Vitality Tests for Pulp Diagnosis of Traumatized Teeth: A Systematic Review.

INTRODUCTION: The objective of this systematic review was to evaluate the efficacy of vitality tests (pulse oximetry and flowmetry) in the pulpal diagnosis of traumatized teeth in comparison with sensibility tests.

METHODS: This review was registered in the PROSPERO database (CRD42018097361) and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic systematic search of the literature was performed in the PubMed (Medline), Scopus, Web of Science, Cochrane Library, Lilacs, and Gray Literature databases and the reference lists of articles published until May 2018. The data of the included articles were extracted, and the methodological quality was judged using the QUADAS-2 quality assessment tool following the Cochrane recommendations.

RESULTS: The initial search retrieved 173 potential articles. After the duplicates were removed, 77 articles remained; the titles and abstracts of these 77 articles were read, resulting in the selection of 19 articles for reading the full text. Five articles were selected for data extraction and qualitative analysis. The vitality tests evaluated in the studies were pulse oximetry, laser Doppler flowmetry, and ultrasound Doppler flowmetry compared with cold testing, electrical testing, or both. In all articles, the results were favorable for vitality tests; however, a high risk of bias was found in at least 1 item of the quality evaluation of the included studies.

CONCLUSIONS: Because of the high risk of bias and deficiency in the research design, there is still a need for further studies in relation to pulse oximetry, laser Doppler flowmetry, and ultrasound Doppler flowmetry, which consistently prove the diagnostic accuracy and superiority when compared with sensibility tests on traumatized teeth.