Pulp Test New Presentation

8/4/2019 Pulp Test New Presentation

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DR ASMA NAWAZ CHANNA

FCPS 2 TRAINE

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Pulp testing is a useful and

essential diagnostic aid in

pulp disease and apicalperiodontitis.(2)

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Indications of pulp testing are

1. Assess pulp vitality.

2. Prior to procedure.

3. After trauma.

4. For differential diagnosis.

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1.PULP SENSIBILITY TEST:

Assessment of pulp

response.thermal and electric test.(1)

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2.PULP VITALITY TEST:

Assessment of the pulps

blood supply1. Pulp tissue may have have

an adequate vascularsupply but is not

necessarily innervated.

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Is better measure of true

pulp health then

sensibility.(1)1. Laser Doppler flowmetry

2.

Pulse oximetry3. Dual wavelength

spectrometry(3)

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Assessment of pulpsensibility using routine

methods rely on thestimulation of A nervefibers and there is no direct

indication of the bloodflow.

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Two methods are used tostimulate the A nerve

fibers1. Thermal stimulation

2. Electrical stimulation

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Pulp sensibility tests are

most commonly used

clinically, they are notwithout shortcomings and

limitation.(1)

They yield false positive and

false negative response.(3)

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There are two types:

Cold test

Hot test

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Reponses may be:

Sharpe localized

pain/tingling sensation forthe duration of the appliedtest and for a few second

after a removal of stimuluspulp is healthy(positiveresponse.(2)

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A pulp response lasting more

than half a minute after the

stimulus has been removed isindicating an irreversibly

inflamed pulp.(2)

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No response from the patient

to such stimulation is

normally indication of anecrotic pulp (negative

response.(2)

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It the primary method formany clinicians today.

Cold testing should be usedin conjunction with anelectric pulp tester so that

the results from one test willverify the findings of othertest.

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Cold test technique isespecially used for patient

present with porcelain jacketcrown or porcelain fused tometal.(4)

It requires noarmamentarium exceptrubber dam.(4)

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It help us to distinguishbetween normal and

inflamed pulp(pulpits):1. A response indicates that

nerves are alive .(5)

2. An exaggerated responsemay indicate an in flamedpulp.(5)

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1. No response may indicatethe coronal pulp is

necrotic.(5)2. A prolong and lingering

response after removal of

cold stimuli, usuallyindicates irreversiblepulpits.(5)

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1. False negative response

when there are calcified

canal.2. False positive response

when cold contact with

gingiva.

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Ethyl chloride

Ice

Ice cold waterCo2 snow

Refrigerant spray

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Conventionally made by

filling sterilized discarded

needles/needlesheath/cartridges with water

placing it in freezer.(2,5)

rubber dam

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Fig. Tooth isolated with rubber dam and

bathed in cold water


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-69F _ 119F.(4)-56C_98C .(4)

Frozen CO2,Also known as

dry ice or CO2 snow .(4)

Found to be reliable ineliciting +ve response if vital

pulp present.23


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Fig. Plastic cartridge attached toa cylinder of CO2.

Fig. A stick of dry ice in its applicator

on the tooth


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most widely used.(4)

Result equivalent to CO2.(4)

Ethyl chloride.Dichlorodifluoromethane(DDM).(4)

Tetrafluoroethane(TFE) or(EndoFrost,Roeko,Langenae,Germany).(1,4)

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Fig. A container of compressed refrigerant

spray,dichloro-difluoro-methane (Endo-

Frost, Roeko, Langenau,

Germany).

Fig. Iced cotton pellet in tweezers

following spraying of Endo-Fro


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Temp of TFE is -26.2C.(4)

Always use large#2 cotton

pellet.(4)Apply on mid facial area of

tooth.

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Most useful when a patient

chief complaint is intense

dental pain with hot.(4) start with most posterior

tooth.(4)

Individual tooth rubber dam

isolation indicated.(4)

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Hot water bath.

GP or Compound stick.

Dry rubber polishing cup.

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Fig. Tooth isolated with rubber dam and

bathed in hot water


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Light layer of lubricant

should be applied.(4)

required temp 150C.(4)

Fig. Heated stick of gutta-percha (Obtura) applyingheat to a tooth. Pitt and pael


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Frictional heat may

generated.(4)

34Fig. A rubber cup applied to a tooth togenerate frictional heat


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Response indicate someviable nerve fibers are

present( positive ).(4)EPT results are mostaccurate when no response

obtain(negative). (4)Only works if probe place onnatural tooth structure. (4)

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Isolate the tooth.

Tip of the probe should be

coated with conductingmedium.

Probe placed on incisal 1/3

of facial or buccal surface.

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Fig. An isolated tooth undergoing electric

pulp testing. Electrical conducting gel ispresent between the

electrode and the tooth.


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Fig. An isolated tooth undergoing electric

pulp testing. A hook on the patients lip

completes the circuit. Rubber dam has

been used to isolate the tooth from those

adjacent.


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Complete coverage crown.

Extensive restoration

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A small tip for the electric

pulp tester can be used

under crown margins.

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PULSE OXIMETRY:PULSE OXIMETRY Studies showblood circulation and not

innervations is most accuratedeterminant in assessing pulpvitality.

It is a non invasive oxygensaturation monitor whichprovides continuous pulse ratereading.

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Records blood oxygensaturation levels.

Inflammation, causesdeoxy. of Hb andchange in oxygen

saturation of theblood.

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Uses information with known

absorption curves for

oxygenated & deoxygenatedHb to determine oxygen

saturation levels.

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Detects pulpal inflammation,

Partial necrosis in teeth that

are still vital.

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Measures oxygenation

changes in the capillary bed

rather than in the supplyvessels.

DWLS detects the presence

or absence of oxygenated

blood at 760 nm and 850nm

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DWLS able to differentiate with

reproducible readings between

a pulp chamber of a vital andnon-vital tooth in vivo.

Instrument is small, portable,

relatively inexpensive andsuitable for use in a private

dental office.

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In young children ,in cases of

avulsed and replanted teeth

with open apices the bloodsupply is regained within first

20 days after replantation

but nerve supply lags behind.

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This instrument can give

readings much before the

electrical pulp tester & canshow that the pulp is

healing.

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A non-invasive, electrooptical technique.

Allows semi-quantitativerecording of pulpal bloodflow.

Measures blood flow in thevery small blood vessels ofthe microvasculature.

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Fig. LDF probe showing laser light guides

Fig.LDF probe applied to a sectioned

tooth

showing the passage of light via the

enamel prisms and dentinal tubules to

the pulp.


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Fig. 15. Two probes have been placed in a

putty impression splint for accurate

location on the teeth while the trace is

being recorded.

Fig. The splint in position on the patient

teeth


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Uses a laser beam of known

wavelength directed through

crown of tooth to bloodvessels within pulp.

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Moving red blood cells

cause frequency of laser

beam to be Doppler shiftedand some of light to be back

scattered out of tooth.

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Moving red blood cells cause

frequency of laser beam to

be doppler shifted and someof light to be back scattered

out of tooth.

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The output of which is

proportional to the number

and velocity of the bloodcells.

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The position of crown of toothand location of the pulp withintooth cause variation.

Antihypertensive medications &nicotine affect blood flow tothe pulp.

Equipment is expensive.

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1. Eugene and paul,Dental pulp testing:AReview,International journal ofdentistry.volume2009.ArticalID365785,12pages,doi:10.1155/2009/365758

2. Thomas R.PITT FORD AND SHANON PATEL,Technical equipment for assessment ofdental pulp status,Endodontic topics 2004

3. Samraj RV ,Indera R,Srinivasan MR,KumarA,Resent advances in pulp vitality testing

4. Pop 9th edition

5. Hartys

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Conclusion

An accurate assessment of tooth vitality is of

paramount importance in clinical practice.

Although sensitivity testing is the de facto standard employed by the majority of clinicians,

it has acknowledged limitations. Rapid

advances in knowledge and applied technology

relating to pulpal blood flow may lead the way for a more objective, accurate, and predictable

means of pulp vitality assessment

Documents

Pulp Test New Presentation