dental pulp

DENTAL PULP

Dr. Blagoja Lazovski

dr. Blagoja Lazovski 1

INTROUDCTION

dr. Blagoja Lazovski

The Pulp is a soft mesenchymal connective tissue that

occupies pulp cavity in the central part of the teeth.

It is a special organ because of the unique

environment

2

DEVELOPMENT


During the 8th week of IUL, there is condensation of the mesenchmye under the enamel organ-Dental papilla.

The enamel organ enlarge and enclose the dental papilla in their central portion.

Dental papilla controls the morphology & type of tooth to be formed.

Dental papilla shows :

extensive proliferation of cells

High vascularity

3


Following the differentiation of the IEE into

ameloblasts, odontoblast differentiate from the

peripheral cells of dental papilla

Well organized capillaries are found at

beginning of dentinogenesis

4


Capillaries crowd around the odontoblast during

active dentinogenesis

Rim of the enamel organ (IEE & OEE) is the cervical

loop.

Root formation is carried out by the proliferation of

cells at the cervical loop.

5

Dental Papilla

Dental papilla capped by the

enamel organ


6

GENERAL FEATURES


Total of 52 pulp organs 32 in the permanent and

20 in the primary teeth.

Total pulp volume in permanent teeth is 0.38cc with

mean being 0.02CC

Each of these organs has a shape that conforms to

that of the respective tooth.

Has ability to form dentin throughout life

7


The pulp cavity is divided into

1. Coronal pulp

2. Radicular pulp

8

CORONAL PULP


It is the pulp occupying the pulp chamber of the crown of the tooth

In young teeth it resembles the shape of the outer dentin

It has six surfaces : occlusal, mesial, distal, buccal, lingual and floor.

Pulp horns are projections into the cusp

This pulp constricts at the cervical region where it continues as the radicular pulp

9

RADICULAR PULP


It is the pulp occupying the pulp canals of the root of

the tooth

In the anterior tooth it is single and in the posterior

teeth it is multiple

The radicular portions of the pulp is continuous with

the periapical tissues through apical foramen

As age advances the width of the radicular pulp is

reduced, and so is the apical foramen.

10

APICAL FORAMEN


1. Pulp cavity terminates at root apex as small opening called apical foramen

2. Radicular pulp continuous with connective tissue of the periodontium through this foramen.

3. Diameter in an adult- maxillary teeth-0.4mm

mandibular teeth-0.3mm

4. Wide open during development of root

11

APICAL FORAMEN


5. Undergoes changes

I. Tooth may tipped from horizontal pressure cause apex to tilt in opposite direction, exert pressure on one wall of the foramen causing resorption

6. Same time cementum laid down on opposite side resulting relocation of the original foramen

12


7. Sometimes apical opening is found on the lateral

side of the apex

8. There may be 2-3 foramina split by cementum or

dentin- APICAL DELTA

13

Apical Foramen

Neurovascular bundle entering pulp through the foramen


14

ACCESSORY CANAL


Leading laterally from the radicular pulp into the

periodontal tissue.

Present in the apical third of the root sheath cells

Formed due to premature loss of HERS or when

developing root encounters a blood vessel.

Overall occurrence is 33%

May also be present at the furcation region

15

Accessory Canals


16

Structural Organization of pulp


17

HISTOLOGICAL ZONES OF PULP


ODONTOBLAST LAYER

CELL-POOR ZONE

CELL-RICH ZONE

PULP PROPER

18

THE ODONTOBLASTIC ZONE


A layer of odontoblasts are found along

the pulp periphery.

They are dentin forming cells.

19


CELL FREE ZONE

It is also called weil’s zone

40 microns wide &relatively free of cells

Traversed by

1. blood vessels

2. unmyelinated nerves

3. cytoplasmic process of fibroblasts

This zone is found below the odontoblastic zone

Represents the space into which odontoblasts move during tooth development.

20

CELL RICH ZONE


Present in subodontoblastic layer

Contains more proportions of fibroblast and undifferentiated mesenchymol cells.

Also contains macrophages, dendritic cells and lymophocytes.

Zone formed due to migration of cells from pulp proper

Mitosis seen when dead odontoblasts are replaced

Also contain young collagen fibres during early dentiogenis.

21

PULP CORE


It is central region of the pulp

Contains major blood vessels and nerve of the

pulp

Pulpal cells and fibroblasts are also seen

22

CELLS OF PULP


ODONTOBLASTS

FIBROBLASTS

UNDIFFERENTIATED CELLS

DEFENSE CELLS

23

ODONTOBLASTS


A Peripheral area of the pulp where the odontoblasts reside is termed odontogenic zone.

Arranged in Palisading pattern cells one tall columnar forming a layer of 3 to 5 cells in depth.

Shape may vary cornal pulp- columnar

midportion - cuboidal

Apical region - Flattened

24


These cells have large process extending into

dentin

The no of odontoblasts corresponds to the

number of dentinal tubules

Average no of odontoblasts estimated to 45,000

per Sq.mm of odontogenic zone.

Odontoblasts in the crown are larger than in the

root.

25


Shape of the odontoblasts also reflect the

functional activity of the cell.

During active phase, cells show increase in

endoplasmic reticulum golgi appartus and

secretory vesicles.

Resting (or) Non active phase cells are flattened

little cytoplasm condensed chromatin and

decrease no of ER

26

JUNCTIONAL COMPLEX


Numerous junctions such as gap junctions tight junction and desmosomes are found between odontoblasts.

Indicating exchange of ions and small molecules.

They promote cell to cell adhension and play a role in maintaining polarity of odontoblasts

27


JUNCTIONAL COMPLEXES 28

ODONTOGENIC PROCESS


Odontoblasts give off a single process that extends into dentin and housed within dentinal tubules

These process devoid of major organelles

They contain abundance of microtubular filaments and coated vesicles

Mainly composed of protein-tubulin, act in and vimentin

29

FUNCTIONS OF ODONTOBLASTS


Synthesis of organic matrix

Synthesis of non collagenous substances like

sialoprotein, phosphophoryn, osteocalcin,

ostenoectin & osteopontin

Intracellular accumulation of calcium

Degradation of organic matrix

30

FIBROBALSTS


Cells that occur in greatest number in the pulp

Function is to form, maintain the matrix that consists

of collages, fiber and ground substance throughout

the pulp

The fibroblasts are stellate shaped cells having

extensive process.

31

Fibroblast

H&Estain

Immunohistochemical

method


32


Young teeth - Fibroblasts have abudant

cytoplasm having numerous cell organcells.

Older pulp - Fibroblasts appear spindle shaped

posses short processes having few cytoplasmic

organelles such cells are called fibrocytes

33


Dual function :

a) It has capability of ingesting and

degrading the organic matrix.

b) Pathway of both synthesis and degreadation

in the same cell.

34

UNDIFFERENTIATED MESENCHYME


These mesenchymal cells are distributed through out the pulp, frequently around the perivascular area - believed to be toti potent cell

They are Polyhedral shaped with peripheral processes and large oval nuclei

Difficult to differentiate from fibroblast under light microscopy

Under adequate stimilus they may differentiate into odontoblast or fibroblast or macrophages.

In older pulp,their number and ability to differentiate comes down

35

IMMUNOCOMPETENT CELLS


They play a major role local inflammation and immunity.

They are recruited from blood stream and remain as transient inhabitants in pulp

These cells are

1. Macrophages

2. Mast cells

3. Plasma cells

4. Lympocytes,Neutrophils,Eosinophils basophils and manocytes.

36

MACROPHAGES IN PULP


Described as histiocytes (or) as resting wandering cells

Located close to blood vessel

Have several phenotypes

Macrophages are phagocytes,function of which are engulfment and digestion of foreign material

During inflammation they appear in large no to aid in defense the organism

In all they constitute 8-9% of the pulpal cell population

37

Macrophages

Dark staining nucleus with cytoplasmic

granules


38

PLASMA CELLS


Plasma cells are seen during inflammation of the

pulp

The plasma cells function in the production of

antibodies.

Plasma cells may be present in coronal pulp

They have small nuclei with radiating chromatin

that appears like a cast wheel.

39

Plasma Cell

Peripheral arrangement of chromatin in

nucleus


40

MAST CELLS


Occur in small groups in relation to blood vessels

Present only during pulpal inflammation

Have round nucleus and contain many dark staining

granules in the cytoplasm.

Their number increase during inflammation.

41

LYMPHOCYTES,EOSINOPHILS AND

LEUCOCYTES


Usually found extravascularly in the normal pulp

During inflammation they increase in number.

Lymphocyte present along the walls of blood vessels

Involved in initial immunodefense

Usually they are not found in uninflamed pulp

42


Eosinophils are present in some allergic types of

inflammation

In pulp.they are found in an inflammatory exudate.

43

LYMPHOCYTES IN PULP


44


Leucocytes are not found normally in the

connective tissue

They are transported to such sites in response to

injury and then present directly in the involved

tissue as well as in blood.

They phagocyte foreign material .

45

EXTRACELLULAR MATRIX


Connective tissue fibers

Collagen

Elastin

Fibronectin

Ground substance

Proteoglycans

Glycosaminoglycans

Basement membrane

46

FIBRES (COLLAGEN FIBRES)


Extra cellular structural protein,major constituent of

connective tissue

Collagen fibers appear throughout the pulp

young fine fibers ranging in diameter from 10-12mm.

Pulp collagen fibers do not contribute to dentin matrix

production.

47


After root completion pulp matures and bundles of

collagen fibers increase in number

They scattered throughout the coronal or radicular

pulp,or they appear in bundles.These are termed

diffuse or bundle collagen

Most prevalent in root canals,especially near

apical region.

48

Collagen Fiber

Seen in relation with fibroblasts


49


Type I:

Present as thick striated fibrils

Responsible for pulp architecture

Type III:

Thinner fibrils,mainly distributed in

cell free and cell rich zones

Contributes to the elasticity of pulp

50


Type IV:

Present along the basement membrane of blood

vessels

Type V and VI:

Seen to form dense meshwork of thin microfibrils

through out the stroma

51


Collagen turnover is maintained by fibroblasts

During bacterial infection &

inflammation,collagenolytic activity is

accelerated following collagenase produced by

bacteria,PMN & fibroblats

Collagen synthesis is accelerated during

reparative dentin formation

52

ELASTIC FIBER


1. This has the ability to expand and contract

like a rubber band

2. Elastic fibers are first formed in bundles of

thin micro filaments called Oxytalan fibers

3. Elastin is then deposited in between oxytalan

fibers.

4. Always associated with larger blood vessels

53

Elastic Fiber

Verhoeff's method stains the fibers black


54

FIBRONECTIN


It plays a role in cell-cell & cell-matrix adhesion

Has a major effect on the proliferation, differentiation & organization of cells.

Seen around the blood vessels

Also found in odontoblast layer with fibers passing into predentin

55


Due to its close interaction with odontoblasts and

extracellular fibers,fibrinoectin helps to maintain cell

morphology and provide a tight seal at this site.

Fibronectin may be involved in cell migration and

anchorage in the wound healing process of the

connective tissue of pulp.

It regulates the migration and differentiation of

secondary odontoblasts

Adherent property of fibronectin is due to cell surface

glycoprotein receptors called Integrins

56

GROUND SUBSTANCE


It is a structureless mass,makes up the bulk of the

pulp

Consists of complexes of proteins,carbohydrate

and water.

Broadly classified as

Glycoaminoglycans

Proteoglycans

57

GLYCOSAMINOGLYCANS


GAG found in pulp is mainly chondroitin

sulphate,dermatan sulphate & hyaluronic acid

Proteoglycans occupy larger area and they provide

protection against compression.

During dentinogenesis,the ground substance show

affinity for collagen and influence fibrinogenesis

They have capacity to bind with calcium and help in

mineralisation

58

BASEMENT MEMBRANE


It is a sheet like arrangement of extra cellular

protein matrix at the epithelial-mesenchymal

interface

Composed of 2 layers

lamina densa-electron dense

lamina lucida-electrolucent

59


Basement membrane is a product of connective

tissue and epithelium

It is composed of

Collagen type IV

Laminin-adhesive glycoprotein

Fibronectin

Heparin sulfate

60


Collagen IV provides binding sites for the rest of

basement membrane components

Laminin binds to both cells of connective tissue

and epithelium

In mature pulp,basement membrane forms

interface along endothelial cells & schwann cells

61

FUNCTIONS


Act as sieve between epithelium and connective

tissue

Helps in organisation and differentiation by

enabling interactions between extra cellular

molecules and cell surface receptors

Eg: Odontoblasts during tooth

development

62

CIRCULATION OF THE PULP


The pulp organ is extensively vascularized.

They are supplied by the superior and the

inferior alveolar arteries

The blood vessels gain entry into the pulp through

the apical foramen and at times through

accessory foramen.

63


The arterioles on entering the pulp show a

reduction in thickness of vessel wall musculature

and therefore luman size increases.

Pulpal blood flow is more rapid than in most area

of the body

So pulpal pressure is highest of body tissues

The flow of blood in asterioles - 0.3 to 1mm/sec

Venules – 0.15mm/sec

Capilaries – 0.08mm/sec

64

Organization of Pulp Vasculature


⃟ Pulp is a micro circulatory system which lacks true arteries and veins

⃟ The largest vessels are arterioles & venules which regulate the local interstitial environment

⃟ They enter the tooth through the apical foramen

⃟ Pulp tissue pressure is 14cm H20

65

Organization of pulp vasculature

neurovascular bundle


66


ARTERIOLES:

Arterioles

(50µ diameter)

Terminal arterioles

Precapillaries

Metarterioles

Capillaries (8µ)

67


The branching point of terminal arterioles is

characterized by smooth muscle clumps that act

as sphincters which are under the local cellular &

neuronal control

Thus pulpal inflammation elicits a localised

circulatory response restricted to the area of

inflammation

Arteriolar pressure – 43mm Hg.

68


Apical third Middle third

PULP VASCULATURE

69

Microcirculatory System

Arterioles & venules


70

CAPILLARIES


Function as exchange vessels regulating the transport of diffusion of substances between blood and local interstitial tissue elements

They consists of single layer of endothelium surrounded by basement membrance

Capillary pressure –35 mmHg

Capillary wall is 0.5µ thick & acts as semipermeable membrane

71


Based on the property of semi permeability

capillaries may be grouped as

Class I : Fenestrated capillaries

Class II: Continuous capillaries

(non fenestrated)

Class III : Discontinuous capillaries

Class IV : Tight junction capillaries

Class I & II are present in the dental pulp

72

Capillary network is organized in 3 layers


1. Terminal capillary network located in the “odontoblastic layer”

2. “Capillary network” present adjacent to the odontoblastic layer & consists of pre capillary & post capillary vessels

3. Venular network of vessels

During aging & decreased metabolism these layers appear as single layer

73

SEM shows extensive arborization of capillaries from the

metarterioles


74

VENULES


Collecting venules receive pulpal blood flow from

the capillaries & transfer it to the venules

Arterio-venous anastomosis permits direct

shunting from arterioles to venules

Venular pressure –19mm Hg

75

LYMPHATICS


Lymphatic vessels are formed from fine meshwork

of small, thin walled lymph capillaries

Lymph capillaries coalesce to form larger

lymphatic vessels with valves

They start as blind openings near Weil’s zone &

odontoblastic layer

The larger lymphatic vessels run along the blood

vessels & nerves

76


Multiple collecting lymph vessels exit though the apical foramen & drain lymph from pulp into the periodontium

Role in pulp:

They remove high molecular solutes from the interstital fluids thus maintain interstitial COP

They transport lymph to the regional lymph node before it enters into the blood vessels. This provides an immuno surveillance function.

77

METABOLSIM


Metabolism has been studied by measuring the rate of O2 consumption & production of Coz lactic acid by pulp tissue

Radiospriometry is also used to evaluate the metabolism. Pulp tissue is placed in 14C labeled substractures, such as succinate & rate of apperance of CO2 is measured.

During dentinogenesis, rate of O2 consumption is high than after crown completion.

78


Greatest metabolic activity is seen in the

odontoblast layer.

Reduced pH of pulp causes decreases in O2

consumption as in pulp abscess.

In addition to the glycolytic pathway, the pulp

has the ability to produce energy through

Pentose shunt pathway, suggesting that the pulp

can function under varying degrees of ischemia

79


Several dental materials have shown to inhibit O2

consumption Eg. ZOE , Ca(OH)2 & silver amalgam

Pulpal irritation causes increases in

cycloxygenase products, which is inhibited by

ZOE

As cellular composition reduces, the rate of

oxygen consumption decreases.

80

INNERVATION


Principles role is to help in conscious recognition

of irritants to the pulp, which gives the

opportunity to have the problem corrected

before irreversible effects can occur

Nerve fibers, mylinated & unmyelinated, enter

the tooth through the apical foramen

81

INNERVATION


Dental pulp contains sensory and motor fibers to

fulfill the vasomotor and defense function

Sensory afferent fibers are branches of

maxillary & mandibular division of trigeminal

nerve.

82


After entering the foramen, they arborize. Larger

fibers are present in the central zone. They

divide as they proceed peripherally and

coronally.

Subjacent to the cell rich zone, the nerves branch

extensively forming a parietal layer of nerves-

NERVE PLEXUS OF RASHKOW. This layer

contains both A and C fibers.

83

Types of nerve fibers


84


Above the cell free zone, myelinated fibers begin

to lose their myelin sheath.

In the cell free zone, they form a rich network

responsible for pain

In the cell free zone, they form a rich network

responsbile for pain.

Many of these fibers pass between the

odontoblastic zone.

85


Nerve endings may also enter the dentinal

tubules

incidence - 10-20% in cusp tips

1% at the level of CEJ

Motor nerves are supplied by the sympathetic

division of autonomic nervous system.

86


They wrap around the arteries and terminate in

the tunica media.

They control the diameter of the vascular lumen &

therefore blood flow & volume & ultimately the

intrapulpal pressure.

87

Table 3.2 Classification and function of fibers in peripheral nerves

Fiber

Diameter

(m)

Conduction velocity

(speed of impulse,

m/sec)

Function

A-alpha ()

A-beta()

6-20

5-12

15-80 (myelinated)

30-70

Afferent fibers for touch, pressure

proprioception, vibration

(mechanorecptors)

A-gamma()

A-delta ()

B

1-5

1-3

2-30 (myelinated)

3-15 (myelinated)

Afferent fibers for pain and temperature

Visceral afferent fibers preganglionic

visceral efferent fibres

C 04-1.0 0.4-2(unmyelinated) Afferent fibers for pain and tempature;

post ganglionic visceral efferent fibers


Neuropeptides in Pulp


Neuropeptides are proteins that have been associated with central & peripheral nervous system

Following are the neuropeptides demonstrated in pulp :

Originate from trigeminal ganglion (C fibres)

Substance P

CGRP

Neurokinin A

89

FUNCTIONS OF DENTAL PULP


INDUCTIVE

FORMATIVE

NUTRITIVE

PROTECTIVE

DEFENSE

90

INDUCTIVE


It induces oral epithelial differentiation into

dental lamina and enamel organ

It also induces the enamel organ to

differentiate into a particular type of

tooth morphology

91

FORMATIVE


The cells of Pulp induces dentin formation

This involves formation of primary and secondary

dentin.

The primary dentin is tubular and regularly

arranged.Formed before root closure

Secondary dentin contain fewer tubules and is

formed after root closure.

92

NUTRITIVE


Dental pulp maintains the vitality of dentin by

providing O2 and nutrients to the odontoblasts

Also provides continuing source of dentinal fluid

Nutrition made possible by rich peripheral

capillary network.

93

PROTECTIVE


Pulp helps in recognition of stimuli like

heat,cold,pressure,chemicals by way of

sensory nerve fibres.

Vasomotor innervation controls the muscular wall

of blood vessels.This regulates the blood volume

and rate of blood flow and hence the intrapulpal

pressure.

94

DEFENSIVE (OR) REPARATIVE


Pulp as remarkable reparative abilities

It responds to irritation by producing reparative dentin and mineralizing and affected dentinal tubules.

Mild to moderate irritation results in continued peritubular dentin formation, sclerosis and intratubular calcifiction-(Tublar sclerosis)

95


Stimuli like operative procedures abrasion, caries

can result in rapid dentin formation (Tertiary

dentin)

Inflamed pulp due to bacterial infection the cells

in pulp aid in the process of repair

(macrophages, lymphocycts, neutrophils,

monocytes, plasma , mast cells)

96

PULP OF DECIDUOUS TEETH


Overall dimensions smaller

Pulp chambers larger

Roots are long and slender and root canals narrower and follow a tortuous course

Pulp horns at a higher level, especially mesial horns of primary molars

Resorption starts soon after root completion

Root resorption and dentin deposition changes size shape and number of root canals.

97

PRIMARY PULP ORGAN


Primary pulp functions for a mean of 8.3 years.

This time can be divided into three periods

Pulp organ growth

Time of crown and root development

Pulp maturation (3 years, 9 months)

Time after root completion to beginning

of root resorption

Pulp regression (3 Years , 6 months)

Beginning of root resorption to exfoliatin

98

REGRESSIVE CHANGES (AGING)


Cell Changes

Appearance of fewer cells in aging pulp

Cells are characterized by a decrease in size and no of cytoplasmic organelles

Active pulpal fibrocyte (or) fibroblast has abundant rough-surfaced endoplasmic reticulum notable golgi complex, numerous mitochondria

99


Fibroblast exhibit less perinuclear cytoplasm, long

thin cytoplasmic processes.

Intra cellular organelles are reduced in no and size

100

FIBROSIS


Diffuse fibrillar components

Accumulation of both Bundles of collagen fibres

Fiber bundles may appear arranged longitudinally in the radicular pulp and more diffuse in coronal pup

Collagen accumulation also occurs in some older pulps

Increase in fibers in the pulp organ is gradual and generalized

101


External trauma such as dental caries (or) deep

restorations cause a localized fibrosis (or) scarring

effect

Increase in collages fibers decrease in the size of

the pulp

Vascular changes occur in aging pulp

102

Pulp Fibrosis


103


Atherosclerotic plaques may appear in pulpal

vessels.

Calcifications are found that surround vessels.

Calcification is found most often in the region

near the apical foramen.

104

Pulp Stones(denticles)


Appearing in either or both coronal and root portions of the pulp organ

Develop in teeth that appear to be normal in other respects.

Asymptomatic unless they impinge on nerves (or)blood vessels

Seen in functional as well as embedded unerupted teeth.

105

Classification


1. True denticles

2. False denticles

3. Diffuse calcifications

106


True denticles

True denticles are similar in structure to dentin

They have dental tubules and contain processes of

the odontoblasts

Usually located close to the apical foramen

107


Development of true denticles is caused by the

inclusion of remnants of the epithelial root sheath

with in the pulp

Epithelial remnants induce the cells of pulp to

differentiate into odentoblasts then form the dentin

mass.

108

True Denticle

H&E section of true denticle

Higher magnification


109

False denticles


They do not exhibit dentinal tubules

They appear as concentric layers of calcified tissue

Some cases these calcification sites appear within

a bundle of collagen fibers.

Some cases they appear in pulp free of collagen

accumulations

110


Some cases arises around vessels

Center of these concentric layers of calcified tissues

there may be remnants of necrotic and calcified

cells

Calcification of thrombi in blood vessels called

phleholiths, may also serve as nidi for false

denticles

111


An denticles begin as small nodules but increase in size by incremental growth

Classified as free, attached (or) embedded depending on their relation to the dentin

a) Free denticle – entirely surrounded by pulp tissue

b) Attached denticle – Partly fused with the dentin

c) Embedded denticles – Entirely surrounded by dentin

Incidence as well as the size of pulp stones increase with age.

112

False Denticle

False calcification seen along the walls of the blood

vessel


113

Diffuse Calcifications


Appear as irregular calcific deposits in the pulp

tissue, following collagenous fiber bundles, blood

vessels,

Sometimes they develop into larger mass, persist as

calcified spicules

114


These calcifications are usually found in the root

canal and less often in coronal area

These calcification surrounds blood vessels

These calcifications may be classified as

dystrophic calcification

115

Diffuse calcification

Diffuse calcification of the pulp, seen along with

pulp fibrosis


116

Dystrophic Mineralization


Ground substance alterations in the dental pulps occurs on aging, such charges may contribute to cellular degeneration and increase dystrophic mineralization.

Circulatory disturbances may be the initiating factor

Mineralizations also seen in the myelin sheaths of nerves.

117


Their beginnings are also found in the vessel

walls as in arteriosclerosis.

Older, fibrotic pulp attract mineral salts more

readily.

A mineralized pulp when extirpated, feels

wooden hard.

118

Dystropic mineralization due to caries and

periodontal disease


DM also increase as result of disease processes

such as caries and periodontal diseases

Teeth whose pulps one chronically inflammed

contain DM in regions of previous liquefaction

necrosis.

119


Alkaline phosphate in odontoblasts may function

as a calcium pyso phosphatus, there by

stimulating ca2 uptuke in pulps.

Teeth with periodontal disease, DM increase in

both cornonal and radicular pulp.

120

AGE CHANGES


Formation of secondary dentin through out life,

reduces the size of the pulp chamber and root

canals

Decrease in cellularity

Odontoblast decrease in size & number, & may

disappear in certain areas. Especially on pulpal

floor over bifurcation & trifurca

121


Increase in number & thickness in collagen fibers

particularly radicular pulp

Reduction in the nerve fibers & blood vessels

Increase resistance of pulp against action of

enzymes

In dentin,

Increase in peritulular dentin

Dentinal sclerosis, reduces permeability

Increase in dead tracts

122

Factors infulencing Tertiary

Dentinogenesis


Reactionary Dentinogenesis:

Shallow cavity- RDT > 0.5mmRD

Deep cavity - RDT 0.25mm - RD

Very deep cavity- RDT 0.008 –0.25mm RD

Reparative Dentinogenesis:

Pulp exposure – RDT< 0.008mm- Reparative dentin

formation.

123

Tertiary Dentinogenesis


124

CLINICAL CONSIDERATIONS


1. Anatomic considerations

2. Factors to be considered during endodontic

treatment.

3. Effect of Operative Procedures

4. Effect of dental materials on pulp

5. Effects subsequent to restoration

125

ANATOMIC CONSIDERATIONS

dr. Blagoja Lazovski Pulp Chamber with stone Cervical horns

126

OPERATIVE PROCEDURES


Anatomic considerations

1) Shape of the pulp chamber and its extensions into

the cusps pulpal horns is important.

2) Wide pulp chamber into tooth of young person

will make a deep cavity preparation hazardous

127


3) The pulpal horns project high into the cusps

exposure of pulp can occur

4) If opening a pulp chamber for treatment its size

and variation in shape must be taken into

consideration

128


FACTORS TO BE CONSIDERED DURING

ENTODONTIC TREATMENT

5) Age advance , the pulp chamber becomes

smaller difficult to locate the root canals.

6) Shape of the apical foramen and its location

may play an important part in treatment of root

canals.

7) Accessory canals, and multiple canals are rarely

seen in roentgenograms.

129

FACTORS TO BE CONSIDERED DURING OPERATIVE

PROCEDURES


8) The pulp is highly responsive to stimuli, even slight

stimulus cause inflammatory cell infiltration.

9) Dehydration causes pulpal damage operative

procedures producing this condition should be

avoided.

130


Filling material contain harm ful chemicals

Silicate cement - acid

Composites - monomer

Vital pulp is essential to good dentition.

Now vital tooth becomes brittle and is subject to

fracture.

131

EFFECT OF DENTAL MATERIALS ON PULP


GIC – Well tolerated by pulp

Calcium hydroxide – includes dentin bridge formation.

Zine oxide – eugenol- has an anti-bacterial effect.

Formocresol – Cause chronic inflammation of the pulp.

Dentin bonding agent – can irritate the pulp causing

inflammation

132

DETECTION OF PULP VITALITY


Electric pulp testing

More accurate than some of the tests used to

detamine pulp vitality

Heat testing

Thermal testing

Cold

Anesthetic testing

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Anesthetic testing

Test cavity

This test performed when other methods of diagnosis have failed

The test cavity is made drilling through enamel – dentin junction of an unanaesthetized tooth

Pulse oximeter

Based on evaluating oxygen saturation of the tissue.

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CONCUSION


THE PRESEVATION OF A HEALTHY PULP DURING

OPERATIVE PROCEDURES AND SUCCESSFUL

MANAGEMENT IN CASES OF DISEASES ARE TWO

OF MOST IMPORTANT CHALLENGE TO THE

CLINICAL DENTIST.

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dental pulp

Health & Medicine

blagoja lazovski

dental pulp

pulp organs

pulp core22it

pulp chamber

pulp canals

pulp horns

radicular pulp continuous