Diagnostic accuracy of thermal and electric pulp tests for pulp sensibility assessment after pulpotomy - a histomorphometric study

The pulpotomy procedure is based on the principles of minimal intervention dentistry and is aimed at the preservation of radicular pulp. It has been proposed as an alternative to root canal treatment for the management of carious exposed teeth. Based on the current outcome assessment criteria, the pulpotomy procedure is considered successful if the patient is asymptomatic and the radiograph reveals normal periapical architecture. This provides an indirect assessment of pulp survival after pulpotomy. Pulp sensibility tests, which stimulate the dental nerve fibers, are diagnostic aids for determining the status of pulp in routine clinical practice. It is assumed that the pulpotomized teeth do not respond to pulp sensibility tests due to the absence of coronal pulp tissue and the presence of heavy restoration in the pulp chamber. Therefore, the position statement by the European Society for Endodontology (ESE) does not include the use of a pulp sensibility test in the outcome assessment criteria. On the contrary, the findings of a retrospective study done at our department and limited published literature in peer-reviewed international journals suggests that the pulp sensibility tests can elicit a response in pulpotomized teeth and can be used as a tool to determine the pulp survival after pulpotomy procedure. However, every test, even with the highest level of precision, will misclassify a certain proportion of patients. Hence, it is important to determine the accuracy of a test to classify a patient’s response before it can be proposed as a tool for outcome assessment. To characterize the pulp sensibility test’s accuracy, histological examination is considered as the gold standard reference. Till date to the best of our knowledge, there is no study in the literature that compares the responses of pulp sensibility tests and the histological status of pulp after the pulpotomy procedure (partial or complete) in permanent teeth. Hence, the current study is planned with the primary goal of evaluating the diagnostic accuracy of pulp sensibility tests (thermal and electric pulp test) after partial and complete pulpotomy in permanent teeth.