Dental Pulp
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About This Presentation
basics of dental pulp
Slide Content
DENTAL PULP
11
Dr. Madhu Billa
I MDS
DEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICS
SIBAR INSTITUTE OF DENTAL SCIENCES
Dr.MadhuBillaDr.MadhuBilla
11
Dr. Madhu Billa
I MDS
DEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICS
SIBAR INSTITUTE OF DENTAL SCIENCES
Dr.MadhuBillaDr.MadhuBilla
CONTENTSCONTENTS
Introduction
Anatomy
Structural organization of pulp
Cells of pulp
Extra-cellular matrix
Circulation & Innervation of pulp
Functions of pulp
Pulp calcification
Age changes
Clinical significance
Dr.MadhuBillaDr.MadhuBilla 22
Introduction
Anatomy
Structural organization of pulp
Cells of pulp
Extra-cellular matrix
Circulation & Innervation of pulp
Functions of pulp
Pulp calcification
Age changes
Clinical significance
Dr.MadhuBillaDr.MadhuBilla 22
INTRODUCTIONINTRODUCTION
The Pulp is a soft mesenchymal connective The Pulp is a soft mesenchymal connective
tissue that occupies pulp cavity in the central tissue that occupies pulp cavity in the central
part of the teeth. part of the teeth.
It is a special organ because of its unique It is a special organ because of its unique
environmentenvironment
Dr.MadhuBillaDr.MadhuBilla 33
The Pulp is a soft mesenchymal connective The Pulp is a soft mesenchymal connective
tissue that occupies pulp cavity in the central tissue that occupies pulp cavity in the central
part of the teeth. part of the teeth.
It is a special organ because of its unique It is a special organ because of its unique
environmentenvironment
Dr.MadhuBillaDr.MadhuBilla 33
FEATURES OF PULPFEATURES OF PULP
Enclosed within dentinEnclosed within dentin
Resembles embryonic connective tissueResembles embryonic connective tissue
Microcirculatory system with no collateral Microcirculatory system with no collateral
systemsystem
Retains ability to form dentin throughout lifeRetains ability to form dentin throughout life
Dr.MadhuBillaDr.MadhuBilla 44
Enclosed within dentinEnclosed within dentin
Resembles embryonic connective tissueResembles embryonic connective tissue
Microcirculatory system with no collateral Microcirculatory system with no collateral
systemsystem
Retains ability to form dentin throughout lifeRetains ability to form dentin throughout life
Dr.MadhuBillaDr.MadhuBilla 44
ANATOMY OF PULPANATOMY OF PULP
52 pulp organs – 32 + 2052 pulp organs – 32 + 20
Total pulp volume in permanent teeth is 0.38 Total pulp volume in permanent teeth is 0.38
cc. with mean being 0.02 cc.cc. with mean being 0.02 cc.
The pulp cavity is divided into coronal pulp The pulp cavity is divided into coronal pulp
and radicular pulpand radicular pulp
Dr.MadhuBillaDr.MadhuBilla 55
52 pulp organs – 32 + 2052 pulp organs – 32 + 20
Total pulp volume in permanent teeth is 0.38 Total pulp volume in permanent teeth is 0.38
cc. with mean being 0.02 cc.cc. with mean being 0.02 cc.
The pulp cavity is divided into coronal pulp The pulp cavity is divided into coronal pulp
and radicular pulpand radicular pulp
Dr.MadhuBillaDr.MadhuBilla 55
CORONAL PULPCORONAL PULP
It is the pulp occupying the pulp chamber of It is the pulp occupying the pulp chamber of
the crown of the tooththe crown of the tooth
In young teeth it resembles the shape of the In young teeth it resembles the shape of the
outer dentinouter dentin
It has six surfaces: occlusal, mesial, distal, It has six surfaces: occlusal, mesial, distal,
buccal, lingual and floorbuccal, lingual and floor
Pulp horns are projections into the cuspPulp horns are projections into the cusp
This pulp constricts at the cervical region This pulp constricts at the cervical region
where it continues as the radicular pulpwhere it continues as the radicular pulp
Dr.MadhuBillaDr.MadhuBilla 66
It is the pulp occupying the pulp chamber of It is the pulp occupying the pulp chamber of
the crown of the tooththe crown of the tooth
In young teeth it resembles the shape of the In young teeth it resembles the shape of the
outer dentinouter dentin
It has six surfaces: occlusal, mesial, distal, It has six surfaces: occlusal, mesial, distal,
buccal, lingual and floorbuccal, lingual and floor
Pulp horns are projections into the cuspPulp horns are projections into the cusp
This pulp constricts at the cervical region This pulp constricts at the cervical region
where it continues as the radicular pulpwhere it continues as the radicular pulp
Dr.MadhuBillaDr.MadhuBilla 66
RADICULAR PULPRADICULAR PULP
It is the pulp occupying the pulp canals of the It is the pulp occupying the pulp canals of the
root of the toothroot of the tooth
In the anterior tooth it is single and in the In the anterior tooth it is single and in the
posterior teeth it is multipleposterior teeth it is multiple
It is more fibrous & whitish color, which It is more fibrous & whitish color, which
protects the neurovascular bundleprotects the neurovascular bundle
As age advances the width of the radicular As age advances the width of the radicular
pulp is reduced, and so is the apical foramenpulp is reduced, and so is the apical foramen
Dr.MadhuBillaDr.MadhuBilla 77
It is the pulp occupying the pulp canals of the It is the pulp occupying the pulp canals of the
root of the toothroot of the tooth
In the anterior tooth it is single and in the In the anterior tooth it is single and in the
posterior teeth it is multipleposterior teeth it is multiple
It is more fibrous & whitish color, which It is more fibrous & whitish color, which
protects the neurovascular bundleprotects the neurovascular bundle
As age advances the width of the radicular As age advances the width of the radicular
pulp is reduced, and so is the apical foramenpulp is reduced, and so is the apical foramen
Dr.MadhuBillaDr.MadhuBilla 77
APICAL FORAMENAPICAL FORAMEN
It forms the portal of entry or exit for the It forms the portal of entry or exit for the
contents of the pulpcontents of the pulp
Mean size:Mean size:
Maxillary teeth – 0.4 mmMaxillary teeth – 0.4 mm
Mandibular teeth – 0.3 mm Mandibular teeth – 0.3 mm
Migration or horizontal pressure causes the Migration or horizontal pressure causes the
apex to tilt, changing the position of the apical apex to tilt, changing the position of the apical
foramenforamen
Dr.MadhuBillaDr.MadhuBilla 88
It forms the portal of entry or exit for the It forms the portal of entry or exit for the
contents of the pulpcontents of the pulp
Mean size:Mean size:
Maxillary teeth – 0.4 mmMaxillary teeth – 0.4 mm
Mandibular teeth – 0.3 mm Mandibular teeth – 0.3 mm
Migration or horizontal pressure causes the Migration or horizontal pressure causes the
apex to tilt, changing the position of the apical apex to tilt, changing the position of the apical
foramenforamen
Dr.MadhuBillaDr.MadhuBilla 88
There may be 2-3 foramina separated by There may be 2-3 foramina separated by
cementum or dentin- APICAL DELTA.cementum or dentin- APICAL DELTA.
Largest in palatal root of maxillary teeth and Largest in palatal root of maxillary teeth and
distal root of mandibular teeth.distal root of mandibular teeth.
It is usually 0.5-0.75 mm It is usually 0.5-0.75 mm
occlusal to the anatomic apex.occlusal to the anatomic apex.
Dr.MadhuBillaDr.MadhuBilla 99
cementum or dentin- APICAL DELTA.cementum or dentin- APICAL DELTA.
Largest in palatal root of maxillary teeth and Largest in palatal root of maxillary teeth and
distal root of mandibular teeth.distal root of mandibular teeth.
It is usually 0.5-0.75 mm It is usually 0.5-0.75 mm
occlusal to the anatomic apex.occlusal to the anatomic apex.
Dr.MadhuBillaDr.MadhuBilla 99
ACCESSORY CANALACCESSORY CANAL
Leading laterally from the radicular pulp into Leading laterally from the radicular pulp into
the periodontal tissue.the periodontal tissue.
Present in the apical third of the root.Present in the apical third of the root.
Formed due to premature loss of HERS or Formed due to premature loss of HERS or
when developing root encounters a blood when developing root encounters a blood
vessel.vessel.
May also be present at the furcation region.May also be present at the furcation region.
Dr.MadhuBillaDr.MadhuBilla 1010
Leading laterally from the radicular pulp into Leading laterally from the radicular pulp into
the periodontal tissue.the periodontal tissue.
Present in the apical third of the root.Present in the apical third of the root.
Formed due to premature loss of HERS or Formed due to premature loss of HERS or
when developing root encounters a blood when developing root encounters a blood
vessel.vessel.
May also be present at the furcation region.May also be present at the furcation region.
Dr.MadhuBillaDr.MadhuBilla 1010
ACCESSORY CANALSACCESSORY CANALS
Dr.MadhuBillaDr.MadhuBilla 1111
Dr.MadhuBillaDr.MadhuBilla 1111
CANAL CONFIGURATIONCANAL CONFIGURATION
by Weine in 1982by Weine in 1982
Dr.MadhuBillaDr.MadhuBilla 1212
by Weine in 1982by Weine in 1982
Dr.MadhuBillaDr.MadhuBilla 1212
VERTUCCI CLASSIFICATIONVERTUCCI CLASSIFICATION
Dr.MadhuBillaDr.MadhuBilla 1313
Dr.MadhuBillaDr.MadhuBilla 1313
DEVELOPMENTDEVELOPMENT
The primitive oral cavity or The primitive oral cavity or
stomodeum, is lined by a stomodeum, is lined by a
stratified squamous epithelium stratified squamous epithelium
called as called as oral ectodermoral ectoderm..
During 6th week of the During 6th week of the
intrauterine life or two to three intrauterine life or two to three
weeks after the rupture of the weeks after the rupture of the
buccopharyngeal membrane, buccopharyngeal membrane,
basal cells of the oral ectoderm basal cells of the oral ectoderm
in certain areas proliferate faster in certain areas proliferate faster
than the adjacent cells and forms than the adjacent cells and forms
dental laminadental lamina..
Bud stageBud stage
1414Dr.MadhuBillaDr.MadhuBilla
The primitive oral cavity or The primitive oral cavity or
stomodeum, is lined by a stomodeum, is lined by a
stratified squamous epithelium stratified squamous epithelium
called as called as oral ectodermoral ectoderm..
During 6th week of the During 6th week of the
intrauterine life or two to three intrauterine life or two to three
weeks after the rupture of the weeks after the rupture of the
buccopharyngeal membrane, buccopharyngeal membrane,
basal cells of the oral ectoderm basal cells of the oral ectoderm
in certain areas proliferate faster in certain areas proliferate faster
than the adjacent cells and forms than the adjacent cells and forms
dental laminadental lamina..
Bud stageBud stage
1414Dr.MadhuBillaDr.MadhuBilla
Early cap stage;Early cap stage;
Certain areas along the Certain areas along the
dental lamina, dental lamina,
ectodermal cells ectodermal cells
multiply rapidly and multiply rapidly and
forms knob like forms knob like
structures called as structures called as
enamel organs.enamel organs.
As cell proliferation As cell proliferation
continues enamel organ continues enamel organ
increases in size and increases in size and
resembles a cap in shaperesembles a cap in shape
1515Dr.MadhuBillaDr.MadhuBilla
Certain areas along the Certain areas along the
dental lamina, dental lamina,
ectodermal cells ectodermal cells
multiply rapidly and multiply rapidly and
forms knob like forms knob like
structures called as structures called as
enamel organs.enamel organs.
As cell proliferation As cell proliferation
continues enamel organ continues enamel organ
increases in size and increases in size and
resembles a cap in shaperesembles a cap in shape
1515Dr.MadhuBillaDr.MadhuBilla
Late cap stage;Late cap stage;
1616
On the inside of the On the inside of the
cap ectomesenchymal cap ectomesenchymal
cells proliferate faster cells proliferate faster
than surrounding than surrounding
mesenchyme and mesenchyme and
forms forms dental papillae.dental papillae.
Dr.MadhuBillaDr.MadhuBilla
1616
On the inside of the On the inside of the
cap ectomesenchymal cap ectomesenchymal
cells proliferate faster cells proliferate faster
than surrounding than surrounding
mesenchyme and mesenchyme and
forms forms dental papillae.dental papillae.
Dr.MadhuBillaDr.MadhuBilla
Bell stageBell stage
1717
After the inner enamel After the inner enamel
epithelium differentiates epithelium differentiates
into ameloblasts, the into ameloblasts, the
peripheral connective peripheral connective
tissue cells of the dental tissue cells of the dental
papillae differentiates into papillae differentiates into
odontoblasts and start odontoblasts and start
producing dentine.producing dentine.
It is at this time, when the It is at this time, when the
first layer of dentine has first layer of dentine has
formed that dental papillae formed that dental papillae
is the called the is the called the dental pulpdental pulp
Dr.MadhuBillaDr.MadhuBilla
1717
After the inner enamel After the inner enamel
epithelium differentiates epithelium differentiates
into ameloblasts, the into ameloblasts, the
peripheral connective peripheral connective
tissue cells of the dental tissue cells of the dental
papillae differentiates into papillae differentiates into
odontoblasts and start odontoblasts and start
producing dentine.producing dentine.
It is at this time, when the It is at this time, when the
first layer of dentine has first layer of dentine has
formed that dental papillae formed that dental papillae
is the called the is the called the dental pulpdental pulp
Dr.MadhuBillaDr.MadhuBilla
ZONES OF PULPZONES OF PULP
ODONTOBLAST LAYERODONTOBLAST LAYER
CELL-POOR ZONECELL-POOR ZONE
CELL-RICH ZONECELL-RICH ZONE
PULP PROPERPULP PROPER
Dr.MadhuBillaDr.MadhuBilla 1818
ODONTOBLAST LAYERODONTOBLAST LAYER
CELL-POOR ZONECELL-POOR ZONE
CELL-RICH ZONECELL-RICH ZONE
PULP PROPERPULP PROPER
Dr.MadhuBillaDr.MadhuBilla 1818
ODONTOBLAST LAYERODONTOBLAST LAYER
Present next to predentin with odontoblastic Present next to predentin with odontoblastic
process passing through predentin into dentinprocess passing through predentin into dentin
Contains nerve fibers(AContains nerve fibers(Aδδ), capillaries,dendritic ), capillaries,dendritic
cellscells
In the Coronal pulpIn the Coronal pulp
–Cells tall columnar, palisadingCells tall columnar, palisading
–Layers of 3-4 cellsLayers of 3-4 cells
–More odontoblasts per unit areaMore odontoblasts per unit area
Dr.MadhuBillaDr.MadhuBilla 1919
Present next to predentin with odontoblastic Present next to predentin with odontoblastic
process passing through predentin into dentinprocess passing through predentin into dentin
Contains nerve fibers(AContains nerve fibers(Aδδ), capillaries,dendritic ), capillaries,dendritic
cellscells
In the Coronal pulpIn the Coronal pulp
–Cells tall columnar, palisadingCells tall columnar, palisading
–Layers of 3-4 cellsLayers of 3-4 cells
–More odontoblasts per unit areaMore odontoblasts per unit area
Dr.MadhuBillaDr.MadhuBilla 1919
Cells in the mid-root region are cuboidal and Cells in the mid-root region are cuboidal and
appear flattened at the apical region.appear flattened at the apical region.
No.of odontoblasts per unit area in the No.of odontoblasts per unit area in the
radicular pulp is reduced.radicular pulp is reduced.
Neighbouring odontoblasts exhibit junction Neighbouring odontoblasts exhibit junction
complexes.complexes.
Dr.MadhuBillaDr.MadhuBilla 2020
appear flattened at the apical region.appear flattened at the apical region.
No.of odontoblasts per unit area in the No.of odontoblasts per unit area in the
radicular pulp is reduced.radicular pulp is reduced.
Neighbouring odontoblasts exhibit junction Neighbouring odontoblasts exhibit junction
complexes.complexes.
Dr.MadhuBillaDr.MadhuBilla 2020
CELL POOR ZONECELL POOR ZONE
Present in coronal pulp next to odontoblast Present in coronal pulp next to odontoblast
layer, also called WEIL’S zonelayer, also called WEIL’S zone
40µ wide & relatively free of cells40µ wide & relatively free of cells
Traversed byTraversed by
blood vesselsblood vessels
unmyelinated nervesunmyelinated nerves
cytoplasmic process of fibroblastscytoplasmic process of fibroblasts
Dr.MadhuBillaDr.MadhuBilla 2121
Present in coronal pulp next to odontoblast Present in coronal pulp next to odontoblast
layer, also called WEIL’S zonelayer, also called WEIL’S zone
40µ wide & relatively free of cells40µ wide & relatively free of cells
Traversed byTraversed by
blood vesselsblood vessels
unmyelinated nervesunmyelinated nerves
cytoplasmic process of fibroblastscytoplasmic process of fibroblasts
Dr.MadhuBillaDr.MadhuBilla 2121
Nerve plexus of RashkowNerve plexus of Rashkow
Presence/ absence of this zone depends on Presence/ absence of this zone depends on
the functional statusthe functional status
Relatively diminished inRelatively diminished in
younger pulpyounger pulp
older pulpolder pulp
Dr.MadhuBillaDr.MadhuBilla 2222
Presence/ absence of this zone depends on Presence/ absence of this zone depends on
the functional statusthe functional status
Relatively diminished inRelatively diminished in
younger pulpyounger pulp
older pulpolder pulp
Dr.MadhuBillaDr.MadhuBilla 2222
CELL RICH ZONECELL RICH ZONE
Present in subodontoblastic layerPresent in subodontoblastic layer
Prominent in coronal pulpProminent in coronal pulp
Contains more proportions of fibroblast than Contains more proportions of fibroblast than
pulp properpulp proper
Also contains macrophages, dendritic cells and Also contains macrophages, dendritic cells and
lymphocytes.lymphocytes.
Dr.MadhuBillaDr.MadhuBilla 2323
Present in subodontoblastic layerPresent in subodontoblastic layer
Prominent in coronal pulpProminent in coronal pulp
Contains more proportions of fibroblast than Contains more proportions of fibroblast than
pulp properpulp proper
Also contains macrophages, dendritic cells and Also contains macrophages, dendritic cells and
lymphocytes.lymphocytes.
Dr.MadhuBillaDr.MadhuBilla 2323
PULP PROPERPULP PROPER
It is the central mass of the pulpIt is the central mass of the pulp
Contains larger blood vessels and nervesContains larger blood vessels and nerves
Pulpal cells and fibroblasts are also seenPulpal cells and fibroblasts are also seen
Dr.MadhuBillaDr.MadhuBilla 2424
It is the central mass of the pulpIt is the central mass of the pulp
Contains larger blood vessels and nervesContains larger blood vessels and nerves
Pulpal cells and fibroblasts are also seenPulpal cells and fibroblasts are also seen
Dr.MadhuBillaDr.MadhuBilla 2424
STRUCTURAL ORGANIZATION STRUCTURAL ORGANIZATION
Dr.MadhuBillaDr.MadhuBilla 2525
Dr.MadhuBillaDr.MadhuBilla 2525
Odontoblast cellsOdontoblast process
Dentin Pulp
2626Dr.MadhuBillaDr.MadhuBilla
Dentin Pulp
2626Dr.MadhuBillaDr.MadhuBilla
CELLS OF PULPCELLS OF PULP
ODONTOBLASTSODONTOBLASTS
FIBROBLASTSFIBROBLASTS
UNDIFFERENTIATED CELLSUNDIFFERENTIATED CELLS
IMMUNOCOMPETENT CELLSIMMUNOCOMPETENT CELLS
MAST CELLSMAST CELLS
Dr.MadhuBillaDr.MadhuBilla 2727
ODONTOBLASTSODONTOBLASTS
FIBROBLASTSFIBROBLASTS
UNDIFFERENTIATED CELLSUNDIFFERENTIATED CELLS
IMMUNOCOMPETENT CELLSIMMUNOCOMPETENT CELLS
MAST CELLSMAST CELLS
Dr.MadhuBillaDr.MadhuBilla 2727
ODONTOBLASTODONTOBLAST
Highly differentiated cells derived from neural Highly differentiated cells derived from neural
crest cellscrest cells
4040μμ length and 5-7 length and 5-7μμ wide wide
During active phase, cells show increase in During active phase, cells show increase in
ER, golgi apparatus & secretory vesiclesER, golgi apparatus & secretory vesicles
After primary dentin formation dentin forming After primary dentin formation dentin forming
activity slows down with decrease in no.of activity slows down with decrease in no.of
organellesorganelles
Dr.MadhuBillaDr.MadhuBilla 2828
Highly differentiated cells derived from neural Highly differentiated cells derived from neural
crest cellscrest cells
4040μμ length and 5-7 length and 5-7μμ wide wide
During active phase, cells show increase in During active phase, cells show increase in
ER, golgi apparatus & secretory vesiclesER, golgi apparatus & secretory vesicles
After primary dentin formation dentin forming After primary dentin formation dentin forming
activity slows down with decrease in no.of activity slows down with decrease in no.of
organellesorganelles
Dr.MadhuBillaDr.MadhuBilla 2828
ODONTOBLASTIC PROCESSODONTOBLASTIC PROCESS
It is a direct extention from cell body into the It is a direct extention from cell body into the
dentinal tubuledentinal tubule
Diameter 3-4Diameter 3-4μμ, no cell organelles, no cell organelles
Has well developed cytoskeleton with Has well developed cytoskeleton with
microfilaments & microtubules. Mainly microfilaments & microtubules. Mainly
composed of protein- tubulin, actin and composed of protein- tubulin, actin and
vimentin.vimentin.
Dr.MadhuBillaDr.MadhuBilla 2929
It is a direct extention from cell body into the It is a direct extention from cell body into the
dentinal tubuledentinal tubule
Diameter 3-4Diameter 3-4μμ, no cell organelles, no cell organelles
Has well developed cytoskeleton with Has well developed cytoskeleton with
microfilaments & microtubules. Mainly microfilaments & microtubules. Mainly
composed of protein- tubulin, actin and composed of protein- tubulin, actin and
vimentin.vimentin.
Dr.MadhuBillaDr.MadhuBilla 2929
JUNCTIONAL COMPLEXJUNCTIONAL COMPLEX
Neighbouring odontoblasts exhibit a series of Neighbouring odontoblasts exhibit a series of
junctional complexesjunctional complexes
They promote cell to cell adhesion and play a They promote cell to cell adhesion and play a
role in maintaining polarity of odontoblasts.role in maintaining polarity of odontoblasts.
Dr.MadhuBillaDr.MadhuBilla 3030
Neighbouring odontoblasts exhibit a series of Neighbouring odontoblasts exhibit a series of
junctional complexesjunctional complexes
They promote cell to cell adhesion and play a They promote cell to cell adhesion and play a
role in maintaining polarity of odontoblasts.role in maintaining polarity of odontoblasts.
Dr.MadhuBillaDr.MadhuBilla 3030
Junctional complexes have been classified by Seltzer Junctional complexes have been classified by Seltzer
and Bender as. and Bender as.
Impermeable junctions/ zona occludensImpermeable junctions/ zona occludens- The tight - The tight
junction, or zona occludens, is so classified because of junction, or zona occludens, is so classified because of
the fusion of adjacent plasma membranes.the fusion of adjacent plasma membranes.
Adhering junctions/ zona adherensAdhering junctions/ zona adherens: where a gap of : where a gap of
200-300A is seen. Under light microscopy, adhering 200-300A is seen. Under light microscopy, adhering
junctions were referred to as intercellular bridges. junctions were referred to as intercellular bridges.
Dr.MadhuBillaDr.MadhuBilla 3131
and Bender as. and Bender as.
Impermeable junctions/ zona occludensImpermeable junctions/ zona occludens- The tight - The tight
junction, or zona occludens, is so classified because of junction, or zona occludens, is so classified because of
the fusion of adjacent plasma membranes.the fusion of adjacent plasma membranes.
Adhering junctions/ zona adherensAdhering junctions/ zona adherens: where a gap of : where a gap of
200-300A is seen. Under light microscopy, adhering 200-300A is seen. Under light microscopy, adhering
junctions were referred to as intercellular bridges. junctions were referred to as intercellular bridges.
Dr.MadhuBillaDr.MadhuBilla 3131
Communicating junctions/ gap junctionCommunicating junctions/ gap junction: :
where a gap of 10-20A is seen. Communicating where a gap of 10-20A is seen. Communicating
junctions, or gap junctions (nexus-type junctions, or gap junctions (nexus-type
junctions), are sites of cell-to-cell junctions), are sites of cell-to-cell
communication between adjacent odontoblasts communication between adjacent odontoblasts
and between odontoblasts and fibroblasts of the and between odontoblasts and fibroblasts of the
subodontoblastic layer. subodontoblastic layer.
Dr.MadhuBillaDr.MadhuBilla 3232
where a gap of 10-20A is seen. Communicating where a gap of 10-20A is seen. Communicating
junctions, or gap junctions (nexus-type junctions, or gap junctions (nexus-type
junctions), are sites of cell-to-cell junctions), are sites of cell-to-cell
communication between adjacent odontoblasts communication between adjacent odontoblasts
and between odontoblasts and fibroblasts of the and between odontoblasts and fibroblasts of the
subodontoblastic layer. subodontoblastic layer.
Dr.MadhuBillaDr.MadhuBilla 3232
JUNCTIONAL COMPLEXESJUNCTIONAL COMPLEXES
Dr.MadhuBillaDr.MadhuBilla 3333
Dr.MadhuBillaDr.MadhuBilla 3333
FUNCTIONS OF FUNCTIONS OF
ODONTOBLASTSODONTOBLASTS
Synthesis of organic matrixSynthesis of organic matrix
Synthesis of non collagenous substances like Synthesis of non collagenous substances like
sialoprotein, phosphophoryn, osteocalcin, sialoprotein, phosphophoryn, osteocalcin,
osteonectin& osteopontinosteonectin& osteopontin
Intracellular accumulation of calciumIntracellular accumulation of calcium
Degradation of organic matrixDegradation of organic matrix
Dr.MadhuBillaDr.MadhuBilla 3434
ODONTOBLASTSODONTOBLASTS
Synthesis of organic matrixSynthesis of organic matrix
Synthesis of non collagenous substances like Synthesis of non collagenous substances like
sialoprotein, phosphophoryn, osteocalcin, sialoprotein, phosphophoryn, osteocalcin,
osteonectin& osteopontinosteonectin& osteopontin
Intracellular accumulation of calciumIntracellular accumulation of calcium
Degradation of organic matrixDegradation of organic matrix
Dr.MadhuBillaDr.MadhuBilla 3434
FIBROBLASTSFIBROBLASTS
Maximum in number and have the capacity to Maximum in number and have the capacity to
synthesise and maintain connective tissue synthesise and maintain connective tissue
matrix.matrix.
Main functionsMain functions
synthesise type I & type III collagensynthesise type I & type III collagen
synthesise non-collogenous protein synthesise non-collogenous protein
matrix- proteoglycans & GAGs matrix- proteoglycans & GAGs
Synthetic cells have branched cytoplasmic Synthetic cells have branched cytoplasmic
extentions with nucleus at one end of the cell. extentions with nucleus at one end of the cell.
Common in young pulpCommon in young pulpDr.MadhuBillaDr.MadhuBilla 3535
Maximum in number and have the capacity to Maximum in number and have the capacity to
synthesise and maintain connective tissue synthesise and maintain connective tissue
matrix.matrix.
Main functionsMain functions
synthesise type I & type III collagensynthesise type I & type III collagen
synthesise non-collogenous protein synthesise non-collogenous protein
matrix- proteoglycans & GAGs matrix- proteoglycans & GAGs
Synthetic cells have branched cytoplasmic Synthetic cells have branched cytoplasmic
extentions with nucleus at one end of the cell. extentions with nucleus at one end of the cell.
Common in young pulpCommon in young pulpDr.MadhuBillaDr.MadhuBilla 3535
Also have the capability of ingesting and Also have the capability of ingesting and
degrading the same matrix. Thus these cells degrading the same matrix. Thus these cells
have dual function with pathways for both have dual function with pathways for both
synthesis and degradation of small size.synthesis and degradation of small size.
They play important role in inflammation and They play important role in inflammation and
healinghealing
They release inflammatory mediators They release inflammatory mediators
cytokines and growth factors cytokines and growth factors
Dr.MadhuBillaDr.MadhuBilla 3636
degrading the same matrix. Thus these cells degrading the same matrix. Thus these cells
have dual function with pathways for both have dual function with pathways for both
synthesis and degradation of small size.synthesis and degradation of small size.
They play important role in inflammation and They play important role in inflammation and
healinghealing
They release inflammatory mediators They release inflammatory mediators
cytokines and growth factors cytokines and growth factors
Dr.MadhuBillaDr.MadhuBilla 3636
FIBROBLASTFIBROBLAST
Dr.MadhuBillaDr.MadhuBilla 3737
Dr.MadhuBillaDr.MadhuBilla 3737
UNDIFFERENTIATED UNDIFFERENTIATED
MESENCHYMEMESENCHYME
These mesenchymal cells are distributed These mesenchymal cells are distributed
through out the pulp, frequently around the through out the pulp, frequently around the
perivascular areaperivascular area
They are stellate shaped with a high nucleus : They are stellate shaped with a high nucleus :
cytoplasmic ratiocytoplasmic ratio
Under adequate stimulus they may Under adequate stimulus they may
differentiate into odontoblast or fibroblast.differentiate into odontoblast or fibroblast.
In older pulp, their number and ability to In older pulp, their number and ability to
differentiate comes downdifferentiate comes down
Dr.MadhuBillaDr.MadhuBilla 3838
MESENCHYMEMESENCHYME
These mesenchymal cells are distributed These mesenchymal cells are distributed
through out the pulp, frequently around the through out the pulp, frequently around the
perivascular areaperivascular area
They are stellate shaped with a high nucleus : They are stellate shaped with a high nucleus :
cytoplasmic ratiocytoplasmic ratio
Under adequate stimulus they may Under adequate stimulus they may
differentiate into odontoblast or fibroblast.differentiate into odontoblast or fibroblast.
In older pulp, their number and ability to In older pulp, their number and ability to
differentiate comes downdifferentiate comes down
Dr.MadhuBillaDr.MadhuBilla 3838
Appear larger than fibroblasts and are Appear larger than fibroblasts and are
polyhedral in shapepolyhedral in shape
Found along the pulp vessels in cell rich zone Found along the pulp vessels in cell rich zone
and scattered throught out the central pulpand scattered throught out the central pulp
These are mainly totipotent cells and and when These are mainly totipotent cells and and when
need arises they may become odontoblasts need arises they may become odontoblasts
,fibroblasts or macrophages ,fibroblasts or macrophages
Dr.MadhuBillaDr.MadhuBilla 3939
polyhedral in shapepolyhedral in shape
Found along the pulp vessels in cell rich zone Found along the pulp vessels in cell rich zone
and scattered throught out the central pulpand scattered throught out the central pulp
These are mainly totipotent cells and and when These are mainly totipotent cells and and when
need arises they may become odontoblasts need arises they may become odontoblasts
,fibroblasts or macrophages ,fibroblasts or macrophages
Dr.MadhuBillaDr.MadhuBilla 3939
IMMUNOCOMPETENT CELLSIMMUNOCOMPETENT CELLS
They play a major role local inflammation and They play a major role local inflammation and
immunity.immunity.
They are recruited from blood stream & They are recruited from blood stream &
remain as transient inhabitants in pulpremain as transient inhabitants in pulp
These cells areThese cells are
LymhpocytesLymhpocytes
MacrophagesMacrophages
Dendritic cellsDendritic cells
Mast cellsMast cells
Dr.MadhuBillaDr.MadhuBilla 4040
They play a major role local inflammation and They play a major role local inflammation and
immunity.immunity.
They are recruited from blood stream & They are recruited from blood stream &
remain as transient inhabitants in pulpremain as transient inhabitants in pulp
These cells areThese cells are
LymhpocytesLymhpocytes
MacrophagesMacrophages
Dendritic cellsDendritic cells
Mast cellsMast cells
Dr.MadhuBillaDr.MadhuBilla 4040
LYMPHOCYTES IN PULPLYMPHOCYTES IN PULP
Present along the walls of blood vesselsPresent along the walls of blood vessels
CD8+ T lymphocytes > CD4+ T CD8+ T lymphocytes > CD4+ T
lymphocytes, B lymphocytes are very rare.lymphocytes, B lymphocytes are very rare.
Involved in initial immunodefenseInvolved in initial immunodefense
Plasma cells may be present in coronal pulpPlasma cells may be present in coronal pulp
Dr.MadhuBillaDr.MadhuBilla 4141
Present along the walls of blood vesselsPresent along the walls of blood vessels
CD8+ T lymphocytes > CD4+ T CD8+ T lymphocytes > CD4+ T
lymphocytes, B lymphocytes are very rare.lymphocytes, B lymphocytes are very rare.
Involved in initial immunodefenseInvolved in initial immunodefense
Plasma cells may be present in coronal pulpPlasma cells may be present in coronal pulp
Dr.MadhuBillaDr.MadhuBilla 4141
MACROPHAGES IN PULPMACROPHAGES IN PULP
Described as histiocytesDescribed as histiocytes
Located close to blood vesselLocated close to blood vessel
Have several phenotypesHave several phenotypes
They express varying combinations of several They express varying combinations of several
macrophage associated antigens and so help in macrophage associated antigens and so help in
T lymphocyte activationT lymphocyte activation
Dr.MadhuBillaDr.MadhuBilla 4242
Described as histiocytesDescribed as histiocytes
Located close to blood vesselLocated close to blood vessel
Have several phenotypesHave several phenotypes
They express varying combinations of several They express varying combinations of several
macrophage associated antigens and so help in macrophage associated antigens and so help in
T lymphocyte activationT lymphocyte activation
Dr.MadhuBillaDr.MadhuBilla 4242
MACROPHAGES MACROPHAGES
Dark staining nucleus with cytoplasmic Dark staining nucleus with cytoplasmic
granulesgranules
Dr.MadhuBillaDr.MadhuBilla 4343
Dark staining nucleus with cytoplasmic Dark staining nucleus with cytoplasmic
granulesgranules
Dr.MadhuBillaDr.MadhuBilla 4343
DENDRITIC CELLSDENDRITIC CELLS
Discrete populations of hematopoetically Discrete populations of hematopoetically
derived leucocytesderived leucocytes
Characterised by Characterised by
▪ ▪ peculiar dendritic morphologypeculiar dendritic morphology
▪ ▪ expression of high amount of expression of high amount of
class II MHC moleculesclass II MHC molecules
▪ ▪ high motilityhigh motility
▪ ▪ capacity of antigen presentation capacity of antigen presentation
to T lymphocytesto T lymphocytes
Dr.MadhuBillaDr.MadhuBilla 4444
Discrete populations of hematopoetically Discrete populations of hematopoetically
derived leucocytesderived leucocytes
Characterised by Characterised by
▪ ▪ peculiar dendritic morphologypeculiar dendritic morphology
▪ ▪ expression of high amount of expression of high amount of
class II MHC moleculesclass II MHC molecules
▪ ▪ high motilityhigh motility
▪ ▪ capacity of antigen presentation capacity of antigen presentation
to T lymphocytesto T lymphocytes
Dr.MadhuBillaDr.MadhuBilla 4444
MAST CELLSMAST CELLS
Occur in small groups in relation to blood Occur in small groups in relation to blood
vesselsvessels
Present only during pulpal inflammationPresent only during pulpal inflammation
Cytoplasmic granules of these cells containCytoplasmic granules of these cells contain
▪▪Heparin- anticoagulantHeparin- anticoagulant
▪▪Histamine- inflammatory mediatorHistamine- inflammatory mediator
Dr.MadhuBillaDr.MadhuBilla 4545
Occur in small groups in relation to blood Occur in small groups in relation to blood
vesselsvessels
Present only during pulpal inflammationPresent only during pulpal inflammation
Cytoplasmic granules of these cells containCytoplasmic granules of these cells contain
▪▪Heparin- anticoagulantHeparin- anticoagulant
▪▪Histamine- inflammatory mediatorHistamine- inflammatory mediator
Dr.MadhuBillaDr.MadhuBilla 4545
EXTRACELLULAR MATRIXEXTRACELLULAR MATRIX
Connective tissue fibersConnective tissue fibers
▪ ▪ CollagenCollagen
▪ ▪ ElastinElastin
▪ ▪ FibronectinFibronectin
Ground substanceGround substance
▪ ▪ ProteoglycansProteoglycans
▪ ▪ GlycosaminoglycansGlycosaminoglycans
Basement membraneBasement membrane
Dr.MadhuBillaDr.MadhuBilla 4646
Connective tissue fibersConnective tissue fibers
▪ ▪ CollagenCollagen
▪ ▪ ElastinElastin
▪ ▪ FibronectinFibronectin
Ground substanceGround substance
▪ ▪ ProteoglycansProteoglycans
▪ ▪ GlycosaminoglycansGlycosaminoglycans
Basement membraneBasement membrane
Dr.MadhuBillaDr.MadhuBilla 4646
COLLAGENCOLLAGEN
Extra cellular structural protein, major Extra cellular structural protein, major
constituent of connective tissueconstituent of connective tissue
It has a triple helical domain, formed by 3 It has a triple helical domain, formed by 3
polypeptide chains(polypeptide chains(ααchains) bound by chains) bound by
hydrogen bonds & hydrophobic interactionhydrogen bonds & hydrophobic interaction
Fibrils display characteristic striation at Fibrils display characteristic striation at
intervals of 64nm. Hallmark for identification intervals of 64nm. Hallmark for identification
of collagen fibrils.of collagen fibrils.Dr.MadhuBillaDr.MadhuBilla 4747
Extra cellular structural protein, major Extra cellular structural protein, major
constituent of connective tissueconstituent of connective tissue
It has a triple helical domain, formed by 3 It has a triple helical domain, formed by 3
polypeptide chains(polypeptide chains(ααchains) bound by chains) bound by
hydrogen bonds & hydrophobic interactionhydrogen bonds & hydrophobic interaction
Fibrils display characteristic striation at Fibrils display characteristic striation at
intervals of 64nm. Hallmark for identification intervals of 64nm. Hallmark for identification
of collagen fibrils.of collagen fibrils.Dr.MadhuBillaDr.MadhuBilla 4747
COLLEGEN FIBRECOLLEGEN FIBRE
Dr.MadhuBillaDr.MadhuBilla 4848
Dr.MadhuBillaDr.MadhuBilla 4848
Type I:
▪present as thick striated fibrils
▪responsible for pulp architecture
Type III:
▪thinner fibrils, mainly distributed in cell free & cell
rich zones
▪contributes to the elasticity of pulp
Type IV:
▪present along the basement membrane of
blood vessels
Type V & VI:
▪seen to form dense meshwork of thin micro
fibrils through out the stroma
Dr.MadhuBillaDr.MadhuBilla 4949
▪present as thick striated fibrils
▪responsible for pulp architecture
Type III:
▪thinner fibrils, mainly distributed in cell free & cell
rich zones
▪contributes to the elasticity of pulp
Type IV:
▪present along the basement membrane of
blood vessels
Type V & VI:
▪seen to form dense meshwork of thin micro
fibrils through out the stroma
Dr.MadhuBillaDr.MadhuBilla 4949
COLLAGEN FIBRESCOLLAGEN FIBRES
Seen in relation with fibroblastsSeen in relation with fibroblasts
Dr.MadhuBillaDr.MadhuBilla 5050
Seen in relation with fibroblastsSeen in relation with fibroblasts
Dr.MadhuBillaDr.MadhuBilla 5050
Collagen turnover is maintained by pulp
fibroblasts
During bacterial infection & inflammation,
collagenolytic activity is accelerated following
collagenase produced by bacteria, PMN &
fibroblasts
Collagen synthesis is accelerated during
reparative dentin formation.
Dr.MadhuBillaDr.MadhuBilla 5151
fibroblasts
During bacterial infection & inflammation,
collagenolytic activity is accelerated following
collagenase produced by bacteria, PMN &
fibroblasts
Collagen synthesis is accelerated during
reparative dentin formation.
Dr.MadhuBillaDr.MadhuBilla 5151
ELASTIC FIBERELASTIC FIBER
Elastin molecules form the unit structure of Elastin molecules form the unit structure of
Elastic fibersElastic fibers
These elastin molecules join to form a random These elastin molecules join to form a random
coil structurecoil structure
This has the ability to expand and contract like This has the ability to expand and contract like
a rubber band.a rubber band.
Dr.MadhuBillaDr.MadhuBilla 5252
Elastin molecules form the unit structure of Elastin molecules form the unit structure of
Elastic fibersElastic fibers
These elastin molecules join to form a random These elastin molecules join to form a random
coil structurecoil structure
This has the ability to expand and contract like This has the ability to expand and contract like
a rubber band.a rubber band.
Dr.MadhuBillaDr.MadhuBilla 5252
Elastic fibers are first formed in bundles of
thin micro filaments called Oxytalan fibers
Elastin is then deposited inbetween oytalan
fibers to form elastic fibers.
Always associated with larger blood vessels
Dr.MadhuBillaDr.MadhuBilla 5353
thin micro filaments called Oxytalan fibers
Elastin is then deposited inbetween oytalan
fibers to form elastic fibers.
Always associated with larger blood vessels
Dr.MadhuBillaDr.MadhuBilla 5353
FIBRONECTINFIBRONECTIN
It is a multifunctional stromal glycoprotein It is a multifunctional stromal glycoprotein
that exists asthat exists as
• • a circulatory plasma proteina circulatory plasma protein
• • a protein that attaches to cellsa protein that attaches to cells
• • insoluble fibrils forming a part of the extra insoluble fibrils forming a part of the extra
cellular matrix cellular matrix
It plays a role in cell-cell & cell-matrix It plays a role in cell-cell & cell-matrix
adhesion adhesion
Has a major effect on the proliferation, Has a major effect on the proliferation,
differentiation & organization of cellsdifferentiation & organization of cells
Dr.MadhuBillaDr.MadhuBilla 5454
It is a multifunctional stromal glycoprotein It is a multifunctional stromal glycoprotein
that exists asthat exists as
• • a circulatory plasma proteina circulatory plasma protein
• • a protein that attaches to cellsa protein that attaches to cells
• • insoluble fibrils forming a part of the extra insoluble fibrils forming a part of the extra
cellular matrix cellular matrix
It plays a role in cell-cell & cell-matrix It plays a role in cell-cell & cell-matrix
adhesion adhesion
Has a major effect on the proliferation, Has a major effect on the proliferation,
differentiation & organization of cellsdifferentiation & organization of cells
Dr.MadhuBillaDr.MadhuBilla 5454
GROUND SUBSTANCEGROUND SUBSTANCE
It is a structureless mass, gel-like consistency, It is a structureless mass, gel-like consistency,
makes up the bulk of the pulpmakes up the bulk of the pulp
Consists complexes of proteins, carbohydrate Consists complexes of proteins, carbohydrate
and water.and water.
Broadly classified asBroadly classified as
GlycoaminoglycansGlycoaminoglycans
ProteoglycansProteoglycans
Dr.MadhuBillaDr.MadhuBilla 5555
It is a structureless mass, gel-like consistency, It is a structureless mass, gel-like consistency,
makes up the bulk of the pulpmakes up the bulk of the pulp
Consists complexes of proteins, carbohydrate Consists complexes of proteins, carbohydrate
and water.and water.
Broadly classified asBroadly classified as
GlycoaminoglycansGlycoaminoglycans
ProteoglycansProteoglycans
Dr.MadhuBillaDr.MadhuBilla 5555
GLYCOSAMINOGLYCANSGLYCOSAMINOGLYCANS
GAG are branched polymers of glucosamine & GAG are branched polymers of glucosamine &
galactoseamine, along with ester sulfate groups, galactoseamine, along with ester sulfate groups,
uronic acid & carboxyl groupuronic acid & carboxyl group
4 main types:4 main types:
Chondroitin sulphate/dermatan sulphateChondroitin sulphate/dermatan sulphate
Keratin sulphateKeratin sulphate
Heparin sulphateHeparin sulphate
Hyaluronic acid (non-sulphated)Hyaluronic acid (non-sulphated)
GAG found in pulp is mainly chondroitin GAG found in pulp is mainly chondroitin
sulphate, dermatan sulphate & hyaluronic acidsulphate, dermatan sulphate & hyaluronic acid
Dr.MadhuBillaDr.MadhuBilla 5656
GAG are branched polymers of glucosamine & GAG are branched polymers of glucosamine &
galactoseamine, along with ester sulfate groups, galactoseamine, along with ester sulfate groups,
uronic acid & carboxyl groupuronic acid & carboxyl group
4 main types:4 main types:
Chondroitin sulphate/dermatan sulphateChondroitin sulphate/dermatan sulphate
Keratin sulphateKeratin sulphate
Heparin sulphateHeparin sulphate
Hyaluronic acid (non-sulphated)Hyaluronic acid (non-sulphated)
GAG found in pulp is mainly chondroitin GAG found in pulp is mainly chondroitin
sulphate, dermatan sulphate & hyaluronic acidsulphate, dermatan sulphate & hyaluronic acid
Dr.MadhuBillaDr.MadhuBilla 5656
PROTEOGLYCANSPROTEOGLYCANS
Proteoglycans consists of a central protein core Proteoglycans consists of a central protein core
with side chains of GAGswith side chains of GAGs
Due to presence of various structural groups of Due to presence of various structural groups of
GAG, proteoglycans are hydrophilic & act as GAG, proteoglycans are hydrophilic & act as
polyanionspolyanions
Thus proteoglycans carry high –ve charge that Thus proteoglycans carry high –ve charge that
prevent diffusion of larger molecules but prevent diffusion of larger molecules but
attract cationic material.attract cationic material.
Dr.MadhuBillaDr.MadhuBilla 5757
Proteoglycans consists of a central protein core Proteoglycans consists of a central protein core
with side chains of GAGswith side chains of GAGs
Due to presence of various structural groups of Due to presence of various structural groups of
GAG, proteoglycans are hydrophilic & act as GAG, proteoglycans are hydrophilic & act as
polyanionspolyanions
Thus proteoglycans carry high –ve charge that Thus proteoglycans carry high –ve charge that
prevent diffusion of larger molecules but prevent diffusion of larger molecules but
attract cationic material.attract cationic material.
Dr.MadhuBillaDr.MadhuBilla 5757
ROLE IN PULPROLE IN PULP
During dentinogenesis, the ground substance During dentinogenesis, the ground substance
show affinity for collagen and influence show affinity for collagen and influence
fibrinogenesisfibrinogenesis
Chondroitin sulfate has strong capacity to bind Chondroitin sulfate has strong capacity to bind
with calcium and help in mineralisationwith calcium and help in mineralisation
Decorin is suggested to be synthesized by Decorin is suggested to be synthesized by
odontoblasts and may play a role in mineral odontoblasts and may play a role in mineral
nucleationnucleation
Dr.MadhuBillaDr.MadhuBilla 5858
During dentinogenesis, the ground substance During dentinogenesis, the ground substance
show affinity for collagen and influence show affinity for collagen and influence
fibrinogenesisfibrinogenesis
Chondroitin sulfate has strong capacity to bind Chondroitin sulfate has strong capacity to bind
with calcium and help in mineralisationwith calcium and help in mineralisation
Decorin is suggested to be synthesized by Decorin is suggested to be synthesized by
odontoblasts and may play a role in mineral odontoblasts and may play a role in mineral
nucleationnucleation
Dr.MadhuBillaDr.MadhuBilla 5858
BASEMENT MEMBRANEBASEMENT MEMBRANE
It is a sheet like arrangement of extra cellular It is a sheet like arrangement of extra cellular
protein matrix at the epithelial-mesenchymal protein matrix at the epithelial-mesenchymal
interfaceinterface
Composed of 2 layersComposed of 2 layers
lamina densa - electron denselamina densa - electron dense
lamina lucida - electrolucentlamina lucida - electrolucent
Basement membrane is a product of Basement membrane is a product of
connective tissue and epitheliumconnective tissue and epithelium
Dr.MadhuBillaDr.MadhuBilla 5959
It is a sheet like arrangement of extra cellular It is a sheet like arrangement of extra cellular
protein matrix at the epithelial-mesenchymal protein matrix at the epithelial-mesenchymal
interfaceinterface
Composed of 2 layersComposed of 2 layers
lamina densa - electron denselamina densa - electron dense
lamina lucida - electrolucentlamina lucida - electrolucent
Basement membrane is a product of Basement membrane is a product of
connective tissue and epitheliumconnective tissue and epithelium
Dr.MadhuBillaDr.MadhuBilla 5959
1-4µm wide, relatively cell free1-4µm wide, relatively cell free
Ultrastructurally it is also called as basal Ultrastructurally it is also called as basal
lamina, but it is not just a membrane but but a lamina, but it is not just a membrane but but a
basal complex consisting of lamina and fibresbasal complex consisting of lamina and fibres
Lamina densa contains type IV collagen Lamina densa contains type IV collagen
coated with heparin sulphate and appears as coated with heparin sulphate and appears as
chicken wire configurationchicken wire configuration
Anchoring fibrils which contain type VII Anchoring fibrils which contain type VII
collagen are inserted into lamina densacollagen are inserted into lamina densa
Dr.MadhuBillaDr.MadhuBilla 6060
Ultrastructurally it is also called as basal Ultrastructurally it is also called as basal
lamina, but it is not just a membrane but but a lamina, but it is not just a membrane but but a
basal complex consisting of lamina and fibresbasal complex consisting of lamina and fibres
Lamina densa contains type IV collagen Lamina densa contains type IV collagen
coated with heparin sulphate and appears as coated with heparin sulphate and appears as
chicken wire configurationchicken wire configuration
Anchoring fibrils which contain type VII Anchoring fibrils which contain type VII
collagen are inserted into lamina densacollagen are inserted into lamina densa
Dr.MadhuBillaDr.MadhuBilla 6060
FUNCTIONS:FUNCTIONS:
▪ ▪ Act as sieve between epithelium & Act as sieve between epithelium &
connective tissueconnective tissue
▪ ▪ Helps in organisation & differentiation by Helps in organisation & differentiation by
enabling interactions between extracellular enabling interactions between extracellular
molecules & cell surface receptorsmolecules & cell surface receptors
Dr.MadhuBillaDr.MadhuBilla 6161
▪ ▪ Act as sieve between epithelium & Act as sieve between epithelium &
connective tissueconnective tissue
▪ ▪ Helps in organisation & differentiation by Helps in organisation & differentiation by
enabling interactions between extracellular enabling interactions between extracellular
molecules & cell surface receptorsmolecules & cell surface receptors
Dr.MadhuBillaDr.MadhuBilla 6161
CIRCULATION OF THE PULPCIRCULATION OF THE PULP
Pulp organ is extensively vascularised with Pulp organ is extensively vascularised with
blood vessels arising from superior & inferior blood vessels arising from superior & inferior
alveolar arteries.alveolar arteries.
Pulp has a micro circulatory system which Pulp has a micro circulatory system which
lacks true arteries & veins.lacks true arteries & veins.
The largest vessels are arterioles & venules The largest vessels are arterioles & venules
which regulate the local interstitial which regulate the local interstitial
environment.environment.
Dr.MadhuBillaDr.MadhuBilla 6262
Pulp organ is extensively vascularised with Pulp organ is extensively vascularised with
blood vessels arising from superior & inferior blood vessels arising from superior & inferior
alveolar arteries.alveolar arteries.
Pulp has a micro circulatory system which Pulp has a micro circulatory system which
lacks true arteries & veins.lacks true arteries & veins.
The largest vessels are arterioles & venules The largest vessels are arterioles & venules
which regulate the local interstitial which regulate the local interstitial
environment.environment.
Dr.MadhuBillaDr.MadhuBilla 6262
PULP VASCULATUREPULP VASCULATURE
Dr.MadhuBillaDr.MadhuBilla 6363
Dr.MadhuBillaDr.MadhuBilla 6363
Pulpal blood flow is more rapid than in most Pulpal blood flow is more rapid than in most
areas of bodythis is perhaps attributable to the areas of bodythis is perhaps attributable to the
fact that pulpal pressure is highest of body fact that pulpal pressure is highest of body
tissuestissues
Flow of blood in arterioles- 0.3-1mm/sec in Flow of blood in arterioles- 0.3-1mm/sec in
venules 0.15mm/sec and in capillaries venules 0.15mm/sec and in capillaries
0.08mm/sec0.08mm/sec
Dr.MadhuBillaDr.MadhuBilla 6464
areas of bodythis is perhaps attributable to the areas of bodythis is perhaps attributable to the
fact that pulpal pressure is highest of body fact that pulpal pressure is highest of body
tissuestissues
Flow of blood in arterioles- 0.3-1mm/sec in Flow of blood in arterioles- 0.3-1mm/sec in
venules 0.15mm/sec and in capillaries venules 0.15mm/sec and in capillaries
0.08mm/sec0.08mm/sec
Dr.MadhuBillaDr.MadhuBilla 6464
Vessles consists of 3 layersVessles consists of 3 layers
• tunica intima: consists of squamous or cuboidal tunica intima: consists of squamous or cuboidal
endothelial cellsendothelial cells
•Tunica media: 5µ thick consists of smooth Tunica media: 5µ thick consists of smooth
muscle cells, ocassionally the endothelial cell muscle cells, ocassionally the endothelial cell
wall is in contact with muscle cells which is wall is in contact with muscle cells which is
termed myoendothelial junctiontermed myoendothelial junction
•Tunica adventitia: made of collagen fibres Tunica adventitia: made of collagen fibres
forming a loose network around larger arteriesforming a loose network around larger arteries
Dr.MadhuBillaDr.MadhuBilla 6565
• tunica intima: consists of squamous or cuboidal tunica intima: consists of squamous or cuboidal
endothelial cellsendothelial cells
•Tunica media: 5µ thick consists of smooth Tunica media: 5µ thick consists of smooth
muscle cells, ocassionally the endothelial cell muscle cells, ocassionally the endothelial cell
wall is in contact with muscle cells which is wall is in contact with muscle cells which is
termed myoendothelial junctiontermed myoendothelial junction
•Tunica adventitia: made of collagen fibres Tunica adventitia: made of collagen fibres
forming a loose network around larger arteriesforming a loose network around larger arteries
Dr.MadhuBillaDr.MadhuBilla 6565
CAPILLARIES:
•Function as exchange vessels regulating
the transport or diffusion of substances
between blood and local interstitial tissue
elements
• They consists of single layer of
endothelium surrounded by basement
membrane
• Capillary pressure: 35 mmHg
• Capillary wall is 0.5μ thick & acts as
semi permeable membraneDr.MadhuBillaDr.MadhuBilla 6666
•Function as exchange vessels regulating
the transport or diffusion of substances
between blood and local interstitial tissue
elements
• They consists of single layer of
endothelium surrounded by basement
membrane
• Capillary pressure: 35 mmHg
• Capillary wall is 0.5μ thick & acts as
semi permeable membraneDr.MadhuBillaDr.MadhuBilla 6666
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-19mmHg
Dr.MadhuBillaDr.MadhuBilla 6767
•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-19mmHg
Dr.MadhuBillaDr.MadhuBilla 6767
LYMPHATICSLYMPHATICS
Lymphatic vessels are formed from a fine
meshwork of small, thin walled lymph
capillaries
They start as blind openings near Weil’s zone
& odontoblastic layer
The larger lymphatic vessels run along the
blood vessels & nerves
Dr.MadhuBillaDr.MadhuBilla 6868
Lymphatic vessels are formed from a fine
meshwork of small, thin walled lymph
capillaries
They start as blind openings near Weil’s zone
& odontoblastic layer
The larger lymphatic vessels run along the
blood vessels & nerves
Dr.MadhuBillaDr.MadhuBilla 6868
More numerous in in central part of pulp than More numerous in in central part of pulp than
in peripheral areasin peripheral areas
Those draining the anterior teeth pass to Those draining the anterior teeth pass to
submental lymphnodes and those draining the submental lymphnodes and those draining the
posterior teeth pass to submandibular and deep posterior teeth pass to submandibular and deep
cervical lymphnodes.cervical lymphnodes.
Dr.MadhuBillaDr.MadhuBilla 6969
in peripheral areasin peripheral areas
Those draining the anterior teeth pass to Those draining the anterior teeth pass to
submental lymphnodes and those draining the submental lymphnodes and those draining the
posterior teeth pass to submandibular and deep posterior teeth pass to submandibular and deep
cervical lymphnodes.cervical lymphnodes.
Dr.MadhuBillaDr.MadhuBilla 6969
INNERVATIONINNERVATION
Principle role is to help in conscious
recognition of irritants to the pulp,
Dental pulp contains sensory and motor fibers
to fulfill the vasomotor and defense function
Sensory afferent fibers are branches of
maxillary & mandibular divisions of
trigeminal nerve.
Dr.MadhuBillaDr.MadhuBilla 7070
Principle role is to help in conscious
recognition of irritants to the pulp,
Dental pulp contains sensory and motor fibers
to fulfill the vasomotor and defense function
Sensory afferent fibers are branches of
maxillary & mandibular divisions of
trigeminal nerve.
Dr.MadhuBillaDr.MadhuBilla 7070
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 Aδ and C fibers
.
In the cell free zone, they form a rich network
responsible for pain.
Dr.MadhuBillaDr.MadhuBilla 7171
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 Aδ and C fibers
.
In the cell free zone, they form a rich network
responsible for pain.
Dr.MadhuBillaDr.MadhuBilla 7171
TYPES OF NERVE FIBRESTYPES OF NERVE FIBRES
Dr.MadhuBillaDr.MadhuBilla 7272
Dr.MadhuBillaDr.MadhuBilla 7272
NERVE FIBERSNERVE FIBERS
A-fibers C-fibers
•Myelinated •Unmyelinated
•20% •80%
•Diameter – 2-5µm •0.3-1.2µm
•Conduction velocity
6-30m/sec
• 0.4-2m/sec
•Distributed in odontoblastic &
subodontoblastic zones &
associated with Dental pain.
•Distributed throughout the pulp
tissue & associated with pain
due to pulp damage.
•Impulses are intercepted as
sharp & prickling pain.
•Conduct throbbing & aching
pain.
•Low threshold of excitability.•High threshold of excitability.
7373Dr.MadhuBillaDr.MadhuBilla
A-fibers C-fibers
•Myelinated •Unmyelinated
•20% •80%
•Diameter – 2-5µm •0.3-1.2µm
•Conduction velocity
6-30m/sec
• 0.4-2m/sec
•Distributed in odontoblastic &
subodontoblastic zones &
associated with Dental pain.
•Distributed throughout the pulp
tissue & associated with pain
due to pulp damage.
•Impulses are intercepted as
sharp & prickling pain.
•Conduct throbbing & aching
pain.
•Low threshold of excitability.•High threshold of excitability.
7373Dr.MadhuBillaDr.MadhuBilla
FUNCTIONS OF DENTAL FUNCTIONS OF DENTAL
PULPPULP
INDUCTIVE
FORMATIVE
NUTRITIVE
PROTECTIVE
DEFENSE
Dr.MadhuBillaDr.MadhuBilla 7474
PULPPULP
INDUCTIVE
FORMATIVE
NUTRITIVE
PROTECTIVE
DEFENSE
Dr.MadhuBillaDr.MadhuBilla 7474
INDUCTIVEINDUCTIVE
It induces epithelial differentiation into dental
lamina & enamel organ
It also induces the enamel organ to become a
particular type of tooth
Dr.MadhuBillaDr.MadhuBilla 7575
It induces epithelial differentiation into dental
lamina & enamel organ
It also induces the enamel organ to become a
particular type of tooth
Dr.MadhuBillaDr.MadhuBilla 7575
FORMATIVEFORMATIVE
Pulp induces dentin formation that surrounds
& protects the pulp
This involves formation of primary &
secondary dentin
The primary dentin is tubular & regularly
arranged. Formed before root closure
Dr.MadhuBillaDr.MadhuBilla 7676
Pulp induces dentin formation that surrounds
& protects the pulp
This involves formation of primary &
secondary dentin
The primary dentin is tubular & regularly
arranged. Formed before root closure
Dr.MadhuBillaDr.MadhuBilla 7676
NUTRITIVENUTRITIVE
Dental pulp maintains the vitality of dentin by
providing O2 & nutrients to the odontoblasts
Also provides continuing source of dentinal
fluid
Nutrition made possible by rich peripheral
capillary networkDr.MadhuBillaDr.MadhuBilla 7777
Dental pulp maintains the vitality of dentin by
providing O2 & nutrients to the odontoblasts
Also provides continuing source of dentinal
fluid
Nutrition made possible by rich peripheral
capillary networkDr.MadhuBillaDr.MadhuBilla 7777
PROTECTIVEPROTECTIVE
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 & rate of blood flow & hence the
intrapulpal pressure
Dr.MadhuBillaDr.MadhuBilla 7878
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 & rate of blood flow & hence the
intrapulpal pressure
Dr.MadhuBillaDr.MadhuBilla 7878
DEFENSEDEFENSE
When irritated or injured the pulp will respond
by
1. Dentinal pain
2. Smear layer formation
3. Tubular sclerosis
4. Irritation dentin formation
5. Inflammation of subjacent connective
tissue
Dr.MadhuBillaDr.MadhuBilla 7979
When irritated or injured the pulp will respond
by
1. Dentinal pain
2. Smear layer formation
3. Tubular sclerosis
4. Irritation dentin formation
5. Inflammation of subjacent connective
tissue
Dr.MadhuBillaDr.MadhuBilla 7979
REGRESSIVE CHANGESREGRESSIVE CHANGES
(AGING)(AGING)
Dr.MadhuBillaDr.MadhuBilla 8080
(AGING)(AGING)
Dr.MadhuBillaDr.MadhuBilla 8080
Cell changesCell changes
-in addition to appearance of fewer cells in the in addition to appearance of fewer cells in the
aging pulp the cells are characterized by aging pulp the cells are characterized by
decrease in size and number of cytoplasmic decrease in size and number of cytoplasmic
organellesorganelles
Fibrosis:
In aging pulp accumulation of both diffuse
fibrillary components and bundles of collagen
fibres usually appear
Dr.MadhuBillaDr.MadhuBilla 8181
-in addition to appearance of fewer cells in the in addition to appearance of fewer cells in the
aging pulp the cells are characterized by aging pulp the cells are characterized by
decrease in size and number of cytoplasmic decrease in size and number of cytoplasmic
organellesorganelles
Fibrosis:
In aging pulp accumulation of both diffuse
fibrillary components and bundles of collagen
fibres usually appear
Dr.MadhuBillaDr.MadhuBilla 8181
PULP CALCIFICATIONSPULP CALCIFICATIONS
It is a common occurrence with incidence of 50% It is a common occurrence with incidence of 50%
of all teethof all teeth
Size may range from microscopic particle to Size may range from microscopic particle to
stones that may occlude the pulp chamberstones that may occlude the pulp chamber
Composed of carbonated hydroxyapitite crystalsComposed of carbonated hydroxyapitite crystals
Pulp calcification may bePulp calcification may be
Pulp stonesPulp stones
Diffuse calcificationsDiffuse calcifications
Calcific MetamorphosisCalcific Metamorphosis
Dr.MadhuBillaDr.MadhuBilla 8282
It is a common occurrence with incidence of 50% It is a common occurrence with incidence of 50%
of all teethof all teeth
Size may range from microscopic particle to Size may range from microscopic particle to
stones that may occlude the pulp chamberstones that may occlude the pulp chamber
Composed of carbonated hydroxyapitite crystalsComposed of carbonated hydroxyapitite crystals
Pulp calcification may bePulp calcification may be
Pulp stonesPulp stones
Diffuse calcificationsDiffuse calcifications
Calcific MetamorphosisCalcific Metamorphosis
Dr.MadhuBillaDr.MadhuBilla 8282
Pulp denticles, are classified as - Pulp denticles, are classified as -
According to structure:According to structure:
1)True denticles1)True denticles
2)False denticles2)False denticles
3)Diffuse calcifications3)Diffuse calcifications
According to location:According to location:
1)Free- entirely surrounded by pulp 1)Free- entirely surrounded by pulp
2)Attached-partially fused with dentine.2)Attached-partially fused with dentine.
3)Embeded- entirely surrounded by dentine 3)Embeded- entirely surrounded by dentine
8383
Goga, R., Chandler, N. P. and Oginni, A. O. (2008), Pulp stones: a review.
International Endodontic Journal, 41: 457–468
Dr.MadhuBillaDr.MadhuBilla
According to structure:According to structure:
1)True denticles1)True denticles
2)False denticles2)False denticles
3)Diffuse calcifications3)Diffuse calcifications
According to location:According to location:
1)Free- entirely surrounded by pulp 1)Free- entirely surrounded by pulp
2)Attached-partially fused with dentine.2)Attached-partially fused with dentine.
3)Embeded- entirely surrounded by dentine 3)Embeded- entirely surrounded by dentine
8383
Goga, R., Chandler, N. P. and Oginni, A. O. (2008), Pulp stones: a review.
International Endodontic Journal, 41: 457–468
Dr.MadhuBillaDr.MadhuBilla
TRUE DENTICLESTRUE DENTICLES
Round or ovoid with smooth surfaces and Round or ovoid with smooth surfaces and
concentric lamellae.concentric lamellae.
Appear to grow by addition of collagen on Appear to grow by addition of collagen on
their surfacetheir surface
Believed to be formed around HERSBelieved to be formed around HERS
They contain dentinal tubules, and are They contain dentinal tubules, and are
frequently found near root apex.frequently found near root apex.Dr.MadhuBillaDr.MadhuBilla 8484
Round or ovoid with smooth surfaces and Round or ovoid with smooth surfaces and
concentric lamellae.concentric lamellae.
Appear to grow by addition of collagen on Appear to grow by addition of collagen on
their surfacetheir surface
Believed to be formed around HERSBelieved to be formed around HERS
They contain dentinal tubules, and are They contain dentinal tubules, and are
frequently found near root apex.frequently found near root apex.Dr.MadhuBillaDr.MadhuBilla 8484
FALSE DENTICLESFALSE DENTICLES
They have a rough surface no particular shape &
laminations
Grow due to mineralization of preformed
collagen fibers
Cause of such calcification may be, degenerating
cells, blood thrombi or collagen fibrils all of which
form a nidi for calcification
Usually present in the pulp chamber.
Dr.MadhuBillaDr.MadhuBilla 8585
They have a rough surface no particular shape &
laminations
Grow due to mineralization of preformed
collagen fibers
Cause of such calcification may be, degenerating
cells, blood thrombi or collagen fibrils all of which
form a nidi for calcification
Usually present in the pulp chamber.
Dr.MadhuBillaDr.MadhuBilla 8585
True denticles are not dystrophic structures, since they True denticles are not dystrophic structures, since they
are composed of dentin and formed by detached are composed of dentin and formed by detached
dentinoblasts or fragments of Hertwig's sheath, which dentinoblasts or fragments of Hertwig's sheath, which
may stimulate undifferentiated cells to assume may stimulate undifferentiated cells to assume
dentinoblastic activity. dentinoblastic activity.
False denticles are formed when a degenerating tissue False denticles are formed when a degenerating tissue
structure serves as a nidus for deposition of concentric structure serves as a nidus for deposition of concentric
layers of calcified tissue. layers of calcified tissue.
8686
Goga, R., Chandler, N. P. and Oginni, A. O. (2008), Pulp stones: a review.
International Endodontic Journal, 41: 457–468
Dr.MadhuBillaDr.MadhuBilla
are composed of dentin and formed by detached are composed of dentin and formed by detached
dentinoblasts or fragments of Hertwig's sheath, which dentinoblasts or fragments of Hertwig's sheath, which
may stimulate undifferentiated cells to assume may stimulate undifferentiated cells to assume
dentinoblastic activity. dentinoblastic activity.
False denticles are formed when a degenerating tissue False denticles are formed when a degenerating tissue
structure serves as a nidus for deposition of concentric structure serves as a nidus for deposition of concentric
layers of calcified tissue. layers of calcified tissue.
8686
Goga, R., Chandler, N. P. and Oginni, A. O. (2008), Pulp stones: a review.
International Endodontic Journal, 41: 457–468
Dr.MadhuBillaDr.MadhuBilla
Dr.MadhuBillaDr.MadhuBilla 8787
CalcificationsCalcifications
These are found in both healthy and aging pulps, These are found in both healthy and aging pulps,
although their incidence increases with agealthough their incidence increases with age
8888Dr.MadhuBillaDr.MadhuBilla
These are found in both healthy and aging pulps, These are found in both healthy and aging pulps,
although their incidence increases with agealthough their incidence increases with age
8888Dr.MadhuBillaDr.MadhuBilla
Dystrophic calcification is a deposition of calcium salts in
dead or degenerating tissue. It may be due to local
alkalinity of the destroyed tissue that attracts the salts.
This mineralization thus may occur in minute areas of
young pulp tissue affected by minor circulatory
disturbance.
Diffuse calcifications are generally observed in the root
canal but may also be seen in the pulp chamber.
8989
Goga, R., Chandler, N. P. and Oginni, A. O. (2008), Pulp stones: a review.
International Endodontic Journal, 41: 457–468
Dr.MadhuBillaDr.MadhuBilla
dead or degenerating tissue. It may be due to local
alkalinity of the destroyed tissue that attracts the salts.
This mineralization thus may occur in minute areas of
young pulp tissue affected by minor circulatory
disturbance.
Diffuse calcifications are generally observed in the root
canal but may also be seen in the pulp chamber.
8989
Goga, R., Chandler, N. P. and Oginni, A. O. (2008), Pulp stones: a review.
International Endodontic Journal, 41: 457–468
Dr.MadhuBillaDr.MadhuBilla
AGE CHANGESAGE CHANGES
Formation of secondary dentin through out Formation of secondary dentin through out
life, reduces the size of the pulp chamber & life, reduces the size of the pulp chamber &
root canalsroot canals
Decrease in cellularityDecrease in cellularity
Odontoblast decrease in size & number, & Odontoblast decrease in size & number, &
may disappear in certain areas. Especially on may disappear in certain areas. Especially on
pulpal floor over bifurcation & trifurcationpulpal floor over bifurcation & trifurcation
Dr.MadhuBillaDr.MadhuBilla 9090
Formation of secondary dentin through out Formation of secondary dentin through out
life, reduces the size of the pulp chamber & life, reduces the size of the pulp chamber &
root canalsroot canals
Decrease in cellularityDecrease in cellularity
Odontoblast decrease in size & number, & Odontoblast decrease in size & number, &
may disappear in certain areas. Especially on may disappear in certain areas. Especially on
pulpal floor over bifurcation & trifurcationpulpal floor over bifurcation & trifurcation
Dr.MadhuBillaDr.MadhuBilla 9090
Increase in number & thickness in collagen Increase in number & thickness in collagen
fibers particularly in radicular pulp fibers particularly in radicular pulp
Reduction in the nerve fibers & blood vesselsReduction in the nerve fibers & blood vessels
Increase resistance of pulp against action of Increase resistance of pulp against action of
enzymesenzymes
In dentin, In dentin,
Increase in peritubular dentinIncrease in peritubular dentin
Dentinal sclerosis, reduces permeability Dentinal sclerosis, reduces permeability
Increase in dead tractsIncrease in dead tracts
Dr.MadhuBillaDr.MadhuBilla 9191
fibers particularly in radicular pulp fibers particularly in radicular pulp
Reduction in the nerve fibers & blood vesselsReduction in the nerve fibers & blood vessels
Increase resistance of pulp against action of Increase resistance of pulp against action of
enzymesenzymes
In dentin, In dentin,
Increase in peritubular dentinIncrease in peritubular dentin
Dentinal sclerosis, reduces permeability Dentinal sclerosis, reduces permeability
Increase in dead tractsIncrease in dead tracts
Dr.MadhuBillaDr.MadhuBilla 9191
CLINICAL CONSIDERATIONSCLINICAL CONSIDERATIONS
Anatomic considerationsAnatomic considerations
Effect of dental materials on pulpEffect of dental materials on pulp
Effect of Operative Procedures Effect of Operative Procedures
Effects subsequent to restorationEffects subsequent to restoration
Dr.MadhuBillaDr.MadhuBilla 9292
Anatomic considerationsAnatomic considerations
Effect of dental materials on pulpEffect of dental materials on pulp
Effect of Operative Procedures Effect of Operative Procedures
Effects subsequent to restorationEffects subsequent to restoration
Dr.MadhuBillaDr.MadhuBilla 9292
ANATOMIC ANATOMIC
CONSIDERATIONSCONSIDERATIONS
Dimensions of tooth preparation are dictated Dimensions of tooth preparation are dictated
by pulpal morphologyby pulpal morphology
Young permanent teeth have wider pulp Young permanent teeth have wider pulp
chamber and so do deciduous teethchamber and so do deciduous teeth
Cervical horns present in maxillary molars Cervical horns present in maxillary molars
complicate class V restoration and endodontic complicate class V restoration and endodontic
treatmenttreatment
developmental disturbances and advanced agedevelopmental disturbances and advanced age
Dr.MadhuBillaDr.MadhuBilla 9393
CONSIDERATIONSCONSIDERATIONS
Dimensions of tooth preparation are dictated Dimensions of tooth preparation are dictated
by pulpal morphologyby pulpal morphology
Young permanent teeth have wider pulp Young permanent teeth have wider pulp
chamber and so do deciduous teethchamber and so do deciduous teeth
Cervical horns present in maxillary molars Cervical horns present in maxillary molars
complicate class V restoration and endodontic complicate class V restoration and endodontic
treatmenttreatment
developmental disturbances and advanced agedevelopmental disturbances and advanced age
Dr.MadhuBillaDr.MadhuBilla 9393
ANATOMIC ANATOMIC
CONSIDERATIONSCONSIDERATIONS
Dr.MadhuBillaDr.MadhuBilla 9494
CONSIDERATIONSCONSIDERATIONS
Dr.MadhuBillaDr.MadhuBilla 9494
EFFECT OF DENTAL EFFECT OF DENTAL
MATERIALS ON PULPMATERIALS ON PULP
Amalgam
corrosion products inhibit cell growth
high thermal conductivity
Glass ionomers
well tolerated by pulp
RMGI used for direct pulp capping
Zinc Oxide Eugenol
has an anti-bacterial and anodyne effect
higher concentrations leads to chronic
inflammation & thrombosis of vessels
Dr.MadhuBillaDr.MadhuBilla 9595
MATERIALS ON PULPMATERIALS ON PULP
Amalgam
corrosion products inhibit cell growth
high thermal conductivity
Glass ionomers
well tolerated by pulp
RMGI used for direct pulp capping
Zinc Oxide Eugenol
has an anti-bacterial and anodyne effect
higher concentrations leads to chronic
inflammation & thrombosis of vessels
Dr.MadhuBillaDr.MadhuBilla 9595
Zinc Phosphate
strong to moderate cyto-toxic reactions is due to
leeching of zinc ions and low pH
Resin adhesive systems
The formation of hybrid layer secures the enamel-
resin interface with a continuous seal which acts as a
biometric barrier Dentin bonding agents monomer
molecules reaching the pulp can irritate the pulp
causing inflammation
Dr.MadhuBillaDr.MadhuBilla 9696
strong to moderate cyto-toxic reactions is due to
leeching of zinc ions and low pH
Resin adhesive systems
The formation of hybrid layer secures the enamel-
resin interface with a continuous seal which acts as a
biometric barrier Dentin bonding agents monomer
molecules reaching the pulp can irritate the pulp
causing inflammation
Dr.MadhuBillaDr.MadhuBilla 9696
EFFECTIVE DEPTHEFFECTIVE DEPTH
The effective depth is the area of minimum The effective depth is the area of minimum
thickness of sound dentin separating the pulpal thickness of sound dentin separating the pulpal
tissue from the carious lesiontissue from the carious lesion
2mm or more, healthy reparative reaction2mm or more, healthy reparative reaction
0.8 – 2mm, unhealthy reparative reation0.8 – 2mm, unhealthy reparative reation
0.3 – 0.8mm, pulpal destructon0.3 – 0.8mm, pulpal destructon
(Marzouk, 2006)(Marzouk, 2006)
9797Dr.MadhuBillaDr.MadhuBilla
The effective depth is the area of minimum The effective depth is the area of minimum
thickness of sound dentin separating the pulpal thickness of sound dentin separating the pulpal
tissue from the carious lesiontissue from the carious lesion
2mm or more, healthy reparative reaction2mm or more, healthy reparative reaction
0.8 – 2mm, unhealthy reparative reation0.8 – 2mm, unhealthy reparative reation
0.3 – 0.8mm, pulpal destructon0.3 – 0.8mm, pulpal destructon
(Marzouk, 2006)(Marzouk, 2006)
9797Dr.MadhuBillaDr.MadhuBilla
CONCLUSIONCONCLUSION
9898
Pulp to the tooth is like heart to the body,
providing constant source of nutrition to maintain
the vitality of the tooth. Every precaution should
be taken to preserve the vitality of the tooth.
The preservation of the healthy pulp during
operating procedure and successful management in
cases of diseases are two most important challenge
to the clinicians
Dr.MadhuBillaDr.MadhuBilla
9898
Pulp to the tooth is like heart to the body,
providing constant source of nutrition to maintain
the vitality of the tooth. Every precaution should
be taken to preserve the vitality of the tooth.
The preservation of the healthy pulp during
operating procedure and successful management in
cases of diseases are two most important challenge
to the clinicians
Dr.MadhuBillaDr.MadhuBilla
REFERENCESREFERENCES
GROSSMANS ENDODONTIC PRACTICEGROSSMANS ENDODONTIC PRACTICE
S.COHENS PATHWAYS OF PULP-9S.COHENS PATHWAYS OF PULP-9
THTH
EDITION EDITION
ORBANS ORAL HISTOLOGYORBANS ORAL HISTOLOGY
TEN CATES ORAL HISTOLOGYTEN CATES ORAL HISTOLOGY
SELZERS AND BENDERS THE DENTAL PULPSELZERS AND BENDERS THE DENTAL PULP
R. INOKIS DYNAMIC ASPECTS OF DENTAL PULPR. INOKIS DYNAMIC ASPECTS OF DENTAL PULP
FRANKLIN S. WEINE – 5FRANKLIN S. WEINE – 5
THTH
EDITION EDITION
9999Dr.MadhuBillaDr.MadhuBilla
GROSSMANS ENDODONTIC PRACTICEGROSSMANS ENDODONTIC PRACTICE
S.COHENS PATHWAYS OF PULP-9S.COHENS PATHWAYS OF PULP-9
THTH
EDITION EDITION
ORBANS ORAL HISTOLOGYORBANS ORAL HISTOLOGY
TEN CATES ORAL HISTOLOGYTEN CATES ORAL HISTOLOGY
SELZERS AND BENDERS THE DENTAL PULPSELZERS AND BENDERS THE DENTAL PULP
R. INOKIS DYNAMIC ASPECTS OF DENTAL PULPR. INOKIS DYNAMIC ASPECTS OF DENTAL PULP
FRANKLIN S. WEINE – 5FRANKLIN S. WEINE – 5
THTH
EDITION EDITION
9999Dr.MadhuBillaDr.MadhuBilla
THANK YOU….THANK YOU….
Dr.MadhuBillaDr.MadhuBilla 100100
Dr.MadhuBillaDr.MadhuBilla 100100
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