Assessing the vitality of dental pulp is crucial in determining the appropriate treatment approach for dental conditions. Traditionally, clinicians have relied on subjective sensibility tests, such as temperature or electric stimuli, which provide indirect information and can be inconclusive. These methods primarily evaluate neural responses, rather than the actual vascular circulation of the pulp. In recent years, innovative techniques like pulse oximetry and laser Doppler flowmetry have emerged as objective measures to assess pulp vitality. Additionally, histological analysis offers valuable insights into the morphology of dental pulp tissue. This study, “Comparison of the vitality tests used in the dental clinical practice and histological analysis of the dental pulp” examines the correlation between clinical tests and histological analysis to gain a deeper understanding of dental pulp vitality.
The study was approved by the Slovenian national medical ethics committee, and it involved the examination of 26 healthy permanent premolars from seven patients aged 12 to 20 years. The teeth were free from any visible defects and scheduled for extraction due to orthodontic reasons. Clinical tests, including pulse oximetry for oxygen saturation measurement and an electric pulp tester, were conducted prior to the extractions. Histological analysis of the dental pulp tissue was performed using staining techniques and immunohistochemistry. The density of blood vessels and myelinated nerve fibers was evaluated, and statistical analyses were conducted to establish correlations between the clinical and histological findings.
The results of the study by Ana Tenyi, from the Department of Dental Diseases and Normal Dental Morphology, Medical Faculty University of Ljubljana, Slovenia and Aleksandra Milutinović, from the Institute of histology and embryology, Medical Faculty University of Ljubljana, Slovenia, found intriguing correlations between the clinical tests and histological analysis of dental pulp. First, a positive correlation was found between the volume density of blood vessels in the pulp tissue and oxygen saturation levels measured through pulse oximetry.
This finding, that a higher density of blood vessels is associated with increased oxygen saturation in the dental pulp, supports the validity of pulse oximetry as an objective method for assessing pulp vitality. Furthermore, a negative correlation was discovered between the volume density of myelinated nerve fibers and the lowest electrical voltage felt by the patients during the electric pulp testing. This suggests that teeth with a higher density of nerve fibers have a lower threshold for electrical stimulation. Interestingly, teeth with closed apices exhibited a higher density of nerve fibers in the upper part of the dental pulp compared to teeth with open apices. However, there were no significant differences in the perception of electrical voltage between the two groups, indicating individual variations in sensitivity.
While the sample size and focus on healthy teeth for orthodontic extraction limit the generalizability of the findings, these results provide valuable insights into the relationship between clinical tests and histological characteristics of dental pulp. Pulse oximetry emerges as a reliable method for assessing pulp vitality, reflecting the vascularity and oxygen saturation of the pulp tissue. The presence of a higher density of nerve fibers may contribute to a lower threshold for electrical stimulation, suggesting the involvement of neural factors in pulp sensibility. The positive correlation between blood vessel density and oxygen saturation, as well as the negative correlation between nerve fiber density and electrical voltage perception, provide valuable insights into the complex nature of dental pulp. While further research with larger and more diverse samples is needed, these findings contribute to our understanding of dental pulp vitality and its relationship to clinical assessments. By demonstrating the utility of pulse oximetry in evaluating oxygen saturation and the importance of nerve fiber density in electrical sensibility, this study emphasizes the potential for more objective and accurate methods in assessing pulp vitality.
These findings have important implications for dental professionals. The use of pulse oximetry can provide a quantitative measurement of oxygen saturation in the dental pulp, enabling clinicians to assess the health and viability of the pulp tissue more accurately. This information can aid in determining the appropriate treatment approach, such as the need for pulp preservation or the possibility of pulp regeneration. Moreover, the observed correlation between nerve fiber density and electrical sensibility highlights the influence of neural factors on pulp sensitivity. Understanding the role of nerve fibers in the perception of electrical stimuli can assist clinicians in evaluating and managing patient discomfort during dental procedures. It also emphasizes the importance of individual variations in sensitivity and the need for personalized treatment approaches.
The limitations of this study would be the small sample size and the focus on healthy teeth for orthodontic extraction. Further research with larger and more diverse samples is necessary to validate these findings and explore potential differences in pulp vitality among different dental conditions or age groups. Additionally, longitudinal studies could provide valuable insights into the changes in pulp vitality over time and the impact of aging on pulp health.
The translation of the preceding English text in Slovenian:
Ocenjevanje vitalnosti zobne pulpe je ključno pri določanju ustreznega pristopa k zdravljenju zobnih stanj. Tradicionalno so se klinični zdravniki zanašali na subjektivne senzibilitetne teste, kot so temperaturni ali električni dražljaji, ki podajajo posredne informacije in so lahko nezanesljivi. Te metode primarno ocenjujejo nevronske odzive, ne pa dejanskega vaskularnega obtoka pulpe. V zadnjih letih so kot objektivne metode za ocenjevanje vitalnosti pulpe se pojavile inovativne tehnike, kot so pulzna oksimetrija in laserska Dopplerjeva flowmetrija. Poleg tega histološka analiza nudi dragocene vpoglede v morfologijo tkiva zobne pulpe. Ta študija, “Primerjava testov vitalnosti, ki se uporabljajo v zobni klinični praksi, in histološke analize zobne pulpe”, preučuje korelacijo med kliničnimi testi in histološko analizo za boljše razumevanje vitalnosti zobne pulpe.
Študijo je odobril slovenski nacionalni medicinski etični komite, vključevala pa je pregled 26 zdravih stalnih premolarjev od sedmih pacientov, starih od 12 do 20 let. Zobje so bili brez vidnih napak in so bili načrtovani za ekstrakcijo zaradi ortodontskih razlogov. Klinični testi, vključno s pulzno oksimetrijo za merjenje nasičenosti kisika in električnim testerjem pulpe, so bili izvedeni pred ekstrakcijami. Histološka analiza tkiva zobne pulpe je bila izvedena z uporabo tehnik obarvanja in imunohistokemije. Ocenjena je bila gostota krvnih žil in mieliniziranih živčnih vlaken, izvedene so bile statistične analize za ugotavljanje korelacij med kliničnimi in histološkimi ugotovitvami.
Rezultati študije Ane Tenyi, iz Oddelka za zobne bolezni in normalno zobno morfologijo, Medicinske fakultete Univerze v Ljubljani, Slovenija in Aleksandre Milutinović, iz Inštituta za histologijo in embriologijo, Medicinske fakultete Univerze v Ljubljani, Slovenija so pokazali zanimive korelacije med kliničnimi testi in histološko analizo zobne pulpe. Najprej je bila ugotovljena pozitivna korelacija med volumensko gostoto krvnih žil v tkivu pulpe in nasičenostjo s kisikom, izmerjeno s pulzno oksimetrijo.
To ugotovitev, da je višja gostota krvnih žil povezana z večjo nasičenostjo s kisikom v zobni pulpi, podpira veljavnost pulzne oksimetrije kot objektivne metode za ocenjevanje vitalnosti pulpe. Poleg tega je bila odkrita negativna korelacija med volumensko gostoto mieliniziranih živčnih vlaken in najnižjo električno napetostjo, ki so jo pacienti občutili med električnim testiranjem pulpe. To nakazuje, da zobje z višjo gostoto živčnih vlaken imajo nižji prag za električno stimulacijo. Zanimivo je, da so zobje z zaprtimi konicami pokazali višjo gostoto živčnih vlaken v zgornjem delu zobne pulpe v primerjavi z zobmi z odprtimi konicami. Vendar med dvema skupinama ni bilo pomembnih razlik v zaznavanju električne napetosti, kar kaže na individualne razlike v občutljivosti.
Medtem ko velikost vzorca in osredotočenost na zdrave zobe za ortodontsko ekstrakcijo omejujeta splošno veljavnost ugotovitev, ti rezultati zagotavljajo dragocene vpoglede v razmerje med kliničnimi testi in histološkimi značilnostmi zobne pulpe. Pulzna oksimetrija se pojavlja kot zanesljiva metoda za ocenjevanje vitalnosti pulpe, saj odraža vaskularnost in nasičenost pulpnega tkiva s kisikom. Prisotnost višje gostote živčnih vlaken lahko prispeva k nižjemu pragu za električno stimulacijo, kar nakazuje na vključenost nevronskih dejavnikov v senzibilnost pulpe. Pozitivna korelacija med gostoto krvnih žil in nasičenostjo s kisikom, kot tudi negativna korelacija med gostoto živčnih vlaken in zaznavanjem električne napetosti, prinašajo dragocene vpoglede v kompleksno naravo zobne pulpe. Čeprav je potrebna nadaljnja raziskava z večjimi in bolj raznolikimi vzorci, ti rezultati prispevajo k našemu razumevanju vitalnosti zobne pulpe in njenega razmerja do kliničnih ocen. S prikazom uporabnosti pulzne oksimetrije pri ocenjevanju nasičenosti s kisikom in pomembnosti gostote živčnih vlaken pri električni senzibilnosti, ta študija poudarja potencial za bolj objektivne in natančne metode pri ocenjevanju vitalnosti pulpe.
Te ugotovitve imajo pomembne posledice za zobne strokovnjake. Uporaba pulzne oksimetrije lahko zagotovi kvantitativno merjenje nasičenosti kisika v zobni pulpi, kar omogoča zdravnikom bolj natančno oceno zdravja in vitalnosti pulpnega tkiva. Te informacije lahko pomagajo pri določanju ustreznega pristopa k zdravljenju, na primer potrebe po ohranjanju pulpe ali možnosti regeneracije pulpe. Poleg tega opazna korelacija med gostoto živčnih vlaken in električno senzibilnostjo poudarja vpliv nevronskih dejavnikov na občutljivost pulpe. Razumevanje vloge živčnih vlaken pri zaznavanju električnih dražljajev lahko zdravnikom pomaga pri ocenjevanju in obvladovanju nelagodja pacientov med zobnimi postopki. Prav tako poudarja pomen individualnih razlik v občutljivosti in potrebo po individualiziranih pristopih k zdravljenju.
Omejitve te študije so majhna velikost vzorca in osredotočenost na zdrave zobe za ortodontsko ekstrakcijo. Nadaljnje raziskave z večjimi in bolj raznolikimi vzorci so potrebne za potrditev teh ugotovitev in preučevanje morebitnih razlik v vitalnosti pulpe med različnimi zobnimi stanji ali starostnimi skupinami. Poleg tega bi lahko longitudinalne študije zagotovile dragocene vpoglede v spremembe vitalnosti pulpe skozi čas in vpliv staranja na zdravje pulpe.
Reference: Tenyi A, Nemeth L, Golež A, Cankar K, Milutinović A. Comparison of the vitality tests used in the dental clinical practice and histological analysis of the dental pulp. Bosn J of Basic Med Sci [Internet]. 2022Jun.1 [cited 2023Jun.8];22(3):374-81. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/6841
Editor: Ermina Vukalic
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