Clinical Validation of Smartphone-Enabled Pulse Oximetry for Objective Pulp Vitality Assessment: A Diagnostic Accuracy Study.

Introduction: Pulse oximetry exhibits great potential for use in endodontic diagnosis as an effective method to assess pulp vitality. Cell phone-integrated oximeters represent an emerging alternative that may offer greater accessibility. This study aimed to investigate the relation between pulp oxygenation rates (%SpO) and clinical diagnosis of healthy pulp (HP), reversible pulpitis (RP), symptomatic irreversible pulpitis (IP), or pulp necrosis (PN), comparing two pulse oximeters (conventional and mobile-connected).

Methods: Thirty affected premolars were grouped according to the clinical diagnosis of RP, IP or PN and compared to vitality diagnosis by %SpO obtained by both pulse oximeters: conventional (PO1) and by smartphone-based (PO2). For each affected tooth, two additional teeth (adjacent (A) and contralateral (C)) with HP were tested. Statistical analysis was performed using one-way ANOVA with Tukey's post-hoc test.

Results: The mean %SpO values measured by PO1 were 87.7% for RP, 80.5% for IP, 73.2% for PN, and 91.89% for HP. Corresponding values obtained with PO2 were 85.6% (RP), 79.3% (IP), 72.1% (PN), and 90.1% (HP). Significant differences in %SpO were observed among RP, IP, and PN groups (P<0.05), but not between healthy control subgroups (A and C). PO1 consistently recorded higher oxygen saturation than PO2 across all clinical conditions (P<0.05), demonstrating superior discriminatory capability.

Conclusion(s): Both pulse oximeters demonstrated significant clinical value for pulp vitality assessment and differentiation of pulpal inflammation stages and necrosis. The smartphone-adapted oximeter has proven to be comparable to conventional oximeter in diagnostic performance, while offering data collection efficiency and clinical workflow integration.