Despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut-off ratios over which a tooth could be diagnosed as having a normal pulp.
Aim: To assess whether laser Doppler flowmetry is more accurate than the conventional pulp sensibility tests (Electric pulp test and ethyl chloride) in assessing the pulp status of permanent anterior teeth in children and to identify the LDF's Flux cutoff threshold. Methodology: A cross-sectional cohort diagnostic accuracy study with randomisation was carried out in 8-16 year old children. Participants had one maxillary central or lateral incisor with either a completed root canal treatment or an extirpated pulp and a contra-lateral tooth with vital pulp. The outcome measures included the sensitivity, specificity and predictive values as well as the repeatability of all tests. Statistical analysis included the use of the Receiver Operating Characteristic (ROC) curve and contingency 2x2 tables. Kappa scores were used to assess the repeatability of EPT and ethyl chloride while inter-class correlation was used for LDF. Results: The study included 74 participants as determined by sample size calculation. A significant difference between the Flux values for teeth with vital and non-vital pulps was found. The best cutoff ratio for LDF was 0.6 yielding a sensitivity of 54 % and a specificity of 32 % which were lower than the values of electric pulp test (Sensitivity = 83.8-94.6 %, Specificity = 89.2-97.6 %) and ethyl chloride (Sensitivity = 81.1-91.9 %, Specificity = 73-81.1 %). The repeatability of LDF, EPT and ethyl chloride were 0.85, 0.86 and 0.81, respectively. Conclusion: Laser Doppler flowmetry was unable to differentiate between teeth with vital and non-vital pulps in children between the ages of 8-16 years, with an acceptable level of confidence. The results of this study showed that there was a high probability for false results. Further development of LDF in assessing pulpal blood flow would be required before it could be recommended for clinical use especially in children.
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