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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
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.
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.
90