Clinical Research

Predictive Values of Thermal and Electrical Dental Pulp Tests:

A Clinical Study
Carlos E. Villa-Ch

avez, DDS, MS,* Nuria Pati~no-Mar
ın, DDS, MS, PhD,*
Juan P. Loyola-Rodr
ıguez, DDS, PhD,† Norma V. Zavala-Alonso, DDS, MS, PhD,‡
Gabriel A. Mart
ınez-Casta~
n, MSc, PhD,‡ and Carlo E. Medina-Sol
ıs, DDS, MS§
no

Abstract
Introduction: For a diagnostic test to be useful, it is
necessary to determine the probability that the test
will provide the correct diagnosis. Therefore, it is neces-
T he key to developing a treatment plan for oral rehabilitation is a correct diagnosis,
sary to calculate the predictive value of diagnostics. The
aim of the present study was to identify the sensitivity,
specificity, positive and negative predictive values, accu-
racy, and reproducibility of thermal and electrical tests
of pulp sensitivity. Methods: The thermal tests
studied were the 1, 1, 1, 2-tetrafluoroethane (cold)
and hot gutta-percha (hot) tests. For the electrical
test, the Analytic Technology Pulp Tester (Analytic
Technology, Redmond, WA) was used. A total of
110 teeth were tested: 60 teeth with vital pulp
and 50 teeth with necrotic pulps (disease prevalence
of 45%). The ideal standard was established by
direct pulp inspection. Results: The sensitivities of
the diagnostic tests were 0.88 for the cold test, 0.86
for the heat test, and 0.76 for the electrical test, and
the specificity was 1.0 for all 3 tests. The negative
predictive value was 0.90 for the cold test, 0.89 for
the heat test, and 0.83 for the electrical test, and the
positive predictive value was 1.0 for all 3 tests. The
highest accuracy (0.94) and reproducibility (0.88)
were observed for the cold test. Conclusions: The
cold test was the most accurate method for diagnostic
testing. (J Endod 2013;39:965–969)
Key Words
Electrical dental pulp test, predictive values, thermal
dental pulp tests
and in endodontic treatment, it is important to identify the status of the pulp tissues.
Several methods have been proposed to assess pulp sensitivity and circulation (1). To
determine the sensitivity of the pulpal nerves (vital sensitive teeth or necrotic nonsen-
sitive teeth), dentists use thermal and electrical tests (2–6). The ideal test should be easy
to use, fast, inexpensive, noninvasive, painless, reproducible, and accurate (7). Sensi-
tivity, specificity, and positive and negative predictive values were previously developed
to characterize the accuracy of given tests (8, 9). The sensitivity value indicates the
ability of a test (ideal standard) to identify teeth that are diseased (necrotic pulp).
The specificity value tests the ability of a procedure (ideal standard) to identify teeth
without disease (vital pulp). The positive predictive value is the probability that
a positive test result (a tooth without a sensitive response) represents a diseased
tooth (necrotic pulp), and the negative predictive value is the probability that a tooth
with a negative test result (a tooth with a sensitive response) is free from disease
(vital pulp) (2, 10, 11). Therefore, it is important to determine the positive and
negative predictive values to identify the probability of a correct diagnosis with
thermal and electrical pulp tests (12). Several studies have compared different tests
to assess sensitivity, but none of them calculated the positive and negative predictive
values (1, 4,13–17). Petersson et al (2) evaluated the ability of thermal and electrical
tests to register pulp vitality using direct visual inspection as the ideal standard. Their
results found an 89% probability that a nonsensitive reaction with the cold test indicated
necrotic pulp (positive predictive value), a 48% probability for the heat test, and an 88%
probability for the electrical test. The probability that a sensitive reaction indicated a vital
pulp (negative predictive value) was 90% for the cold test, 83% for the heat test, and
84% for the electrical test. Gopikrishna et al (18) evaluated the efficacy for assessing
pulp vitality of a new, custom-made pulse oximeter dental probe compared with the
electrical and thermal tests. The sensitivity, specificity, and predictive values for each
test were calculated by comparing the test results with direct visual inspection. The posi-
tive predictive value was 0.92 for the cold test and 0.91 for the electrical test, and the
negative predictive value was 0.81 for the cold test and 0.74 for the electrical test. There
have been several reports on the determination of predictive values from sensitivity tests,
but the procedures (the construction of the 2  2 table) and the interpretation of the
data have been different from those established in the literature to calculate predictive
values (7–9, 19, 20). Therefore, the aim of the present study was to identify the
sensitivity, specificity, positive and negative predictive values, accuracy, and
reproducibility of thermal and electrical tests to determine pulp sensitivity.

From the *Laboratory of Clinical Investigation, †Laboratory of Molecular Biology and Oral Microbiology, and ‡Laboratory for Nanobiomaterials, The Master’s Degree
in Dental Science with Specialization in Advanced General Dentistry Program, San Luis Potosi University, San Luis Potosi, Mexico; and §Area of Dentistry, Institute of
Health Sciences, Autonomous University of the State of Hidalgo, Pachuca, Hidalgo, Mexico.
Supported by the Laboratory of Clinical Investigation and The Master’s Degree in Dental Science with Specialization in Advanced General Dentistry Program at San
Luis Potosi University, Fund Research Supporting–San Luis Potosi University (FAI-UASLP) and National Council for Science and Technology (CONACYT).
Address requests for reprints to Dr Nuria Pati~no-Mar
ın, Fuente de la selva # 166, Col Balcones del Valle, CP 78280 San Luis Potos
ı SLP, M
exico. E-mail address:
1nuriapm@gmail.com
0099-2399/$ - see front matter
Copyright ª 2013 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2013.04.019

JOE — Volume 39, Number 8, August 2013 Thermal and Electrical Dental Pulp Tests 965
Downloaded for Anonymous User (n/a) at University El Bosque from ClinicalKey.com by Elsevier on February 21,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Clinical Research
Materials and Methods
A cross-sectional study was performed from June 2008 to January
2012. According to the ethical principles of the Declaration of Helsinki,
informed and voluntary written consent was obtained from the patients
before the clinical tests. A total of 110 subjects without previous clinical
diagnoses of pulp status were examined. All of the variables were ob-
tained from the Master’s Degree in Dental Science with Specialization
in Advanced General Dentistry Program, San Luis Potosi University,
San Luis Potosi, Mexico. The inclusion criteria were as follows: patients
who were 17 to 70 years old and systemically healthy patients of either
sex who did not use drugs for 3 months before the study began. The
exclusion criteria were teeth with full-surface crowns, large restora-
tions, recent trauma, regressed pulpal chambers, or calcified root
canals and orthodontic treatment.
The endodontic diagnostic tests were performed by 3 different
researchers (to have independent results) who were blinded to clinical
signs and symptoms, dental histories, and radiographic findings. The
tests were assigned randomly for each subject involved in the study.
Each participant was instructed to raise his/her hand at the moment
that he/she felt a sensation during testing.
Cold Pulpal Testing
A clinical researcher sprayed a no. 2 cotton pellet with a refrigerant
spray (1, 1, 1, 2-tetrafluoroethane) (Hygenic Endo-Ice Green [Endo-
Ice]; Coltene Whaledent, Cuyahoga Falls, OH), which was then placed
onto the crown of the tooth (at the middle third of the buccal surface)
for 18 seconds or until the participant raised a hand to indicate that he/
she felt a cold sensation (4, 13, 15, 19). A digital infrared thermometer
was used to ensure that the temperature used was the same for all of the
patients ( 26 C).
Hot Pulpal Testing (Hot Gutta-percha)
A second researcher placed a heated gutta-percha rod onto the
crown of the tooth (at the middle third of the buccal surface) for 18
seconds or until the participant raised a hand to indicate that he/she
felt a hot sensation (4, 13, 15, 19). The researcher used a digital
infrared thermometer to ensure that the temperature used was the
same for all of the patients (80 C).
Electrical Pulp Testing
A third researcher used an electric pulp tester (Analytic Tech-
nology Pulp Tester; Analytic Technology, Redmond, WA) to apply an
electrical impulse to the crown of the tooth (at the middle third of
the buccal surface). A tooth with a response at a level lower than 70
was considered vital (2, 19).
The researchers allowed at least 5 minutes to elapse after each
pulp test (4). All teeth were tested with the 3 different methods, and
pulp tests were performed after clinical isolation with cotton rolls
and drying of the tooth with air. Twelve endodontically treated teeth
were used as negative controls.
Ideal Standard
After the conclusion of the tests, the researchers who administered
the treatment anesthetized the teeth with 2% lidocaine and 1:100,000
diluted epinephrine. The teeth were isolated with rubber dams. The
gold standard (pulp status) was detected by opening the pulp chamber,
and the pulp status (vital/necrotic) was recorded by observing bleeding
within the pulp chamber after the access cavity was created. The pres-
ence (vital pulp) or absence (necrotic pulp) of bleeding was used as the
reference standard. When vital tissue was observed in the apices but
necrotic tissue was observed in the chamber, the tooth was considered
partially necrosed (and thus necrotic).
Teeth with Vital Pulp
The results of the tests in teeth with vital pulp were reported (in
seconds) as follows: (1) the number of seconds from the application
of the stimulus until the participant raised a hand was defined as the first
time (FT) evaluation for the cold and heat tests, and (2) the number of
seconds from removing the stimulus until the absence of the sensation
felt during testing was defined as the second time (ST) evaluation. The
subjects of the study were slated for endodontic treatment because of
their vital teeth had irreversible pulpitis and their nonvital teeth had
necrotic pulp.
Statistical Analysis
An expert calibrated the examiners for all of the variables. Each
participant contributed 1 tooth to the analysis for a total of 110 teeth.

TABLE 1. Type and Clinical Evaluation of the Teeth According to the Ideal Standard
Necrotic pulp* Vital pulp*
Jaw Tooth n = 50 n = 60
Frequency (%)
Maxilla Incisors 7 (14.0) 3 (5.0)
Canines 3 (6.0) 3 (5.0)
Premolars 8 (16.0) 11 (18.4)
Molars 9 (18.0) 15 (25.0)
Total 27 (54.0) 32 (53.4)
Mandible Incisors 3 (6.0) 0 (0.0)
Canines 1 (2.0) 2 (3.3)
Premolars 3 (6.0) 5 (8.3)
Molars 16 (32.0) 21 (35.0)
Total 23 (46.0) 28 (46.6)
Clinical evaluation Healthy† 5 (10.0) 0 (0.0)
Caries 25 (50.0) 49 (81.6)
Caries and amalgam 6 (12.0) 0 (0.0)
Restoration 8 (16.0) 11 (16.6)
Fistula 3 (6.0) 0 (0.0)
Incisal wear 3 (6.0) 0 (0.0)
*Ideal standard.
†
Apparently healthy crown.

966 Villa-Ch
avez et al. JOE — Volume 39, Number 8, August 2013

Downloaded for Anonymous User (n/a) at University El Bosque from ClinicalKey.com by Elsevier on February 21,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.

TABLE 2. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy, and Reproducibility
Comparison between tests Sensitivity
Ideal standard vs cold test 0.88
Ideal standard vs hot test 0.86
Ideal standard vs electrical 0.76
*Test of kappa (Cohen).
The true-positive, false-positive, true-negative, and false-negative
responses were identified. Based on these parameters, the sensitivity,
specificity, positive predictive value, negative predictive value, accuracy
([a + d]/[a + b + c + d]), and prevalence ([a + c]/[a + b + c + d])
were calculated for each test. Reproducibility was determined with the
kappa test (Cohen) (10, 11). Correlations (Spearman rho) were calcu-
lated between the times of the responses (FT and ST) of the patients (in
vital teeth) and the tests. The results were analyzed with Stata statistical
software (version 11; StataCorp, College Station, TX).
Results
One hundred ten subjects (66% female) 17 to 70 years old (38 
15 years) were evaluated. Fifty pulps were classified as necrotic (no
bleeding), and 60 pulps were classified as vital (bleeding from
pulp). Table 1 shows the types and the clinical evaluations of the teeth
according to the ideal standard. The most frequent teeth included were
molars, and dental caries was the most common pathology in the study.
The cold test identified 44 of the 50 necrotic pulps as necrotic (true-
positives), and the remaining 6 teeth had sensitive responses (false-
negatives). The heat test identified 43 of the 50 teeth with necrotic pulps
as nonsensitive (true-positives) and 7 teeth as sensitive (false-nega-
tives). The electrical test identified 38 of 50 teeth with necrotic pulps
as nonsensitive (true-positives) and 12 as sensitive (false-negatives).
All 60 teeth that had clinically vital pulp (true-negatives) showed sensi-
tive responses with all of the tests (cold, hot, and electrical). The sensi-
tivity, specificity, positive and negative predictive values, accuracy, and
reproducibility are shown in Table 2. The highest values were observed
when comparing the ideal standard with the cold test; the sensitivity was
0.88, and the specificity was 1.00. This result indicates that 88% of the
teeth with necrotic pulp were identified as necrotic, whereas 100% of
the teeth with vital pulp were identified as vital. The positive predictive
value was 1.00, and the negative predictive value was 0.90. Thus, there
was a probability of 100% that no sensitive reactions represented
necrotic pulp, and 90% of vital pulps had reactions observed with
the cold test. The accuracy was 94%, and the reproducibility was
0.88, indicating that the reproducibility was almost perfect (21). The
results of the tests (in seconds) in teeth with vital pulp are shown in
Table 3. The fastest FT response was observed with the cold test
(2.5  3.3), and the fastest ST was observed with the electrical test
TABLE 3. Results of the Tests in Teeth with Vital Pulp
Time(s) Cold test Hot test Electrical test
Mean  SD
FT 2.5  3.3 3.3  4.3
ST 2.2  2.7 2.7  3.2 1.7  2.3
Cold test vs Cold test vs
hot test electrical test
Rho*
FT 0.66 — —
ST 0.72 0.61
FT, first time; SD, standard deviation; ST, second time.
*Rho = correlation of Spearman with P < .0001.
JOE — Volume 39, Number 8, August 2013
Downloaded for Anonymous User (n/a) at University El Bosque from ClinicalKey.com by Elsevier on February 21,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Clinical Research
Specificity PPV NPV Accuracy Reproducibility*
1.00 1.00 0.90 0.94 0.88
1.00 1.00 0.89 0.93 0.86
1.00 1.00 0.83 0.89 0.76
(1.7  2.3). The strongest correlation was observed with the ST for
the cold and heat tests (rho = 0.72, P < .0001).
Discussion
In a diagnostic test (cold, heat, and electrical), it is necessary to
know the probability that the test will provide the correct diagnosis.
Therefore, it is necessary to calculate the predictive values of diagnostic
tests because sensitivity and specificity do not provide us with this infor-
mation (12). The aim of the present study was to identify the sensitivity,
specificity, positive and negative predictive values, accuracy, and repro-
ducibility of thermal and electrical tests to register pulp sensitivity. When
predictive positive and negative values are estimated, the prevalence of
the disease must be considered because the predictive values change
with the prevalence (2, 8, 9, 20–22). Therefore, to compare
predictive values from different studies, it is necessary to have the
same prevalence.
Comparison of Predictive Values
The predictive values in this study were based on a prevalence of
45%. Petersson et al (2), who also reported predictive values, used
a disease prevalence of 39% for their calculations; when the predictive
values in the present study were recalculated with a prevalence of 39%,
the results were similar to those reported by Petersson et al. In the cold
test, the negative predictive value obtained was 0.90 (prevalence of
45%), but when the same value was recalculated with a disease preva-
lence of 39%, the negative predictive value was 0.92 (negative predictive
value = (specificity  [1 – prevalence])/([1 – sensitivity])  preva-
lence + specificity  [1 – prevalence]) (12). The positive predictive
value was 1.0 (prevalence of 45%), and when the value was recalculated
with a prevalence of 39%, the value was 1.0 (positive predictive value =
[sensitivity  prevalence]/[sensitivity  prevalence + (1 specificity)
 (1 – prevalence]) (12). In the heat test, the negative predictive value
was 0.89 (prevalence of 45%), but when a prevalence of 39% was used,
the negative predictive value was 0.91. The positive predictive value ob-
tained was 1.0 for both rates of prevalence (39% and 45%). For the
electrical test, the negative predictive value obtained was 0.90 using
a disease prevalence of 39%, but it was 0.86 in the present study,
with a prevalence of 45%. The positive predictive value was 1.0 for
both rates of prevalence (39% and 45%).
Gopikrishna et al (18) evaluated the efficacy for assessing pulp
vitality of a new, custom-made pulse oximeter dental probe compared
with electrical and thermal tests. The predictive values for each test were
calculated with a prevalence of 52%. When the predictive values of this
study were recalculated with a prevalence of 52%, the results were as
—
follows: the positive predictive value was 1.0 with the cold test and
1.0 with electrical test. The negative predictive value was 0.88 with
Electrical the cold test and 0.80 with the electrical test. Therefore, the results of
test the present study are consistent with those of Gopikrishna et al. Several
studies have compared different tests to assess sensitivity, but they did
not provide information about predictive values (1, 4, 13–17). In
0.60 contrast, there have been several reports on the determination of
predictive values from sensitivity tests, but the procedures (the
construction of the 2  2 table) and the interpretation of the data
Thermal and Electrical Dental Pulp Tests 967
Clinical Research
have been different from those established in the literature to calculate
predictive values (7, 8, 19, 20).
Procedures and Data Interpretation
The following points are important to consider when reporting the
findings from diagnostic tests: (1) the definitions of both negative and
positive responses to a test according to the ideal standard and (2) the
distribution of the values within the 2  2 table. In this study, predictive
values were defined as follows: the positive predictive value is the prob-
ability that a positive test result (tooth without a sensitive response) indi-
cates a diseased tooth (necrotic pulp), and the negative predictive value
is the probability that a tooth with a negative test result (tooth with
a sensitive response) is free from disease (vital pulp) (8, 9, 20). In
this study, the positive and negative test results were calculated with
the presence (positive result of the test = disease presence =
necrotic pulp = nonsensitive response) or absence (negative result
of the test = without disease = vital pulp = sensitive response) of
disease according to the ideal standard. The distribution of the values
within the 2  2 table used was that reported in the literature for the
calculation of diagnostic tests (8, 9, 18).
False-positives and -negatives
A diagnostic test should always report positive values in the pres-
ence of disease and negative values in the absence of disease. False-
positives and -negatives can result in misdiagnoses (8, 9). In the
present study, we observed 25 false-negative responses in teeth with
necrotic pulp; the cold test identified 12% (n = 6 responses), the
heat test identified 14% (n = 7 responses), and the electrical identified
24% (n = 12 responses). All of the teeth with false-negative responses
showed 1 or more of the following clinical traits: multirooted teeth, the
presence of dental caries, periodontal disease (4- to 10-mm pocket
depths), and metallic restorations. Different explanations have been
proposed for false-negative results. For example, these responses
might be caused by conduction of the current to the adjacent gingival
or periodontal tissues. Canal moisture from putrescence of the pulp
tissue (also called moist gangrene) or the presence of inflamed
pulp tissue in partially necrotic, infected pulp might be a factor.
Furthermore, the breakdown products associated with localized
necrosis might conduct electrical current to adjacent inflamed pulp
tissue. A calcified tooth structure might also be capable of conducting
electrical current to tissue apical to an area of pulp necrosis. Addition-
ally, the electrical current might be conducted to adjacent teeth
through contact with class II restorations, especially if they are
metallic. Furthermore, a multirooted tooth might have inflamed
pulp tissue in 1 canal, whereas the pulp chamber and other canals
might be necrotic and infected. Finally, pulp sensitivity tests rely on
the patient’s response; therefore, a false response might occur in
anxious or young patients (5).
Sensitivity of Vital Teeth
It was previously reported that 2.1 seconds was required from the
application of the stimulus until the participant raised a hand in the cold
test (14). In the present study, the average time recorded was 2.5
seconds, which is consistent with the literature. We did not find reports
on the ST. Factors such as pulp chamber size, enamel thickness, and the
concentration of neural elements at the test site probably affected the
results (16). In the present study, the stimulus was placed in the middle
third of the buccal surface (7, 13, 20). However, it has been reported that
thermal tests are considered to be more accurate when the stimulus is
applied to the cervical aspect of a tooth and as close as possible to the
gingival margin. This location represents the thinnest aspect of the
968 Villa-Ch
avez et al.
Downloaded for Anonymous User (n/a) at University El Bosque from ClinicalKey.com by Elsevier on February 21,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
enamel or restoration as well as the closest distance to the pulp
chamber. In contrast, others believe that for anterior teeth, the cold
stimulus should be placed on the incisal third, and for posterior teeth,
it should be placed on the incisal aspect of the mesiobuccal cusp.
These areas are approximate to the pulp horn (5, 15). The variability
of the electric pulp response threshold in premolars was determined;
3 sites (the tip of the buccal cusp and the middle third and the
cervical third of the buccal surface) on each tooth crown were tested.
The buccal cusp tip of the first mandibular premolars responded
more quickly than any other tested site. This location represents the
highest concentration of neural elements in the pulp horns (16, 23).
In addition, it was reported that an increase in periodontal attachment
loss and gingival recession is correlated with a decrease in pain with
the cold stimuli in mandibular incisors in adults (24).
With regard to the length of time that the stimulus was left on the
tooth, in the present study, it was 18 seconds or until the participant
raised a hand to indicate that he/she felt a sensation. Several authors
have reported a mean length of 10 to 15 seconds (4, 13, 15,17–19,
24). Responses to carbon dioxide dry ice sticks (CO2) and refrigerant
spray tests have been reported within defined time intervals (1–5,
6–10, and 11–15 seconds) by tooth type (anterior, premolar, or
molar). Most teeth, regardless of the test method, responded within
5 seconds. However, responses were identified at intervals of 6–10
and 11–15 seconds (14); for this reason, it was decided to increase
the stimulus by 3 seconds in the present study to identify the possibility
of a pulp response after 15 seconds. When the data were analyzed,
a response was not found in 18 seconds.
The following strategies were used to control bias: (1) thermal and
electrical tests were compared with an ideal standard; (2) the compar-
isons of all tests were conducted by 3 different researchers; (3) the eval-
uation of the test was blind; (4) the assigning of the tests was undertaken
randomly; (5) the examiners were calibrated for all of the variables
before starting the study; (6) the location and duration of the stimulus
were the same in all of the tests; (7) an infrared sensor was used to
monitor the temperature in the thermal test and to ensure the temper-
ature during application of the test; (8) the presence and absence of
disease were defined; and (9) in the present study, the researchers al-
lowed at least 5 minutes to elapse after each pulp test. It has been re-
ported in in vitro studies that at least 2 minutes are required to
elapse for the pulp after the application of thermal stimuli because
the pulpal border of the dentin returns to its normal temperature within
this period (13, 15, 19).
Accuracy and Reproducibility
The most accurate test was the cold test (0.94), and the most
reproducible was the cold test (kappa = 0.88) followed by the heat
(0.86) and the electrical (0.76) tests, which is in agreement with other
studies (2, 11, 17, 20, 25). It is necessary to consider that the results of
this study might be different from those of earlier studies because the
present study excluded teeth with full-surface crowns, large restora-
tions, recent trauma, regressed pulpal chambers, or calcified root
canals and orthodontic treatment.
To determine the sensitivity of the pulp, thermal and electrical tests
were used, but these tests can have false results. In the clinic, selecting
a diagnostic test with less possibility of false results is recommended.
Therefore, it is necessary to calculate predictive values to identify the
tests more objectively.
Conclusions
The results from this study determined that the probability that
a nonsensitive reaction indicated necrotic pulp (positive predictive
JOE — Volume 39, Number 8, August 2013

value) was 100% for the 3 tests. The results indicated that the proba-
bility that a sensitive reaction represented a vital pulp (negative predic-
tive value) was 90% with the cold test, 89% with the heat test, and 83%
with the electrical test.
Acknowledgments
The authors deny any conflicts of interest related to this
study.
References
1. Setzer FC, Kataoka SH, Natrielli F, et al. Clinical diagnosis of pulp inflammation
based on pulp oxygenation rates measured by pulse oximetry. J Endod 2012;38:
880–3.
2. Petersson K, S€oderstr€om C, Kiani-Anaraki M, et al. Evaluation of the ability of
thermal and electrical test to register pulp vitality. Endod Dent Traumatol 1999;
15:127–31.
3. Newton CW, Hoen MM, Goodis HE, et al. Identify and determine the metrics, hier-
archy, and predictive value of all the parameters and/or methods used during
endodontic diagnosis. J Endod 2009;35:1635–44.
4. Pantera EA Jr, Anderson RW, Pantera CT. Reliability of electric pulp testing after
pulpal testing with dichlorodifluoromethane. J Endod 1993;19:312–4.
5. Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part I: general information
and thermal tests. Int Endod J 2010;43:738–62.
6. Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part II: electric pulp tests
and test cavities. Int Endod J 2010;43:945–58.
7. Dastmalchi N, Jafarzadeh H, Moradi S. Comparison of the efficacy of a custom-made
pulse oximeter probe with digital electric pulp tester, cold spray, and rubber cup for
assessing pulp vitality. J Endod 2012;38:1182–6.
8. Weinstein MC, Fineberg HV. The use of diagnostic information to revise probabili-
ties. In: Weinstein MC, Fineberg HV, eds. Clinical Decision Analysis. Philadelphia:
Saunders; 1980:75–130.
JOE — Volume 39, Number 8, August 2013
Downloaded for Anonymous User (n/a) at University El Bosque from ClinicalKey.com by Elsevier on February 21,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Clinical Research
9. Jaeschke R, Guyatt G, Sackett DL. Users’ guides to the medical literature. III. How to
use an article about a diagnostic test. A. Are the results of the study valid? Evidence-
Based Medicine Working Group. JAMA 1994;271:389–91.
10. Landis RJ, Koch GG. The measurement of observer agreement for categorical data.
Biometrics 1977;33:159–74.
11. Cohen J. Weighted kappa: nominal scale agreement with provision for scaled
disagreement or partial credit. Psychol Bull 1968;70:213–20.
12. Altman DG, Bland JM. Diagnostic tests 2: Predictive values. BMJ 1994;309:102.
13. Fuss Z, Trowbridge H, Bender IB, et al. Assessment of reliability of electrical and
thermal pulp testing agents. J Endod 1986;12:301–5.
14. Jones VR, Rivera EM, Walton RE. Comparison of carbon dioxide versus refrigerant
spray to determine pulpal responsiveness. J Endod 2002;28:531–3.
15. Peters DD, Baumgartner JC, Lorton I. Adult pulpal diagnosis. I. Evaluation of the
positive and negative responses to cold and electrical pulp test. J Endod 1994;
20:506–11.
16. Filippatos CG, Tsatsoulis IN, Floratos S, et al. The variability of electric pulp response
threshold in premolars: a clinical study. J Endod 2012;38:144–7.
17. Chen E, Abbott PV. Evaluation of accuracy, reliability, and repeatability of five dental
pulp tests. J Endod 2011;37:1619–23.
18. Gopikrishna V, Tinagupta K, Kandaswamy D. Evaluation of efficacy of a new custom-
made pulse oximeter dental probe in comparison with the electrical and thermal
tests for assessing pulp vitality. J Endod 2007;33:411–4.
19. Weisleder R, Yamauchi S, Caplan DJ, et al. The validity of pulp testing: a clinical
study. J Am Dent Assoc 2009;140:1013–7.
20. Saeed MH, Mazhari NA, Al-Rawi NH. The efficacy of thermal and electrical tests to
register pulp vitality. J Int Dent Med Res 2011;4:117–22.
21. Kramer MS, Feinstein AR. Clinical biostatistics. LIV. The biostatistics of concordance.
Clin Pharmacol Ther 1981;29:111–23.
22. Hyman JJ, Cohen ME. The predictive value of endodontic diagnostic tests. Oral Surg
Oral Med Oral Pathol 1984;58:343–6.
23. Byers MR. Dental sensory receptors. Int Rev Neurobiol 1984;25:39–94.
24. Rutsatz C, Baumhardt SG, Feldens CA, et al. Response of pulp sensibility test is
strongly influenced by periodontal attachment loss and gingival recession.
J Endod 2012;38:580–3.
25. Bierma MM, McClanahan S, Baisden MK, et al. Comparison of heat-testing method-
ology. J Endod 2012;38:1106–9.
Thermal and Electrical Dental Pulp Tests 969