Reliability of electric pulp test and thermal pulp test for assessing pulpal response in patients undergoing orthodontic treatment - A systematic review

Objective > To assess the reliability of pulp sensibility tests in patients undergoing orthodontic treatment. Background > The orthodontic force may cause transient changes in pulp vasculature leading to alteration in its response threshold. This may vary with the type, duration and magnitude of forces used. Thus, it is imperative to monitor the pulp sensibility and vitality of teeth during the course of orthodontic treatment. Material and methods > Sources: PubMed, Web of Science, Embase, Scopus, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Randomized clinical trials and/or observational studies evaluating the pulp sensibility response of patients undergoing orthodontic treatment were included. Study characteristics, sample characteristics, methodology details, outcome assessment, and main results were recorded in excel sheet. The Newcastle-Ottawa scale (NOS) was used to assess risk of bias (ROB). Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Results > Thirteen observational studies were included. Total number of participants who under- went orthodontic treatment was 2956 (average age 17.53 +/- 3.81 years). The type and duration of orthodontic force was variable in the different studies. The pulp sensibility response was assessed using either Electric pulp test (EPT), or Thermal pulp test (TPT), or both. Pulp response threshold increased after application of orthodontic force, with number of negative responses peaking at about 2-3 months. Most of the studies presented with a high ROB. The certainty of evidence was considered low. Conclusions > Based on limited comparative data, TPT was considered more reliable than EPT and that the pulp response threshold increased after application of orthodontic force, peaking at about two or three months. PROSPERO database (CRD42022307390).