How standard deviation contributes to the validity of a LDF signal: a cohort study of 8 years of dental trauma.

The aim of this cohort study was to document the potential of laser Doppler flowmetry (LDF) for diagnosing tooth vitality in traumatized teeth in a population of 88 referred patients with dental trauma over a period of 8 years (2011-2018). The main reason to refer was tooth discoloration (26%), and the main trauma cause was a traffic injury (35%). Taking into account that referral for LDF is best given within the week after trauma, 66% of referrals were overdue. In 73% of cases, root canal treatment could be avoided, and in 65%, the presence of a fixed orthodontic retainer showed beneficial for pulp recovery. Data of 394 teeth were collected and submitted to multilevel modelling statistics. As a general conclusion, both LDF perfusion and concentration values proved to be highly reliable in the appreciation of tooth vitality. The difference of variability of standard deviation and range of LDF measurements involving intra-subject control teeth showed statistically significant in discriminating between vital and non-vital pulps. In non-vital teeth, the diagnostic combination of LDF, sensibility tests and peri-apical X-ray is advised.

Diurnal variations and pulpal status: is there a need for FFT besides LDF?

The aim of this article was to investigate the use of laser Doppler flowmetry (LDF) combined with a fast Fourier transformation (FFT). LDF data in relation to three different scenarios were evaluated: (a) LDF records of a right central upper incisor of one patient were used for FFT analysis. These records were obtained by means of 30 pre-manufactured splints, handled by dentists without any experience in LDF recording. (b) Diurnal variations in one patient were analysed with LDF and FFT using 11 splints by one and same experienced investigator at four specific moments of the day. (c) Pulpal status was analysed using 17 splints. Eleven for a patient, standing as case model and six splints for six other patients. In this specific group, each patient had one vital and one non-vital central maxillary incisor and was analysed separately by LDF and FFT. The data of assessment (b) showed diurnal variations on LDF values of almost 80%, indicating that LDF registration is best performed in the same time period of the day. Data verification with FFT confirmed the findings without FFT of assessment (a) and (b). In assessment, (c) FFT demonstrated a clear distinction between a vital and a non-vital pulp for those cases with one vital tooth and one root canal treated tooth. In those cases with one vital incisor and the other traumatised, FFT was undeterminated. Considered that FFT was obtained after LDF recording and remained undeterminated for a decision in cases with decreasing pulpal blood flow in time, the added value of FFT in pulpal traumatology was minimal.

Laser Doppler flowmetry: reproducibility, reliability, and diurnal blood flow variations.

The aim of this investigation was (1) to evaluate the reliability of laser Doppler flowmetry (LDF) taking into consideration the use of a silicone splint and the inclination of the probe towards the buccal surface of a human tooth and (2) to determine whether diurnal variations of pulpal blood flow can be registered by means of LDF. Forty-one splints were made by one and the same principal investigator for the registration of pulpal blood flow in vivo in a maxillary right central incisor. Thirty dentists, without experience in LDF recording, were then asked to drill a right-angled shaft in a pre-manufactured splint with a referral point at 2 mm from the enamel-cement border central on the buccal surface of the right central upper incisor. The remaining 11 splints were handled by the principal investigator. The shafts in the 30 splints were analysed using Cone Beam CT imaging of the axial and sagittal angles and compared these to the 11 shafts prepared by the trained principal investigator. LDF was recorded for 90 s in each splint and statistically analysed. LDF values without the use of a splint were statistically significantly different (p < 0.05) and the variance was greater, indicating the superiority of splint use. Significant diurnal variations on LDF values were observed, indicating that special attention should be paid to registration during the day, especially when multiple measurements are to be compared.