ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Laser Doppler Flowmetry May Provide Additional Information For Treatment Planning In Patients Suffering From A Traumatic Injury To Their Teeth Compared To Other Methods Of Pulp Testing
Clinical Question In patients suffering from a traumatic injury, would laser Doppler flowmetry studies on blood flow be more accurate than electric pulp testing methods at determining pulp vitality?
Clinical Bottom Line Laser Doppler flowmetry in conjunction with clinical and radiographic evidence can be utilized to analyze the pulpal status of teeth suffering from traumatic injury.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15702708Winzap-Kalin/ 2005Patients with traumatic injury to maxillary incisorsCase Control Study
Key results“In 47.8% of the traumatized teeth and in 55.3% of the control group the three LDF measurements corresponded with the sensitivity testing using CO2 and with the clinical and radiological findings. In 31.9% of the traumatized teeth and in 7.9% of the control group the LDF-measurements differed from the CO2-measurements, but were in agreement with the other clinical and radiographic findings. The information obtained by laser Doppler flowmetry is of additional importance for the treatment planning.”
#2) 15125592Strobl/ 2004Patients with trauma to single maxillary incisorCase Control Study
Key results“In 15 trauma patients, a single maxillary incisor treated by repositioning and splinting was investigated by LDF to assess local PBF values. Perfusion units were taken in four sessions, on the day of splint removel, and 12, 24 and 36 weeks after splint removal. Analysis of the tooth fracture type-related PBF measurements revealed root fractures to be associated with a significant decrease (P < 0.05) and uncomplicated crown fractures to be associated with a significant increase in PBF values (P < 0.05), while complicated crown fractures showed no significant difference between the session-related values (P > 0.05).” “The main findings of this study suggest splint therapy of root fractures of the central maxillary incisor to be associated with a short- and long-term decrease in pulpal blood flow values. The Laser Doppler Flowmetry may become useful in the detection of transient ischaemic episodes and the identification of teeth at risk for adverse sequelae such as avascular necrosis and tissue loss.”
#3) 10825841Evans/ 1999Patients with trauma to anterior teeth; both vital and non-vitalCase Control Study
Key resultsThis paper also concluded that the technique sensitivity and specificity were 1.0 based on the analysis of the recordings; claiming that none of the other standard pulpal diagnostic methods tested were as reliable. “This was usually due to low sensitivities, which ranged between 0.92 for sensibility testing with ethyl chloride down to 0.36 for periapical radiolucency and 0.16 for a history of pain. Laser Doppler flowmetry was found to be a reliable method of assessing the pulpal status of traumatised anterior teeth, although it is technique-sensitive and time-consuming to use.”
Evidence Search Search laser doppler flowmetry[MeSH Terms] Search dental pulp test Search "Tooth Fractures"[Mesh]
Comments on
The Evidence
Case control studies are the most valid form of study that can be utilized for determining the effects of testing methods on traumatized teeth. Stimulation of traumatized teeth in patients in a clinical study would not be ethical, as such case control studies are the most valid form of study for testing traumatized teeth.
Applicability Laser Doppler flowmetry should be used in conjunction with clinical and radiographic findings in determining a treatment plan for patients with traumatic injuries; However, LDF is very technique sensitive and readings can be contaminated by non-pulpal signals.
Specialty/Discipline (Endodontics)
Keywords Pulp vitality testing, Laser Doppler Flowmetry, Traumatic dental injuries
ID# 839
Date of submission: 04/07/2011spacer
E-mail vanscoy@livemail.uthscsa.edu
Author Jennifer Vanscoy
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Fabricio Teixeira, DDS, MS, PhD
Faculty mentor/Co-author e-mail fabricio-teixeira@uiowa.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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by Christopher Adams & Andrea Le (San Antonio) on 11/30/2017
A PubMed search on LDF as useful diagnostic tool was performed in November 2017. Several more recent, albeit tangentially related articles have been published: a case study concerning LDF in monitoring healing post-dental trauma, Liao/2017 PMID: 28527847, and a study on the sensitivity and specificity of oxygen tension measurements using LDF, Maga/2016 PMID: 28101516. Both articles corroborated the CAT's findings and support the use of LDF in clinical practice.
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