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Dental Pulp Diagnostic

Dental Pulp Diagnostic. Dr. Csaba Dobó Nagy Department of Oral Diagnostics. Pulp conditions. normal when there is a response to the stimulus provided be the sensibility test and this response is not pronunced or exaggerated,and it does not linger

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Dental Pulp Diagnostic

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  1. DentalPulpDiagnostic Dr. Csaba Dobó Nagy Department of Oral Diagnostics

  2. Pulp conditions • normalwhen there is a response to the stimulus provided be the sensibility test and this response is not pronunced or exaggerated,and it does not linger • Pulpitisis present when tehere is an exaggerated response that produse pain. Pulpitis can be considered as reversible or irreversible, depending on the severity of pain and whether the pain lingers or not. • Pulp necrosis: the tooth is pulpless or has had previous root canal therapy

  3. Diagnosticobjectives of pulp testing • Assesment of pulphealthbasedonitsqualitativesensoryresponse • Priortorestorative, endodontic and orthodonticprocedures • As a follow-up and for monitoring thepulpafter trauma of thetheeth • Indifferentdiagnosis, suchasexcludingperiapicalpathosis of pulporigin • Replication of sympthoms and triggers of paindiagnosticpurposes: • Tolocalisethesource of pain • As an aidinexcludingnonodontogenicorofacialpain

  4. Definition • Pulp Vitality Testing: Assesment of the pulp’s blood supply • Pulp Sensibility Testing: assesment of the pulp’s sensory response • Pulp Sensitivity : condition of th pulp being very responsive to a stimulus

  5. Pulp Testing Techniques/Pulp Senibility Testing • Thermal Tests • Cold tests: • Ice • Refrigeant Spray (chlor-etil, dichlor-difluorometane-DDM, tetrafluoro-etane TFE) • Carbon-dioxide snow • Heat test • Warm gutta-percha • Touch and heat • Electric pulp test • Test cavity preparation

  6. Pulp Vitality Testing 3. Other: • Photoplethysmography : toimprovepulseoximetry , byadding a lightwithashorterwavelength • Spectrophotometry: dualwavelengthlights • TransmittedLaserLight (TLL): separatedsending/receivingprobes • Transillumination: colourchangesthatmayindicatepulppathosis • Ultravioletlightphotography: fluoresenspatterns • Surfacetemperaturemeasurment (breathing)

  7. Comparison of pulp testing • Cold tests • Rate of temperature decrease: CO2 in 5 sec. 2°C, • Heat tests • melting point of Guttapercha between 78°C -150°C, but 11°C increase cause damage in the pulp • Electric pulp tests • In recently erupted teeth it takes 5 years myelinated (Aδ) fibres reach DEJ • Orthodontic movement sensory functions may be disturbed up to 9 months • 2-6 weeks recovery following trauma • Contamination (ginigva, metal restauration)

  8. Types of NerveFibres and theirdistributioninsidethedentalpulp • Dentalpulp is a highlyinnervatedtissuethatcontainssensorytrigeminalafferentaxons • N trigeminalsensorynervefibers • 90% of A fibresareA –delta fibres , whicharelocatedatthepulp-dentinborderinthecoronalportion of thepulp and concentratedinthepulphorns • C fibresarelocatedinthecore of thepulp and extendintothecell –free zoneunderneaththeodontoblasticlayer • Symphateticefferentfibresregulatetheblood flow

  9. Pulp tests and innervation • Electric current simulates Aδ-fibres, but not the C-fibres, because their high treshold. • Cold simuli produce stronger response than cold stimuli, because of the outward flow of fluid. • Repeated application of cold will reduce the displacement of fluid – less painful. • Aδ-fibres are more affected by the reduction of blood flow than C-fibres, because they more sensitive to hypoxia. • Uncontrolled heat can injure pulp release mediators that affect the C-fibres.

  10. Positive/negative hydrostatic pressure +150 Hgmm -150 Hgmm

  11. Neuro-parakrin inflammation

  12. Comparison of pulp tests

  13. Recovery of traumatic teeth function

  14. Faults of electric pulp test • False-negative • False-pozitive • Localization: • Incizal third • Molars, premolars neck • EKG gel

  15. Determination of pulp circulation • Yet no available clinical test • Senzibility tests 84-90% reliable for pulp vitality. • Fals-pozitive: remaining C-fibres • Fals-negative: • Calcification • recent trauma • developing tooth

  16. Differentiation of reverzibilis/irreverzibilis pulpitis

  17. Small area dentin-recording

  18. microdialysis bradikin↑10x gyulladt pulpábanJOE, 2000;26:744

  19. Special clinical cases • Dentin hypersensitivity • Pulpitis chronica • Pulp-perio

  20. irreversibilis pulpitis?

  21. Pulpitis chronica

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