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Preoperative and Intraoperative Molecular Pulpal Diagnostics: Practical and Biological Considerations
Raj Kumar Narkedamalli1, Henry F Duncan2, Jothi Varghese3
1Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India.
International Endodontic Journal
|August 14, 2026
Summary
Objective molecular diagnostics for pulpitis show promise. Gingival crevicular fluid (GCF) offers a site-specific approach, potentially improving endodontic treatment accuracy over traditional methods.
Area of Science:
- Dentistry
- Oral Biology
- Biomarker Research
Background:
- Conventional pulpitis diagnosis relies on subjective patient responses and indirect indicators, limiting accuracy.
- This can lead to under- or over-treatment due to difficulties differentiating reversible and irreversible pulpitis.
- Objective, molecular-based diagnostics are needed for precise endodontic care.
Purpose of the Study:
- To review the biological basis of pulpal inflammation.
- To evaluate limitations of current diagnostic methods for pulpitis.
- To explore molecular biomarkers and biological fluids for objective pulpitis assessment.
Main Methods:
- Comprehensive literature search of PubMed/MEDLINE, Scopus, and Web of Science.
- Inclusion of original research, reviews, and clinical studies on pulpitis and diagnostics.
- Qualitative synthesis of selected literature to identify themes.
Main Results:
- Pulpitis involves complex immune/vascular responses not fully captured by traditional tests.
- Molecular biomarkers offer objective measures of pulpitis presence, severity, and progression.
- Gingival crevicular fluid (GCF) is a promising preoperative fluid, superior to saliva/blood, though standardization is needed. Intraoperative fluids also show potential.
Conclusions:
- GCF-based molecular diagnostics are plausible for preoperative pulpitis assessment.
- Further validation via prospective studies and standardized thresholds is required for clinical use.
- Objective diagnostics could enhance endodontic treatment decisions.