The study was performed the Department of Conservative Dentistry and Endodontics from 1st February 2022 to 30th April, 2022.
Sample Size Calculation
In order to detect an appropriate effect with power of 0.9 and p ≤ 0.05 based on previous studies12 was considered as significant with three group, G*Power(G* Power for Windows, Version 3.1.9.7, University Duesseldorf, Germany) suggested that 22 participants would be required in each group, which was rounded off to 25 (N=75).
A total of 160 patients were screened of whom 25 patients were selected in each group thus a total of 100 patients were asked to take part.
3 Inclusion criteria
3.1 Healthy patients belonging to the category of American Society of Anaesthesiologist I[7] between the ages of 18-60 of either sex with chief complaint of pain occurring as a result of pulpal involvement due to caries.
3.2 Tooth with chief complaint should be free of any kind of restorations, full or partial coverage prosthesis.
3.3 The control tooth should be caries free and having healthy periodontium with pocket depth less than 3mm measured using a Williams probe and without any restorations full or partial coverage prosthesis.
3.4 A single offending tooth was identified as the cause of pain
4 Exclusion Criteria
4.1 Patients with more than one tooth with pain
4.2 Patients undergoing orthodontic treatment
4.3 Patients with periodontal changes pockets greater than 3 mm measured using a Williams probe and tooth with mobility greater than 1
4.4 Patients who refuse to take part in the study
4.5 Patients who are pregnant or having comorbidities including diabetes mellitus type 1 and 2, hypertension, chronic kidney disease, chronic liver disease, cancer, HIV, organ transplant, prosthesis and cardiac anomalies
4.6 Patients who took non-steroidal anti-inflammatory for pain relief prior to attending the dental clinic
4.7 Tooth with open apex
The study was performed by a single investigator. Intra examiner reliability for the diagnosis was assessed using Cohen unweighted Kappa statistics and the it was 0.87 indicating good reliability . Patient’s medical and dental histories was noted , including history of pain regarding – location, duration, onset, type, nature, progression, aggravating and relieving factors. The type of pain history along with corroborations with radiographs gave the initial indication regarding the diagnosis. Digital intra oral radiographs were taken for the tooth with chief complaint and analysed for depth of caries, degeneration or resorptive process in the pulp, thickening of the periodontal ligament, pulp stones and for any periapical changes.
Based on the patients pain history, clinical examination and radiographic findings the patients were divided into 3 groups – Group I-Reversible Pulpitis, Group II- Irreversible Pulpitis and Group III-Pulpal Necrosis
The patients were made to sit in an upright position and pulp sensibility tests were performed. All the tests were performed by a single postgraduate students of the Department of Conservative Dentistry and Endodontics.
5 Thermal Testing- The response to the thermal tests were noted either as produces a mild to moderate transient response as clinically normal pulp; sharp pain subsiding on removal of stimuli as reversible pulpitis, sharp pain followed by a dull prolonged ache as irreversible pulpitis and no response as pulpal necrosis
6.1 Heat Test
Both the symptomatic and control tooth were isolated using Optra Gate (Ivoclar, Liechtenstein) and dried with three way syringe. Heat test was performed using gutta-percha sticks (GC, JAPAN).The heated Gutta Percha (60°C) stick was placed on the incisal surface and middle third of the posterior tooth surface for testing and the patients response was noted.
6.2 Cold Test
Cold test was performed by propane spray (-60°C) (Endo Frost; Coltene Whaldent). Tooth was isolated with cotton rolls and dried using three way syringe, ice spray was used on small cotton pellets. The pellets were placed on the incisal third and the middle third on the buccal surface.[8 ]
6.3 Electric Pulp Test
For electric pulp testing the tooth was isolated and dried. The lip clip was placed in the corner of the mouth. The main electrode was coated with a conducting media ( Toothpaste was used) and applied to the middle third of the facial/labial surface of the tooth. The current flow was slowly increased to allow the patient enough time to respond before warmth or tingling sensation became painful. Both the test and the control teeth were tested three.[9]
6.4 Pulse Oximeter Test
Oxygen saturation levels of both symptomatic and control tooth were recorded by a modified pulse oximeter monitor. Here a portable fingertip type pulse oximeter was used. The probe holder for the device was made using flexible silicone allowing it to adapt to both anterior and posterior teeth. ( Figure 1)
The patient was made to sit in an upright position on the dental chair. The measurements were taken for patient’s all ten fingers thrice to monitor the accuracy of the pulse oximetry device and the average reading was noted.(Figure 2) Each tooth to be evaluated was isolated with Optra-Gate(Ivoclar). Light emitting diode of the sensor was placed on labial surface/ buccal surface of the teeth, parallel to that of receptor diode which was placed on palatal surface of same teeth. Care was taken to avoid any movement during the procedure to maintain parallel alignment of two diodes throughout the procedure. All the readings were repeated thrice and the average reading was noted. (Figure 3 &4)
The sensibility tests were done in triplicates in order to establish its validity and to show if any difference, numerical or statistical which might have a bearing on the diagnosis of the pulpal condition exists. Moreover all three sensibility tests done on the same tooth gives an indication of the correctness of the methods.
All the data collected were subjected to statistical analysis.
7. Statistical analysis
The collected data were statistically analysed using the GraphPad Prism for Windows, Version 9.0 (GraphPad Software, La Jolla California USA). As the data is approximately normally distributed, Parametric tests were carried out for inferential statistics. Descriptive statistics were used to report the values of central tendency(mean, median) and measures of dispersion(standard deviation, range). Analysis of variance and the Tukey HSD test were used for statistical analysis of the teeth measurements with P < .01. The Student’s t test for paired results was used to compare the index finger with the positive control measurements in healthy teeth. A P-value of less than 0.05 was considered to be statistically significant.