endodontics

3. PULP VITALITY TESTS
• Assessment of pulp vitality is a crucial
diagnostic procedure in the practice of
Dentistry.
3

4. PULP TESTING:
PULP SENSIBILITY
TESTING
THERMAL TEST
1. COLD
2. HEAT TEST
ELECTRIC PULP
TEST
TEST CAVITY
ANESTHETIC
TESTING
PULP VITALITY
TESTING
LASER DOPPLER
FLOWMETRY
PULSE OXIMETRY
OTHERS
4
SPECTROPHOTOMETRY
TRANSMITTED LASER LIGHT
ULTRAVIOLET LIGHT
PHOTOGRAPHY

5. COLD TEST
5
ICE
• simplest cold
testing agent
• zero cost
CARBON
DIOXIDE
SPRAY
• CO2 snow, or dry
ice, is prepared
from a
pressurized liquid
CO2 cylinder
REFRIGERAN
T SPRAY
• Dichlorodifluorometane
(ozone layer depletion) So
replaced by tetrafluoroethane
or propen/butane/isobutene
gas mix.

6. • Cold thermal testing causes contraction of the dentinal fluid within the
dentinal tubules, resulting in a rapid outward flow of fluid within the patent
tubules. This rapid movement of dentinal fluid results in ‘hydrodynamic
forces’ acting on the Aδ nerve fibres within the pulp–dentine complex, leading
to a sharp sensation lasting for the duration of the thermal test.
• The cold test may be used to differentiate between reversible and irreversible
pulpitis.
• If the patient feels a lingering pain, even after the cold stimulus is removed, a
diagnosis of Irreversible pulpitis may be reached and if the pain subsides
immediately after stimulus removal, a diagnosis of Reversible pulpitis.
VELAYUTHAM GOPIKRISHNA, GALI PRADEEP & NAGENDRABABU VENKATESHBABU. Assessment of
pulp vitality: a review. International Journal of Paediatric Dentistry 2009; 19: 3-15.

7. • The cold test may be used to differentiate between reversible and irreversible pulpitis.
7
Application
of cold
stimuli
Contraction
of dentinal
tubule
Rapid
outflow of
fluid
Stimulate A
delta fiber
Sharp
sensation

9. HEAT TEST
9
agents for hot
stimuli
Hot
air
Hot
water
Hot
burnisher
Hot
guttapercha

10. • Area to be tested is isolated, dried and application of test agents.
• Applied on occlusobuccal 3rd of exposed crown.
• Avoid excessive heat or prolonged application.
• Activation of C fibres may result in a lingering pain, therefore heat tests should
be applied for no more than 5 s. However, inadequate heating of the gutta-
percha stick could result in the stimulus being too weak to elicit a response
from the pulp.

11. ANESTHETIC TEST
• Restricted to patient who are in pain at the time of test.
• Anesthetize one tooth at a time until pain disappear.
• Infiltration or intraligament injection is used.
• Injection is given in the Posterior most teeth in the area
of suspect.
11

12. TEST CAVITY
• Drilling through enamel-dentin junction of
unanesthetized tooth.
• Drilling in slow speed without use of water
coolant.
• If Sensitivity or pain felt – indication of pulp
vitality.
12

13. ELECTRIC PULP TEST
13
• Objective: to evaluate the vitality of the tooth by
stimulating the sensory fibers and based on response
we analyze the tooth.
• EPT is used to stimulate intact Aδ nerves in the pulp–
dentine complex by applying an electric current on the
tooth surface. A positive result an ionic shift in
the dentinal fluid within the tubules causing
local depolarization and subsequent generation
of an action potential from intact Aδ nerves.
• More accurate

14. PLACEMENT OF THE TIP
• FOR ANTERIORS : Incisal 3rd on labial surface of the tooth.
• FOR POSTERIORS : Middle 3rd on labial surface of the tooth.

15. TECHNIQUE
Describe test to patient to reduce anxiety
Isolation of teeth
Check electric pulp tester for function
Apply electrolyte on tooth electrode
Place on dried enamel on occlusobuccal or incisolabial surface
Retract patient cheek away
Complete the circuit by asking patient to touch the metal handle
Turn rheostat slowly to increase current slowly
Ask patient to indicate when sensation felt
Record result according to numerical scale on tester
15

16. POSITIVE RESPONSE – INDICATION OF VITALITY
NO RESPONSE – INDICATION OF PULP NECROSIS
• False positive results
A non-vital tooth appears to respond positively to testing:
• Moist necrotic pulp.
• Multi-rooted teeth with partially necrotic pulp.
• False negative results
it means that a vital tooth has not responded positively to testing:
• incomplete root development, which have a higher threshold .
• Calcification in pulp and dentin is extensive.
16

17. 17
Non-invasive device used for
recording blood oxygen
saturation levels during the
administration of intravenous
anaesthesia.
Pulse oximetry
WORKING OF A PULSE OXIMETER. (A) LED-EMITTING RED LIGHT AT 660 NM. (B) LED
EMITTING INFRARED LIGHT AT 940 NM. (C) PHOTODETECTOR. (D) PULSE OXIMETER
MONITOR. (E) PULSE OXIMETER SENSOR. (F) CUSTOM-MADE PULSE OXIMETER
SENSOR HOLDER. HBO2, OXYGENATED HEMOGLOBIN; HBR, DEOXYGENATED
HEMOGLOBIN; SPO2, OXYGEN SATURATION OF ARTERIAL BLOOD

18. 18
LED transmits red and infrared light through a
vascular bed such as finger or ear.
Oxygenated haemoglobin and deoxygenated
haemoglobin absorb different amounts of
red/infrared light.
The pulsatile change in the blood volume causes periodic
changes in the amount of red/ infrared light absorbed by the
vascular bed before reaching the photo detector.
This change analysed by pulse oximeter to determine the saturation
of arterial blood

19. • Advantages
Effective and objective method of evaluating dental pulp vitality.
• Useful in cases of impact injury where the blood supply remains intact but the
nerve supply is damaged.
• Pulpal circulation can be detected independent of gingival circulation.
• Pulp pulse readings are reproducible.
• Smaller and cheaper commercial oximeters are now available for routine clinical
use in an average dental office.
• Drawbacks
• Background absorption associated with venous blood and tissue constituents is
not differentiated.
• Probes should be specific for the anatomy of a tooth as the oxygen saturation
values from the teeth routinely register lower than the readings from the
patient's finger 19

20. LASER DOPPLER FLOWMETRY
• Laser Doppler flowmetry technique was first described in dental literature in
1986 by Gazelius et al.
• NON INVASIVE, OBJECTIVE, PAINLESS
• Measure velocity of red blood cells in capillaries.
• Flowmeter produces regular signal fluctuations for vital teeth.
• Non vital teeth showed no such synchronous signals but produced irregular
fluctuations or very steep spike traces that are attributed to a movement artifact. 20

21. 21
 Pulp-testing in children: sensibility tests are not reliable in children, because they
are subjective and rely upon patient's response. LDF is a suitable method for the
measurement of Peripheral Blood Film (PBF) in deciduous incisors.

22. Advantages
• Accurate
• Reliable
• Reproducible
• Non painful
• Luxation injuries
• Useful in young children whose responses are unreliable and its non invasive nature
helps to promote patient cooperation and acceptance.
Limitations
Too expensive a device for use in a dental office.
• The sensor should be maintained motionless and in constant contact with the tooth
for accurate readings.
• The laser beam must interact with the moving cells within the pulpal vasculature.
22

23. REFRENCES
• Textbook of Pediatric Dentistry by “Pinkham”.
• Velayutham Gopikrishna, Kush Tinagupta, and Deivanayagam Kandaswamy. Evaluation
of Efficacy of a New Custom-Made Pulse Oximeter Dental Probe in Comparison With the
Electrical and Thermal Tests for Assessing Pulp Vitality. JOE — 2006.12.003.
• Grossman’s Endodontic Practice (twelfth edition) – Chapter 4 – ‘Diseases of the Dental Pulp’
• Textbook of Pediatric dentistry by ‘‘Nikhil Mariah’’.
• Peterson K, Soderstrom C, Kiani-Anaraki M, Ltvy G. Evaluation of the ability of thermal and
electrical tests to register pulp vitality. Endod Dent Traumatol 1999; 15: 127-131.
• Textbook of Pedodontics by ‘‘Shobha Tandon’’.
• Samraj RV, Indira R , Srinivasan MR, Kumar A. Recent advances in pulp vitality testing.
Endodontology, 2003 Vol.15.
• Textbook of Pedodontics by ‘‘Shobha Tandon’’.
• Gopikrishna V et al. Assessment of pulp vitality: a review. International Journal of
Paediatric Dentistry 2009; 19: 3-15.
• Textbook of Pediatric dentistry by S. G. DAMLE