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)
15448461Miller/200410 human premolars (5 maxillary & 5 mandibular)Experimental on extracted teeth
Key resultsResults 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.
10530156Petersson/199959 teeth with unknown pulpal status and 16 intact teethComparative Study
Key resultsThe 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.
PMC2837315Chen/2009Review Article
Key resultsAlthough 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) 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
None available