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Objectives: To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth., Background: Cracks are a common clinical finding in teeth and yet clinicians still struggle to identify the full extent and orientation of cracks for their appropriate timely management. The biomechanics of crack development can be due to multiple factors and can differ from an unrestored tooth to a restored or endodontically treated tooth., Data & Sources: This narrative review has been designed following the guidelines published by Green et al. 2006 [1] Published literature in the English language that addresses the objectives of this review up to July 2022 was sourced from online databases and reference lists. The relevance of the papers was assessed and discussed by two reviewers. A total of 101 publications were included in this narrative review., Conclusions: The initiation and development of cracks in teeth are likely linked to an interplay between the masticatory forces and fracture resistance of the remaining tooth structure. From the identified literature, the quality and quantity of remaining tooth structure in a restored or endodontically-treated tooth affects the biomechanics of crack development compared to an unrestored tooth. The extent, orientation, and size of the cracks do affect a clinician's ability to detect cracks in teeth. There is still a need to develop reliable diagnostic tools that will accurately identify cracks in teeth beneath restorations to enable effective monitoring of their propagation and provide appropriate interventions., Clinical Significance: The development and propagation of cracks in an unrestored tooth differ greatly from a restored and endodontically treated tooth; mainly linked to the quantity and quality of the remaining tooth structure and the forces acting on them. Identifying the extent of cracks in teeth remains challenging for early clinical intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review., Competing Interests: Conflict of interest: None declared., (Copyright: © 2020 European Endodontic Journal.)

Statement of Problem: Conventional diagnostic aids based upon imagery and patient symptoms do not indicate whether restorative treatments have eliminated structural pathology., Purpose: The purpose of this clinical study was to evaluate quantitative percussion diagnostics (QPD), a mechanics-based methodology that tests the structural integrity of teeth noninvasively. The study hypothesis was that QPD would provide knowledge of the structural instability of teeth after restorative work., Material and Methods: Eight participants with 60 sites needing restoration were enrolled in an IRB-approved clinical study. Each participant was examined comprehensively, including QPD testing. Each site was disassembled and microscopically video documented, and the results were recorded on a defect assessment sheet. A predictive model was developed for the pathology rating based on normalized fit error (NFE) values using data from the before treatment phase of the study published previously. Each restored site was then tested using QPD. The mean change in NFE values after restoration was evaluated by the pathology rating before treatment. The model was then used to predictively classify the rating after restoration based on the NFE values after treatment. The diagnostic potential of the rating was explored as a marker for risk of pathology after restoration., Results: After restoration, 51 of the 60 sites fell below an NFE of 0.04, representing a greatly stabilized tooth site sample group. Several sites remained in the high-risk category and some increased in pathologic micromovement. Two models were used to determine severity with indicative cutoff points to group sites with similar values., Conclusions: The data support the hypothesis that QPD can indicate a revised level of structural instability of teeth after restoration., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Introduction: Accurate identification and assessment of an inflamed or necrotic tooth is essentialfor endodontic treatment. The purpose of this research was to investigate possible sources of error associated with the use of the electric pulp tester (EPT)., Methods: Forty-six intact teeth (23 tooth pairs) in 22 patients were evaluated in vivo. For the tooth pairs, one tooth had to have been previously endodontically treated and restored with a class II amalgam restoration. The restoration was required to have proximal contact with a class II amalgam of another vital posterior tooth. EPT was performed on pulpless and vital teeth for experimental groups (enamel, restoration, contacting, or isolated)., Results: The highest rate of false positive responses (82%) was found in the pulpless restored contacting group, suggesting that EPT impulses are able to travel through proximal metallic contacts and stimulate teeth distant from the EPT probe. All vital tooth groups had a high rate of positive responses with no significant diferences., Conclusions: If a tested tooth contains an interproximal restoration contacting adjacent restorations or the gingival, the teeth must be isolated (rubber dam) and the EPT probe should be placed in a region suspected to have uninterrupted tubule paths to the pulp.

Treatment of an endo-perio lesion involving a non-vital young permanent tooth is a highly challenging task to Pediatric Dentists. There is a quest for the newer biological approach to management of these lesions as traditional methods have various disadvantages. Recently, platelet-rich fibrin (PRF), a second-generation platelet concentrate, is rich in growth factors have been used in the periodontal regeneration procedure. The purpose of this paper is to describe the efficacy of PRF in the treatment of a deep intra bony defect associated with an endo-perio lesion in an immature right mandibular first premolar of 12-year-old female patient. A freshly prepared autologous PRF membrane was placed in the bony defect following debridement. Clinical and radiographic follow-up were performed at regular intervals that revealed absence of pain, gain in clinical attachment level, reduction in probing depth, and excellent bone regeneration indicating successful outcome.

Management of the pulpal tissue in primary teeth is a clinical challenge facing dental practitioners on a regular basis. This article reviews the most common treatments used at the present time in the management of the pulp in deciduous teeth. It gives an overview of treatment options and the indications and contra-indications for the different treatment modalities. The evidence behind the medicaments used, their actions and success rates are discussed. Practical guidelines for choosing to retain or extract deciduous teeth and management of the primary tooth pulp with different clinical presentations are discussed. Areas of future research are highlighted.

Aims: To examine (1) the occurrence of magnetic resonance imaging (MRI) signal changes in the painful regions of patients with atypical odontalgia (AO) and (2) the correlation of such findings to periapical bone defects detected with a comprehensive radiographic examination including cone beam computed tomography (CBCT)., Methods: A total of 20 patients (mean age 52 years, range 34 to 65) diagnosed with AO participated. Mean pain intensity (± standard deviation) was 5.6 ± 1.8 on a 0-10 numerical rating scale, and mean pain duration was 4.3 ± 5.2 years. The inclusion criterion was chronic pain (> 6 months) located in a region with no clear pathologic cause identified clinically or in periapical radiographs. In addition to a clinical examination and a self-report questionnaire, the assessments included radiographic examinations (panoramic, periapical, and CBCT images), and an MRI examination. Changes in MRI signal in the painful region were recorded. Spearman's rank correlation between radiographic and MRI findings was calculated., Results: Eight of the patients (40%) had MRI signal changes in the pain region. The correlation to radiographic periapical radiolucencies was 0.526 (P = .003). Of the eight teeth displaying changes in MRI signal, six showed periapical radiolucency in the radiographs., Conclusion: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings.

Introduction: Inflammatory cysts, granulomas, abscesses, and fibrous scars represent most periapical radiolucencies. However, other less common lesions, such as orthokeratinized odontogenic cysts (OOCs), can be found at this region, and they deserve to be discussed because the prognosis for an OOC is different from that expected for the ordinary inflammatory periapical diseases., Methods: An interesting case of OOC associated with a nonvital tooth in a 40-year-old woman is described. After a previous clinical diagnosis of a radicular cyst, the tooth was extracted, and the lesion was enucleated and submitted to microscopy examination., Results: Because of the detection of an orthokeratinized epithelium lining, a diagnosis of OOC was concluded. After 2 years of periodic follow-up, no signs of recurrence were detected., Conclusions: The presence of keratin in radicular lesions must be carefully evaluated to eliminate the diagnosis of lesions with more aggressive behavior, such as an OOC or even a keratocystic odontogenic tumor. Hence, histopathologic examination is mandatory to confirm the type of lesion and to differentiate other pathologic conditions, therefore establishing patients' prognoses precisely., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Vertical root fracture is a frequent complication in endodontically treated teeth and usually leads to extraction of the affected tooth. Differential diagnosis may be difficult, especially in patients with periodontal and endodontic disease. This case report describes the diagnosis and clinical and radiographic features of apical periodontitis and vertical root fracture of the same tooth, which were separated by an interval of several years. Vertical root fracture of the mesial root was diagnosed with the help of an exploratory flap and microscopic observation.

Supernumerary teeth are common in general population and occur frequently in patients with familial trait. However, it is rare to find supernumeraries in individuals with no associated disease or syndrome. Supernumerary teeth are found in any region of maxilla and mandible, with a predisposition for anterior maxilla. A case of endodontically involved supernumerary lateral incisor is described.

The restoration of endodontically treated anterior teeth (ETAT) may pose a significant clinical challenge given the wide variety of therapeutic options available. Accurate analysis of the remaining tooth structure is critical in the diagnostic process, leading to selection of the proper treatment option. A novel, simple, and precise classification that allows the evaluation of ETAT is presented. Important factors related to the crown or abutment such as height, wall thickness, and circumferential integrity and root-related factors such as diameter of the canal, depth of the preparation, and canal shape are discussed. This classification may serve to establish a comprehensive diagnosis and assign prognosis to ETAT, which may be helpful for interclinician communication and standardized comparisons in clinical research.

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.)

Introduction: The aim of this study was to compare the clinical accuracy, reliability, and repeatability of laser Doppler flowmetry (LDF), an electric pulp test (EPT), and various thermal pulp sensibility tests., Methods: Pulp tests were done on 121 teeth in 20 subjects by using LDF, EPT, and thermal pulp testing (CO(2), Endo Frost [EF], Ice) during 2 or 3 test sessions with at least 1-week intervals. The order of testing was reversed on the second visit. A laser Doppler flowmeter was used to measure mean pulp blood flow (Flux) calibrated against a brownian motion medium and zeroed against a static reflector. The laser source was 780 nm, with 0.5-mm fiber separation in the probe, 3.1 kHz as the primary bandwidth for filter set to 0.1-second time output constant. Customized polyvinylsiloxane splints were fabricated for each participant, and a minimum of 90-second recording time was used for each tooth. Raw data were analyzed by using repeated measure analysis of variance, pairwise comparisons, and interclass correlations (ICC)., Results: The accuracy of EPT, CO(2), and LDF tests was 97.7%, 97.0%, and 96.3%, respectively, without significant differences (P > .3). Accuracy of EF and Ice was 90.7% and 84.8%, respectively. EPT (P = .015) and CO(2) (P = .022) were significantly more accurate than EF. LDF was more accurate than EF, but this was not statistically significant (P = .063). Ice was significantly less accurate than EPT (P = .004), CO(2) (P = .005), LDF (P = .006), and EF (P = .019). With the exception of Ice (effect of visit: F(2,38) = 5.67, mean squared error = 0.01, P = .007, η(2)(p) = 0.23), all tests were reliable. Ice (ICC = 0.677) and LDF (ICC = 0.654) were the most repeatable of the tests, whereas EPT (ICC = 0.434) and CO(2) (ICC = 0.432) were less repeatable., Conclusions: CO(2), EPT, and LDF were reliable and the most accurate tests, but CO(2) and EPT were less repeatable yet less time-consuming than LDF. EF was reliable but not as accurate as EPT and CO(2) and less repeatable than Ice and LDF. Ice was the most repeatable but the least accurate and least reliable test., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

BACKGROUND. Accurate determination of the pulp status is the most important part of conservative pulp therapy. AIM. The aim of this study was to assess the ability of thermal and electrical pulp tests to assess the pulp status in primary teeth. DESIGN. Seventy-eight primary molar teeth in 36 children were investigated. Fifty-six teeth had unknown pulp status in need of endodontic treatment, and 22 were intact teeth with no signs of pulp disease. Cold, hot and electrical pulp testing (EPT) were performed on each tooth. The gold standard was established by direct inspection of the pulp after an access cavity had been made. The sensitivity, specificity, positive and negative predictive values for each test and different sequential combinations of pulp testing were calculated. Sequential combination test analysis was used for data analysis. RESULTS. The highest accuracy was found for EPT, followed by heat and cold tests. No significant difference was found between the accuracy of EPT and the heat test (P-values > 0.05); however, the accuracy of EPT was significantly higher than that of the cold test (P-value< 0.05). CONCLUSION. Based on this study, EPT can be used as a reliable test for diagnosing the pulp status in primary teeth., (© 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.)

This study was designed to evaluate and compare the reliability of laser Doppler flowmetry (LDF), pulse oximetry (PO) and electric pulp tester (EPT) for assessing the pulpal status as a vitality test method by calculating their sensitivity, specificity and predictive values. Data were collected from 59 pairs of maxillary anterior teeth (38 pairs of central, 21 pairs of lateral incisors) in 51 patients (range 12-18years, mean age 14·6±1·73years, 28 women, 23 men). The teeth with complete endodontic fillings constituted the study group, and the healthy, contralateral teeth of the same patients were constituted the control group. The calculated sensitivity was 0·915 for the EPT and 0·813 for the PO. And the specificity of EPT was 0·881 and PO was 0·949. The difference between the LDF values obtained from the study, and control group was statistically significant (P=0·0001). The findings of this study indicated that LDF can reliably discriminate the vitality of the teeth with a sensitivity and specificity of 1·0 for this sample. Laser Doppler flowmetry was found to be a more reliable and effective method than PO and EPT of assessing the pulpal status of human teeth., (© 2010 Blackwell Publishing Ltd.)

Background: This case report describes a dilemma that occurred after a maxillary right lateral window sinus lift was performed. The patient developed a gnawing pain in the sinus region but manifested no signs of sinusitis, and the subjacent teeth were asymptomatic. Differentiating between a pain that could be originating in the maxillary sinus or adjacent premolars was problematic., Methods: After several weeks, a CT scan revealed no signs of sinusitis, despite the patient's belief that her discomfort was caused by her sinus lift. By the process of elimination, the decision was made to extract subjacent, asymptomatic premolars that had 50% bone loss and were previously endodontically treated., Results: Extraction of asymptomatic premolars resulted in total elimination of her pain., Conclusions: A differential diagnosis with regard to the source of the patient's pain had to be arrived at by the process of elimination rather than by validation. Confirmation that there was no sinus infection facilitated making the decision to remove asymptomatic premolars.

Anomalies, though rare, are potential restorative and endodontic challenges. This case report presents a unique case with a bizarre combination of anomalies, including single conical unbifurcated posterior root forms, taurodontism, dens invaginatus, prominent labial lobes of the canines, pyramidal cusps of the premolars, dens evaginatii of the molar crowns, and localized reduction in tooth size involving the entire dentition without any other apparent systemic complication. On literature review, only 4 such cases were found to be reported. An accurate assessment of the presence of single conical unbifurcated posterior root forms was made with the help of spiral computerized tomography. This case report highlights the use of high-end diagnostic imaging modalities such as spiral computerized tomography in making a confirmatory diagnosis of the multiple morphologic abnormalities.

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.

Endodontic disease is a highly prevalent (>10% of all dogs) and insidiously painful process that can have significant local and systemic effects. The root canal system is a delicate organ and is prone to inflammation, infection, and partial and complete necrosis. Vital pulp therapy must be performed quickly, gently, and meticulously if it is to be effective. The relatively high rate of failure in direct pulp capping makes regular follow-up radiographs of critical importance to ensure patient health. Once a tooth is dead, there are often no obvious clinical signs; therefore, clinicians must be educated in the diagnosis of the disease processes. Once properly educated, the practitioner must remain vigilant for subtle signs of the disease process. Standard root canal therapy is an effective method of removing the inflammation, infection, and associated discomfort of the endodontically diseased tooth while maintaining its function. Endodontic failure most likely remains hidden unless dental radiology is used. Follow-up radiographs at regular intervals throughout the patient's life are critical for ensuring the long-term success of any endodontic therapy.

Pulp sensitivity and vitality changes were evaluated in 69 traumatized maxillary incisors and in 38 control teeth during a follow-up period of 20 months. Examinations included thermal testing using carbon dioxide snow (CO2) and the laser Doppler flowmetry (LDF). These measurements were compared to the clinical and radiological findings. In 47.8% of the traumatized teeth and in 55.3% of the control group the three LDF measurements corresponded with the sensitivity testing using CO2 and with the clinical and radiological findings. In 31.9% of the traumatized teeth and in 7.9% of the control group the LDF-measurements differed from the CO2-measurements, but were in agreement with the other clinical and radiographic findings. The information obtained by laser Doppler flowmetry is of additional importance for the treatment planning. Since the clinical examination of traumatized teeth is sometimes inconclusive, the laser Doppler flowmetry is a further diagnostic tool but it cannot replace the radiological or clinical examination.

A case is presented of a 13-year-old boy with chronic idiopathic thrombocytopenic purpura (ITP) who sustained traumatic labial luxation of both lower central incisors, with partial alveolar fracture resulting in displacement of the labial alveolar plate. Intravenous immunoglobulin (Fleibogamma, 1 g/kg body weight x 2 days) was administered, resulting in the patient's platelet count rising from 15,000/mm3 to 70,000/mm3. Under general anesthesia, the displaced lower labial alveolus and luxated teeth were repositioned and splinted 2 days following trauma. Healing was uneventful. Subsequently, both lower central incisors became nonvital and were endodontically treated. The dental treatment of this patient with ITP is discussed in terms of emergency management, and subsequent care.

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.

There is little evidence for which cold delivery method is most accurate in determining pulp responsiveness. This study compared carbon dioxide dry ice sticks (CO2) versus refrigerant spray (RS) to generate a patient response from different types of teeth restored to varying degrees. Fifteen human patients were selected. In each quadrant, three teeth were identified and the restoration type recorded. Blindfolded patients were randomly tested with either CO2 or RS in a crossover design at two different sessions. Responsiveness was recorded as yes/no and the interval (in seconds) from application to response was determined. Results showed that (a) CO2 and RS were equivalent in producing a pulpal response regardless of tooth and presence of restoration, and (b) CO2 took significantly (p < 0.05) longer to evoke a response than RS using paired t tests. In conclusion, RS and CO2 were equivalent in determining pulpal responsiveness, but the elicited response from RS was faster.

This retrospective study ascertained the incidence and clinicopathologic features of central giant cell granulomas (CGCGs) associated with teeth with necrotic pulps or teeth that had received previous endodontic treatment and determined whether periapical CGCGs can result in endodontic misdiagnosis. Clinical and histopathologic data of biopsy specimens diagnosed as CGCG were collected from the archives of the Oral Pathology Laboratory, Temple University, and were reviewed. Over the 9-year period, 16 of 79 cases (20%) of CGCG were associated with a tooth that had a history of pulp necrosis. Of those, 14 (88%) were associated with previous root canal treatment. The data from this series of 79 cases of CGCG also showed that CGCGs were less common in women, less common before age 30, and did not cross the midline of the jaw as often as previously reported. Clinical and histopathologic data were compared from (1) CGCGs associated with teeth with vital pulps or that occurred in edentulous areas; (2) CGCGs associated with teeth with necrotic pulps; and (3) 194 cases of periapical granulomas and radicular cysts. These data strongly suggest that CGCGs associated with teeth with necrotic pulps are not directly related to periapical inflammation and may be misdiagnosed as endodontic lesions. Posttreatment follow-up and routine submission of periapical surgical specimens are emphasized.

A healthy 26 year old female underwent unsuccessful surgery for an incorrectly diagnosed sebaceous cyst in the cheek. Eventually the problem was traced to a non-vital tooth 24. When the tooth was treated endodontically, the situation resolved in one week.

Laser Doppler flowmetry is a non-invasive electrooptical technique which allows the semi-quantitative recording of pulpal blood flow. This study aimed to determine the reliability (measured as the sensitivity and specificity) of laser Doppler flowmetry as a method of assessing the vitality of traumatised anterior teeth, and to compare it with standard pulpal diagnostic tests. Recordings of pulpal blood flow were taken from 67 non-vital anterior teeth (55 patients), where the pulpal status was confirmed by pulpectomy. For comparison, recordings were also taken from 84 vital anterior teeth (84 patients). Analysis of the recordings allowed diagnostic criteria to be developed which gave the technique a sensitivity and specificity of 1.0 for this sample. None of the other standard pulpal diagnostic methods tested was as reliable. This was usually due to low sensitivities, which ranged between 0.92 for sensibility testing with ethyl chloride down to 0.36 for periapical radiolucency and 0.16 for a history of pain. Laser Doppler flowmetry was found to be a reliable method of assessing the pulpal status of traumatised anterior teeth, although it is technique-sensitive and time-consuming to use.

The aim of the present study was to evaluate the ability of thermal and electrical tests to register pulp vitality. Sensitivity, specificity, negative predictive value and positive predictive value were calculated by comparing the test results with a "gold standard". The thermal tests studied were a cold test (ethyl chloride) and a heat test (hot gutta-percha). For the electrical test, the Analytic Technology Pulp Tester was used. The examined teeth were 59 teeth with unknown pulpal status in need of endodontic treatment and 16 intact teeth, all with radiographically normal periapical bone structures. In total 46 teeth with vital pulps and 29 teeth with necrotic pulps were tested. This gave a disease prevalence of 39%. The gold standard was established by direct pulp inspection of the 59 teeth in need of endodontic treatment. In the 16 intact teeth the pulp was judged as vital. The number of true positive (TP), false positive (FP), true negative (TN) and false negative (FN) test results was calculated for each method as compared to the gold standard. Based on this, the sensitivity, specificity, positive predictive value and negative predictive value were calculated for each method. The sensitivity was 0.83 for the cold test, 0.86 for the heat test and 0.72 for the electrical test. The specificity was 0.93 for the cold test, 0.41 for the heat test and 0.93 for the electrical test. The positive predictive value was 0.89 for the cold test, 0.48 for the heat test and 0.88 for the electrical test, and the negative predictive value was 0.90 for the cold test, 0.83 for the heat test and 0.84 for the electrical test. This indicated that the probability of a non-sensitive reaction representing a necrotic pulp was 89% with the cold test, 48% with the heat test and 88% with the electrical test. It also indicated that the probability of a sensitive reaction representing a vital pulp was 90% with the cold test, 83% with the heat test and 84% with the electrical test.

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.

Odontogenic keratocysts manifest themselves as radiolucencies that can appear anywhere in the maxilla or mandible, including periradicular areas; they may thus masquerade as lesions of endodontic origin. This retrospective study examined 239 odontogenic keratocysts received by the Oral Pathology Laboratory at Temple University School of Medicine over a 3-year period. Twenty-one (9%) of the cysts received were located periradicularly; of these 21, 12 (57%) were associated with nonvital or endodontically treated teeth and thus mimicked lesions of endodontic origin. Because of its aggressive nature and tendency to recur, the periradicular odontogenic keratocyst should be included in the differential diagnosis of lesions that are refractory to endodontic treatment.