Tooth vitality testing using moorVMS-LDF
Contents
1. W moor instruments innovation in microvascular assessment Tooth vitality testing using moorVMS LDF Application note 100 Application Laser Doppler LD is considered more reliable than sensory testing for vitality assessment 4 This is because there can be adequate vascularisation to support tooth pulp vitality even when sensation is lost due to nerve damage Blood flow is assessed by placing laser Doppler probes in contact with the teeth typically using a dental putty splint to support the probe The graph below illustrates a simultaneous comparison of blood flow in Vital and Non Vital teeth Further confirmation can be obtained by using FFT analysis of the blood flow recording to investigate the presence or absence of the cardiac pulse of oe ee ee ee oe SOS Tes SHIMFCUKAT4 BERS IL e wena swa t force omits Trace Characteristics C E lt vital Relatively high blood flow usually with a pulsatile cardiac frequency component Non Vital Relatively low blood flow SS aa with no clear pulsatility Equioment Required The following equipment is required for tooth Pulp Vitality testing moorVMS LDF laser moorVMS PC Windows 15 20mm VP3 blunt needle end Doppler module software and PC delivery laser Doppler probe for assessment of front teeth VP5 blunt needle 90 degree end Bur drill Size 2 round bur and Quick Setting Dental delivery laser Doppler probe for countersunk with a size 6 impression putt2. g both the pulsatility and SIE Won Vitel magnitude of the traces Trace Characteristics os Vital Relatively high blood flow usually with a pulsatile cardiac frequency component lt Non Vital Relatively low blood flow with no clear pulsatility i moorVMS PC V1 0 for Vascular Monitor System Review DB 15 Ill vms ka File Edit wae Hs Time 00 00 20 750 Selected Ch vital Value 9 5 Time Constants 0 5 sec Graphs Linked Options Setup Analysis Service Window Help MA Sd HOR Rik Henk IE As a further aid to vitality assessment Pirie ie t i it is possible to quantify and assess Ro peo SeMAx cardiac pulsatility of the tooth blood flow the flux traces can be Review DB 15 IIL ym X transformed with Fourier analysis FFT using moorVMS PC software FFT examples are shown left note the prominence of the peak at cardiac bo aia Spectrum 60 70 80 90 100 110 120 130 140 FFT No 2048 eiei en frequency here about 60 cycles per minute indicating pulp vitality Review DB 15 IIL vm X Practical Suggestions Supporting the probe Dental Putty Splint Measurements free of movement artefact signals can be obtained when the laser Doppler optic fibre probe is Supported in a dental putty splint although successful hand held measurements have bee
3. n reported The splint also ensures reproducible positioning at follow up to assess progress Dental splints are made for the individual patient using dental impression putty e g President Putty Mould the putty to the patients teeth then drill a small hole size 2 at 2 to 8mm from the gingival margin first test positions using a needle Dental putty probe holder for chronic blood flow measures Dental putty probe holder in position with 2 laser Doppler probes Publications 1 Chen E amp Abbott P V 2011 Evaluation of accuracy reliability and repeatability of five dental pulp tests Journal of endodontics 2 Mesaros S Trope M Maixner W amp Burkes E J 1997 Comparison of two laser Doppler systems on the measurement of blood flow of premolar teeth under different pulpal conditions International endodontic journal 3 Roeykens H amp De Moor R 2011 The use of laser Doppler flowmetry in paediatric dentistry European archives of paediatric dentistry official journal of the European Academy of Paediatric Dentistry 4 Roeykens H Van Maele G Martens L amp De Moor R 2002 A two probe laser Doppler flowmetry assessment as an exclusive diagnostic device in a long term follow up of traumatised teeth a case report Dental traumatology official publication of International Association for Dental Traumatology 5 Zerari Mailly F amp Braud A 2012 Glutamate control of pulpal blood flow i
4. n the incisor dental pulp of the rat European Journal of Oral Science 402 7 Further Reading moorVMS LDF User Manual Q36 cleaning and handling of optic probes www moor co uk information about laser Doppler monitors and probes Clinical advice courtesy of Heather Pitt Ford St Thomas amp Guys Hospital London www primadentalgroup com bur drill Supplies Important Disclaimer This information is provided to further clinical research into diagnostic capabilities of laser Doppler The moorVMS LDF is CE marked for human use but not specifically for clinical diagnosis of tooth vitality Calibrated equipment with a current service record should only be used Confounding Factors There are several factors that can prevent a clear descrimination between vital and non vital teeth Assuming your machine is in service and is calibrated the following additional notes may be useful Instrument Noise laser Doppler monitors are calibrated using a two point calibration The two points used are 1 the factory set instrument zero value and 2 the flow value following calibration It is possible to check instrument zero by placing the probe in a static reflector In this case a value of less than 2 perfusion units should be seen but not 0 This is deliberate so that the user has confidence that the correct amount of instrument noise has been subtracted at factory set up If O perfusion units is seen it is not possible to determine if to
5. o much noise has been subtracted If you do measure O perfusion units then please contact service moor co uk for advice Scattered light from gingiva light scattered into the gingiva where faster moving blood is present can influence the assessment by adding to the low flow seen in the tooth This is more likely if the probe is placed near the gingiva This can be prevented by making a shield from thin black rubber sheeting to surround the tooth prior to fitting the dental splint Refer to the Matthews paper listed in the publications for further information Bandwidth the moorVMS LDF defaults to 14 9Khz upper bandwidth This will enable pulsatility to be seen more clearly A restricted bandwidth of 3Khz will offer superior signal to noise in very low flow conditions but is less suited for FFT analysis Notes innovation in microvascular assessment W moor instruments Moor Instruments Ltd Millwey Axminster Devon EX13 5HU UK tel 44 0 1297 35715 fax 44 0 1297 35716 email sales moor co uk website www moor co uk Issue 2
6. y to make assessment of rear teeth dental splint for optic probes Method Ensure your moorVMS LDF module is calibrated and with an in date service record Ensure your probes are clean disinfect with Cidex OPA where facilities and local regulations allow If sterilisation is required use the Sterrad low temperature technique See Q36 Cleaning and handling of optic probes supplied with all optic probes Set the LD time constant of the system to 0 1 seconds to view pulsatility Consider using warm mouth wash to enhance local flow then insert the dental splint into the patients mouth Ensure the probe tip is in contact with the tooth is held firmly in the dental splint see practical suggestions Ensure optic fibres are supported and not swinging free possibly tape the probe leads to fixed surfaces Sample continuously for at least a minute to obtain a trace free of movement artefact signals Vitality is assessed by the magnitude of the LD signal presence of cardiac pulsatility and other natural soontaneous variations in blood flow Please refer to publications for further hints tips Analysis 4 moorVMS PC V1 0 for Vascular Monitor System Review DB 15 Ill vms x Tooth Vitality is confirmed by BS File Edit Options Setup Analysis Service Window Help o x KOS B88 a3SBFli eawuvn T Te a k AlE ee Time 90 00 21 050 Selected Ch Vital value 10 8 Time Constants 0 5 sec Graphs Linked examinin
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