Pulp Vitality Testing: A Review of Current Methods and Emerging Technologies

Abstract

Accurate assessment of pulp vitality is fundamental in endodontic diagnosis and treatment planning, as it
directly influences therapeutic decisions and long-term outcomes. Traditional sensibility tests, such as thermal
and electric pulp testing, remain widely used in clinical practice due to their accessibility and ease of application.
However, these methods measure neural responses rather than true vascular vitality, and are prone to
false-positive or false-negative outcomes, particularly in teeth with immature apices, extensive restorations, or
trauma. Recent advances have shifted focus toward vascular-based vitality assessment, utilizing technologies
such as pulse oximetry, laser Doppler flowmetry, and photoplethysmography, which evaluate pulpal blood
flow as a more direct indicator of pulp health. Emerging optical modalities, biosensors, and artificial intelligence–
enhanced diagnostic systems further highlight the future of pulp testing, with the potential to improve
accuracy, reproducibility, and clinical utility. This review synthesizes the current evidence on conventional
and emerging pulp vitality testing methods, discusses their respective strengths and limitations, and explores
future directions in developing reliable, patient-friendly, and standardized diagnostic strategies.