Assessment of operator-associated variability in thermal pulp sensibility tests: A simulation study using a custom-designed testing apparatus.

Abstract

Objective: Thermal pulp sensibility tests are critical, cost-effective tools for assessing pulp vitality and guiding disease prognosis. However, their accuracy and efficacy are often compromised by subjective patient responses and operator variability. This study evaluated operator-associated variability for the performance of hot and cold pulp sensibility tests using a custom-designed testing apparatus.

Materials and methods: In this cross-sectional study, 23 dentists performed heat and cold tests on the apparatus while thermal and temporal parameters were recorded. Key outcome measures included were tool heating/cooling time, heat dissipation time, tool temperature on tooth, maximum tooth temperature, and maximum tool temperature.

Results: Metallic instrument (burnisher) used for heat testing exceeded temperatures of 400°C for both experienced (more than 5 years) and inexperienced operators. Heat application duration often surpassed 10 s, posing a risk. Conversely, cold testing using the Endo-Frost cold spray (-50°C) failed to attain sufficiently low temperatures to stimulate a pulpal response. Significant loss in tool temperature, particularly during cold tests, further compromised the efficacy.

Conclusion: This study highlights considerable operator-induced variability in thermal pulp sensibility testing, with potential implications for diagnostic accuracy and patient safety. Study findings emphasize the necessity of standardized protocols to mitigate operator-related discrepancies and improve the diagnostic reliability.