Pulp Testing
Ziyad kamal
Fall Semester 2020/21
AAUJ/Faculty of Dentistry
Pulp - Vitality tests
❖ To determine the vitality (or non‐vitality) of the dental pulp.
❖ When interpreted with the history and results of the examination ,
vitality tests may also provide a rough guide to status of
inflammatory change of the pulp (pulpitis).
❖ Results of pulp testing must be interpreted with caution; it only
tests the integrity of the nerve supply in the pulp, whereas it is
the blood supply that maintains pulpal health
❖ Vitality test results do not correlate well with histological changes
occurring within the pulp.
Vitality tests
❖ Testing should begin on a normal, healthy tooth, rather than a
painful tooth or a tooth likely to provide an exaggerated response
❖ Testing should never be limited only to the tooth in question.
Surrounding (healthy) and contralateral teeth should also be
tested and the results compared.
❖ Testing stimuli should be applied to normal enamel of the crown
of the tooth, avoiding any restorations and soft issues(conductors
insulators)
❖ More reliable conclusions can be drawn if the results of two
different tests are combined (e.g. heat and cold, or cold and
electrical tests).
vitality testing must be done
before administration of local
anesthetic to determine the need
for endodontic therapy.
Vitality tests
Vitality tests
❖The following vitality tests are described:
- Thermal (HOT AND COLD )
- Electrical
- Diagnostic access cavity, without anesthesia
most reliable vitality test
- Anesthesia testing (selective)
- Percussion test
THERMAL TEST
❖ A healthy tooth with a vital, non‐inflamed pulp
can usually be stimulated within a temperature
range of some 20–50 °C without pain.
❖ Teeth with inflamed pulps (pulpitis) may react
with severe pain on temperature stimulation even
within the above range.
❖ Extremes of temperature are employed in
thermal vitality tests
Cold Test
❖Ice water bath
The advantages of this cold test are that the entire tooth is cooled down and teeth
restored with full coverage metal restorations may be evaluated
Cold Test
❖ice-stick not very effective, (0 C - 10 C)
Ice sticks can be made in the dental surgery by freezing water in local anesthetic
needle sheaths, which have not been contaminated or have been adequately disinfected
Cold Test
ethyl chloride (-4 C)
dichloro-difluoro-methane (DDM) (-50 C) (compressed refrigerant spray)
More recently, ozone friendly non-chlorofluorocarbon sprays have
been introduced in certain countries
Cold Test
frozen carbon dioxide CO2 (dry ice) stick (-70 C). ( effective even in teeth with crowns)
A negative response to cold may be an indication of pulpal necrosis but this is also
influenced by other factors such as the amount of secondary dentine
The colder tests (DDM and CO2snow) appear to be the more reliable than
ethyl chloride in stimulating vital teeth; this may be due to their greater
rate of temperature reduction
Heat Test
Use vaseline on the tooth to
prevent the gutta-percha from
sticking to the tooth
The disadvantages of using
heated gutta-percha
-prolonged heating could result in
pulp damage should be applied for
no more than 5 s
-may be difficult to use on posterior gutta-percha softens at 65 C
teeth because of limited access
- Inadequate heating of the gutta-percha stick could result in the stimulus being
too weak to elicit a response from the pulp
Frictional heat may be generated by using
a rubber cup intended for prophylaxis
(without paste) against the buccal aspect
of a tooth
The normal use of thermal tests on teeth
has been shown not to be harmful to
healthy pulp tissue
Cold Tests
❖ Should be applied until the patient definitely
responds to the stimulus or for a maximum
of 15 s, whichever comes first
❖ Cold tests have appeared to be more reliable
than heat tests
❖ The colder the stimulus, the more effective
the investigation is in assessing the status
of the nerve supply within the tooth
Electric Pulp Tester
❖ Stimulate pulpal sensory nerve endings (Myelinated A-
delta fibers)
❖ Isolate the tooth and its surroundings, Air-dry the area
❖ Place the pulp tester tip at the incisal edge/cusp tip area
with a small amount of toothpaste (ask for a sensation of
tingling)
In most models, the circuit must be
closed by a lip electrode or the
patient touching the metal part
of the pulp tester
to ensure
maximum The readout is not a quantitative
current measurement of the health of the pulp,
passes from the and therefore does not indicate to what
electrode to the extent the pulp is healthy/unhealthy; a
tooth surface response only implies that the A fibers are
sufficiently healthy to function
plastic strips if large metal fillings are
present
make sure that the electrode lies flat
against the surface of the tooth
A hook on the patient’s lip completes the
circuit
The tester should be applied on the tooth surface adjacent to a pulp horn, that is,
the region of highest nerve density within the pulp;
the incisal-third of anterior teeth
the mid-third of posterior teeth.
the response threshold in healthy
teeth may be lowest in incisors,
slightly greater in premolars
and greatest in molar teeth
To improve objectivity the tests should be
repeated after a recovery period of
1min, unless too much discomfort has
been caused.
Results of vitality testing
❖These may be:
• Positive (normal).
• Exaggerated, brief. <<15 sec. after removal of the stimulus.
• Exaggerated, prolonged. > 15 sec , PAIN ON HEAT
• Negative. necrotic, sclerosed root canals
• False positive.
• False negative.
• Inconclusive.
non-vital teeth
Ineffective tooth isolation
vital teeth
Drugs that increase patient’s
threshold for pain
Poor contact of pulp tester to
tooth
Fistulograph
. Local anesthesia is rarely needed
A small size gutta-percha point (nr. 25 - 30) is inserted into the sinus tract using
forceps/tweezers. The point is advanced in small increments in the direction of least
resistance. Local anaesthesia is rarely needed. Usually approximately 10 - 20 mm of the
point can be pushed into the tract.
Fistulograph
