Dental Pulp

dr. Blagoja Lazovski 1

DENTAL PULP

Dr. Blagoja Lazovski

INTROUDCTION
2

 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

dr. Blagoja Lazovski

DEVELOPMENT
3

 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

4

 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


5

 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.


Dental Papilla
6

Dental papilla capped by the
enamel organ


GENERAL FEATURES
7

 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


8

The pulp cavity is divided into

1. Coronal pulp
2. Radicular pulp


CORONAL PULP
9

 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


RADICULAR PULP
10

 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.


APICAL FORAMEN
11

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


APICAL FORAMEN
12

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


13

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


14
Apical Foramen

Neurovascular bundle
entering pulp
through the
foramen


ACCESSORY CANAL
15

 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


Accessory Canals
16


Structural Organization of pulp
17


HISTOLOGICAL ZONES OF PULP
18

ODONTOBLAST LAYER
CELL-POOR ZONE
CELL-RICH ZONE
PULP PROPER


THE ODONTOBLASTIC ZONE
19

 A layer of odontoblasts are found along
the pulp periphery.

 They are dentin forming cells.


20

 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.


CELL RICH ZONE
21

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.

PULP CORE
22

It is central region of the pulp
Contains major blood vessels and nerve of the
pulp
Pulpal cells and fibroblasts are also seen


CELLS OF PULP
23

 ODONTOBLASTS
 FIBROBLASTS
 UNDIFFERENTIATED CELLS
 DEFENSE CELLS


ODONTOBLASTS
24

 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


25

 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.


26

 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


JUNCTIONAL COMPLEX
27

 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


JUNCTIONAL COMPLEXES
28


ODONTOGENIC PROCESS
29

 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


FUNCTIONS OF ODONTOBLASTS
30

Synthesis of organic matrix
Synthesis of non collagenous substances like
sialoprotein, phosphophoryn, osteocalcin,
ostenoectin & osteopontin
Intracellular accumulation of calcium
Degradation of organic matrix


FIBROBALSTS
31

 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.


Fibroblast
32

H&Estain

Immunohistochemical
method

33

 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


34

 Dual function :
a) It has capability of ingesting and
degrading the organic matrix.
b) Pathway of both synthesis and degreadation
in the same cell.


UNDIFFERENTIATED MESENCHYME
35

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

IMMUNOCOMPETENT CELLS
36

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.


MACROPHAGES IN PULP
37

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


Macrophages
38

Dark staining nucleus with cytoplasmic
granules


PLASMA CELLS
39

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.


Plasma Cell
40

Peripheral arrangement of chromatin in
nucleus


MAST CELLS
41

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.


LYMPHOCYTES,EOSINOPHILS AND
LEUCOCYTES
42

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


43

Eosinophils are present in some allergic types of
inflammation
In pulp.they are found in an inflammatory exudate.


LYMPHOCYTES IN PULP
44


45

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 .


EXTRACELLULAR MATRIX
46

Connective tissue fibers
Collagen
Elastin
Fibronectin
Ground substance
Proteoglycans
Glycosaminoglycans
Basement membrane


FIBRES (COLLAGEN FIBRES)
47

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.


48

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.


Collagen Fiber
49

Seen in relation with fibroblasts


50

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


51

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


52

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


ELASTIC FIBER
53

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


Elastic Fiber
54

Verhoeff's method stains the fibers black


FIBRONECTIN
55

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


56

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

GROUND SUBSTANCE
57

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


GLYCOSAMINOGLYCANS
58

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


BASEMENT MEMBRANE
59

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


60

Basement membrane is a product of connective
tissue and epithelium
It is composed of
 Collagen type IV
 Laminin-adhesive glycoprotein
 Fibronectin
 Heparin sulfate


61

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


FUNCTIONS
62

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


CIRCULATION OF THE PULP
63

 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.


64

 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


Organization of Pulp Vasculature
65

⃟ 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


Organization of pulp vasculature
66

neurovascular bundle


67

 ARTERIOLES:
Arterioles
(50µ diameter)

Terminal arterioles

Precapillaries

Metarterioles

Capillaries (8µ)


68

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.


PULP VASCULATURE
69

Apical third Middle third

Microcirculatory System
70

Arterioles & venules


 CAPILLARIES
71

 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


72

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


Capillary network is organized in 3 layers
73
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


SEM shows extensive arborization of capillaries from the
metarterioles
74


VENULES
75

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


LYMPHATICS
76

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


77

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.

METABOLSIM
78

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.


79

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


80

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.


INNERVATION
81

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


INNERVATION
82

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.


83

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.


Types of nerve fibers
84


85

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.


86

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.


87

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.


Table 3.2 Classification and function of fibers in peripheral nerves
Diameter Conduction velocity Function
(m) (speed of impulse,
Fiber m/sec)
A-alpha () 6-20 15-80 (myelinated) Afferent fibers for touch, pressure
A-beta() 5-12 30-70 proprioception, vibration
(mechanorecptors)
A-gamma()
A-delta () 1-5 2-30 (myelinated) Afferent fibers for pain and temperature
B 1-3 3-15 (myelinated) 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

88 dr. Blagoja Lazovski

Neuropeptides in Pulp
89

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


FUNCTIONS OF DENTAL PULP
90

INDUCTIVE
FORMATIVE
NUTRITIVE
PROTECTIVE
DEFENSE


INDUCTIVE
91

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


FORMATIVE
92

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.


NUTRITIVE
93

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.


PROTECTIVE
94

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.


DEFENSIVE (OR) REPARATIVE
95

 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)


96

 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)


PULP OF DECIDUOUS TEETH
97

 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.


PRIMARY PULP ORGAN
98

 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


REGRESSIVE CHANGES (AGING)
99

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


100

 Fibroblast exhibit less perinuclear cytoplasm, long
thin cytoplasmic processes.
 Intra cellular organelles are reduced in no and size


FIBROSIS
101

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


102

 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


Pulp Fibrosis
103


104

 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.


Pulp Stones(denticles)
105

 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.


Classification
106

1. True denticles
2. False denticles
3. Diffuse calcifications


107

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


108

 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.


True Denticle
109

 H&E section of
true denticle

 Higher
magnification

False denticles
110

 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


111

 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


112

 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.

False Denticle
113

False calcification seen along the walls of the blood
vessel

Diffuse Calcifications
114

 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


115

 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


Diffuse calcification
116

Diffuse calcification of the pulp, seen along with
pulp fibrosis

Dystrophic Mineralization
117

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.


118

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.


Dystropic mineralization due to caries and
periodontal disease
119

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.


120

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.


AGE CHANGES
121

 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


122

 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

Factors infulencing Tertiary
Dentinogenesis
123

Reactionary Dentinogenesis:
 Shallow cavity- RDT > 0.5mmRD

 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.

Tertiary Dentinogenesis
124


CLINICAL CONSIDERATIONS
125

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


ANATOMIC CONSIDERATIONS
126

Pulp Chamber with stone dr. Blagoja LazovskiCervical horns

OPERATIVE PROCEDURES
127

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


128

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


129

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.

FACTORS TO BE CONSIDERED DURING OPERATIVE
PROCEDURES
130

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.


131

 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.


EFFECT OF DENTAL MATERIALS ON PULP
132

 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


DETECTION OF PULP VITALITY
133

 Electric pulp testing
 More accurate than some of the tests used to
detamine pulp vitality
Heat testing
 Thermal testing
Cold
 Anesthetic testing


134

 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.


CONCUSION
135

 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.


Dental Pulp

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