Pulp Tester Research Articles

Evaluation of Cold and Electric Pulp Tests for Assessing the Success of Inferior Alveolar Nerve Block for Mandibular First Molars diagnosed with Symptomatic Irreversible Pulpitis

IntroductionFear of dentistry, often due to past painful experiences, is a significant barrier preventing patients from visiting dentists. Achieving effective pain control, especially during root canal treatments, is crucial. However, inferior alveolar nerve blocks (IANB) have a low success rate, influenced by factors such as anxiety, anatomical variations, and technique limitations, leading to anesthesia failure. Although numerous studies have examined the cold test and EPT in assessing the success of local anesthesia, no standardized method has been established. This study evaluated the effectiveness of electric pulp test (EPT) and cold tests in assessing the depth of anesthesia in patients with symptomatic irreversible pulpitis (SIP) in the mandibular first molar teeth. MethodsA cross-sectional study was conducted on 50 patients with SIP who met the inclusion criteria and exhibited lip numbness. Following the administration of the IANB and confirmation of lip numbness, cold tests and EPT were performed on all patients. Subsequently, the preparation of the access cavity (gold standard test) was initiated, and patients' responses during cavity preparation were recorded as either "presence of pain or discomfort" or "absence of pain or discomfort," indicating IANB failure and success, respectively. Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR-/+), and accuracy (AC) with 95% confidence intervals (CI) were calculated for each test separately as well as for sequential testing. ResultsIANB failure was determined in 56% of the patients. A comparative analysis of diagnostic tests (cold test and EPT) showed no significant difference in SN, NPV, and AC; however, the cold test had higher SP, PPV, and LR+. Combining cold test and EPT evaluations improved SN, NPV, PPV, and LR-, but SP and AC were similar to EPT alone. No correlation was found between IANB success and patient age, sex, or initial pain. ConclusionsDespite evidence of lip numbness, a significant number of IANBs failed in cases of painful pulpitis. A positive result from the cold test strongly indicated anesthesia failure. The findings of the current study suggested that when the cold test yielded a negative result, further evaluation with EPT was necessary to confirm anesthetic success and ensure complete pain control.

Comparative Efficacy of Biodentine® and Calcium Hydroxide in Pulp Capping Treatment

Background: This study is focused on — Assessing Biodentine and Calcium hydroxide in indirect pulp capping procedures. Various materials have been used in indirect pulp capping but this comparative study may help appreciate which material produces better results: Biodentine or Calcium hydroxide. Objective: To compare treatment outcomes post indirect pulp capping treatment using Biodentine® and Calcium hydroxide (Ca(OH)2) . Materials and Methods: A blinded, randomized clinical control trial involving 50 consenting subjects, comparing Biodentine® (test) and Ca(OH)2 (control). Cavity preparation was done and the cavity was dressed with either Biodentine® or Ca(OH)2 and then restored with Glass ionomer cement. The subjects’ teeth were later examined clinically and radiographically at 3, 6, and 9 months post treatment. The indicators of clinical success were absence of pain, swellings, sinus, fistula, abscess, mobility, tenderness to percussion, normal response to electric pulp tester, and Endo-ice cold test. The indicator of radiographic success was absence of periapical pathosis. The probability level of p<0.05 was considered significant. Results: The success rate at three months was 100% for both groups; at six months, it was 92% for both groups and at nine months, 92% of subjects were successful in the Biodentine® group while the Ca(OH)2 group recorded 88% which was statistically insignificant (P=0.74). Conclusion: Biodentine® and Calcium hydroxide have shown comparable effectiveness in improving treatment outcomes, thus, contributing to the longevity of the teeth, and the period of optimum efficaciousness of the pulp capping materials in this study was three months.

Full pulpotomy versus root canal therapy in mature teeth with irreversible pulpitis: a randomized controlled trial

BackgroundVital pulp therapy (VPT) is recommended as an alternative treatment to root canal therapy (RCT) for management of teeth with carious pulp exposure. This randomized clinical trial aimed to compare the outcomes and postoperative pain, and to evaluate the time and cost after full pulpotomy (FP) and RCT in mature molar teeth with irreversible pulpitis (IP).MethodsA total of 160 mature molar teeth with IP were randomly divided into two treatment groups. The FP group (test group) was treated with FP using iRoot BP Plus by an endodontist, the RCT group (control group) was treated with RCT using iRoot SP as sealer by the same endodontist. Pain was recorded preoperatively and daily until day 7 postoperatively. The treatment time and cost were recorded. Clinical and radiographic assessments were collected, and pulp sensibility tests were done by electric pulp test (EPT) at 3-, 6-, 12- month postoperatively. Data were analyzed through chi-square test, Mann-Whitney U test, Fisher exact and independent t test.ResultsFP and RCT had comparable success rates (Clinical, 97.3% vs. 98.6%; radiographic, 93.3% vs. 94.6%) (P > 0.05). Pain levels decreased over time from day 1 to day 7 postoperative in both groups, and the FP group had larger reductions in pain intensity than RCT at day 1 (P < 0.05). In the FP group, there were 5, 3 and 3 unresponsive teeth with EPT at 3-, 6- and 12- month follow-ups, respectively. The treatment time and cost in the FP group were significantly lower than in the RCT group (P < 0.05).ConclusionsFP could be an appropriate alternative treatment for management of mature teeth with IP in short follow-up.Trial registrationThe trial was registered in Chinese Clinical Trial Registry (ChiCTR2200063380 at 05/09/2022).

Pulp Vitality Diagnosis by Means of an Optical Pulp Scanning Device.

This study aimed to evaluate the diagnostic accuracy of an Optical Pulp Scanning (OPS) device. A total of 421 teeth from 107 emergency patients were investigated. Pulp vitality was assessed using conventional diagnostic methods (ConvDia), cold pulp testing (CPT), and a final diagnosis (FinDia) based on the pulp chamber contents (PCCs) of teeth requiring endodontic treatment (EmeTe). Following ConvDia, OPS screening was performed, endodontic access was prepared, and the FinDia was established. The specificity, sensitivity, as well as positive and negative predictive values of ConvDia, CPT, and FinDia were calculated against the OPS results. The null hypothesis stated that specificity and sensitivity would be equal to or lower than 90% and 80%, respectively. OPS sensitivity was 66.2% and 72.2% (EmeTe) for ConvDia, 66.2% and 69.8% (EmeTe) for CPT, and 76.9% for FinDia. Specificity was 26.4% and 25.5% (EmeTe) for ConvDia, 26.9% and 21.7% (EmeTe) for CPT, and 31.5% for FinDia. These results suggest that, at its current stage of development, the OPS device does not provide an acceptable level of diagnostic accuracy, particularly in vital teeth.

Effect of orthodontic space closure on dental pulp sensitivity. Prospective clinical trial.

Orthodontic tooth movement (OTM) is a biological process that can influence the function of the pulp, including its innervation. The excitability of the nerve fibres of the pulp may be altered by forces exerted on the nerve fibres or by reduced blood flow to the pulp. The aim of this clinical study was to evaluate the sensitivity of the dental pulp during levelling and during the phase of space closure, to assess the role of certain controlled risk factors. Twenty-two adolescent participants requiring orthodontic space closure in transcanine sector were enrolled in a prospective clinical study. Patients were observed before OTM, after levelling and 1 month during active space closure. The sensitivity threshold of the pulp was measured using the electric pulp test (EPT). Dental models were obtained using an intraoral scanner, allowing measurement of interdental distances and calculation of OTM speed. The teeth were categorized according to position and tooth type. The EPT values increased significantly during orthodontic treatment (one-way RM-ANOVA, P = .014). There was a significant difference in EPT values between the tooth categories. Teeth with a single root adjacent to the residual space had the highest EPT thresholds (two-way RM-ANOVA, P < .001; Holm-Sidak, P < .05). OTM reduced pulpal sensitivity. Pulpal sensitivity during active space closure was similar to sensitivity during the levelling phase. The pulpal sensitivity of molars was less affected by OTM than that of single-rooted teeth, while teeth closer to the gap had a significantly higher pulpal sensitivity threshold during active OTM.

Electric Pulp Test Threshold Responses in Healthy Mature Permanent Teeth

Electric pulp testers assess only the neural component of pulp sensibility in dental practice, while vascular status is evaluated with laser Doppler flowmeters and pulp oximeters, which are more reliable for determining vitality in traumatic teeth. Objective: To determine the accuracy of the electric pulp test in healthy mature permanent teeth. Methods: This cross-sectional study was conducted at the Liaquat University of Medical and Health Sciences Jamshoro by consecutive sampling on 220 participants aged 18-35, who had healthy, mature permanent central incisors, canines, first premolars, and first molars, with no history of cardiac pacemakers and metallic restorations. Teeth were isolated, dried, and tested with a COXO C-Pulse electric pulp tester using toothpaste as a conducting medium. Threshold responses were recorded at increasing currents, with each tooth tested twice to determine the mean value. Accuracy was assessed using additional metrics post-therapy. Chi-square tests were employed to compare accuracy across gender and age groups, with significance set at p&lt;0.05. Results: The mean age of the patients was 25.55 ± 5.41 years. 132 (60%) subjects were female, 88 (40%) subjects were male in this study. Accuracy of the electric pulp test in healthy mature permanent teeth was detected in 181 (82.3%) subjects in this study. Conclusion: It was concluded that the electric pulp tester method seems to be a reliable way to evaluate how sensitive the live nerve tissue inside a tooth is for healthy permanent teeth that have fully formed.

Assessment of the onset of analgesia and length of analgesia following the use of PBM with different wavelengths: a clinical study

This clinical study assessed photobiomodulation (PBM) induced analgesic effects of diode lasers and an LED light source on the dental pulp. Baseline responses to electric pulp testing (EPT) were recorded in 93 healthy unrestored premolar teeth in 26 adults (age range 22–63 years) attending a private dental practice. The teeth were irradiated on buccal and lingual aspects of the crown, by placing the tips on the middle third of the crown of the teeth, on separate days for each of 4 different light sources (660, 808, or 904 nm diode lasers, or a novel multi-wavelength LED light source (700–1100 nm)) using comparable parameters (100 mW, 30 s, 6 J). EPT scores were measured after a further 1-, 2-, 5- and 20-min. Discomfort caused by PBM therapy was recorded using the Wong-Baker scale. EPT changes were tracked over time using repeated measures analysis of variance. Baseline EPT scores were very consistent between different days (linear regression r2 0.9422–0.9648). All PBM devices caused a significant elevation in EPT at 5 min, with an earlier onset at 2 mins for 904 nm and LED. The LED was the only light source that elevated scores at 20 min. Across 2–20 min, when ranked by effectiveness, the greatest EPT elevations were seen for LED, followed by 904 nm, then 660 nm and finally 808 nm. Discomfort during PBM was most common with 904 nm, followed by 808 nm. No discomfort occurred from the LED. Among the light sources utilized, the LED multi-wavelength system demonstrated the largest increase in EPT readings, suggesting its potential as a non-pharmacological alternative for achieving dental analgesia compared to diode lasers.

Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different endodontic sealers: A randomized controlled clinical trial.

A randomized controlled clinical trial to evaluate postoperative pain and investigate periapical healing after root canal treatment using eugenol, resin-based, and calcium silicate-based sealers (CSBSs) sealers. Sixty-three individuals diagnosed with apical periodontitis confirmed using cold test and electronic pulp tester, periapical pathology with periapical index score of 2 or more, previous endodontic treatment failure exhibiting a visual analog scale pain score of 3 or above, were enrolled in this investigation. The patients were randomly allocated into three groups and following biomechanical preparation, the canals were obturated using Meta CeraSeal, AH plus, and eugenol-based sealers. Postprocedural pain intensity was assessed at 24 h, 48 h, and 7 days, while periapical healing was evaluated at 3- and 6-month follow-ups. Statistical analysis was done using the Chi-square and Friedman's test. The mean of periapical lesions for Meta CeraSeal (4.7, 1.6), AH Plus (4.68, 3.19), 24 and eugenol-based (2.66, 1.75) at 3 months and 6 months, respectively. The mean & std. deviation of pain scores at 24 h for Meta CeraSeal (0.62 ± 1.857), AH Plus (1.62 ± 1.962), and eugenol-based (0.48 ± 1.250). At 48 h for Meta CeraSeal (0.33 ± 1.528), AH Plus (1.33 ± 1.798). On the 7th day, Meta CeraSeal (0.24 ± 1.091) and AH Plus (0.71 ± 1.384) for eugenol-based at 48 h, and on the 7th day, none of the patients had pain. Evaluation of the apical sealer puff displayed no suggestive variations (P = 0.634). Notably, no analgesics were taken. No suggestive dissimilarity was noted between eugenol, resin-based, and CSBSs sealers.

Pulp Cavity Calcification in SLE Patient Associated with Long-term Use of Glucocorticoids: A Case Study with Endodontic Approaches

Background Calcification in the tooth pulp cavity occurs in response to various factors, including dental trauma and chronic irritation. Systemic lupus erythematosus (SLE) is the most common type of lupus, causing widespread inflammation and tissue damage in the affected organs. The SLE condition is generally managed by long-term use of drugs, including glucocorticoids (GCs). Objective This study aimed to assess the association of pulp cavity calcification in SLE patients with long-term use of GCs and to present endodontic perspectives on the issue. Case Presentation A female SLE patient with a history of long-term use of GCs visited our hospital for an oral surgery examination due to an accident. The crown of tooth 11 was visibly fractured. The tooth was sensitive to cold stimulus, while tooth 21 was mobile. Various examinations (including electric pulp test and panoramic radiography) pointed to the diagnosis of chronic pulpitis in the affected teeth (11 and 21), and cone beam computed tomography (CBCT) revealed that the pulp cavities in all teeth were almost completely calcified. Thus, the root canal treatment (RCT) was attempted and followed by crown restoration for the affected teeth. The involvement of GCs in the pulp cavity calcification was assessed. Conclusion According to this case and a series of related studies, long-term use of glucocorticoids is associated with the incidence of pulp cavity obliteration (PCO). More frequent dental examinations and appropriate adjustments in medication use (dose and duration) should be considered and implemented.

Evaluation of Oxygen Saturation Levels Using a Custom-modified Finger Pulse Oximeter for Assessment of Pulp Vitality in Various Clinical Situations in Pediatric Dental Practice: An In Vivo Study.

A major drawback of traditional pulp testing procedures is that they depend on neural responses rather than vascular circulation. Hence, this study aimed to develop a custom-modified dental sensor using a finger pulse oximeter (PO) that is applicable to any type of tooth so as to test its ability and accuracy in evaluating the oxygen saturation (SaO2) values of teeth at different developmental stages as a measure of pulp vitality. A customized finger PO was employed to determine the systemic and pulp SaO2 levels in 300 children. A total of 600 teeth (primary and permanent) were divided into group I (100 primary molars), group II (200 permanent molars), group III (200 permanent incisors), and 100 endodontically treated (primary and permanent) teeth were included in group IV. The mean SaO2 values thus obtained in various groups were compared. Intragroup comparison of mean SaO2% of the patient's finger (systemic), test teeth, and control teeth showed significant differences (p ≤ 0.001). Intergroup comparisons also revealed significant differences in most of the groups. The modified PO probe can be applied to any type of tooth. It was found to be accurate and sensitive enough to detect changes in SaO2 levels in various clinical situations irrespective of developmental stage. It proved to be a direct method of evaluation of pulp vitality by objective means. Patil A, Garg N, Pathivada L, et al. Evaluation of Oxygen Saturation Levels Using a Custom-modified Finger Pulse Oximeter for Assessment of Pulp Vitality in Various Clinical Situations in Pediatric Dental Practice: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(S-1):S30-S36.

A 12-month randomized controlled trial to assess the efficacy of revitalization of retreated mature incisors with periapical radiolucency in adolescents

The use of regenrative endodontics is restoring the health status of the root canals of retreated mature teeth is a novel approach. Therefore, the current trial aimed to compare the effectiveness of regenerative endodontic procedures (REPs) to non-surgical root canal retreatment (NS-RCR) in reducing periapical radiolucency over one year for the retreatment of mature incisors with periapical periodontitis. The secondary purpose was to assess clinical success and regain pulp sensibility. A parallel randomized controlled trial, 66 mature incisors with periapical radiolucencies were randomly divided into two equal groups and retreated with either REPs or NS-RCR. At baseline and after 6 and 12 months, teeth were assessed clinically and radiographically using a periapical index (PAI). The Mann–Whitney test was used to analyze nonparametric PAI scores. The Electric pulp test readings were analyzed using the repeated measure analysis of variance (ANOVA). Over the follow-up intervals, there was no significant intergroup difference in the PAI medians, the majority of the teeth displayed a reduction in periapical radiolucency. At the end of the follow-up period, the clinical successes for the REP and NS-RCR groups were 93.9% and 97%, respectively (p = 0.555). Positive pulp sensibility was recorded in 54.54% of cases in the REPs after 12 months. Both approaches showed a comparable diminishing of periapical radiolucencies and equivalent clinical results. A conventional, non-surgical endodontic retreatment may not always be necessary.

An innovative cell-based transplantation therapy for an immature permanent tooth in an adult: a case report

BackgroundImmature teeth with necrotic pulps present multiple challenges to clinicians. In such cases, regenerative endodontic procedures (REPs) may be a favorable strategy. Cells, biomaterial scaffolds, and signaling molecules are three key elements of REPs. Autologous human dental pulp cells (hDPCs) play an important role in pulp regeneration. In addition, autologous platelet concentrates (APCs) have recently been demonstrated as effective biomaterial scaffolds in regenerative dentistry, whereas the latest generation of APCs—concentrated growth factor (CGF), especially liquid phase CGF (LPCGF)—has rarely been reported in REPs.Case presentationA 31-year-old woman presented to our clinic with the chief complaint of occlusion discomfort in the left mandibular posterior region for the past 5 years. Tooth #35 showed no pulp vitality and had a periodontal lesion, and radiographic examination revealed that the tooth exhibited extensive periapical radiolucency with an immature apex and thin dentin walls. REP was implemented via transplantation of autologous hDPCs with the aid of LPCGF. The periodontal lesion was managed with simultaneous periodontal surgery. After the treatment, the tooth was free of any clinical symptoms and showed positive results in thermal and electric pulp tests at 6- and 12-month follow-ups. At 12-month follow-up, radiographic evidence and three-dimensional models, which were reconstructed using Mimics software based on cone-beam computed tomography, synergistically confirmed bone augmentation and continued root development, indicating complete disappearance of the periapical radiolucency, slight lengthening of the root, evident thickening of the canal walls, and closure of the apex.ConclusionhDPCs combined with LPCGF represents an innovative and effective strategy for cell-based regenerative endodontics.

Regenerative Endodontic Treatments for Immature Devital Permanent Molar Teeth: Four Case Reports

Objective: To apply regenerative endodontic treatment to immature permanent molar teeth devitalised due to dental caries and to follow the clinical and radiographic outcomes. Cases: Four patients presented to our university with complaints of pain. Radiological evaluations revealed profound dentinal caries, apical lesions, and open root tips. Clinical examinations yielded negative results on the electric pulp test (EPT) for all four teeth. Given the presence of immature necrotic teeth, the treatment for these cases was planned as regenerative endodontic treatment. This treatment was administered under local anaesthesia, following the protocol recommended by the American Endodontic Association. Results: Over a follow-up period of 10 to 15 months, certain patients exhibited a reduction in periapical lesions and completion of root formation. However, root development persisted in other patients. Conclusion: Follow-up and observations indicate that regenerative endodontic treatment is an effective alternative for the management of immature permanent molar teeth.

Comparison of the vitality test with sensitivity tests in mature and immature teeth: clinical trial.

One of the most important steps in deciding on the treatment of a tooth is to determine the vitality and health status of the pulp. Since immature teeth innervation is not completed, the response to sensitivity tests may not yield definite results. Pulse oximetry (PO) which is considered as a vitality test, measures the arterial oxygen saturation (SpO2). This study aims to compare PO, electric pulp test (EPT) and cold test in mature and immature permanent teeth. 20 immature and 20 mature permanent incisors of 6-12-year-old ASA1 children who did not use any analgesics, were included in the study. Pulp vitality of the teeth was determined by EPT, cold test and PO. An infant probe of PO device (CMS60D, Contec Medical Systems Co. Ltd, China) was used to determine the SpO2 of the teeth. The SpO2 level is controlled on the patient's finger by a children's probe and an infant probe of PO. Shapiro-Wilk, Spearman rank correlation test and Kruskal-Wallis test/Dunn post-hoc analysis were used for statistical comparisons. There was no significant correlation between finger SpO2 and the mature/immature teeth SpO2 (r=-0.026, r = 0.253). Arterial oxygen saturation values in the immature teeth were significantly higher than in the mature teeth (p = 0.002). There was a high correlation between the vitality response of the EPT, cold test and PO. Pulse oximetry can be used as an effective vitality test compared to sensitivity tests in both immature and mature permanent incisors.

Pediatric Patient with Chronic Hyperplastic Pulpitis: Case Report and Pathology Overview

Pulp polyp (PP) is a type of irreversible pulpitis that occurs more frequently in young teeth, also referred to as chronic hyperplastic pulpitis or proliferative pulpitis, refers to a tissue condition characterized by excessive tissue growth in the pulp chamber. This process is often activated by an open cavity (traditionally induced by caries) and a chronic stimulus. This clinical case aimed to present a surgical traditional approach to extract a tooth diagnosed with a pulp pathology which is classified as a pulp polyp (PP) in a primary first molar. This article has been elaborated following the guidelines for case reports. A 7-year-old pediatric male patient with no systemic complications and no history of dental follow-up was referred to undergo care at the supervised internship clinic at the Maurício de Nassau University Center to assess his oral health condition in the year 2024 and to evaluate multiple caries lesions and sensitivity in some teeth. The patient didn’t show any painful symptoms or signs of secondary infection and did not respond positively to pulp tests. The extraction of unit 74 was performed with minor local anesthesia and atraumatic technique. The removal was successful and the child did not have any complications, the recovery went well, respectively. Pulp polyps can be treated by removing the pulp polyp followed by pulpectomy or root canal therapy, which removes the diseased pulp and seals the canals, or, in extreme situations, by teeth extraction.

Invasive Oral Squamous Cell Carcinoma Mimicking a Dentoalveolar Abscess: Report of a Case in a 14-Year-Old Patient

IntroductionA diagnosis of oral squamous cell carcinoma in adolescent patients is extremely rare. When an oral squamous cell carcinoma lesion arises near the teeth and/or periodontium, it can be easily misdiagnosed as an inflammatory condition of endodontic or periodontal origin. MethodsThis is a case report of an otherwise healthy 14-year-old patient who was referred for endodontic evaluation and treatment of a soft-tissue swelling in the anterior maxilla. ResultsThe unexpected definitive diagnosis of invasive oral squamous cell carcinoma underscores the importance of proper diagnostic testing. ConclusionsAccurate interpretation of pulp testing results, periapical and cone beam computed tomography imaging, timely biopsy, and prompt definitive treatment are critical when a lesion of nonodontogenic origin is suspected.

Exploring approaches to pulp vitality assessment: A scoping review of nontraditional methods.

Diagnostic procedures for pulp vitality assessment are a crucial aspect of routine dental practice. This review aims to provide a comprehensive overview of nontraditional techniques and methodologies for assessing pulp vitality, specifically exploring promising approaches that are currently not used in dental practice. The study protocol was registered a priori (https://osf.io/3m97z/). An extensive electronic search was conducted across multiple databases, including MEDLINE via PubMed, Scopus, Web of Science, and Embase. Inclusion criteria were guided by the research question based on the PCC model as follows: "What are the potential nontraditional techniques (Concept) for assessing pulp vitality (Population) in the field of endodontics or clinical practice (Context)?" Studies were included that explored possible approaches to pulp vitality assessment, utilizing a range of techniques, whilst any studies using traditional pulp tests (cold, heat, and electric stimulation) or well-known methods (pulse oximetry and laser Doppler flowmetry) were excluded. Reviewers independently screened articles and extracted data. A patent search was also performed. Of 3062 studies, 65 were included that described nontraditional approaches for assessing pulp vitality. These included a range of optical diagnostic methods, ultrasound Doppler flowmetry (UDF), magnetic resonance imaging (MRI), terahertz imaging, tooth temperature measurements, as well as invasive methodologies, including 133xenon washout, radioisotope-labelled tracers, hydrogen gas desaturation, intravital microscopy and fluorescent microspheres isotope clearance. The patent search included artificial intelligence and biomarkers methods. This review provides details for potential innovative tests that may directly describe pulp vitality. Importantly, these methods range from clinically impractical through to promising methods that may transform clinical practice. Several nontraditional techniques have the potential to enhance diagnostic accuracy and could provide valuable insights into the assessment of pulp vitality in challenging clinical scenarios.

Identification of the Ideal Reference Site and Pain Threshold Values for the Placement of Electric Pulp Testers in Permanent Upper and Lower Anterior Teeth: A Cross-Sectional Study.

Electric pulp testers (EPTs) are widely used diagnostic tools for diagnosing traumatized teeth. Several factors can affect the result of an electric pulp test. One such factor that will affect the diagnosis is the electrode tip placement. Hence, the current study aims to identify the most painful site and response time threshold in healthy anterior teeth. A total of 90 individuals, 48 male and 42 female, aged 19 to 25 years,were recruited. An EPT was placed on three different sites: the cervical, middle, and incisal third of the labial surface of both upper and lower anterior teeth (central incisor, lateral incisor, and canine) with an appropriate electrolyte as a conducting medium. Later, the threshold values were recorded, and pain assessment was done using the Memojis pain scale (MPS). Finally, the data was analyzed statistically using the Mann-Whitney U test. Mean and standard deviation values of reaction time were collected from 540 EPT readings (three sites from 180 teeth).Among the three sites tested, the difference between the upper and lower central incisors was statistically insignificant (p > 0.05). Similarly, when upper and lower lateral incisors and canines were compared, a statistically significant difference was observed among the three sites (p<0.05). There was a significant difference (p<0.05) in the pain scores only on the incisal and cervical thirds of the upper and lower central incisors. Only the incisal third showed a statistically significant difference (p<0.05) between the pain scores in the upper and lateral incisors. At the same time, a statistically significant difference in the pain scores was observed among the three tested sites between the upper and lower canines (p<0.05). Conclusion: Lower threshold values were appreciated at the incisal third of all the upper and lower anterior teeth for placing the EPT. Most individuals have experienced a score of 2 (hurts little bit) for the perceived pain using EPTs for both the upper and lower anterior teeth.

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P&gt;0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P&lt;0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Efficacy of TheraCal LC and Biodentine as Direct Pulp Capping Agents - An Clinico-Histological Study.

To assess clinically and histologically the efficacy of TheraCal LC and Biodentine as Direct Pulp Capping agents. Sixty caries-free maxillary first premolar teeth which were scheduled for orthodontic extraction were selected for the study and were divided equally into Group 1 (Theracal LC) and Group 2 (Biodentine). Thermal and electric pulp testing was performed on the teeth to assess pulp vitality followed by tooth preparation to expose pulp horns under local anesthesia. After achieving hemostasis, the direct pulp capping agent was placed and composite restoration was done. All the teeth were evaluated and compared in terms of clinical and histological findings after 6 weeks. The statistical analysis used was the Kruskal-Wallis test. Teeth with Theracal LC showed no sensitivity to heat, cold, or percussion, whereas sensitivity to heat, cold, or percussion was noted with Biodentine. Histological evaluation revealed that TheraCal LC has higher efficiency in complete dentin bridge formation, had maximum dentin thickness, and showed minimal or no pulpal disorganization and pulpal inflammation as compared to Biodentine. TheraCal LC proves to be a promising future as a direct pulp capping agent.