Evaluation of a new means of pulpal diagnosis through a prospective study of 133 cases

What is it about?

Regenerative approaches to dental pulp have long been adopted with pulp capping, using materials such as calcium hydroxide[1] and the Cvek partial pulpotomy technique.[2] Like all disciplines, endodontics is punctuated by fashion effects. Among these effects, some are ephemeral, others settle in time, and pulpotomy should be reconsidered as a viable permanent treatment approach for permanent teeth as well as for primary teeth. The literature is enriched with articles about vital pulp therapy (VPT) as an alternative to traditional root canal treatment for teeth, diagnosed with irreversible symptomatic pulpitis with a success rate higher than conventional treatment over a period of 5 years. The success of the VPT depends on the diagnostic criteria established for assessing the pulp status. An accurate diagnosis of the inflammatory state of the pulp is critical to choose a correct treatment strategy.[3],[4] The most accurate method for assessment of pulpal status still the histological examination by which the extent of inflammation or presence of necrosis is observed.[5] However, it is difficult, if not impossible, to clinically determine it. In cases of irreversible pulpitis, the pulp becomes inflamed to a varying degree, but it is not possible to precisely establish the level of inflammation on the basis of indirect diagnostic methods.[6] It should be known that in our practice the tests used to diagnosis a pulpal status (thermal or electrical tests) give us a subjective idea and are dependent on the pain's perception by the patient. On the other hand, vitality tests such as laser Doppler flowmetry and oximetry give an objective idea but remain clinically inapplicable. Following the answers obtained, the clinician will establish a pulpal diagnosis. In the literature, the diagnosis obtained is qualified by indirect or provisional. In light of these recent data, it is necessary to develop a diagnostic means that is histologically reliable and clinically applicable. When planning endodontic treatment, direct observation of the pulp at the root canal entrances (color of pulpal bleeding/pulpal bleeding flow) can be valuable to our diagnosis. We named this observation “In situ observation.” The questions that arise are: Can this “in situ observation” be used to refine our diagnosis Is there a correlation between the initial diagnosis and the final diagnosis with the in situ observation? We will, therefore, try to answer these questions through a prospective study.

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