Identify and Define All Diagnostic Terms for Pulpal Health and Disease States

School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Journal of endodontics (Impact Factor: 3.38). 12/2009; 35(12):1645-57. DOI: 10.1016/j.joen.2009.09.032
Source: PubMed


Consensus Conference Subcommittee 2 was charged with the identification and definition of all diagnostic terms for pulpal health and disease states by using a systematic review of the literature.
Eight databases were searched, and numerous widely recognized endodontic texts were consulted. For each reference the level of evidence was determined, and the findings were summarized by members of the subcommittee. Highest levels of evidence were always included when available. Areas of inquiry included quantification of pulpal pain, the designation of conditions that can be identified in the dental pulp, diagnostic terms that can best represent pulpal health and disease, and metrics used to arrive at such designations.
On the basis of the findings of this inquiry, specific diagnostic terms for pulpal health and disease are suggested. In addition, numerous areas for further study were identified.

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    • "A systematic review of the literature trying to give consistency of the terminology, mentioned that the terms " Pulp Canal Obliteration " and " Calcific Metamorphosis " appear to be inaccurate because the canal is rarely completely obliterated, and there is actually no " metamorphosis " of the tooth, just a progressive deposition of dentine (secondary or tertiary) resulting in radiographically apparent shrinkage of the pulp canal space. Hence, the authors recommend the term " mineralization " to define this condition (Levin et al., 2009). "
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    ABSTRACT: Calcific Metamorphosis (CM) is a pulpal response to dental trauma characterized by a deposition of hard tissue within the canal space. A tooth with CM usually presents a discoloration and a partial or total obliteration of the pulp canal space, and its vital pulp tests and symptoms are difficult. Since pulp necrosis cannot be supposed even the negative responses, the periradicular status is the only reliable criterion. Two permanent teeth diagnosed as CM and pathological root resorption, extracted from two males (22 and 53 years of age) due to severe mobility were prepared and sectioned for histological and histometrical evaluation. Images were captured, processed and measured in a total mapping of each specimen with software Pinnacle Studio 9.4® (Pinnacle Systems Inc.), Adobe® Photoshop® (CS 8.0.1, Adobe Systems Inc.) and Image J® (National Institute of Health, Bethesda, MD, USA). The images showed the simultaneous occurrence of CM and root resorption. The means of the total measurements showed that the area of radicular affection (R) was higher than the coronal affection (C), both in quantity (R: 13.75 mm 2-28.75%-/C: 4.7 mm 2-5.47%-) and quality (R: absence of CM / C: presence of CM). CM showed a fibrotic pattern, a cortical bone-like pattern and a cancellous bone-like pattern, representing a kind of reparative reaction probably initiated by the resorption process. Concurrent CM and pathological root resorption are uncommon in the same tooth, and the possibility to obtain specimens of permanent teeth to make histological and histometric evaluations of them represents a situation even more infrequent. This morphohistometric evaluation can expand the spectrum of useful variables to make clinical and therapeutic odontological decisions.
    Full-text · Article · Jun 2015 · International Journal of Morphology
    • "Symptomatic irreversible pulpitis is a pulpal state characterized by mild/severe pain that lingers after removal of a stimulus. In such cases, pulpectomy/extraction is required to alleviate the symptoms and prevent apical periodontitis.[1] However, as the severity of pulpal inflammation cannot be measured quantitatively, it must be based on clinical findings rather than histological diagnosis; moreover, there is poor correlation between the two.[2] In addition, pulps of teeth clinically diagnosed with irreversible pulpitis were shown to have the potential to heal after pulpotomy with appropriate biomaterials such as mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM) cement.[3–7] "
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    ABSTRACT: Dental pulp has the ability of repair/regeneration. Indirect pulp therapy (IPT) is recommended for pulp preservation in asymptomatic teeth with extremely deep caries as well as teeth with clinical symptoms of reversible pulpitis. In this case study, we performed IPT with calcium enriched mixture (CEM) cement on a symptomatic permanent molar. After clinical/radiographic examinations the tooth was diagnosed with irreversible pulpitis and associated apical periodontitis. IPT involved partial caries removal, the placement of CEM cement pulp cap and overlying adhesive permanent restoration. At the 1 week follow-up, patient's spontaneous symptoms had resolved. One-year follow-up demonstrated pulp vitality, clinical function, as well as the absence of pain/tenderness to percussion/palpation/cold sensitivity tests; periapical radiograph showed a healing periradicular lesion with newly formed bone, that is normal pulp with normal periodontium. These favorable results indicate that IPT/CEM may be a good treatment option in comparison to endodontic treatment in young patients. IPT of deep-caries lesion is an easier, more practical and valuable treatment plan than complete caries removal.
    No preview · Article · Apr 2013 · Journal of Conservative Dentistry
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    • "A variety of methods are used to assess the condition of injured or diseased dental pulp. Whilst such methods have been reviewed thoroughly and repeatedly in many textbooks and narrative reviews, no consensus has been reached as to which method or combination of methods will give the most accurate information (Levin et al. 2009). The aim of this systematic review was to assess the diagnostic accuracy of contemporary methods used to assess the condition of the pulp in injured or diseased teeth. "
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    ABSTRACT: Mejàre IA, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tranæus S, Bergenholtz G. Diagnosis of the condition of the dental pulp: a systematic review. International Endodontic Journal, 45, 597–613, 2012. The aim of this systematic review was to appraise the diagnostic accuracy of signs/symptoms and tests used to determine the condition of the pulp in teeth affected by deep caries, trauma or other types of injury. Radiographic methods were not included. The electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to June 2011. The complete search strategy is given in an Appendix S1 (available online as Supporting Information). In addition, hand searches were made. Two reviewers independently assessed abstracts and full-text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 155 articles were read in full text. Of these, 18 studies fulfilled pre-specified inclusion criteria. The quality of included articles was assessed using the QUADAS tool. Based on studies of high or moderate quality, the quality of evidence of each diagnostic method/test was rated in four levels according to GRADE. No study reached high quality; two were of moderate quality. The overall evidence was insufficient to assess the value of toothache or abnormal reaction to heat/cold stimulation for determining the pulp condition. The same applies to methods for establishing pulp status, including electric or thermal pulp testing, or methods for measuring pulpal blood circulation. In general, there are major shortcomings in the design, conduct and reporting of studies in this domain of dental research.
    Full-text · Article · Feb 2012 · International Endodontic Journal
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