{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:28:27Z","timestamp":1792074507862,"version":"4.4.0"},"reference-count":63,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T00:00:00Z","timestamp":1653436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well\u2010designed and well\u2010executed clinical trials on the diagnosis of the true status of the pulp.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Three PICO questions were formulated and agreed <jats:italic>a priori<\/jats:italic> by the European Society of Endodontology to evaluate the clinical tests for sensibility testing, determination of biomarkers and pulp bleeding with regard to their suitability to correctly diagnose the condition of the pulp tissue for the development of S3\u2010Level guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search was conducted using PubMed, Clarivate Analytics' Web of Science, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials from inception to 21 January 2022. Additionally, a hand search was performed, and the contents of the major subject journals were also examined. Eligibility criteria followed the proposed PICO questions. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The risk of bias was assessed by the QUADAS\u20102 tool for diagnostic accuracy studies, the Newcastle\u2013Ottawa scale for noncomparative, nonrandomized studies and the Newcastle\u2013Ottawa Quality Assessment scale adapted for cross\u2010sectional studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 28 studies out of 29 publications were considered eligible and were included in the review. Twelve studies were identified to investigate the diagnostic accuracy of the pulp vitality. Ten studies fulfilled the criteria to evaluate the diagnostic accuracy of the pulpal conditions, while 6 studies investigating the expression of biomarkers were eligible. Three studies addressing the prognostic factors and therapeutic interventions relating to pulpal status were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The core problem in pulp diagnostics is that a reliable reference standard is lacking under clinical conditions. Based on limited evidence, the most promising current approach seems to define a combination of different clinical tests and symptoms, probably in future including molecular diagnosis (\u201cdiagnostic package\u201d) will be required to ascertain the best possible strategy to clinically diagnose true pulpal conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The effectiveness of diagnosing pulpitis is low due to limited scientific evidence regarding the accuracy and reproducibility of diagnostic tests. There is a lack of evidence to determine the true status of the pulp or to identify prognostic indicators allowing for a reliable pre\u2010operative estimation of the outcome of vital pulp treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registration<\/jats:title><jats:p>PROSPERO database (CRD42021265366).<\/jats:p><\/jats:sec>","DOI":"10.1111\/iej.13762","type":"journal-article","created":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T14:14:50Z","timestamp":1652192090000},"page":"296-325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["Effectiveness of diagnosing pulpitis: A systematic review"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7162-9795","authenticated-orcid":false,"given":"David","family":"Donnermeyer","sequence":"first","affiliation":[{"name":"Department of Periodontology and Operative Dentistry Westphalian Wilhelms\u2010University  M\u00fcnster 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