Correlation between Clinical and Histologic Pulp Diagnoses
Abstract
Introduction Clinicians routinely face conditions in which they have to decide whether the dental pulp can be saved or not. This study evaluated how reliable the clinical diagnosis of normal pulp/reversible pulpitis (savable pulp) or irreversible pulpitis (nonsavable pulp) is when compared with the histologic diagnosis. Methods The study material consisted of 95 teeth collected consecutively in a general practice over a 5-year period and extracted for reasons not related to this study. Based on clinical criteria, teeth were categorized as having normal pulps, reversible pulpitis, or irreversible pulpitis. The former 2 were grouped together because they represent similar conditions in terms of prognosis. Teeth were processed for histologic and histobacteriologic analyses, and pulps were categorized as healthy, reversibly inflamed, or irreversibly inflamed according to defined criteria. The number of matching clinical/histologic diagnosis was recorded. Results The clinical diagnosis of normal pulp/reversible pulpitis matched the histologic diagnosis in 57 of 59 (96.6%) teeth. Correspondence of the clinical and histologic diagnosis of irreversible pulpitis occurred in 27 of 32 (84.4%) cases. Infection advancing to the pulp tissue was a common finding in teeth with irreversible pulpitis but was never observed in normal/reversibly inflamed pulps. Conclusions Findings using defined criteria for clinical and histologic classification of pulp conditions revealed a good agreement, especially for cases with no disease or reversible disease. This means that the classification of pulp conditions as normal pulps, reversible pulpitis, and irreversible pulpitis has high chances of guiding the correct therapy in the large majority of cases. However, there is still a need for refined and improved means for reliable pulp diagnosis.
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Current evidence shows significant discrepancies between clinical symptoms and histological status of the pulp.
“Future research should focus on establishing clearer correlations between clinical symptoms and histological status of the pulp, as current evidence shows significant discrepancies between these parameters [25].”
From Consensus‐Based Recommendations on Pulp Therapies in Primary and Permanent Teeth: <scp>IAPD</scp> Porto Forum (2026) · cites this paper as [25]
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Igna, A., Mircioagă, D., Boariu, M., & Stratul, S. (2022) · Medicina · doi:10.3390/medicina58050665 · Cited by 28 · see citing works
“A study investigating the correlation of symptoms with the histological appearance of the pulp demonstrated that the classification of pulp conditions as normal, reversible, and irreversible pulpitis (based on treatment prognosis) has high chances of guiding the correct therapy in most cases, especially the ones with…”
BackgroundAlfaisal, Y., Idris, G., Peters, O., Zafar, S., Nagendrababu, V., & Peters, C. I. (2024) · International Endodontic Journal · doi:10.1111/iej.14036 · Cited by 27
Lee, C. S., Ramsey, A. A., Brito-Gariepy, H. D., Michot, B., Podborits, E., Melnyk, J., & Gibbs, J. (2017) · Molecular Pain · doi:10.1177/1744806917715173 · Cited by 27
“The clinical diagnosis that defines this etiology is irreversible pulpitis, and it is often, but not always, extremely painful.(4,5) As the infection progresses throughout the pulpal tissue, the pulp degenerates and ultimately becomes completely necrotic, while the inflammation continues to spread in the periodontal t…”
BackgroundFourier Transform Infrared Imaging analysis of dental pulp inflammatory diseases.
Giorgini, E., Sabbatini, S., Conti, C., Rubini, C., Rocchetti, R., Fioroni, M., Memè, L., & Orilisi, G. (2017) · Oral Diseases · doi:10.1111/odi.12635 · Cited by 27 · see citing works
“The hallmark features of irreversible pulpitis are an advanced degenerative process of the pulp and the presence of a continuous pain that may be initiated by cold, but is also more reliably produced by heat (Levin et al, 2009; Michelson and Holland, 2002; Ricucci et al, 2014; Keiser et al, 2002).”
BackgroundGene expression profile of pulpitis
Galicia, J., Henson, B. R., Parker, J., & Khan, A. A. (2016) · Genes and Immunity · doi:10.1038/gene.2016.14 · Cited by 27 · see citing works
Komora, P., Vámos, O., Gede, N., Hegyi, P., Kelemen, K., Galvács, A., Varga, G., Kerémi, B., & Vág, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-69367-7 · Cited by 26 · see citing works
Bioceramic Materials in Clinical Endodontics
Drukteinis, S., & Camilleri, J. (2021) · doi:10.1007/978-3-030-58170-1 · Cited by 26
Buzoglu, H. D., Ozcan, M., Bozdemir, O., Akkurt, K. S. A., Zeybek, N. D., & Bayazıt, Y. (2023) · Clinical Oral Investigations · doi:10.1007/s00784-023-05203-y · Cited by 25 · see citing works
“Ricucci et al. [32] stated that there is localized pulp necrosis in the carious pulp exposure site, which is considered an indicator of irreversible pulpitis, as in this study, and beyond that, the coronal pulp maybe with little inflammation or may be surrounded by PMNL and chronic inflammatory…”
ResultAzim, A. A., Merdad, K. A., & Peters, O. (2022) · International Endodontic Journal · doi:10.1111/iej.13816 · Cited by 25 · see citing works
“The objective finding, however, would be clinical and radiographic signs of caries as shown in histological studies (Ricucci et al., 2014).”
BackgroundMethodAbuelniel, G., Duggal, M., Duggal, S., & Kabel, N. (2021) · European Journal of Paediatric Dentistry · doi:10.23804/ejpd.2021.22.01.04 · Cited by 25 · see citing works
“Although a history of pain, and bleeding from the amputation site, amongst other clinical indicators can give a reasonable indication whether there is inflammation present in the radicular pulp, this is not always accurate [Aguilar, Linsuwanont, 2010; Ricucci et al., 2014].”
Silva, E. J. N. L., Pinto, K. P., Riche, F. N. S. J., Carestiato, M. G. H., Martins, J. N. R., Duncan, H. F., VERSIANI, M. A., & De‐Deus, G. A. (2025) · International Endodontic Journal · doi:10.1111/iej.14210 · Cited by 22 · see citing works
Louzada, L., Hildebrand, H., Neuhaus, K. W., & Duncan, H. (2024) · International Endodontic Journal · doi:10.1111/iej.14149 · Cited by 24 · see citing works
“Coronal pulpotomy, on the other hand, generally eliminates all inflammatory pulp tissue even in cases of irreversible pulpitis as the tissue in the root is generally free of inflammatory change (Ricucci et al., 2014).”
Fibroblast membrane-camouflaged nanoparticles for inflammation treatment in the early stage
Sun, L.-Z., He, L.-B., Wu, W., Luo, L., Han, M.-Y., Liu, Y.-F., Shi, S.-J., Zhong, K.-J., Yang, J.-J., & Li, J.-Y. (2021) · International Journal of Oral Science · doi:10.1038/s41368-021-00144-2 · Cited by 24 · see citing works
“Early pulpitis is characterized by inflammation localized to the coronal pulp, and it was selected as an early inflammation model.(31) To determine the early pulpitis triggered by LPS in vivo, histologic observations were conducted at different time points (24, 48, and 72 h) (Fig.”
BackgroundCharacterization of Root Canal Microbiota in Teeth Diagnosed with Irreversible Pulpitis.
Zahran, S., Witherden, E. A., Mannocci, F., & Koller, G. (2020) · Journal of Endodontics · doi:10.1016/j.joen.2020.12.009 · Cited by 24
Chung, M., Lee, S., Chen, D., Kim, U., Kim, Y., Kim, S., & Kim, E. (2019) · Materials · doi:10.3390/ma12081259 · Cited by 24
Zhu, L., Liu, W., Deng, X., Chen, Z., Chen, J., & Qian, W. (2024) · BMC Oral Health · doi:10.1186/s12903-024-05011-0 · Cited by 23 · see citing works
“According to the histologic study of Ricucci et al., clinical signs and symptoms of patient are not well correlated with the actual extent of inflammation of the exposed pulp [27].”
- Authors
- Ricucci, D., Loghin, S., & Siqueira, J. F.
- Corresponding author
- Ricucci, Domenico
- ORCID
- Ricucci, Domenico
- Venue
- Journal of Endodontics
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 40
- Issue
- 12
- Pages
- 1932-1939
- ISSN
- 0099-2399 (ISSN-L)
- OpenAlex
- W2079366348
- Cited by
- 477
- References
- 0
- Citations by year
- 2026: 60 · 2025: 58 · 2024: 77 · 2023: 61 · 2022: 55 · 2021: 43 · 2020: 39 · 2019: 28 · 2018: 18 · 2017: 13 · 2016: 17 · 2015: 7
- FWCI
- 14.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Endodontics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Dentistry › Oral Surgery › Endodontics and Root Canal Treatments
- Health Sciences › Dentistry › Orthodontics › Dental materials and restorations
- Health Sciences › Dentistry › Periodontics › Oral Health Pathology and Treatment
- Keywords
- diagnosis, histopathological diagnosis, pulp diagnosis, reversible pulpitis, irreversible pulpitis, pulpitis, pulp infection, endodontic treatment
- MeSH terms
- Adolescent, Adult, Aged, Bacteria, Composite Resins, Dental Amalgam, Dental Caries, Dental Materials, Dental Pulp, Dental Pulp Necrosis, Dental Pulp Test, Dental Restoration, Permanent, Dentin, Dentin, Secondary, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Odontoblasts, Prognosis, Pulpitis, Young Adult
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