Keywords
Sites
Accuracy
Predictive values
Molar teeth
How to Cite
Abstract
A test frequently used to complement endodontic diagnoses is the cold test; however, in the last 20 years, authors have reported incorrect results within pulp sensitivity tests. Specifically, a high frequency of false results in posterior teeth, were found. The aim of this study was to identify the most appropriate site for the cold test in molar teeth with a need for endodontic treatment, calculating predictive values, accuracy and reproducibility. A cross-sectional study was performed, evaluating 390 subjects. A total of 152 subjects of both genders from the ages of 15-65 years old participated. The ideal standard was established by direct pulp inspection, and the cold test agent used was 1,1,1,2-tetrafluoroethane. The patients were divided into four groups in relation to the molar tooth: (1) mandibular first molar, (2) mandibular second molar, (3) maxillary first molar, and (4) maxillary second molar. 169 teeth and 676 sites were studied. (a) The most appropriate sites for cold test were the middle third of the buccal surface and cervical third of the buccal surface in the mandibular molars with the following results: Middle third of the first molar: Accuracy 0.93, positive predictive value 0.90 and negative predictive value 0.96. Middle third of the second molar: Accuracy 0.93, positive predictive value 1.00 and negative predictive value 0.90. In relation to third cervical the results were: First molar: Accuracy 0.93, positive predictive value 0.89 and negative predictive value 0.97 y second molar: Accuracy 0.93, positive predictive value 1.00 and negative predictive value 0.90. (b) The highest reproducibility was observed in the middle third of the buccal surface with cervical third of the buccal surface in the mandibular second molar (1.00). The most appropriate site and reproducibility of the sites are auxiliary to complement endodontic diagnose with the cold test.
References
Villa-Chávez C. E., Patiño-Marín N., Loyola-Rodríguez J. P., Zavala-Alonso N. V., Martínez-Castañón G. A., Medina-Solís C. E. Predictive values of thermal and electrical dental pulp tests: a clinical study. J Endod. 2013; 39 (8): 965-969.
Dastmalchi N., Jafarzadeh H., Moradi S. Comparison of the efficacy of a custom-made pulse oximeter probe with digital electric pulp tester, cold spray, and rubber cup for assessing pulp vitality. J Endod. 2012; 38 (9): 1182-1186.
Gopikrishna V., Tinagupta K., Kandaswamy D. Comparison of electrical, thermal, and pulse oximetry methods for assessing pulp vitality in recently traumatized teeth. J Endod. 2007; 33 (5): 531-535.
Jespersen J. J., Hellstein J., Williamson A., Johnson W. T., Qian F. Evaluation of Dental Pulp Sensibility Tests in a Clinical Setting. J Endod. 2014; 40 (3): 351-354.
Peters D. D., Baumgartner J. C., Lorton L. Adult pulpal diagnosis. I. Evaluation of the positive and negative responses to cold and electrical pulp tests. J Endod. 1994; 20 (10): 506-511.
Chen E., Abbott P. V. Evaluation of accuracy, reliability, and repeatability of five dental pulp tests. J Endod. 2011; 37 (12): 619-1623.
Farac R. V., Morgental R. D., Lima RKDP, Tiberio D, dos Santos MTBR. Pulp sensibility test in elderly patients. Gerodontology. 2012; 29 (2): 135-139.
Jones V. R., Rivera E. M., Walton R. E. Comparison of carbon dioxide versus refrigerant spray to determine pulpal responsiveness. J Endod. 2002; 28 (7): 531-533.
Weisleder R., Yamauchi S., Caplan D., Trope M., Teixeira F. The validity of pulp testing a clinical study. J Am Dent Assoc. 2009;140 (8):1013-1017.
Altman D. G., Bland J. M. Diagnostic tests. 1: sensitivity and specificity. BMJ. 1994; 308 (6943): 1552.
Safari S., Baratloo A., Elfil M., Negida A. Evidence based emergency medicine part 2: positive and negative predictive values of diagnostic tests. Emerg (Tehran). 2015; 3 (3): 87-88.
Gopikrishna V., Tinagupta K., Kandaswamy D. Evaluation of efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. J Endod. 2007; 33 (4): 411-414.
Banoo S., Bell D., Bossuyt P., Herring A., Mabey D., Poole F., et al. Evaluation of diagnostic tests for infectious diseases: general principles. Nat Rev Microbiol. 2010; 8 (12): S17-S29.
Petersson K., Söderström C., Kiani-Anaraki M., Lévy G. Evaluation of the ability of thermal and electrical tests to register pulp vitality. Endod Dent Traumatol. 1999; 15 (3): 127-131.
Alghaithy R. A., Qualtrough A. J. Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review. Int Endod J. 2017; 50 (2): 135-142.
Cartagena A. F., Parreiras S. O., Loguercio A. D., Reis A., Campanha N. H. In-office bleaching effects on the pulp flow and tooth sensitivity - case series. Braz Oral Res. 2015; 29 (1): S1806-83242015000100223.
Altman D. G., Bland J. M. Diagnostic tests 2: predictive values. BMJ. 1994;309(6947):102.
Davies AL, Rawlinson A. A comparison between two electric vitality testers and ethyl chloride with special reference to a newly available device. Int Endod J. 1988; 21 (5): 320-326.
Lilja J. Innervation of different parts of the predentin and dentin in young human premolars. Acta Odontol Scand. 1979; 37 (6): 339-346.
Rutsatz C., Baumhardt S. G., Feldens C. A., Rösing C. K., Grazziotin-Soares R., Barletta F. B. Response of pulp sensibility test is strongly influenced by periodontal attachment loss and gingival recession. J Endod. 2012; 38 (5): 580-583.
Peters D. D., Baumgartner J. C., Lorton L. Adult pulpal diagnosis. I. Evaluation of the positive and negative responses to cold and electrical pulp tests. J Endod. 1994; 20 (10): 506-511.
Fuss Z., Trowbridge H. O., Bender I., Rickoff B. Assessment of reliability of electrical and thermal pulp testing agents. J Endod. 1986;12 (7): 301-305.
Al-Salman T. H. The effects of type of tooth and the placement site of electrode on the electrical pulp testing of the anterior teeth. Al–Rafidain Dent J. 2005; 5 (2): 97-102.
Jacobson J. J. Probe placement during electric pulp-testing procedures. Oral Surg Oral Med Oral Pathol. 1984; 58 (2): 242-247.
Lin J., Chandler N., Purton D., Monteith B. Appropriate Electrode Placement Site for Electric Pulp Testing First Molar Teeth. J Endod. 2007; 33 (11): 1296-1298.
Macho G. A., Berner ME. Enamel thickness of human maxillary molars reconsidered. Am J Phys Anthropol. 1993; 92 (2): 189-200.