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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Background
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Background
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Self-citation
Outcomes of pulpotomy using calcium silicates in permanent teeth with symptomatic irreversible pulpitis: A systematic review and meta-analysis
Aljarbou, F. A., Abushanan, A., AlMokhatieb, A., Mustafa, M., Alam, M. K., & Alamri, H. (2024) · Saudi Endodontic Journal · doi:10.4103/sej.sej_26_24 · Cited by 3
Influence of Diclofenac Potassium versus Prednisolone on Post-endodontic Pain and Pulpal Interleukin-8 expression in Symptomatic Irreversible Pulpitis Cases: A Randomized Placebo-Controlled Trial.
Soliman, A. A., Ezzat, K., Shaker, O., & Abouelenien, S. (2024) · Journal of Endodontics · doi:10.1016/j.joen.2024.05.019 · Cited by 3
The clinical outcomes of vital intact teeth close to large cystic lesions of endodontic origin: A prospective clinical study.
Erovigni, F., Bosso, I., Alovisi, M., Mela, L., Bianchi, L., Bobba, I., Migliaretti, G., Bianchi, C., & Pasqualini, D. (2024) · International Endodontic Journal · doi:10.1111/iej.14050 · Cited by 3
Comparing Patient Outcomes for Teeth Treated with Traditional Root Canal Therapy Versus Pulpotomy: A Randomized Controlled Trial
Pawar, M., Agwan, M. A. S., Lokhande, S., Sutaria, B., Sutaria, S. P., Langaliya, A., & Mehta, D. (2024) · Journal of Pharmacy and Bioallied Sciences · doi:10.4103/jpbs.jpbs_986_23 · Cited by 3
“[5,6] This root canal therapy (RCT) seeks to address this knowledge gap by conducting a head‑to‑head comparison of patient outcomes between traditional RCT and pulpotomy for the management of dental pulp infections.”
Vital pulp therapies versus conventional endodontics for the treatment of mature teeth with pulp inflammation: A systematic review
Martínez-Salas, C., & Bucchi, C. (2024) · Saudi Endodontic Journal · doi:10.4103/sej.sej_138_23 · Cited by 3
Outcome after Partial Pulpotomy: Long-term Results of the Prospective Clinical MMP-9 Study
Petrovic, J., Sekundo, C., Gehrig, H., Rampf, S., El-Sayed, S., Ritz, A., & Mente, J. (2023) · Oral Health & Preventive Dentistry · doi:10.3290/j.ohpd.b4438901 · Cited by 3
“36 An essential role in evaluating the degree of inflammation of the pulp is the bleeding duration after partial pulpotomy, which was therefore an important diagnostic criterion defined before the start of the study.”
Background
Review of modern materials for the treatment of pulpal hyperemia
Adamchik, A., Kirsh, K. D., Ivashchenko, V. A., & Zaporozhskaya-Abramova, E. (2023) · Endodontics Today · doi:10.36377/1683-2981-2023-21-2-124-132 · Cited by 3
Immunohistochemical expression of estrogen receptor alpha in the maxillary sinus, pulp, and periodontal ligament of adjacent teeth in late pregnancy in rats
Hassan, G. S., Helal, M., & Ibrahim, H. (2022) · Odontology : official journal of The Society of the Nippon Dental University · doi:10.1007/s10266-022-00770-0 · Cited by 3
“Noteworthy, the histological changes of dental pulp were mimicking the histological features of reversible pulpitis [33] suggesting that these structural modulation could be a transient effect possibly caused by pregnancy hormonal factors.”
Background
Effectiveness of pulpotomy vs root canal treatment on postoperative pain and the treatment outcome in the management of permanent mature posterior teeth with symptomatic irreversible pulpitis: A systematic review and meta- analysis
Vibha, H., Mrunalini, V., Surelee, C., & Simren, B. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns7.11920 · Cited by 3
“(19,21-22,25-28,30-31) MTA has been suggested as a pulpotomy agent to achieve the desired treatment outcome.”
Background
Outcomes and Predisposing Factors of Two Prophylactic Treatments in Dens Evaginatus Premolars: A Retrospective Study.
Lerdrungroj, K., Banomyong, D., Nakornchai, S., Ngoenwiwatkul, Y., & Porkaew, P. (2022) · Journal of Endodontics · doi:10.1016/j.joen.2022.04.004 · Cited by 3
Cracked tooth syndrome diagnosis part 1: integrating the old with the new
Bailey, O., & Whitworth, J. (2020) · doi:10.12968/denu.2020.47.6.494 · Cited by 3
Radiological and clinical assessment of pulpotomy on mature permanent molars with irreversible pulpitis: literature review
Seck, A., Kaboré, W. A., Ndiaye, D., Ndiaye, I., & Benoist, F. L. (2019) · IP Indian Journal of Conservative and Endodontics · doi:10.18231/2456-8953.2018.0025 · Cited by 3
“teeth with irreversible pulpitis clinical signs and indicative symptoms, the inflamed part of the dental pulp must be removed by partial or full pulpotomy for the remaining pulp tissue to heal.(4) This turns out to be a”
Background
Current and Future Views on Pulpal Pain and Neurogenesis
Lundy, F., karim, I. E., & Scheven, B. (2018) · Clinical Approaches in Endodontic Regeneration · doi:10.1007/978-3-319-96848-3_2 · Cited by 3
Tissue Engineering: An Analogous Platelet Rich Fibrin for Coronal Pulpotomy in Revival of Pulp Tissue Vitality in Adult Molar with Pulpitis, a Case Report
Aleid, A. A. (2018) · doi:10.12691/ijdsr-6-3-5 · Cited by 3
“With innovations, researchers using technology advancement in clinical, histological and histobacteriologcal techniques have concluded that 84% of the time clinical diagnosis of irreversible pulpit matched with histological diagnosis [27].”
Background
General dentists’ use of diagnostic equipment and methods
Kong, C.-H., Davis, M., Fong, K., & Abbott, P. (2017) · Australian Endodontic Journal · doi:10.1111/aej.12200 · Cited by 3
Regenerative Endodontics in Teeth With Irreversible Pulpitis: A Scoping Review
Torabinejad, M., Najafimakhsoos, N., & Bogen, G. (2026) · International Endodontic Journal · doi:10.1111/iej.70179 · Cited by 2
Effectiveness of Pulpotomy in the Management of Symptomatic Irreversible Pulpitis in Mature Permanent Teeth: An Umbrella Review
Mtalsi, M., Asmar, M. E., Abouelala, M., & Arabi, S. E. (2026) · Cureus · doi:10.7759/cureus.104814 · Cited by 2
“Thus, a tooth that clinically presents with irreversible pulpitis does not necessarily present with it histologically, with the possibility of having part of the pulp healthy or presenting with reversible inflammation [3,4].”
Partial pulpotomy for carious pulp exposure in adult mature permanent teeth: a systematic review and meta-analysis
Abdelkhader, S., Koller, G., Kang, J., & Mannocci, F. (2025) · BMC Oral Health · doi:10.1186/s12903-025-07408-x · Cited by 2
“The methodology employed in this study adhered to the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the checklist [28, 29] [Appendix 2].”
Cytotoxicity and bioactivity of CIMMO DTA restorative cement in human activated-dental pulp cells in vitro
Scardini, I. D. L., Spigariol, K. D. S., dos Santos, M., Sipert, C. R., & Santos, L. M. (2025) · Brazilian Dental Journal · doi:10.1590/0103-644020256402 · Cited by 2
“Due to the dentinal permeability in teeth with deep carious, pulpal inflammation is usually observed during restorative procedure execution (21).”
Endovital and endocrown: A synergistic approach for conservative management of a grossly carious mandibular molar
Durga, K., Rana, A., Thomas, D., & Galhotra, V. (2025) · Journal of conservative dentistry and endodontics · doi:10.4103/jcde.jcde_797_24 · Cited by 2
“[4] Once this inflamed tissue is removed, the remaining healthy pulp can often be preserved by appropriate biomaterials.”
The role of endodontists in managing patients with molar incisor hypomineralisation
Costa, L., Dantas, J. F. S., & Santos, P. (2025) · Primary Dental Journal · doi:10.1177/20501684251317770 · Cited by 2
“5,15 49 A longitudinal study has shown that selective carious tissue removal in teeth with MIH and open apex helps maintain pulp vitality, allowing for continued root development and physiological apical closure.”
Novel pain assessment tool specific for pulp symptoms to aid diagnosis.
Kumar, V., Sharma, S., Kumar, V., Chawla, A., Kalaivani, M., Baidya, D., Tomson, P. L., Abbott, P., & Logani, A. (2025) · International Endodontic Journal · doi:10.1111/iej.14195 · Cited by 2
Pulp Vitality Diagnosis by Means of an Optical Pulp Scanning Device
Marroquín, B. B., Borgschulte, M., Savic, A., Ertl, T., & Wolf, T. G. (2024) · Dental journal · doi:10.3390/dj12100326 · Cited by 2
“A correlation between the histopathological status of the pulp and clinical findings, both subjective and objective, can be drawn through a thorough evaluation of the patient’s health history, oral inspection, pulp tests, and radiographic results [2].”
Background
Effect of Curcuma longa (Turmeric), as an intra-canal medicament, on inter-appointment endodontic pain in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial
Singla, R., Gupta, C., Gill, G., Jain, N., Arora, S., Algarni, Y., Kader, M. A., Cicciù, M., & Minervini, G. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e33797 · Cited by 2
“It was considered that necrotic pulps possess a significantly higher number of microbes [43] and thus have higher chances of flare-ups or IAP, whereas root canals with irreversibly inflamed vital pulps were considered free of bacteria [44].”
Successful Healing of Periapical Pathology with Partial Pulpotomy in a Mature Permanent Molar: A Case Report
Alsharif, M. B. (2024) · The American journal of case reports · doi:10.12659/ajcr.942937 · Cited by 2
“Until recently, histological studies showed that correlation between clinical diagnosis and histologic diagnosis of teeth diagnosed as irreversible pulpitis is only 84.4% and the remaining 15.6% are still in the reversible pulpitis stage histologically [4].”
BackgroundInfluential
A Narrative on Inflammatory Biomarkers in Endodontics
Chandak, M., Jidewar, N., Mishra, A., Chandak, R., Bajaj, P., Sedani, S., & Chaudhari, P. (2024) · Journal of International Clinical Dental Research Organization · doi:10.4103/jicdro.jicdro_20_23 · Cited by 2
Restorative management of the posterior tooth that has undergone a pulpotomy
Longridge, N., Hyde, J. S., Jarad, F., & Albadri, S. (2023) · Dental Update · doi:10.12968/denu.2023.50.11.932 · Cited by 2
Partial Pulpotomy in Mature Permanent Molars with Symptoms Indicated Irreversible Pulpitis Using MTA: A Study of Three Case Reports over Four-Year Follow-Up
Zenaldeen, R., Kaddoura, R., Alzoubi, H., Achour, H., & Aljabban, O. (2023) · Case Reports in Dentistry · doi:10.1155/2023/1344101 · Cited by 2
“At the same time, the in ﬂ am-matory process in these teeth is restricted to the coronal part directly underneath the carious lesions unless they are long-standing [1, 2].”
Vital pulp therapy following pulpotomy in immature permanent teeth with carious exposure.
Han, S., & Zhang, Q. (2023) · Journal of Clinical Pediatric Dentistry · doi:10.22514/jocpd.2023.054 · Cited by 2
“Patients’ clinical symptoms and reactions toward the test temperature can be used as an indication to determine the presence of pulpitis [26].”
Background
Vital pulp therapy: the past, present and future
El-Ma’aita, A., Qualtrough, A., Darcey, J., & Hunter, M. (2022) · Dental Update · doi:10.12968/denu.2022.49.11.905 · Cited by 2
Etiologies, risk factors and outcomes of dental pulp necrosis
Abdulwahab, M. A., Alqahtani, M., Alshammari, A. A., Jiffri, S. E., Alasim, A. M., Alsharidah, F. M., Alqunfuthi, N., Alnamnakani, B., Alshahrani, R., Alshahrani, N. A., et al. (2021) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20214793 · Cited by 2
“Irreversible pulpitis is considered to be the most common risk factor for dental pulp necrosis.(16)”
Background
Pulp Capping Materials for the Maintenance of Pulp Vitality
Tomson, P., & Duncan, H. (2021) · doi:10.1002/9781119513568.ch2 · Cited by 2
Clinical Manifestations and Diagnosis
Sigurdsson, A. (2019) · Essential Endodontology · doi:10.1002/9781119272014.ch7 · Cited by 2
A 42 year old female with thermal sensitivity in the lower left first molar tooth
Ali, H., Hossain, M., & Abdin, M. (2018) · Bangabandhu Sheikh Mujib Medical University Journal · doi:10.3329/bsmmuj.v11i3.37415 · Cited by 2
Effect of Pulpal Haemostasis Time on Partial Pulpotomy Outcome in Cariously Exposed Mature Permanent Teeth With Symptomatic Irreversible Pulpitis.
Sulaiman, S., Nawal, R., Yadav, S., Talwar, S., Yadav, S., & Duncan, H. F. (2026) · International Endodontic Journal · doi:10.1111/iej.70214 · Cited by 1
Intraoperative Identification of Vital Radicular Pulp in a Tooth Diagnosed with Pulp Necrosis: Four-Year Outcome of Tampon Pulpotomy
Asgary, S. (2026) · Iranian endodontic journal · doi:10.22037/iej.v21i1.52628 · Cited by 1
“…emerging evidence also highlights a critical limitation in diagnostic pathways: clinical symptoms and sensibility tests may not reliably reflect the true histopathological status of the radicular pulp, and negative sensibility responses do not necessarily indicate complete pulp necrosis [14].”
Influential
Pioneering next-generation bioactive materials for endodontics: Insights of mitochondrial biology
Cheng, S., Liu, X.-Y., Zhou, L., Mao, H., Wen, Y.-H., Meng, X., Zhang, L., & Chen, Z. (2026) · Bioactive Materials · doi:10.1016/j.bioactmat.2026.05.040 · Cited by 1
“Clinical classification [135] Clinical scenarios [136,137] Pathophysiological features & treatment goal [138] Dominant type of mitochondrial stress [27] [139, 140] Material design focus/strategy [73,77, 115] Initial/Mild Pulpitis Indirect/Direct pulp capping • Hyperemia or localized mild coronal…”
Conservative Treatment of Complicated Crown Fractures Utilizing Mineral Trioxide Aggregate and Adhesive Reattachment of Tooth Fragments: A Case Series
Nair, S. J., Jinesh, A., Gupta, S., Chansoria, H., & G, G. K. K. (2026) · Cureus · doi:10.7759/cureus.109186 · Cited by 1
Machine Learning–Based Prediction of Treatment Success, Postoperative Pain, and Analgesic Use after Full Pulpotomy in Permanent Molars with Symptomatic Irreversible Pulpitis
Karakoyunlu, E., Mıdoglu, G., Gürler, K., & Yılmaz, K. (2026) · Journal of Endodontics · doi:10.1016/j.joen.2026.05.009 · Cited by 1
Postoperative pain after pulpotomy versus pulpectomy of primary molars with symptomatic irreversible pulpitis: an equivalent randomized clinical trial
Sermani, D. I., Abdelmotelb, M., & Elheeny, A. (2026) · BMC Oral Health · doi:10.1186/s12903-026-08329-z · Cited by 1
“Depending on the severity of symptoms as an indicator of the extent of pulpal inflammation (i.e., mild symptoms indicate reversible pulp inflammation, while severe symptoms indicate irreversible pulpitis) is widely accepted [28].”
Lipoteichoic acid induces IL-6 production in human pulp stromal cells through TLR2-mediated NF-κB nuclear translocation
Akamp, T., Linnebank, M., Schreiber, L., Rosendahl, A., Fetscher, E., Pohl, S., Buchalla, W., & Widbiller, M. (2026) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2026.106576 · Cited by 1
“Clinically, reversible pulpitis reflects superficial and localized inflammation with preserved healing capacity (Pohl et al., 2024; Ricucci et al., 2014), whereas irreversible pulpitis is characterized by progressive inflammation and severe symptoms requiring urgent endodontic intervention (Pohl et…”
On the necessity of complete caries excavation: a narrative review
Dammaschke, T. (2025) · Head & Face Medicine · doi:10.1186/s13005-025-00573-y · Cited by 1
“However, it is known that in 15.6% of cases, the clinical and histological diagnosis do not match [48].”
Influential

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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