Effective Diagnosis of Pulpitis Review

Effectiveness of Diagnosing Pulpitis: A Systematic Review

• Background: Diagnosis of inflamed pulp is crucial for clinical diagnosis and treatment. Limited well-designed clinical trials exist in this area.
• Objectives: To evaluate clinical tests (sensibility, biomarkers, pulp bleeding) for accurately diagnosing pulp tissue condition, creating S3-level guidelines.
• Methods: A comprehensive literature search (PubMed, Web of Science, Scopus, Google Scholar, Cochrane Central Register) from inception to January 2022, plus hand searching and review of major journals. Inclusion criteria aligned with specific PICO questions.
• Results: 28 studies (out of 29 initially evaluated) were included. 12 studies examined diagnostic accuracy of pulp vitality. 10 assessed pulpal condition accuracy. 6 evaluated biomarker expression. 3 investigated prognostic factors and treatment.
• Discussion: A reliable reference standard for pulp diagnosis under clinical conditions is lacking. A combined clinical approach (including various tests and symptoms, potentially including molecular diagnostics in the future) is suggested.
• Conclusions: Diagnosis of pulpitis effectiveness is low due to limited scientific evidence. Reliable methods for determining pulp status or predicting vital pulp treatment success are not supported by sufficient evidence.

Introduction

• Diagnostic Key: Effective diagnosis is central to endodontic therapy. Diagnostic uncertainty exists regarding pulp tissue condition.
• Reversible vs. Irreversible Pulpitis: Reversible pulpitis is inflammation expected to resolve, while irreversible pulpitis indicates inability to heal.
• Treatment Considerations: The clinical approach depends on the type of pulpitis (mild, moderate, severe). Treatment options vary to preserve pulp vitality or require pulpectomy/root canal treatment.
• Microorganisms: The presence of microorganisms within pulp tissue is critical in determining whether pulpitis can be reversed or not. Clinical symptoms don't perfectly reflect histological tissue changes which can differ substantially.

Review Question and Eligibility Criteria

• PICO 1: Patients without pain, intraoperative diagnosis of potential inflammation, and maintaining the pulp, compared to follow-up success of vital pulp treatment, histological evaluation of the pulp, or inflammatory mediator quantification.
• PICO 2: Patients with nonspontaneous pain, intraoperative diagnosis of pulpal condition, vital pulp therapy and evaluation of inflammatory mediators and histological findings, compared to follow-up results.
• PICO 3: Patients with spontaneous pain, diagnosis of pulpal condition, vital pulp treatment, inflammatory mediator and ocular inspection of exposed pulp tissue, compared to follow-up and histological procedures.

Method

• Protocol and Registration: The review followed PRISMA and other guidelines for systematic reviews, with a pre-registered protocol in PROSPERO.
• Inclusion Criteria: The review focused on permanent teeth suspected of pulpitis. Various criteria determine the types of diagnostic tests used.

Data Collection and Items

• Data Extraction: Two independent reviewers extracted data from included studies. Data items included study characteristics (author, location, and date). Study risk or bias was evaluated using specialized tools (e.g., QUADAS-2 and Newcastle-Ottawa scale).

Results

• Literature Search and Study Selection: A complete search strategy across databases with subsequent identification of relevant studies was conducted.
• Inter-Reviewer Reliability: High agreement between reviewers regarding study eligibility was observed (93%).

Diagnostic Accuracy

• Pulp Vitality: Studies were assessed for diagnostic accuracy regarding factors such as sensitivity, specificity, positive predictive value.
• Clinical Tests: Results discussed the accuracy of cold, heat, and electric pulp tests (EPT) for pulp vitality assessment. Several studies yielded data on individual tests.