Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.
Division of Biostatistics and Computational Biology, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.
Int Endod J. 2021 Jul;54(7):1008-1015. doi: 10.1111/iej.13490. Epub 2021 Feb 25.
This clinical study evaluated the reliability of the 1,1,1,2-tetrafluoroethane (Endo Ice) cold test to determine the pulpal diagnosis of teeth with full-coverage restorations (FCR). The effect of several variables on its reliability was also investigated.
Data collected from 825 patients treated in the Advanced Education Program in Endodontics at the University of Iowa, USA were analysed. The experimental group included 425 teeth with FCR, whilst the control group consisted of 400 teeth with natural crowns (NC). The pulp sensibility test results, tooth type, tooth number, type of crown, age, gender, presence or absence of caries and recent use of analgesics were recorded. Bivariate analyses were performed to assess the variables associated with the accuracy of dental pulp sensibility tests for either teeth with crowns or teeth without crowns using chi-square tests, Fisher's exact tests, Cochran-Mantel-Haenszel tests, and the Wilcoxon rank-sum tests. A P-value of less than 0.05 was used as a criterion for statistical significance, and a P-value in 0.05 < P < 0.10 was used as a criterion for marginal relevance.
The sensibility test results for FCR teeth had an accuracy of 0.866; sensitivity of 0.835; specificity of 0.879; a positive predictive value of 0.746; and a negative predictive value of 0.926. The data indicated a significant difference in the accuracy of pulp sensibility test results between the experimental and control groups (P < 0.001). Although the cold test in FCR teeth still had high accuracy, teeth with NC were significantly more likely to have true-positive and true-negative results (91.5% NC vs. 86.6% FCR, P = 0.024). No significant differences between FCR and NC were found concerning gender, tooth type, type of crown, the presence of abutment and recent use of analgesic (P > 0.05).
Pulp sensibility cold testing with 1,1,1,2-tetrafluoroethane (TFE) on teeth with FCR was less accurate than on teeth without full-coverage crowns. However, the use of TFE cold testing is still a relevant and reliable diagnostic tool, particularly for teeth with a pulpal diagnosis of symptomatic irreversible pulpitis. Clinicians should routinely carry out cold pulp sensibility testing on teeth when making a pulpal diagnosis.
本临床研究评估了 1，1，1，2-四氟乙烷（Endo Ice）冷测试确定全冠修复（FCR）牙齿牙髓诊断的可靠性。还研究了几个变量对其可靠性的影响。
分析了美国爱荷华大学牙髓高级教育项目中 825 名患者的数据。实验组包括 425 颗 FCR 牙齿，对照组包括 400 颗天然冠（NC）牙齿。记录牙髓感觉测试结果、牙齿类型、牙齿数量、冠类型、年龄、性别、有无龋齿和近期使用镇痛药情况。使用卡方检验、Fisher 确切检验、Cochran-Mantel-Haenszel 检验和 Wilcoxon 秩和检验对二变量分析进行评估，以评估与使用全冠或无全冠牙齿的牙髓感觉测试准确性相关的变量。P 值小于 0.05 被用作统计学意义的标准，P 值在 0.05<P<0.10 被用作边缘相关性的标准。
FCR 牙齿的感觉测试结果准确率为 0.866；敏感性为 0.835；特异性为 0.879；阳性预测值为 0.746；阴性预测值为 0.926。数据表明，实验组和对照组之间牙髓感觉测试结果的准确性有显著差异（P<0.001）。尽管 FCR 牙齿的冷测试仍然具有很高的准确性，但 NC 牙齿更有可能出现真正的阳性和真正的阴性结果（91.5% NC 比 86.6% FCR，P=0.024）。FCR 和 NC 之间在性别、牙齿类型、冠类型、基牙存在和近期使用镇痛药方面无显著差异（P>0.05）。
FCR 牙齿的 1，1，1，2-四氟乙烷（TFE）牙髓冷测试的准确性低于无全冠牙齿。然而，使用 TFE 冷测试仍然是一种相关且可靠的诊断工具，特别是对于牙髓诊断为症状性不可复性牙髓炎的牙齿。临床医生在进行牙髓诊断时应常规对牙齿进行冷牙髓感觉测试。
