ELECTRIC PULP

TESTING

DR DITHYKUMARI K K
year MDS
Dept of Endodontics
Contents
• Introduction
• Key uses of pulptesting in clinical practice
• Types of EPTs
• Objective
• Optimal placement of the tester electrode
• Procedure
• Ideal Situations for Electric Pulp Testing
• Potential Deficiencies of Pulp Testers
• Conclusions
• References
Introduction
• The ideal pulp test method should provide a simple, objective, standardized, reproducible,
nonpainful, non injurious, accurate and inexpensive way of assessing the condition of the pulp
tissue (chambers 1982).
• These tests are also defined as sensibility tests, as they assess whether there is response to a
stimulus.
•  The use of electricity as an aid in the diagnosis of pulp diseases is older than the use of
radiography in dentistry (reynolds 1966).
The use of electricity in dentistry is attributed to Magitot Click icon to add picture
and described in his book Treatise on Dental Caries
published in France in 1867 (cited in Prinz 1919).
Magitot advocated the use of an induction current to
localize carious teeth (Prinz 1919).
Electric pulp tester
It is an instrument that uses gradations of electric current to
excite a response from susceptible elements of the pulpal
tissues.
Key uses of pulp testing in clinical
practice
• Investigation of radiolucent areas
• Post-trauma assessment
• Assessment of anaesthesia
• Assessment of teeth which have been pulp capped or
required deep restoration
Types of EPTs

There were two electric testing modes, bipolar and

monopolar, which could be divided in to two subclasses,
those with mains connection and those using batteries
(Ehrmann 1977, Na¨rhi et al. 1979).
Monopolar stimulation will excite periodontal nerves at a level of stimulus below threshold for
some pulp nerves, but they cannot be excited with bipolar stimulation even when intensities 15
times greater than the highest threshold of the pulp nerves are applied (Greenwood et al. 1972).
When bipolar stimulation is used, the current flows from the cathode to the anode, but the current
path is confined to the coronal part of the tooth (Mumford 1957), which probably explains why
the periodontal nerve fibres are not stimulated.
Objective
 to stimulate intact A delta nerves in the pulp–dentine
complex by applying an electric current on the tooth
surface
 A positive result stems from an ionic shift in the dentinal
fluid within the tubules
 causing local depolarization and subsequent generation
of an action potential from intact A delta nerves.
• The response threshold is reached when an adequate number of nerve
terminals are activated to attain a so-called summation effect
Optimal placement of the tester
electrode
Click icon to add picture
• Incisor teeth is at the incisal edge, where the enamel is
thinnest or absent.

• tooth surface nearby to a pulp horn, as this obtains the

highest nerve concreteness with in the pulp.

• This site parallels to the incisal third region of anterior

teeth and the mid-third region of posterior teeth
Optimum site for electrode placement on molars was on
the tip of the mesiobuccal cusp. Click icon to add picture
Procedure
Commonly used electrolytes are Nichollas-colloidal graphite, Grossman toothpaste.
To have fast response, electrode should be applied at the area of high neural density like incisal one
third of anterior teeth (it’s close to pulp horns) and middle third of posterior teeth
• Precaution should be taken to avoid it contacting adjacent gingival tissue or metallic restorations to
avoid false-positive response.
• Confirm the complete circuit from electrode throught he tooth to the body of the patient and then
back to
• the electrode. If gloves are not used, the circuit gets completed when clinician’s finger contact with
electrode
• and patient’s cheeks. But with gloved hands, it can be done by placing patient’s finger on metal
electrode handle or by clipping a ground attachment on to thepatient’s lip.
An electric pulp tester tip and contact medium placed on
sound tooth structure.
If a full coverage restoration is present, a bridging
technique can be utilized. A fine tip of an explorer or file
can be used to contact tooth structure cervical to the
crown margin, and the EPT probe tip contacts the
instrument

The bridging technique

demonstrating an explorer tip
contacting the tooth and the electric
pulp tester tip contacting the explorer
Testing the reliability of the responses can also be achieved using the EPT with the current switched
off or by changing the sequence of the teeth being tested to prevent the results from being affected by
the patient’s reaction because of his/her bias and/or anxiety
• normal response to the stimulus and this response is not pronounced or exaggerated, and it
does not linger
• Pulpitis exaggerated response that produces pain.
• mild pain of short duration reversible pulpitis
• severe pain that lingers irreversible pulpitis
• The absence of responses pulp necrosis, the tooth is pulpless, or has had previous root canal
therapy
Ideal Situations for Electric Pulp Testing
• Anterior teeth
• Traumatic accident.
• In determining when a problem is caused by pulpal or by periodontal damage

• The death of a single pulp may produce a radiolucency that involves the apices of adjacent teeth
and suggest endodontic therapy for multiple members of the arch
Factors that influence EPT result for false positive or false
negative response
• the thickness of enamel and dentine,
• concentration of pulpal neural elements,
• direction of dentinal tubules,

• amount of dentinal fluid

• the distance between the electrode tip and the pulp.
Potential Deficiencies of Pulp Testers.
• The output of current on a given reading may vary from time to time, or even from tooth to tooth.
• Large restorations or bases may prevent the current from reaching dentinal tubules attached to processes extending
to the pulp.
• Molars may give readings not indicative of the true pulpal condition because some combination of vital and
nonvital canals may be present.
• If the canal in proximity to the tooth electrode is vital, a relatively normal
• Reading will be recorded even if the other canals are necrotic.
• The nerve tissue, being highly resistant to inflammation might remain reactive long after the surrounding tissues
have degenerate

.
False-positive response in
• Teeth with acute alveolar abscess
• Electrode may contact gingival tissue, thus giving the
false-positive response
• In multirooted teeth
False-negative response in
• Recently traumatized tooth
• Recently erupted teeth with immature apex
• Patients with high pain threshold
• Calcified canals
• Poor battery or electrical deficiency in plug in pulp
testers
• Teeth with extensive restorations or pulp protecting bases
under restorations
• Patients premedicated with analgesics or tranquilizers
• Partial necrosis of pulp sometimes is indicated as totally
necrosis by electric pulp tester
Considerations/limitations regarding use of EPT
• A response to an EPT does not provide any information about the health status of the pulp, its
circulation, or its integrity.
• The EPT is not reliable for testing immature teeth because the myelinated fibres entering the pulp
may not reach their maximum number until 5 years after tooth eruption or until they have been
in function for 4–5 years.
• EPTs for teeth which have full or partial coverage with a metallic restoration can create difficulty
because of the limited access to tooth structure for tip placement and the large size of many
electrode tips.
SENSITIVITY
• It is the ability of a test to correctly classify an individual as diseased.
• Probability of being test positive when the disease is present.
• Sensitivity – 0.72
SPECIFICITY

• It is the ability of a test to correctly classify an individual as disease free.

• Probability of being test negative when disease is absent.

• Specificity – 81%
• Laser Doppler flowmetry and pulp oximetry were the most accurate diagnostic methods based on
their high accuracy (97%).
• Heat pulp testing was the least accurate diagnostic method based on it low accuracy (72%).
• Electric pulp testing was less likely to correctly identify nonvital teeth but more likely to correctly
identify vital teeth based on its low sensitivity (72%) and high specificity (93%).
• Cold pulp testing showed generally high diagnostic accuracy values among pulp sensibility tests.

⁕ Mainkar A, Kim SG. Diagnostic accuracy of 5 dental pulp tests: a systematic

review and meta-analysis. Journal of endodontics. 2018 May 1;44(5):694-702.
• Xylocaine 2% Jelly and fluoride gel evoked significantly lower threshold values when compared
with Sensodyne Repair & Protect
• the mean sensory threshold from the female group was significantly lower than that of the male
group

⁕ Chunhacheevachaloke E, Ajcharanukul O. Effects of conducting media and

gender on an electric pulp test. International Endodontic Journal. 2016
Mar;49(3):237-44
• Fluorosed teeth showed high threshold response when compared to nonfluorosed teeth,

⁕ Vemisetty H, Vanapatla A, Ravichandra PV, Reddy SJ, Punna R,

Chandragiri S. Evaluation of threshold response and appropriate
electrode placement site for electric pulp testing in fluorosed anterior
teeth: An in vivo study. Dental Research Journal. 2016
May;13(3):245.
Conclusions

• While EPT is a valuable test in general and specialist endodontic practice, no single technique can
reliably interpret and diagnose all pulpal conditions
• Cold testing and EPT may accurately diagnose pulp vitality in over 80% of cases
• Sensibility tests are dependent on patient responses.
REFERENCES
⁕ Frankline S weine endodontic therapy 6th edition
⁕ Cohen’s Pathway of the Pulp, 12th edition
⁕ Gopikrishna V, Pradeep G, Venkateshbabu N. Assessment of pulp vitality: a review. International
journal of paediatric dentistry. 2009 Jan;19(1):3-15.
⁕ Chen E, Abbott PV. Dental pulp testing: a review. International journal of dentistry. 2009
Oct;2009
⁕ Vemisetty H, Vanapatla A, Ravichandra PV, Reddy SJ, Punna R, Chandragiri S. Evaluation of
threshold response and appropriate electrode placement site for electric pulp testing in fluorosed
anterior teeth: An in vivo study. Dental Research Journal. 2016 May;13(3):245.