Comparison of pulse oximeter, cold test, and electric pulp test for assessment of pulp vitality in permanent immature teeth

Abstract

Introduction: Pulp sensitivity tests are commonly used for assessment of pulp vitality. However, indirect assessment of pulp vitality by evaluation of nerve response and subjective nature are the main limitations of these tests. Pulse oximetry is used for assessment of blood oxygen saturation in medicine, and its efficacy for assessment of pulp vitality needs to be evaluated. Aim: This study aimed to assess and compare the efficacy of pulse oximeter with a modified probe, cold test, and electric pulp test for evaluation of pulp vitality in permanent immature teeth. Materials and methods: This cross-sectional study was conducted on 240 permanent maxillary incisors in four groups based on the type of tooth (central and lateral incisors) and degree of root development (complete or incomplete). Also 40 endodontically treated central and lateral incisors teeth in two groups were evaluated as negative controls. Pulp vitality was assessed by an expert clinician using pulse oximeter, cold test, and electric pulp test. Based on the true and false positive and negative responses, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood, diagnostic accuracy, and diagnostic odds ratio were calculated. Results: The pulse oximeter showed diagnostic accuracy of 98.7% in the permanent central incisors with complete and incomplete roots and 100% in the permanent lateral incisors with complete and incomplete roots. The diagnostic accuracy of the electric pulp test was 76.2% and 92.5% in the incomplete and complete central incisors, respectively, and 76.2% and 83.7% in the incomplete and complete lateral incisors, respectively. The cold test had a diagnostic accuracy of 85% and 92.5% in the incomplete and complete central incisors, respectively, and 91.2% and 88.7% in the incomplete and complete lateral incisors, respectively. Conclusions: The findings of this study showed that pulse oximetry has a higher specificity and better accuracy than the cold test and the electric pulp test in assessing the pulp vitality in the diagnosis of vital teeth and should be introduced as a suitable method for this purpose and preferred to the cold and electric pulp tests for more evaluation to diagnose pulp vitality.