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Endod Dent Traumatol 1997; 13: 88-91 Copyright © Munksgaard 1997

Printed in Denmark . Att rights reserved


Endodontics &
Dental Traumatology
ISSN 0109-2502

Possible application of transmitted laser light


for the assessnfient of human pulpal vitality
Sasano T, Nakajima I, Shoji N, Kuriwada S, Sanjo D, Ogino H, T. Sasano\ I. Nai(ajima\ N. Sl1oji^
Miyahara T. Possible application of transmitted laser light for the S. Kuriwada\ 0. Sanjo\ H. Ogino^,
assessment of human pulpal \dtality. Endod Dent Traumatol 1997; T. Miyahara^
13: 88-91. © Munksgaard, 1997. ^Department of Oral Diagnosis, Tohoku University
School of Dentistry, Sendai, ^Advance Company.
Abstract - The purpose of this study was to determine whether use Tokyo, Japan

of transmitted laser light would enable a better assessment of human


pulpal vitality than back-scattered light does (LDF: laser Doppler
flowmetry). The experiments were carried out on ten upper cen-
tral incisors in six subjects aged 23-28 years; five of the teeth were
vital with no restoration, and five were non-vital. For use with
transmitted laser light, the fibers within the probe of a conventional
LDF apparatus were used, one for transmitting light onto the
buccal surface, the other for receiving it at the palatal surface of
the same tooth. For LDF, the probe was fixed at the buccal sur-
face. Blood fiow was measured at three different locations on each
experimental tooth: the incisal third, the center and the cervical
third of the tooth crown. In non-vital teeth, 1) output signals with
transmitted laser light all registered zero, and no oscillation could
be seen in recordings from any location on the tooth, but 2) LDF
signals were above zero, there were regular oscillations related to
heart rate, and passive increases in blood flow (corresponding to
blood pressure increases) were recorded from both the center and
the cervical third of the tooth, indicating that LDF registered blood
flow of non-pulpal origin. In \dtal teeth, LDF signals were signifi-
cantly higher than in non-\dtal teeth at each location on the tooth.
At the central site on vital teeth, the output signals for transmitted
laser light were about twice those seen with LDF, and passive blood
Key words; laser Doppler flowmetry; laser light;
flow changes corresponding to blood pressure increases were more
Dulpal blood flow; pulp vitality
clearly observed. These results indicated that transmitted laser light
Takashi Sasano, Department of Oral Diagnosis,
would be useful for the assessment of tooth pulp vitality both be- Tohoku University School of Dentistry, 4-1
cause the blood flow signals did not include flow of non-pulpal Seiryo-machi, Aoba-ku, Sendai 980-77, Japan
origin, and because its output signals and response to blood flow Tel.: 81-22-717-8390. Fax: 81-22-717-8393
changes were clear and could easily be monitored. Accepted for publication October 16, 1996

Pulp-vitality testing should form an integral part of whether the circulation is intact in the dental pulp.
oral diagnosis. However, the most widely used In this connection, laser Doppler flowmetry (LDF), a
methods, namely electrical and thermal tests, deter- revolutionary tool in the estimation of microcircul-
mine not pulp vitality but, rather, pulp sensitivity to atory flow, has been introduced for the diagnosis of
the stimuli used. Therefore some false responses may pulp vitality in human teeth (3-6). It has been shown
be obtained from traumatieally injured teeth or from that the LDF output signal from a tooth with necrotic
teeth with open apices (1, 2). Furthermore, such tests pulp is significantly lower than that from a vital tooth.
cause pain to the patient and are consequently subjec- However, flowmeter output signals from necrotic pulp
tive. It is of much greater importance to determine are not usually registered as zero. For this reason, it
Pulpal blood flow measurement using transmitted laser light

Transmitted laser light Laser Doppler


A 10

150

50

B 10
B

150

50'

10 c 10

BF
(mV)
Nonvitai tooth
150
150

BP
( mmHg
SO

1 0 sec

Eig. I. Original output-signal recordings obtained by transmitted laser light and the laser Doppler method from a non-vital tooth at three
different locations: cer\ical third (A), center (B) and incisal third (C) of the tooth crown. The output signals measured with transmitted laser
light all registered as zero, and no oscillations could be seen in the recordings made at any locations, while LDF signals from the center
and cervacal third of the tooth crowns registered above zero with regular oscillations, and passive increases in BF (corresponding to BP
increases) were observed at these locations.

has been suggested that part of the signal recorded prises two glass graded-index optical fibers, one trans-
from the enamel surface derives from blood flow in mitting and one receiving, each with a core diameter
tissues outside the pulp, that is, of non-pulpal origin of 100 |_im. When we used transmitted laser light, we
(7--9). In fact, the course followed by transmitted or used a single probe, one fiber of which acted as the
back-scattered laser light around the dental pulp has transmitter on the labial side of the tooth, the other
yet to be described. In an attempt to circumvent this (ha\dng been led to the palatal side) as the receiver.
problem, we tested transmitted laser light against The experiments were carried out on ten upper
back-scattered light, and assessed the clinical value of central incisors in six subjects aged 23-28 years. Five
the new method against that of the more usual laser of the teeth were clinically sound with no restoration.
Doppler method. The other five, which were non-vital, to judge from
radiographic evidence, had root canals filled with gut-
Material and methods ta-percha. We made a plaster model (dental cast) of
each subject's upper jaw before the experiment, and
For all tests, we used a conventional LDF (Laser placed plastic splints of 3 mm thickness on the plaster
flowmeter ALF 2ID, Advance, Tokyo, Japan), emit- model, covering all of the upper tooth including the
ting a 2 mW low-intensity beam of monochromatic palatal side. Then we made a straight hole from the
light from a laser diode. In this apparatus, when the palatal side to the buccal side. When transmitted laser
scattered light measured on the photo-detector is less light was used, transmitting and recei\dng fibers were
than 0.005 |iW, the measuring display registers zero located at the labial and palatal holes, respectively,
and a green lamp lights up on the front panel because and the relationship between these fibers at each loca-
the signal/noise ratio has dropped and the power tion was consequently kept rectilinear at the same
spectrum cannot be normalized. The probe com- level and height. Thus the labial hole was used both

89
Sasano et al.

Transmitted laser light Laser Doppler


A

50

B 10 B
^^'fl|p^|T"M'T'nr

150

ao

10

Vital tooth

150

so
10 sec

Fig. 2. Original output-sigiial recordings obtained by transmitted laser light and the laser Doppler method from a vital tooth at three
different locations: cervical third (A), center (B) atad incisal third (C) of the tooth crown. At the center of the crow^n of the vital teeth, the
output signals measured with transmitted laser light were about twice those for LDF, and the passive BF changes corresponding to BP
increases were more clearly observed; however, the output sigtials for transmitted laser light registered as zero at the cervical third or the
incisal third of the tooth crown.

for the source of transmitted illumination and for


Results and discussion
LDF recording, and the palatal hole was used for the
receiver of transmitted laser light only. Table 1 summarizes measurements made at the three
Measurements of blood flow (BF) were made using different locations on vital and non-vital teeth by
LDF or transmitted laser light at three different loca- means of LDF and transmitted laser light. Typical
tions on each experimental tooth, i.e. the cervical recordings are shown in Fig. 1 and 2. As shown in
third (A), the center (B), and the incisal third (C) of the table, in non-\dtal teeth the output signals meas-
the tooth crown (Fig. 1,2). Zero calibration of blood ured with transmitted laser light all registered as zero,
flow was made in each experiment using the mechan- and no oscillations could be seen in the recordings
ical zero-calibration mode inside the apparatus itself
The s'ystemic blood pressure (BP) of each subject was
monitored from a left forefinger b'y means of a non- Table 1. Mean and standard error of blood fiow measurements (mV) obtained
from eacii of three locations on a maxiiiary central incisor (5 non-vitai and 5
invasive pressure transducer (Finapres®, Ohmeda, vital teeth)
Louisville, KY, USA). The output signals for BF (0-
10 mV) and BP (0-200 mm Hg) were continuously Non-vitai teeth Vital teeth
and simultaneously recorded (Recti-Horiz-8K Re-
Transmitted Laser Transmitted Laser
corder, NEC, Tokyo, Japan). In this experiment, we laser Doppler laser Doppler
obtained increases in BP as follows: subjects were told
to hold their breath and contract their stomach A. Cervical third 0 3.8±0.7 0 5.2±1.2*
muscles for periods of 10 sec. We did this because B. Central 0 1.2+0.4 7.1±2.4* 3.3±0.8*
C. Incisal third 0 0 0 o.5±o.r
our previous report indicated that pulpal blood flow
is strongly dependent on systemic blood pressure (10). * Significantly higher than non-vital teeth (p<0.01, unpaired t-test).

90