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Introduction: The ideal technique for the evaluation of pulp vitality should be noninvasive, painless, objective, reliable, and reproducible. To achieve this, the most routine tests are sensitivity tests. However, a major shortcoming with these tests is that they indirectly indicate pulp vitality by measuring a neural response. Pulse oximetry is a well-established oxygen saturation monitoring technique broadly used in medicine. However, its efficacy as the pulp vitality test should be evaluated. The aim of this study was to design and build a custom-made pulse oximeter dental probe and to evaluate its efficacy in comparison with electric pulp tester, cold spray, and a rubber cup in pulp vitality testing., Methods: Twenty-four single-canal mandibular premolars needing endodontic treatment were selected. The patients did not have systemic disease and did not consume drugs. Also, they had no clinically relevant signs of necrosis. The selected teeth were pulpally tested with 4 kinds of tests including pulse oximetry, the electric test, cold spray, and the rubber cup. After endodontic treatment of these teeth, which revealed the actual status of the pulp, the results were analyzed by the kappa test to show the efficacy of these tests., Results: When comparing electric, cold, heat, and pulse oximeter tests with the gold standard, the kappa agreement coefficient was 18%, 18%, 14%, and 91%, respectively. The sensitivity of pulse oximetry, a rubber cup, electric test, and cold spray was 0.93, 0.60, 0.60, and 0.53, respectively. The specificity of these tests was 1.00, 0.55, 0.22, and 0.66, respectively., Conclusions: Pulp testing by using pulse oximetry is more reliable than the electric test, rubber cup, and cold spray. The custom-made pulse oximeter dental probe is an effective and objective method for pulp vitality assessment., (Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Teeth with vital pulp are those with an adequate vascular supply, so the circulatory status, and not sensitivity response of the pulp tissue, has been proposed to assess pulp vitality. Some experimental methods have been used to assess this; one of them is the measurement of tooth temperature, which may indicate the pulp vasculature. Some authors have found no differences between the temperatures of teeth with vital and nonvital pulp; however, others found that teeth with nonvital pulp have lower temperatures than teeth with vital pulp. Temperature measurement as a diagnostic procedure has been described with the use of thermocouple, thermistors, infrared thermography, and cholesteric liquid crystals. Many factors may influence the results of the temperature measurement procedure. For creating controlled conditions, each patient should be examined in a thermologic environment. Patients should be asked to refrain from smoking and eating/drinking for 60 minutes before the procedure. The room should be insulated and draft free, and the temperature should be maintained at 20 degrees C. It is desirable to have them lie down or sit with adequate support for the head. The use of a rubber dam is also advocated. Tooth temperature measurement as a diagnostic procedure is reviewed to include description of devices for the test, associated factors, and value of the test.

After confirming that the gingival circulation had little effect on transmitted light plethysmography measurement in the upper central incisor in both in vivo experiments and numerical Monte Carlo simulation studies, a three-layer model comprising of a pulp chamber sandwiched between two dentin layers has been introduced to quantify the pulp chamber hematocrit (Hctp) from the measured optical density. Two-flux theory was utilized to derive a mathematical equation for transmitted intensity in terms of tooth dimensions, Hctp, and light-source wavelength. Each layer was assumed homogeneous so as to represent its optical properties by the bulk absorption and scattering constants. The mean error between the Hctp estimate based on the three-layer-model equation and the Hctp actual in the extracted model tooth was -0.00115 with standard deviation (SD) of 0.00733 at 522 nm wavelength, while for 810 nm +0.09157 and 0.02493. The Hctp estimate of the upper central incisor in 10 young volunteers at 522 nm using the three-layer model ranged from 0.002 to 0.061 with the mean of 0.032. The Hctp change reflects blood volume shift in the pulp microcirculation to possibly indicate dental pulp vitality.

Pulse oximeter is a well-established and noninvasive method for measuring vascular health by evaluating oxygen saturation. This study compared the efficacy of a custom-made pulse oximeter dental probe with the electric pulp testing and thermal testing for measuring pulp vitality status of recently traumatized permanent teeth. Readings for pulp vitality for 17 recently traumatized maxillary incisors were taken with custom-made pulse oximeter dental probe (group 1), electrical pulp tester (group 2), and thermal testing (group 3) over a 6-month period. The proportion of recently traumatized teeth showing a positive responsiveness in thermal/electric pulp tests increased from no teeth showing responsiveness on day 0 to 29.4% teeth on the 28th day, 82.35% of teeth at 2 months, and 94.11% teeth at 3 months. However, pulse oximeter gave positive vitality readings that remained constant over the study period from day 0 to 6 months in all patients.

Objectives: To assess whether it is possible to measure tooth vitality using magnetic resonance imaging (MRI)., Methods: Signal intensity measurements were conducted using T(1) and T(2) sequences at the region of interest in 211 teeth (35 patients)., Results: Clinical findings showed that 17.3% of the teeth were avital, whereas 82.7% were found to be vital. Neither the T(2) sequence nor the non-contrast-enhanced T(1) sequence showed significant differences between vital and avital teeth. However, the contrast-enhanced sequence and, in particular, a comparison of signal intensities between the non-contrast-enhanced T(1) sequence and the contrast-enhanced sequence showed a significant difference between vital and avital teeth., Conclusion: Contrast-enhanced MRI enables us to draw conclusions on pulpal perfusion in vivo.

The reliability of laser Doppler flowmetry in a 2-probe assessment of pulpal blood flow is well known. The purpose of this case report was to determine its use as an exclusive and reliable tool for tooth vitality diagnosis in a long-term follow-up. As a result of a traumatic injury to a 24-years old Caucasian female, tooth pulp vitality was studied in 6 maxillary front teeth over 30 weeks through use of 2-probe laser Doppler flowmetry and current sensitivity tests. A similar assessment was repeated after 228 weeks. Confronted with an alveolar bone fracture with a tooth in the fracture line, one intrusion and several luxated teeth, current sensitivity tests are found not to be so reliable indicators of revascularisation as significant results are given later (7 weeks) compared to laser Doppler flowmetry tests (1 week). A pathway with ischaemia (3 weeks), hyperaemia (7 weeks) and restored blood supply in the pulp measured by laser Doppler flowmetry tests was found and avoided endodontic treatment. Teeth vascularisation evolved normally (228 weeks). Despite a high indication in all sensitivity tests for endodontic treatment, the use of laser Doppler flowmetry tests was clear, more reliable than sensitivity tests and exclusive as denervation was postponed and pulp vascularisation was evident.

The aim of this study was to compare subjective sensation with objective neural discharges recorded by microneurography. We examined human teeth that did not respond to pulp vitality testing, but that responded to cavity preparation for endodontic treatment (pathophysiological). Intact teeth and endodontically obturated teeth were used as controls. Pulpal blood flow in the clinical crown and histological examination were also used. Most teeth, both in normal and pathophysiological conditions, did not respond to all pulp vitality tests. Even when teeth in the pathophysiological group showed spike discharges evoked by pulp vitality tests or from spontaneous activity no sensation was elicited. These results confirmed the usefulness of microneurography for research on pulpal sensation and the significance of summation in the perception of sensation in chronically inflamed tooth pulp.