Clinical validation of a proposed diagnostic classification for pulpitis

Abstract

Aim: Determine the reliability and clinical validity of the Wolters classification of pulpitis. Methodology: Prospective diagnostic accuracy study in which patients with pulpitis were included. Based on history, clinical and radiographic examination, participants were categorized into initial, mild, moderate or severe pulpitis based on Wolters classification and received treatment as suggested in the classification. The American Association of Endodontists (AAE) classification was used for comparison. Treatment outcome was evaluated at 12 months. Classification reliability was assessed by measuring the interrater agreement using Fleiss' Kappa. Construct validity was assessed by cluster analysis using an unsupervised machine learning approach. Predictive validity was determined by the association of treatment outcome with the diagnostic category. All statistical analyses were conducted using R v4.3.1; a p-value of.05). Compared with the AAE classification, the new classification in conjunction with proposed treatments resulted in preserving 87% of the pulps compared with historical treatment. Conclusions: We propose that a revised Wolters classification model is suitable for determining mild, moderate, and severe pulpitis to aid in clinical management of pulpitis.