This study aimed to evaluate the diagnostic accuracy of an Optical Pulp Scanning (OPS) device. A total of 421 teeth from 107 emergency patients were investigated. Pulp vitality was assessed using conventional diagnostic methods (ConvDia), cold pulp testing (CPT), and a final diagnosis (FinDia) based on the pulp chamber contents (PCCs) of teeth requiring endodontic treatment (EmeTe). Following ConvDia, OPS screening was performed, endodontic access was prepared, and the FinDia was established. The specificity, sensitivity, as well as positive and negative predictive values of ConvDia, CPT, and FinDia were calculated against the OPS results. The null hypothesis stated that specificity and sensitivity would be equal to or lower than 90% and 80%, respectively. OPS sensitivity was 66.2% and 72.2% (EmeTe) for ConvDia, 66.2% and 69.8% (EmeTe) for CPT, and 76.9% for FinDia. Specificity was 26.4% and 25.5% (EmeTe) for ConvDia, 26.9% and 21.7% (EmeTe) for CPT, and 31.5% for FinDia. These results suggest that, at its current stage of development, the OPS device does not provide an acceptable level of diagnostic accuracy, particularly in vital teeth.

Optical diagnostic techniques represent an attractive complement to conventional pulp vitality tests, as they can provide direct information about the vascular status of the pulp. However, the complex, multi-layered structure of a tooth significantly influences the detected signal and, ultimately, the diagnostic decision. Despite this, the impact of the various dental components on light propagation within the tooth, particularly in the context of diagnostic applications, remains insufficiently studied. To help bridge this gap and potentially enhance diagnostic accuracy, this study employs digital optical twins based on the Monte Carlo method. Using incisor and molar models as examples, the influence of tooth and pulp geometry, blood concentration, and pulp composition, such as the possible presence of pus, on spectrally resolved transmission signals is demonstrated. Furthermore, it is shown that gingival blood absorption can significantly overlay the pulpal measurement signal, posing a substantial risk of misdiagnosis. Strategies such as shifting the illumination and detection axes, as well as time-gated detection, are explored as potential approaches to suppress interfering signals, particularly those originating from the gingiva.

Optical diagnostic techniques represent an attractive complement to conventional pulp vitality tests, as they can provide direct information about the vascular status of the pulp. However, the complex, multi-layered structure of a tooth significantly influences the detected signal and, ultimately, the diagnostic decision. Despite this, the impact of the various dental components on light propagation within the tooth, particularly in the context of diagnostic applications, remains insufficiently studied. To help bridge this gap and potentially enhance diagnostic accuracy, this study employs digital optical twins based on the Monte Carlo method. Using incisor and molar models as examples, the influence of tooth and pulp geometry, blood concentration, and pulp composition, such as the possible presence of pus, on spectrally resolved transmission signals is demonstrated. Furthermore, it is shown that gingival blood absorption can significantly overlay the pulpal measurement signal, posing a substantial risk of misdiagnosis. Strategies such as shifting the illumination and detection axes, as well as time-gated detection, are explored as potential approaches to suppress interfering signals, particularly those originating from the gingiva.