Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Münster, Germany.
Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland.
Int Endod J. 2023 Oct;56 Suppl 3:296-325. doi: 10.1111/iej.13762. Epub 2022 May 25.
The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and well-executed clinical trials on the diagnosis of the true status of the pulp.
Three PICO questions were formulated and agreed a priori by the European Society of Endodontology to evaluate the clinical tests for sensibility testing, determination of biomarkers and pulp bleeding with regard to their suitability to correctly diagnose the condition of the pulp tissue for the development of S3-Level guidelines.
A literature search was conducted using PubMed, Clarivate Analytics' Web of Science, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials from inception to 21 January 2022. Additionally, a hand search was performed, and the contents of the major subject journals were also examined. Eligibility criteria followed the proposed PICO questions. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The risk of bias was assessed by the QUADAS-2 tool for diagnostic accuracy studies, the Newcastle-Ottawa scale for noncomparative, nonrandomized studies and the Newcastle-Ottawa Quality Assessment scale adapted for cross-sectional studies.
In total, 28 studies out of 29 publications were considered eligible and were included in the review. Twelve studies were identified to investigate the diagnostic accuracy of the pulp vitality. Ten studies fulfilled the criteria to evaluate the diagnostic accuracy of the pulpal conditions, while 6 studies investigating the expression of biomarkers were eligible. Three studies addressing the prognostic factors and therapeutic interventions relating to pulpal status were included.
The core problem in pulp diagnostics is that a reliable reference standard is lacking under clinical conditions. Based on limited evidence, the most promising current approach seems to define a combination of different clinical tests and symptoms, probably in future including molecular diagnosis ("diagnostic package") will be required to ascertain the best possible strategy to clinically diagnose true pulpal conditions.
The effectiveness of diagnosing pulpitis is low due to limited scientific evidence regarding the accuracy and reproducibility of diagnostic tests. There is a lack of evidence to determine the true status of the pulp or to identify prognostic indicators allowing for a reliable pre-operative estimation of the outcome of vital pulp treatment.
PROSPERO database (CRD42021265366).
在临床诊断和治疗中，对牙髓炎症状态的诊断至关重要。目前，仅有少数设计良好、执行良好的临床试验用于诊断牙髓的真实状态。
欧洲牙髓病学会通过三个事先制定的 PICO 问题来评估牙髓活力测试、生物标志物测定和牙髓出血的临床检测，以确定其是否适合制定 S3 级指南，从而正确诊断牙髓组织的状况。
从建库到 2022 年 1 月 21 日，我们通过 PubMed、科睿唯安 Web of Science、Scopus、谷歌学术和 Cochrane 对照试验中心检索文献，并进行了手工检索，还查阅了主要专业期刊的内容。纳入标准遵循提出的 PICO 问题。两名独立的评审员参与研究选择、数据提取和评估纳入的研究；有分歧时，由第三名评审员解决。采用 QUADAS-2 工具评估诊断准确性研究的偏倚风险，采用纽卡斯尔-渥太华量表评估非比较、非随机研究，采用纽卡斯尔-渥太华质量评估量表评估横断面研究的偏倚风险。
共有 29 篇出版物中的 28 项研究被认为符合纳入标准，并纳入了本次综述。有 12 项研究用于评估牙髓活力检测的诊断准确性，10 项研究符合评估牙髓状况的诊断准确性标准，6 项研究符合评估生物标志物表达的纳入标准，3 项研究涉及与牙髓状况相关的预后因素和治疗干预。
牙髓诊断的核心问题是在临床条件下缺乏可靠的参考标准。基于有限的证据，目前最有前途的方法似乎是定义不同临床检测和症状的组合，可能在未来还需要包括分子诊断（“诊断包”），以确定确定最佳的临床诊断牙髓状况的策略。
由于缺乏有关诊断测试准确性和可重复性的科学证据，诊断牙髓炎的效果较低。目前缺乏确定牙髓真实状态或识别预后指标的证据，无法可靠地预测活髓治疗的结果。
PROSPERO 数据库（CRD42021265366）。
