Rajiv Gandhi University of Health Sciences Karnataka
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE
KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
|1. |NAME OF THE CANDIDATE AND ADDRESS |DR.DAAMAN NAGPAL |
| |(IN BLOCK LETTERS) |POST GRADUATE STUDENT, |
| | |DEPARTMENT OF CONSERVATIVE |
| | |DENTISTRY AND ENDODONTICS, |
| | |COLLEGE OF DENTAL SCIENCES, |
| | |DAVANGERE-577004. |
| | |KARNATAKA. |
| 2. | NAME OF THE INSTITUTION |COLLEGE OF DENTAL SCIENCES, |
| | |DAVANGERE-577004,KARNATAKA |
|3. |COURSE OF STUDY AND SUBJECT |MASTER OF DENTAL SURGERY IN CONSERVATIVE DENTISTRY AND |
| | |ENDODONTICS |
|4. |DATE OF ADMISSION TO COURSE |14/5/2012 |
|5. |TITLE OF THE TOPIC |“IN VIVO STUDY -DETERMINATION OF EFFICACY OF PULSE OXIMETRY |
| | |IN ASSESSMENT OF PULPAL INFLAMMATION” |
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|6. |BRIEF RESUME OF THE INTENDED WORK: |
| |6.1 NEED FOR THE STUDY: |
| |Diagnosis is the correct determination, discriminative estimation and logical appraisal of conditions found during examination |
| |as evidenced by distinctive signs, marks and symptoms. Correct treatment begins with a correct diagnosis1.The assessment of |
| |pulp vitality is a crucial diagnostic procedure in practice of endodontics. |
| |Different methods of diagnosis are history, transillumination, palpation, percussion, radiographs, thermal and electrical |
| |sensitivity tests. Pulp vitality testing is an important aid in diagnosis of pulpal and periapical pathosis for proper |
| |endodontic diagnosis.2 |
| |The various methods to determine pulp vitality are thermal and electrical stimulation, anaesthetic testing and test cavity.4 |
| |Recent advances in endodontic diagnosis involves pulse oximetry and laser Doppler flowmetry. Pulse oximetry determines vascular|
| |circulation which is a more definite determinant of pulpal vitality than determination of neural responses. Pulse oximetry is a|
| |non invasive method of determining pulp vitality. It measures blood flow by sending light of a known wavelength (640 nm) |
| |through pulpal tissues and determines pulse rate and functional oxyhemoglobin saturation (% SaO2).7 |
| |The aim of our present study is to determine the clinical diagnosis of pulpal inflammation based on pulp oxygenation rates |
| |measured by pulse oximetry.7 |
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| |6.2 REVIEW OF LITERATURE: |
| |A study was conducted to evaluate the efficacy of a new custom made pulse oximeter dental probe in comparison to electrical and |
| |thermal test for assessing pulp vitality. 80 single rooted incisors, canines and premolars in patients were taken and they |
| |underwent electrical sensitivity tests, thermal sensitivity tests and pulse oximetry. A pulse oximetry reading of 75- 85% was taken|
| |as positive response and a reading of less than 75% was taken as negative response. It was shown that the sensitivity and |
| |specificity of pulse oximetry was higher than both electrical and thermal sensitivity testing. Thus it was concluded that custom |
| |made pulse oximeter dental probe is an effective, accurate and objective method of evaluating pulp vitality.3 |
| |A study was conducted to compare the efficacy of electrical, thermal and pulse oximetry methods for assessing pulp vitality in |
| |recently traumatized maxillary incisor teeth. Readings for pulp vitality for 17 recently traumatized maxillary incisors were taken |
| |with pulse oximeter, electrical pulp tester and thermal pulp tester. The proportion of teeth showing a positive response to |
| |thermal/electrical pulp tests increased from day 0 to 3 months whereas pulse oximeter readings remained constant from day 0 to 6 |
| |months. It was concluded that pulse oximeter is an effective, objective method of evaluating pulp vitality in recently traumatized|
| |permanent teeth.4 |
| |A study was conducted to evaluate the use of pulse oximetry as a test for pulp vitality by comparing in the same patient the level |
| |of oxygen saturation in index finger and maxillary incisor and canine teeth without clinically detectable pulp inflammation.17 male|
| |and 17 female patients between 26 and 38 years of age participated and a total of 32 maxillary central incisors and 32 canines were|
| |evaluated. 10 root canal treated teeth were used as negative control group. Pulse oximetry readings were taken from index finger |
| |and then teeth were subjected to thermal tests followed by pulse oximetry. The value of 90.69% showed vital pulps and SaO2 (oxygen |
| |saturation) of fingers was 95% Thus it was concluded that pulse oximetry can be used as a potential aid to test pulp vitality.5 |
| |A study was conducted to assess pulp inflammation based on pulp oxygenation rates. Premolars and molars of 60 human subjects were |
| |included in the study .The clinical diagnosis of reversible pulpitis, irreversible pulpitis and pulpal necrosis was determined on |
| |the basis of clinical signs and symptoms, radiographs and dental history. Pulse oximetry was used to determine blood flow of the |
| |pulp. Approximate % SaO2 (percentage of oxygen saturation) in reversible pulpitis was 87% irreversible pulpitis was 83% and pulpal |
| |necrosis was 75% whereas normal pulp gave 92%. This study confirmed and concluded that pulpal pathology has a lower % SaO2 than |
| |normal pulp.6 |
| |A study was conducted to compare the efficacy of a custom made pulse oximeter probe with digital electric pulp tester, cold |
| |spray, and rubber cup for assessing pulp vitality .Twenty-four single-canal mandibular premolars needing endodontic treatment |
| |were selected. The selected teeth were pulpally tested with 4 kinds of tests including pulse oximetry, the electric test, cold |
| |spray, and the rubber cup. The sensitivity of pulse oximetry, a rubber cup, electric test, and cold spray was 0.93, 0.60, 0.60, and|
| |0.53, respectively. The specificity of these tests was 1.00, 0.55, 0.22, and 0.66, respectively. It was concluded that pulp testing|
| |by using pulse oximetry is more reliable than the electric test, rubber cup, and cold spray. The custom-made pulse oximeter dental |
| | probe is an effective and objective method for pulp vitality assessment.7 |
| |6.3 Aim and Objective Of the Study : |
| |The purpose of the present in vivo study is to investigate a correlation between pulp oxygenation i.e. Percentage of oxygen |
| |saturation (% SaO2 ) rates and clinical diagnosis of reversible pulpitis, irreversible pulpitis and pulpal necrosis. |
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| |Materials and Method: |
| |7.1 Source Of Data: |
| |Ninety human subjects of either gender with or without pain sensation in premolars and molars (maxillary or mandibular) in the age |
| |group of 20 – 60 years will be selected from the OPD of Department Of Conservative Dentistry And Endodontics, College Of Dental |
| |Sciences, Davangere. The possible risks and discomforts will be explained to the patients and informed consent forms will be signed|
| |by the patients. The patients will be divided into three groups of 30 patients each based on clinical diagnosis which will be made |
| |on the basis of history of pain, palpation, percussion, thermal tests, electric test, and radiographs. |
| |Criteria for diagnosis |
| |Healthy pulp – no past history of pain, a normal cold response, and no clinical or radiographic signs and symptoms. |
| |Reversible pulpitis – no past history of pain, a pronounced response to cold, pain subsides quickly, and causative etiology for |
| |reversible pulpitis (cervical abrasion and initial dental caries). |
| |Irreversible pulpitis – a past history of severe, dull, lingering, or spontaneous pain and pain can be elicited on heat. (deep |
| |caries involving pulp). |
| |Pulpal necrosis – a past history of severe, dull, lingering, or spontaneous pain; no thermal response; pain on percussion; pain on |
| |palpation. |
| |Group 1- reversible pulpitis (30 patients) |
|7 |Group 2- irreversible pulpitis (30 patients) |
| |Group 3- pulpal necrosis (30 patients) |
| |Positive and negative control- all patients in each group should have a healthy tooth with normal pulp that serves as positive |
| |control and an endodontically treated tooth with full crown restoration that serves as negative control group. Pulse oximetry |
| |readings will be collected from index fingers of all patients of all groups and they will serve as index finger group. |
| |Positive control – 90 patients (including all three groups). |
| |Negative control- 90 patients (including all three groups). |
| |Index finger group- 90 patients (including all three groups).5 |
| |Then the pulse oximetry findings will be noted down. |
| |Pulse oximeter (Hygeia, model H100B). |
| |Electrical pulp tester (Parkell pulp vitality tester, model PT-20, Farmingdale , NY 11735 USA). |
| |Thermal pulp testing – hot gutta percha and difluordichlormethane (Endo frost, Roeko). |
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| |7.2 Method Of Collection Of Data: |
| |90 patients of either gender in the age group of 20 – 60 years will be selected using simple random sampling technique and clinical|
| |diagnosis of reversible pulpitis, irreversible pulpitis and pulpal necrosis will be made. |
| |Inclusion criteria |
| |Patients should volunteer to take part in study. |
| |Patient having intact crowns or restorations no larger than 2mm away from the area to be tested will be chosen for clinical |
| |examination. |
| |Patient should have a healthy tooth with normal pulp to serve as a positive control. |
| |Patient should have an endodontically treated tooth with full crown restoration to serve as a negative control group. |
| |Exclusion criteria |
| |Patients suffering from syndromes of tooth impairment. |
| |Patients with teeth affected by dental trauma and cavities. |
| |Patient with crown discoloration indicative of trauma. |
| |Patient with periodontal change (pockets >3mm mobility > 1mm, gingival edema). |
| |Patient with orthodontic braces or prosthetic crowns. |
| |Statistical analysis |
| |Results will be subjected for appropriate statistical analysis. |
| |One way ANOVA will be used for simultaneous multiple group comparison followed by post hoc Tukey HSD test for intergroup |
| |comparison. |
| |Student’s unpaired t test will be used for group wise comparison. |
| |7.3: Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, |
| |please describe briefly. |
| |Yes, the study requires interventions conducted on patients. For diagnosis of pulpitis electrical pulp testing will be done where |
| |an electrode is placed on the tooth and current is passed through it to determine response. Thermal pulp testing will be done using|
| |a cotton pellet soaked in endofrost on the tooth to detect inflammation. Pulse oximeter will then be used .The teeth to be |
| |investigated will be isolated and pulse oximeter sensors will be placed parallel to each other on the vestibular and lingual faces |
| |of the teeth. The sensors will be placed in such a way that light travels from facial to lingual surfaces through the middle of |
| |the crown . This will determine the vascular blood flow and oxygen saturation of the pulp. All the above mentioned tests are non |
| |invasive methods of assessing pulpal status. |
| |7.4 : Has ethical clearance been obtained from your institution in case of 7.3 |
| |YES |
| |References |
| |B.Suresh, V.Gopi Krishna. Grossman’s Endodontic Practice - 12th Edition. Pg:2 |
| |Hargreaves.KM, Cohen S. Cohen’s Pathways of The Pulp- 10th Edition. Pg 2-20 |
| |Gopikrishna V, Tinagupta K, Kandaswamy D. Evaluation of efficacy of a new custom made pulse oximeter dental probe in comparison |
| |with electrical and thermal test for assessment of pulp vitality. J Endod. 2007 Apr;33(4):411-4. |
| |Gopikrishna V, Tinagupta K, Kandaswamy D. Comparison of electrical ,thermal and pulse oximetry methods for assessing pulp vitality |
| |. J Endod. 2007 May;33(5):531-5. |
| |Calil E, Caldeira CL, Gavini G, Lemos EM. Determination of pulp vitality in vivo with pulse oximetry. Int Endod J. 2008 |
| |Sep;41(9):741-6. |
| |Setzer FC, Kataoka SH, Natrielli F, Gondim Junior E, Caldeira CL.Clinical diagnosis of pulp inflammation based on pulp oxygenation |
| |rates measured by pulse oximetry. J Endod. 2012 Jul;38(7):880-3. |
| |Dastmalchi N, Jafarzadeh H, Moradi S. Comparison of the efficacy of a custom-made pulse oximeter probe with digital electric pulp |
| |tester, cold spray, and rubber cup for assessing pulp vitality. J Endod. 2012 Sep;38(9):1182-6. |
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|9. |SIGNATURE OF CANDIDATE | |
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|10. |REMARKS OF THE GUIDE | |
|11. |NAME & DESIGNATION OF (IN BLOCK LETTERS) | |
| |11.1 GUIDE |DR. DHANYAKUMAR N.M, M.D.S |
| | |PROFESSOR AND HEAD DEPARTMENT OF CONSERVATIVE DENTISTRY AND |
| | |ENDODONTICS, |
| | |COLLEGE OF DENTAL SCIENCES , |
| |11.2 SIGNATURE |DAVANGERE-577004 |
| | |KARNATAKA |
| |11.3 CO-GUIDE | |
| |(IF ANY) | |
| | | |
| |11.4 SIGNATURE | |
| |11.5 HEAD OF DEPARTMENT | |
| | |DR. DHANYAKUMAR N.M, M.D.S |
| | |PROFESSOR AND HEAD DEPARTMENT OF CONSERVATIVE DENTISTRY AND |
| | |ENDODONTICS, |
| | |COLLEGE OF DENTAL SCIENCES , |
| |11.6 SIGNATURE |DAVANGERE-577004 |
| | |KARNATAKA. |
|12. |REMARKS OF THE CHAIRMAN & PRINCIPAL | |
| | | |
| |12.2 SIGNATURE | |
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