Reference values for pulp oxygen saturation as a diagnostic tool in endodontics: a systematic review and meta-analysis

Abstract

Objectives: This systematic review aimed to identify mean oxygen saturation values (SpO 2) using pulse oximetry in permanent maxillary anterior teeth. Materials and Methods: The MEDLINE, Scientific Electronic Library Online, Cochrane Central Register of Controlled Trials, EMBASE, and Literatura Latino Americana em Ciências da Saúde electronic databases were searched. Combinations and variations of "oximetry" AND "dental pulp test" were used as search terms. Studies reporting means and standard deviations of SpO 2 values were included. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Heterogeneity was assessed using the I 2 statistic, and all analyses were performed using R software. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale. Results: Of the 251 studies identified, 19 met the eligibility criteria and were included (total sample, 4,541 teeth). In the meta-analysis, the mean SpO 2 values were 84.94% (95% confidence interval [CI], 84.85%-85.04%) for the central incisors, 89.29% (95% CI, 89.22%-89.35%) for the lateral incisors, and 89.20% (95% CI, 89.05%-89.34%) for the canines. The studies were predominantly low-quality due to the high risk of bias associated with the index test, unclear risk regarding patient selection, and concerns about outcome assessment. Conclusions: Although most studies were low-quality, the oxygen saturation levels in normal pulp could be established (minimum saturation, 77.52%). Despite the risk of bias of the included studies, the reference values reported herein are clinically relevant for assessments of changes in pulp status.

Assessment of Pulpal Status in Primary Teeth Following Direct Pulp Capping in an Experimental Canine Model

“…The majority of existing PO studies was carried out on anterior teeth [ 14 ], due to limitations imposed by the size of the sensor. In our study, we selected, for the pulse-oximetry vitality testing, the nasal alar SpO₂ sensor because the small size of the sensor makes it appropriate for dental use, even in the posterior area of the oral cavity, ensuring a satisfactory tooth-fit.…”

“…PO testing after DPC registered values of SpO 2 ranging between 82.2% and 86.8% in the treated teeth. According to the literature, average SpO 2 values of healthy teeth are 84.94%–89.29% for central and lateral incisors, 89.20% for canines [ 14 ], 86.20% for premolars [ 32 ], and 85.09% for molars [ 33 ]. Minimum oxygen saturation levels in healthy pulp were identified at around 77.52% [ 14 ].…”

“…According to the literature, average SpO 2 values of healthy teeth are 84.94%–89.29% for central and lateral incisors, 89.20% for canines [ 14 ], 86.20% for premolars [ 32 ], and 85.09% for molars [ 33 ]. Minimum oxygen saturation levels in healthy pulp were identified at around 77.52% [ 14 ]. Anusha et al reported oxygen saturation levels for pulpal diseases: 85.4%—reversible pulpitis 81.6%—irreversible pulpitis; 70.7%—pulp necrosis (94.6%—positive control, healthy teeth; 0%—negative control, endodontically treated teeth) [ 34 ].…”

“…PO, on the other hand, is carried out using a simpler device—a conventional pulse oximeter, but with modified sensor holders [ 10 , 11 , 12 ]—due to the fact that a dedicated PO device/sensor for dental use is not yet available [ 13 ]. Studies on PO in primary teeth are limited, and most of them were performed in anterior teeth [ 12 , 14 ] due to the physical limitation of bulky sensors. Nevertheless, the numerous advantages of PO (non-invasiveness, relatively cheap cost, simple technique and painless procedure) [ 13 ] would make it ideal for routine use in children, for both the initial diagnosis and follow-up of vital pulp treatments.…”

Teeth with molar incisor hypomineralization in children have lower dental pulp oxygen saturation

“…Measurement MIH cases were selected by an experienced and calibrated dental surgeon (Kappa 0.8) for the diagnosis of enamel development defects. The criteria of Ghanim et al (2015)[24] were used to select the sample. The severity criteria of MIH [5] were used to determine the division of the groups.…”