Cited by 477Endodontics and Root Canal TreatmentsDental materials and restorationsOral Health Pathology and Treatment

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Correlation between Clinical and Histologic Pulp Diagnoses

Ricucci, Domenico, Loghin, Simona, Siqueira, José F.·2014·Journal of Endodontics

DOI 10.1016/j.joen.2014.08.010

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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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Clinical signs and symptoms in pulp disease
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Alipour, M., Pouya, B., Aghazadeh, Z., Kafil, H. S., Ghorbani, M., Alizadeh, S., Aghazadeh, M., & Abdolahinia, E. D. (2021) · Stem Cells International · doi:10.1155/2021/3828777 · Cited by 39
Self-Limiting versus Conventional Caries Removal: A Randomized Clinical Trial
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Pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth
Aminabadi, N. A., Parto, M., Emamverdizadeh, P., Jamali, Z., & Shirazi, S. (2017) · Clinical Oral Investigations · doi:10.1007/s00784-017-2098-y · Cited by 43
Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial
Şahin, N., Saygılı, S., & Akçay, M. (2021) · Clinical Oral Investigations · doi:10.1007/s00784-020-03724-4 · Cited by 37
Clinical and Histological Evaluation of Direct Pulp Capping on Human Pulp Tissue Using a Dentin Adhesive System
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“The intensity of the pulp-dentin complex reactions demonstrated in healthy teeth may be lower than those observed in carious teeth [41].”
Background
The management of deep caries in UK primary care: a nationwide questionnaire-based study.
Edwards, D., Bailey, O., Stone, S., & Duncan, H. (2021) · International Endodontic Journal · doi:10.1111/iej.13585 · Cited by 36
“Recently, these clinical diagnoses have been shown to align well with histological diagnoses in the majority of cases (Ricucci et al., 2014); therefore, obtaining comprehensive information from teeth with deep caries is crucial in order to guide decisionmaking in vital pulp treatments, including…”
Background
Comparative accuracy of artificial intelligence chatbots in pulpal and periradicular diagnosis: A cross-sectional study
de Moura, J. D. M., Fontana, C., Lima, V. H. R. D. S., Alves, Í. D. S., Santos, P. A. D. M., & Rodrigues, P. D. A. (2024) · Comput. Biol. Medicine · doi:10.1016/j.compbiomed.2024.109332 · Cited by 35
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“The diagnosis of irreversible pulpitis relies on the patient’s clinical symptoms and reaction to the temperature test [28].”
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“Similar but isolated observations were published in the literature of the ‘60s [8, 11] and also recently [12, 14].”
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“34 Ongoing research is exploring the value and accuracy of biomarkers such as MMP-9 (matrix metalloproteinase-9) to predict pulp status locally from pulpal fluid with promising results.”
Clinical and radiographic comparison of indirect pulp treatment using light-cured calcium silicate and mineral trioxide aggregate in primary molars: A randomized clinical trial
Menon, N., Varma, B., Janardhanan, S., Kumaran, P., Xavier, A. M., & Govinda, B. (2016) · Contemporary Clinical Dentistry · doi:10.4103/0976-237x.194109 · Cited by 33
“correlated clinical and radiographic evaluation of pulp status with histologic findings and found that findings using defined criteria for clinical and histological classification of pulp conditions revealed a good agreement especially for cases with no pulpal disease or reversible disease.[8]”
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Baranwal, H., Mittal, N., Yadav, J., Rani, P., & Kumar, P. G. N. (2022) · Journal of Conservative Dentistry · doi:10.4103/jcd.jcd_118_22 · Cited by 31
Targeted Endodontic Microsurgery: A Retrospective Outcomes Assessment of 24 Cases.
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Investigation of microbial profile, levels of endotoxin and lipoteichoic acid in teeth with symptomatic irreversible pulpitis: a clinical study.
Arruda-Vasconcelos, R., Louzada, L., Feres, M., Tomson, P., Cooper, P., & Gomes, B. (2020) · International Endodontic Journal · doi:10.1111/iej.13402 · Cited by 30
MMP-9 in Dentinal Fluid Correlates with Caries Lesion Depth
Ballal, N. V., Rao, S., Bagheri, A., Bhat, V. R., Attin, T., & Zehnder, M. (2017) · Caries Research · doi:10.1159/000479040 · Cited by 42
“However, because the deep cavities assessed in this study were from teeth without spontaneous pain, it is unlikely that any of these had irreversible pulpitis [Ricucci et al., 2014].”
Background
Extracellular matrix degradation by host matrix metalloproteinases in restorative dentistry and endodontics: An overview
Anshida, V., Kumari, R., Murthy, C. S., & Samuel, A. (2020) · Journal of Oral and Maxillofacial Pathology · doi:10.4103/jomfp.jomfp_34_20 · Cited by 37
“[43] This is because PMN infiltration and associated soft‐tissue breakdown are the key factors in histologically discerning reversible and irreversible pulpitis.[44,45] PMNs that serve as the first cellular barrier to bacterial invasion, in addition to destroying bacteria, destroy the surrounding tissues by secreting…”
Background
Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review
Munir, A., Zehnder, M., & Rechenberg, D. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9040984 · Cited by 29
“From a histological point of view this makes sense, as the infection advances from the crown towards the root [50].”
Background
Characterization of Odontoblast‐like Cell Phenotype and Reparative Dentin Formation In Vivo: A Comprehensive Literature Review
Tziafas, D. (2019) · Journal of Endodontics · doi:10.1016/j.joen.2018.12.002 · Cited by 29
A Diagnostic Insight of Dental Pulp Testing Methods in Pediatric Dentistry
Igna, A., Mircioagă, D., Boariu, M., & Stratul, S. (2022) · Medicina · doi:10.3390/medicina58050665 · Cited by 28
“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…”
Background
Vital pulp therapy—Factors influencing decision‐making for permanent mature teeth with irreversible pulpitis: A systematic review
Alfaisal, Y., Idris, G., Peters, O. A., Zafar, S., Nagendrababu, V., & Peters, C. I. (2024) · International Endodontic Journal · doi:10.1111/iej.14036 · Cited by 32
Molecular, cellular, and behavioral changes associated with pathological pain signaling occur after dental pulp injury
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…”
Background
Fourier 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
“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).”
Background
Gene expression profile of pulpitis
Galicia, J. C., Henson, B., Parker, J. S., & KHAN, A. A. (2016) · Genes and Immunity · doi:10.1038/gene.2016.14 · Cited by 39
Comparison of bioactive material failure rates in vital pulp treatment of permanent matured teeth – a systematic review and network meta-analysis
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
Bioceramic Materials in Clinical Endodontics
Drukteinis, S., & Camilleri, J. (2021) · doi:10.1007/978-3-030-58170-1 · Cited by 26
Evaluation of oxidative stress cycle in healthy and inflamed dental pulp tissue: a laboratory investigation
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
“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…”
Result
Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology
Azim, A. A., Merdad, K. A., & Peters, O. (2022) · International Endodontic Journal · doi:10.1111/iej.13816 · Cited by 25
“The objective finding, however, would be clinical and radiographic signs of caries as shown in histological studies (Ricucci et al., 2014).”
BackgroundMethod
Evaluation of Mineral Trioxide Aggregate and Biodentine as pulpotomy agents in immature first permanent molars with carious pulp exposure: A randomised clinical trial.
Abuelniel, G., Duggal, M., Duggal, S., & Kabel, N. (2021) · European Journal of Paediatric Dentistry · doi:10.23804/ejpd.2021.22.01.04 · Cited by 25
“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].”
A meta‐analysis of calcium silicate‐based cements and calcium hydroxide as promoters of hard tissue bridge formation
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
The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non‐traumatic pulpitis
Louzada, L., Hildebrand, H., Neuhaus, K. W., & Duncan, H. (2024) · International Endodontic Journal · doi:10.1111/iej.14149 · Cited by 24
“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., He, L., Wu, W., Luo, L., Han, M., Liu, Y., Shi, S., Zhong, K., Yang, J., & Li, J. (2021) · International Journal of Oral Science · doi:10.1038/s41368-021-00144-2 · Cited by 28
“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.”
Background
Characterization 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
Effects of Different Calcium Silicate Cements on the Inflammatory Response and Odontogenic Differentiation of Lipopolysaccharide-Stimulated Human Dental Pulp Stem Cells
Chung, M., Lee, S., Chen, D., Kim, U., Kim, Y., Kim, S., & Kim, E. (2019) · Materials · doi:10.3390/ma12081259 · Cited by 24
Full pulpotomy versus root canal therapy in mature teeth with irreversible pulpitis: a randomized controlled trial
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
“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.
Affiliations: Estácio (Brazil) (BR)
Corresponding author: Ricucci, Domenico
ORCID: Ricucci, Domenico
Siqueira, José F.
Venue: Journal of Endodontics
Publisher: Elsevier BV
Published: 2014-12
Volume: 40
Issue: 12
Pages: 1932-1939
ISSN: 0099-2399 (ISSN-L)
DOI: 10.1016/j.joen.2014.08.010
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Endodontics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Dentistry › Oral Surgery › Endodontics and Root Canal Treatments
Health Sciences › Dentistry › General Dentistry › Dental materials and restorations
Health Sciences › Dentistry › General Dentistry › 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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Correlation between Clinical and Histologic Pulp Diagnoses

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