Sensibility tests
• Sensibility test: reference tooth
- Thermal stimulus
• We mostly use cold stimulus
• Concept: a healthy tooth reacts to a cold/hot stimulus with sensitivity or
mild pain, which disappears immediately after the stimulus ceases
• Cold: chloroethyl spray (Kältespray; -10 °C and -25 °C),
• Heat: heated Gutta-percha, rubber polish:
delayed response may occur
- Electrical stimulus
Sensibility tests- Cold test
R T R
Sensibility tests- Cold test
• sprayed cotton pellet should be applied to the midfacial area of the tooth
or crown
• adjacent or contralateral “normal” teeth should be tested first to establish
a baseline response
• however, a multirooted tooth, with at least one root containing vital pulp
tissue, may respond to a cold test and electric pulp test even if one or
more of the roots contain necrotic pulp tissue
Examination and testing-
Thermal stimulus
Altered dentin-liquor flow in dentinal tubules
Sensibility test
• Reversible Pulpitis: stronger than normal reaction, disappears
shortly after the stimulus (immediately or within 10 sec)
• Irreversible Pulpitis: stronger reaction, lasts longer even after the
stimulus has stopped
• Pulpnecrosis: no reaction to thermal stimulus
(BUT; exception: in the case of a closed pulp chamber, as a result of
a warm stimulus -> gases expand -> periapical tissues are stimulated
-> pain)
Sensibility tests- Electric Pulp Testing
• surface is scrubbed with a cotton roll,
isolated with the same roll, and dried
thoroughly with the air syringe.
• electric pulp testers (EPT) cannot contact
metallic restorations, including crowns
• EPT produces a high-frequency electric
current that creates ionic changes in
dentinal fuid, which stimulates the Aδ fbers
in the pulp
• it does not rely on the hydrodynamic fuid
fow of the thermal tests, EPT may be more
small spot of conductive medium is placed on
accurate with calcifc metamorphosis the electrode, which is applied to tooth structure
Sensibility test
Positive answer: there are sensory
nerve fibers
False positive answer: metal restoration,
metal crown, gingiva is touched
Endodontic diagnostics- Vitality test
Laser doppler flowmetry Pulse oximetry
Evaluation of Efficacy of a Pulse Oximeter to Assess Pulp Vitality
Laser Doppler flowmetry in endodontics: a review Mohammed Sadique1, S V Ravi2, Kunjamma Thomas3, Prasanth Dhanapal1, Elsy P Simon4, Mohammed
H. Jafarzadeh International Endodontic Journal, 42, 476–490, 2009 Shaheen2 Journal of International Oral Health 2014; 6(3):70-72
Vitality of the pulp is determined by the intactness and health of the vascular supply, not by the status of the
pulpal nerve fibers.
Examination and testing- Radiological
examination
• X-ray:
Additional examination
IO setting (ref. point+periap.), long tube, parallel technique
Possibly for a small-volume, high-resolution CBCT scan
What can we see on an X-ray? What cannot we see on an X-ray?
- Pulp chamber extent - Reversible Pulpitis and Irreversible Pulpitis
- The tooth is root-filled or not. - Granuloma or Cyst (Differential diagnosis:
- Condensation of the root filling biopsy)
- The number of roots and canals - No soft tissues, e.g.: pulp, only hard tissues
- The curvature of the canals (the recording may surrounding them, e.g.: pulp chamber
be projected!) projection
- Narrowing, impassable area in the canal
(Denticulus, Hypercementosis)
- Deep caries, extensive filling
- External/internal resorption
- Condition of periapical tissues
- Presence of a chronic process
- The estimated length of the tooth
Examination and testing- Radiological
examination
Radiographic images are only
two-dimensional, and often it is
difficult to discriminate the
relative location of overlapping
objects.
• A: When the source of radiation is
directly perpendicular to overlapping
objects, the image is captured
without much separation of the
objects
• B: However, when
the radiation source is at an angle
to offset the overlapping objects, the
image is captured with the objects
being viewed as separated. The
object that is closest to the film (or
sensor) will move the least, with the
object closest to the radiation source
appearing farthest away
Examination and testing- Radiological
examination
Two-dimensional dental radiography has two basic shortcomings:
1. lack of early detection of pathosis in the cancellous bone, because of the
density of the cortical plates
2. the influence of the superimposition of anatomic structures (3D 2D)
Examination and testing- CBCT
Cone-Beam Computerized Tomography (CBCT): cone-shaped radiographic beam is
directed to the target area with a reciprocating capturing sensor on the opposite
side
Cone-beam volumetric tomography has
the advantage of being
able to detect pathosis in the bone
or associated with the teeth without
the obstruction of anatomic
structures. The planes of vision may
be axial, sagittal,
or coronal.
(Courtesy J. Morita USA, Irvine, CA.)