pulp test new presentation
TRANSCRIPT
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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