Title	Pulp Testing May Demonstrate Pulp Vitality Effectively In Patients With Full Coverage Restorations
Clinical Question	In patients with full coverage crowns that become symptomatic, does pulp testing demonstrate vitality as effectively as pulp testing in patients with non-restored teeth?
Clinical Bottom Line	The current standard for testing pulp vitality through full coverage restorations is through frozen carbon dioxide, which has shown to be effective in evaluating pulpal response (Augsburger, 1981). Though current research evidence is weak, it would be beneficial to investigate other methods in order to assess pulpal disease under full coverage restorations for better diagnosis and treatment planning.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 15448461 Miller/2004 10 human premolars (5 maxillary & 5 mandibular) Experimental on extracted teeth Key results Results showed that the non-restored teeth and the teeth with full coverage restorations respond similarly to thermal testing, but 1,1,1,2-tetrafluoethane testing is the most effective method for pulp testing. 10530156 Petersson/1999 59 teeth with unknown pulpal status and 16 intact teeth Comparative Study Key results The probability that a non-sensitive reaction represented a necrotic pulp was 89% with the cold test, 48% with the heat test, and 88% with the electrical test. The probability that a sensitive reaction represented a vital pulp 90% with the cold test, 83% with the heat test, and 84% with the electrical test. PMC2837315 Chen/2009 Review Article Key results Although pulp sensitivity tests (thermal and electric) have limitations, they still remain superior to other vitality and blood flow tests being used and are helpful in endodontic diagnosis. This review also briefly discusses the effect that metallic restorations and full coverage restorations may have on temperature decrease in cold testing.
Evidence Search	"Dental Pulp Test"[Mesh] AND "Crowns"[Mesh]
Comments on The Evidence	Miller’s evidence included a variety of acceptable pulp tests that were used on all the extracted teeth samples. The study included non-restored teeth and a variety of full coverage restorations (PFM, all-porcelain, and gold). This study was not; however, done on real patients. Petersson’s evidence used pulp tests on all patients that were acceptable; however, the study did not include patients with full coverage restorations. Gold standard was direct inspection of the pulp Although Chen’s review article is not a systematic review of randomized controlled trials, it does include comprehensive details on the search for relevant trials. It does not assess individual studies for the validity. Perspective: Although there is much research on the different types of pulp vitality tests, the effect of full coverage restorations has not yet been sufficiently researched. This is a topic that requires future investigation.
Applicability	Dentists perform pulp vitality tests through full coverage crowns frequently in their practices to aid in diagnosis irreversible pulpal involvement. There is insufficient research on whether full coverage restorations can be adequately tested to determine pulpal vitality and the patient’s subjective symptoms become more important in determining the course of treatment. Because research has shown on a long-term basis 4 to 8% of crowned teeth require root canal treatment ten years following placement, often times this requires careful monitoring of the patient’s symptoms to determine the definitive course of action (Whitworth et al., 2002).
Specialty	(Endodontics) (General Dentistry)
Keywords	Pulp, vitality test, crown, root canal, longevity
ID#	2375
Date of submission	03/18/2013
E-mail	Campm@Livemail.uthscsa.edu
Author	Mary Grace Camp
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kevin M. Gureckis, DMD
Faculty mentor e-mail	Gureckis@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available