buccal supraperiosteal injection. This could be due to the widely flared palatal roots receiving accessory innervation from the palatal nerves. Identifying inadequate anesthesia upfront using the electric pulp test (EPT) would give vital information to the clinician on the need of a supplemental palatal injection. Aim: The aim of this study was to assess and evaluate the reliability of the EPT as an indicator of pulpal anesthesia in primary maxillary molars. Methodology: Fifty one primary maxillary molars were subjected to the EPT following a buccal supraperiosteal injection. During the operative procedure, the " Face Legs Activity Cry Consolability" (FLACC) scores were recorded. The outcome of the EPT was correlated with the results of the FLACC score using Pearson's Chi-square test.

Replantation of an avulsed permanent central incisor: a case report with an 8-month follow-up

Background: Avulsion accounts occur in young children. An avulsed permanent tooth that is dropping out from its socket causes a breakdown of the periodontal ligament (PDL) surrounding the tooth root. An avulsed tooth can be replanted and saved if replantation is performed within 30 minutes to 1 hour of the incident. Case Presentation: The case of an 8-year-old male patient with a central incisor in a glass of milk after a fall for 2 hours. The tooth was slowly replanted in the socket and stabilized using a flexible wire and resin composite splint. The patient came for the second appointment, the splint was removed, and a radiograph was taken to ensure no inflammation or root resorption had occurred in the replanted tooth for 8-month follow-ups. The tooth developed ankylosis with a positive response to the cold test and electronic pulp tester, indicating that the tooth was vital and sensory nerve supply was regenerated. Conclusion: The prognosis of avulsed teeth depends on receiving proper emergency care at the right time. A proper storage medium is important to keep the dental pulp and PDL viable.

Selection of the best endodontic treatment option using data mining

Introduction: The presence of postendodontic pain is an important issue, which can affect the patients' quality of life. Appropriate treatment selection, based on specific characteristics (e.g., clinical test results and patients' demographics), may reduce postendodontic pain. We aimed to evaluate the relationship of data mining algorithms in longitudinal data of postendodontic pain and treatment allocation to predict the best treatment option. Materials and Methods: The pain data of an original multicenter randomized clinical trial with two study arms, pulpotomy with mineral trioxide aggregate (PMTA) (n = 188) and root canal therapy (RCT) (n = 168), were used. The linear mixed-effects model and predictive algorithms were fitted in accordance with the personal characteristics of patients and diagnostic test results to determine the best treatment option. Using SPSS 23, SAS 9.1, and WEKA 3.6.9, the preferred treatment was identified via comparing the areas below the receiver operating characteristic curves and identifying the most appropriate algorithm. In addition, a decision tree was used to allocate the best type of treatment modality to reduce posttreatment pain. Results: For &lt; 18-year-old patients with irreversible pulpitis (IP) based on cold test and &gt;18-year-old patients whose electrical pulp test (EPT) exhibited IP, the chosen treatment would be RCT (P &lt; 0.05). However, for &gt;18-year-old patients with IP based on cold test and &lt;18-year-old patients whose EPT revealed IP, the recommended treatment would be PMTA (P &lt; 0.05). Conclusions: The decision tree model seems to be able to predict the reduction of postendodontic pain in ~65% of patients if they receive optimal treatment.

Influence of the restoration after pulpotomy on the strength of electrical stimulus reaching the pulp space: An in vitro investigation.

The study evaluated the influence of coronal restoration after pulpotomy on the strength of electrical stimulus reaching the radicular pulp using an electric pulp test (EPT). The pulp tissue from ten freshly extracted mandibular premolar teeth was removed and replaced with an electroconductive gel. The cathode probe of Powerlab was inserted into the pulp space and the anode probe was attached to the EPT handpiece. The EPT probe coated with electro-conducting material was positioned in the middle third of the buccal crown surface. The EPT stimulus reaching the pulp space of an intact tooth at 40 numerical readings was recorded. The tooth was removed from model and endodontic access was made. The 2-mm thick mineral trioxide aggregate was placed at the cementoenamel junction followed by composite resin restoration. The experimental setup was re-established and postpulpotomy EPT stimulus data were recorded. The data collected were compared using the Wilcoxon signed-rank test. There was a statistically significant difference (P = 0.038) between observed between the strength of EPT stimulus reaching the pulp space in prepulpotomy (mean 91.18 ± 101.02 V and median 25.79 V) and postpulpotomy (mean 58.49 ± 77.13 V and median 13.75 V) tooth samples. The placement of the restoration and pulp capping agent after pulpotomy dampens the strength of EPT stimulus reaching the pulp canal space.

Rehabilitation with Table-Top Restoration Post Bicuspidisation: An Interdisicplinary Case Report

The first teeth to erupt in the oral cavity are the mandibular molars which are more prone to endodontic and periodontal involvement. This may lead to significant issues like an increase in pocket depth, furcation involvement, loss of clinical attachment and mobility of teeth ultimately resulting in tooth loss. Thus, it necessitates cautious oral hygiene measures. Advances in dentistry have led to treatment modalities for preserving teeth which were earlier indicated for extraction. Hence, periodontally compromised tooth with severe furcation involvement, which may not be amenable for regeneration, may be retained by bicuspidisation. Bicuspidisation is a surgical technique which involves separation of mesial and distal roots of mandibular molars along with its crown portion, where both segments are then retained individually, followed by rehabilitation with fixed prosthesis of the individual segments. This not only eliminates furcation involvement but also facilitates effective oral hygiene maintenance. In the present case report, a 50-yearold male patient reported with the chief complaint of pain, sensitivity and food lodgement in left mandibular first molar. Clinical and radiographic examination revealed grade III furcation involvement, significant pocket depths, delayed electric pulp test response and bone loss in furcation area. Bicuspidisation was opted as the suitable treatment modality. Root canal treatment was done, followed by bicuspidisation and subsequent rehabilitation with novel prosthetic technique. The bicuspids were restored using combination of deep margin elevation, and non splinted Lithium Disilicate table-top restorations. Six month follow-up showed good healing of hard and soft tissues around the bicuspidized sections, which was indicative of a successful treatment outcome, and can be attributed to a careful case selection, choice of restorative materials and techniques as well as good oral hygiene compliance.

'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.

Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis.

The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. We searched Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE. Randomized controlled trial studies, cohort studies, case-control studies and cross-sectional studies were included, in which platelet-rich concentrates were tested for periapical healing and root development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered. Selected articles were assessed for risk of bias. Pooled risk ratios (risk ratio, RR) were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Subgroup meta-analysis were conducted according to the type of platelet concentrate used. Of the 1272 screenedstudies, 13 randomized controlled studies, 2 case-control studies and 1 cohort study were selected, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with PRP achieved better apical healing than BC group (RR 1.13, 95% CI 1.01-1.26, P = 0.03), and teeth treated with platelet concentrates showed improved apical closure (RR 1.04, 95% CI 0.86-1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74-1.39, P = 0.93), and thickening of the dentin walls (RR 1.35, 95% CI 0.95-1.93, P = 0.09), although these differences were not statistically significant. Platelet concentrates can be used as successful scaffolds for regenerative endodontic treatment of necrotic immature permanent teeth, and PRP as a scaffold may achieve better periapical healing of teeth with periapical inflammation, although they did not differ significantly from conventional blood clot scaffolds in development of the root.

The clinical effect of radiotherapy on pulpal microvasculature: a systematic review.

Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular and microvascular changes, which can lead to significant clinical consequences. Despite advances in RT delivery systems, radiation injury remains a modern-day clinical problem. The aim of this systematic review is to investigate the available evidence regarding the impact of RT to the dental pulp and the clinical manifestations of these effects.Data and sources A multi-database search (PubMed, Medline, Embase and CINAHL) was performed to identify related papers published from inception until November 2021. An additional manual search was performed to identify further articles. The data extracted from relevant papers were analysed according to the outcomes selected in this review.Study selection The search generated seven articles eligible for analysis with a total of 2,709 teeth included. RT dose exposure ranged from 30-71.2 Gray with a common finding that RT decreases the number of teeth responding to pulp sensibility testing.Conclusions Knowledge related to the impact of RT on dental pulp is limited and based on weak evidence and a low-level quality of studies. Future studies should incorporate exact RT doses to the teeth and use replicable pulpal testing methods. Understanding the pulpal status post-RT remains an important consideration as dental extractions should be avoided in this cohort due to the risk of osteoradionecrosis.

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

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. 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. 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. 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.

Pre-Eruptive Intracoronal Resorption (PEIR): A Case Report

Pre-Eruptive Intracoronal Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR.The patient’s chief complaint was recorded as “spontaneous pain” in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a cone beam computed tomography scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of “Symptomatic Irreversible Pulpitis” and “Normal Apical Tissue,” respectively.The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of “granulation tissue with acute and chronic inflammation”. No caries were detected.Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to Electric Pulp Test was achieved after 3.5 years of follow up.

The use of electrodermal activity in pulpal diagnosis and dental pain assessment.

To explore whether electrodermal activity (EDA) can serve as a complementary tool for pulpal diagnosis (Aim 1) and an objective metric to assess dental pain before and after local anaesthesia (Aim 2). A total of 53 subjects (189 teeth) and 14 subjects (14 teeth) were recruited for Aim 1 and Aim 2, respectively. We recorded EDA using commercially available devices, PowerLab and Galvanic Skin Response (GSR) Amplifier, in conjunction with cold and electric pulp testing (EPT). Participants rated their level of sensation on a 0-10 visual analogue scale (VAS) after each test. We recorded EPT-stimulated EDA activity before and after the administration of local anaesthesia for participants who required root canal treatment (RCT) due to painful pulpitis. The raw data were converted to the time-varying index of sympathetic activity (TVSymp), a sensitive and specific parameter of EDA. Statistical analysis was performed using Python 3.6 and its Scikit-post hoc library. Electrodermal activity was upregulated by the stimuli of cold and EPT testing in the normal pulp. TVSymp signals were significantly increased in vital pulp compared to necrotic pulp by both cold test and EPT. Teeth that exhibited intensive sensitivity to cold with or without lingering pain had increased peak numbers of TVSymp than teeth with mild sensation to cold. Pre- and post-anaesthesia EDA activity and VAS scores were recorded in patients with painful pulpitis. Post-anaesthesia EDA signals were significantly lower compared to pre-anaesthesia levels. Approximately 71% of patients (10 of 14 patients) experienced no pain during treatment and reported VAS score of 0 or 1. The majority of patients (10 of 14) showed a reduction of TVSymp after the administration of anaesthesia. Two of three patients who experienced increased pain during RCT (post-treatment VAS > pre-treatment VAS) exhibited increased post-anaesthesia TVSymp. Our data show promising results for using EDA in pulpal diagnosis and for assessing dental pain. Whilst our testing was limited to subjects who had adequate communication skills, our future goal is to be able to use this technology to aid in the endodontic diagnosis of patients who have limited communication ability.

Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study

IntroductionThis retrospective study evaluated the long-term outcome of direct pulp capping in mature teeth using specific case selection and treatment procedures. MethodsTeeth with pulp exposure due to advanced caries and clinical diagnosis of reversible pulpitis were treated by direct pulp capping. Treatments were conducted over a period of 15 years by a single operator. Under magnification, caries was completely removed, the exposed pulp examined, and capped with either pure calcium hydroxide or a calcium hydroxide-based cement. The cavity was restored and the long-term outcome evaluated from 1 to >35 years. Teeth that were asymptomatic, responded to sensibility pulp tests within normal limits, and showed no radiographic periapical changes were categorized as success. Teeth with no response to pulp tests and/or showing radiographic evidence of apical periodontitis were classified as failures. The effects of independent variables (sex, age, symptoms, number and size of pulp exposures, bleeding time, capping material, bases used over the capping material, and final coronal restoration) on the outcome were evaluated. ResultsIn general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods. The success rate of the direct pulp capping procedure was 100%, 95%, 95%, 86%, and 89% at 1-, 5-, 10-, 20-, and 35-year follow-up examination, respectively. The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001). Other isolated variables associated with the outcome included the size and number of pulp exposures at the 20-year follow-up, and the exposure size, capping material, and restoration type at the 35-year follow-up. Multiple regression analysis confirmed the results for exposure size (P < .05), and disclosed a higher proportion of failures at 5 years when varnish was used as the base. ConclusionsA very high success rate of the direct pulp capping with calcium hydroxide was observed, especially in the first 10 years following treatment. The main variable influencing the outcome was the quality of the coronal restoration.

The Effect of Dental Flourosis on the Electric Pulp Tester Response and Probe Placement Site.

Introduction: The probe placement site for an electric pulp tester. (EPT) will have a significant outcome for the threshold readings. These relationships in previous studies have been documented. As dental flourosis is an endemic in regions of Pakistan the aim of this study was to compare and determine the appropriate EPT probe placement sites on fluorotic and non flourotic teeth.&#x0D; Methodology: In this cross-sectional clinical study equal number of flourotic and non flourotic maxillary central incisors(40 volunteers) were selected from a known region of Pakistan for endemic of flourosis to measure threshold levels on EPT on four different parts of each tooth. (Incisal edge, incisal third, middle third and cervical third). Before the readings were taken flourotic teeth were also categorized on the bases of severity (Deans Index).The purpose was to assess if severity of dental flourosis had an impact on the EPT readings. Once the mean values were taken the Dunn–Bonferroni post hoc tests was used to assess the statistical significance (p&lt;0.05) between the four site in both groups.&#x0D; Results: Mean values from the EPT presented that the threshold values increased from incisal to cervical in gender and both age groups i.e. 20-29 and 30-40. It was also found that the threshold values increased from incisal edge to the cervical third in flourotic and non flourotic teeth. Statical significance was found between the reading of flourotic and non flourotic groups across the four probe site readings taken (p value= 0.00). Like previous literature the insical edge was considered the most ideal site for EPT assessment on anterior incisors. As this is where the lowest threshold response was recorded in our study .Dental flourosis does have a significant effect on the EPT threshold values. This is most likely due to structural changes because of dental flourosis.&#x0D; Recommendations: From the study conducted it can be recommended that clinicians need to be aware of the fact that fluorotic teeth response will vary from natural teeth on the EPT. Also further research needs to be done to assess if other vitality test methods will also alter in their response due to dental defects like flourosis.

Clinic and Radiographic Evaluation of Cemento-osseous Dysplasia: Case Series

Aim: Cemento-osseous dysplasia (COD) is usually asymptomatic and slowly progressive benign fibro-osseous lesion characterized by the replacement of normal bone with fibrous tissue. The aim of this presentation is to evaluate the clinical and radiographical findings of six COD cases that were detected incidentally during radiographic examination.&#x0D; Case Report: Six female patients who four (%66) of them with different dental complaints and two (%33) of them for routine control examination of the previously diagnosed COD with a mean age of 38 applied to our clinic. It was learned that the patients did not have any systemic disorders in their medical anamnesis. There is not any finding on extraoral examination. In intraoral examination, teeth associated with COD lesions were vital as a result of the electric pulp test, and there is no other finding related to the lesion. In the radiography examination, different sizes radiolucent, mixed, and radiopaque lesions were detected in the mandible on control panoramic radiographs. The lesions were examined in detail with cone-beam computed tomography. Local thinning and resorption were observed in the buccal and lingual cortical bone in the relevant region. Histopathological examination revealed that the lesions were definitively diagnosed as SOD in four patients. Based on clinical, radiographic, and histopathological examinations, three (%50) of the lesions were diagnosed as periapical COD and the others (%50) were diagnosed with fluoride COD. All patients were followed up periodically for six months.&#x0D; Conclusion: The findings of this case series showed that all lesions examined were clinically asymptomatic and mixed on radiography. Due to insufficient vascular support of the bone in the COD area, there is a risk of infection and osteomyelitis may occur. Therefore, dentists should be aware of the clinical and radiographic features of COD in clinical practice and follow the patients periodically.

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

Background/purposeThis 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 methodsSeven 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. ResultsThere 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. ConclusionBoth 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.

Assessment of Pulpal Status in Primary Teeth Following Direct Pulp Capping in an Experimental Canine Model.

(1) Background: This study aimed to assess the pulpal response of primary teeth by pulse-oximetry (PO) in a canine model, following direct pulp capping (DPC). (2) Methods: Forty-eight primary teeth from eight canine subjects were divided into three treatment groups, based on the DPC material—calcium hydroxide (CH), MTA, BiodentineTM)—and three corresponding control groups. Data from PO pulp testing were correlated with laser Doppler flowmetry (LDF) testing, computer tomographic (CT) densitometry and histological analysis; the experiment lasted 14 days. (3) Results: SpO₂ recordings revealed statistically significant differences (p = 0.002, <0.05) between the treatment and control groups, and no significant differences (p = 0.257, >0.05) were observed between treatment groups. LDF recordings showed significant differences (p = 0.002, <0.05) between the treatment and control groups and identified significant differences between materials (p = 0.001, <0.05). CT densitometry indicated vital pulps in all teeth, with pulpal inflammation detected in 6/8 CH-capped teeth and 2/8 MTA-capped teeth. Histologic evaluation confirmed vital pulp in all specimens, with different degrees of inflammation. (4) Conclusions: Within its limitations, the present study confirms the diagnostic value of PO evaluation of pulpal status in primary teeth with histologic means after pulp-capping procedures in a canine model. However, various degrees of pulpal inflammation elicited by different pulp-capping materials seem not to correlate with the obtained PO values.