Dental Pulp

1. DENTAL PULP
Dr. Blagoja Lazovski
dr. Blagoja Lazovski 1

2. INTROUDCTION
dr. Blagoja Lazovski
The Pulp is a soft mesenchymal connective tissue that
occupies pulp cavity in the central part of the teeth.
It is a special organ because of the unique
environment
2

3. DEVELOPMENT
dr. Blagoja Lazovski
During the 8
th
week of IUL, there is condensation of
the mesenchmye under the enamel organ-Dental
papilla.
The enamel organ enlarge and enclose the dental
papilla in their central portion.
Dental papilla controls the morphology & type of
tooth to be formed.
Dental papilla shows :
extensive proliferation of cells
High vascularity
3

4. dr. Blagoja Lazovski
Following the differentiation of the IEE into
ameloblasts, odontoblast differentiate from the
peripheral cells of dental papilla

Well organized capillaries are found at
beginning of dentinogenesis

4

5. dr. Blagoja Lazovski
Capillaries crowd around the odontoblast during
active dentinogenesis
Rim of the enamel organ (IEE & OEE) is the cervical
loop.
Root formation is carried out by the proliferation of
cells at the cervical loop.

5

6. Dental Papilla
Dental papilla capped by the
enamel organ
dr. Blagoja Lazovski
6

7. GENERAL FEATURES
dr. Blagoja Lazovski
Total of 52 pulp organs 32 in the permanent and
20 in the primary teeth.
Total pulp volume in permanent teeth is 0.38cc with
mean being 0.02CC
Each of these organs has a shape that conforms to
that of the respective tooth.
Has ability to form dentin throughout life
7

8. dr. Blagoja Lazovski
The pulp cavity is divided into

1. Coronal pulp
2. Radicular pulp


8

9. CORONAL PULP
dr. Blagoja Lazovski
It is the pulp occupying the pulp chamber of the crown
of the tooth
In young teeth it resembles the shape of the outer
dentin
It has six surfaces : occlusal, mesial, distal, buccal,
lingual and floor.
Pulp horns are projections into the cusp
This pulp constricts at the cervical region where it
continues as the radicular pulp
9

10. RADICULAR PULP
dr. Blagoja Lazovski
It is the pulp occupying the pulp canals of the root of
the tooth
In the anterior tooth it is single and in the posterior
teeth it is multiple
The radicular portions of the pulp is continuous with
the periapical tissues through apical foramen
As age advances the width of the radicular pulp is
reduced, and so is the apical foramen.
10

11. APICAL FORAMEN
dr. Blagoja Lazovski
1.Pulp cavity terminates at root apex as small
opening called apical foramen
2.Radicular pulp continuous with connective tissue of
the periodontium through this foramen.
3.Diameter in an adult- maxillary teeth-0.4mm
mandibular teeth-0.3mm
4. Wide open during development of root

11

12. APICAL FORAMEN
dr. Blagoja Lazovski
5. Undergoes changes
I. Tooth may tipped from horizontal pressure cause
apex to tilt in opposite direction, exert pressure on
one wall of the foramen causing resorption
6. Same time cementum laid down on opposite side
resulting relocation of the original foramen
12

13. dr. Blagoja Lazovski
7. Sometimes apical opening is found on the lateral
side of the apex
8. There may be 2-3 foramina split by cementum or
dentin- APICAL DELTA

13

14. Apical Foramen







Neurovascular bundle
entering pulp
through the
foramen
dr. Blagoja Lazovski
14

15. ACCESSORY CANAL
dr. Blagoja Lazovski
Leading laterally from the radicular pulp into the
periodontal tissue.
Present in the apical third of the root sheath cells
Formed due to premature loss of HERS or when
developing root encounters a blood vessel.
Overall occurrence is 33%
May also be present at the furcation region
15

16. Accessory Canals
dr. Blagoja Lazovski
16

17. Structural Organization of pulp
dr. Blagoja Lazovski
17

18. HISTOLOGICAL ZONES OF PULP
dr. Blagoja Lazovski
ODONTOBLAST LAYER
CELL-POOR ZONE
CELL-RICH ZONE
PULP PROPER

18

19. THE ODONTOBLASTIC ZONE
dr. Blagoja Lazovski
A layer of odontoblasts are found along
the pulp periphery.

They are dentin forming cells.
19

20. dr. Blagoja Lazovski
CELL FREE ZONE
It is also called weil’s zone
40 microns wide &relatively free of cells
Traversed by
1.blood vessels
2.unmyelinated nerves
3.cytoplasmic process of fibroblasts
This zone is found below the odontoblastic zone
Represents the space into which odontoblasts move during
tooth development.

20

21. CELL RICH ZONE
dr. Blagoja Lazovski
Present in subodontoblastic layer
Contains more proportions of fibroblast and
undifferentiated mesenchymol cells.
Also contains macrophages, dendritic cells and
lymophocytes.
Zone formed due to migration of cells from pulp
proper
Mitosis seen when dead odontoblasts are replaced
Also contain young collagen fibres during early
dentiogenis.

21

22. PULP CORE
dr. Blagoja Lazovski
It is central region of the pulp
Contains major blood vessels and nerve of the
pulp
Pulpal cells and fibroblasts are also seen
22

23. CELLS OF PULP
dr. Blagoja Lazovski
ODONTOBLASTS
FIBROBLASTS
UNDIFFERENTIATED CELLS
DEFENSE CELLS
23

24. ODONTOBLASTS
dr. Blagoja Lazovski
A Peripheral area of the pulp where the
odontoblasts reside is termed odontogenic
zone.
Arranged in Palisading pattern cells one tall
columnar forming a layer of 3 to 5 cells in
depth.
Shape may vary cornal pulp- columnar
midportion - cuboidal
Apical region - Flattened
24

25. dr. Blagoja Lazovski
These cells have large process extending into
dentin
The no of odontoblasts corresponds to the
number of dentinal tubules
Average no of odontoblasts estimated to 45,000
per Sq.mm of odontogenic zone.
Odontoblasts in the crown are larger than in the
root.
25

26. dr. Blagoja Lazovski
Shape of the odontoblasts also reflect the
functional activity of the cell.
During active phase, cells show increase in
endoplasmic reticulum golgi appartus and
secretory vesicles.
Resting (or) Non active phase cells are flattened
little cytoplasm condensed chromatin and
decrease no of ER
26

27. JUNCTIONAL COMPLEX
dr. Blagoja Lazovski
Numerous junctions such as gap junctions tight
junction and desmosomes are found between
odontoblasts.
Indicating exchange of ions and small molecules.
They promote cell to cell adhension and play a role
in maintaining polarity of odontoblasts
27

28. dr. Blagoja Lazovski


JUNCTIONAL COMPLEXES
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29. ODONTOGENIC PROCESS
dr. Blagoja Lazovski
 Odontoblasts give off a single process that extends
into dentin and housed within dentinal tubules
These process devoid of major organelles
They contain abundance of microtubular filaments
and coated vesicles
Mainly composed of protein-tubulin, act in and
vimentin
29

30. FUNCTIONS OF ODONTOBLASTS
dr. Blagoja Lazovski
Synthesis of organic matrix
Synthesis of non collagenous substances like
sialoprotein, phosphophoryn, osteocalcin,
ostenoectin & osteopontin
Intracellular accumulation of calcium
Degradation of organic matrix
30

31. FIBROBALSTS
dr. Blagoja Lazovski
Cells that occur in greatest number in the pulp
Function is to form, maintain the matrix that consists
of collages, fiber and ground substance throughout
the pulp
The fibroblasts are stellate shaped cells having
extensive process.
31

32. Fibroblast

H&Estain






Immunohistochemical
method
dr. Blagoja Lazovski
32

33. dr. Blagoja Lazovski
Young teeth - Fibroblasts have abudant
cytoplasm having numerous cell organcells.

Older pulp - Fibroblasts appear spindle shaped
posses short processes having few cytoplasmic
organelles such cells are called fibrocytes
33

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


34

35. UNDIFFERENTIATED MESENCHYME
dr. Blagoja Lazovski
These mesenchymal cells are distributed through
out the pulp, frequently around the perivascular
area - believed to be toti potent cell
They are Polyhedral shaped with peripheral
processes and large oval nuclei
Difficult to differentiate from fibroblast under
light microscopy
Under adequate stimilus they may differentiate
into odontoblast or fibroblast or macrophages.
In older pulp,their number and ability to
differentiate comes down
35

36. IMMUNOCOMPETENT CELLS
dr. Blagoja Lazovski
They play a major role local inflammation and
immunity.
They are recruited from blood stream and remain
as transient inhabitants in pulp
These cells are
1. Macrophages
2. Mast cells
3. Plasma cells
4. Lympocytes,Neutrophils,Eosinophils
basophils and manocytes.
36

37. MACROPHAGES IN PULP
dr. Blagoja Lazovski
Described as histiocytes (or) as resting wandering
cells
Located close to blood vessel
Have several phenotypes
Macrophages are phagocytes,function of which
are engulfment and digestion of foreign material
During inflammation they appear in large no to aid
in defense the organism
In all they constitute 8-9% of the pulpal cell
population
37

38. Macrophages
Dark staining nucleus with cytoplasmic
granules
dr. Blagoja Lazovski
38

39. PLASMA CELLS
dr. Blagoja Lazovski
Plasma cells are seen during inflammation of the
pulp
The plasma cells function in the production of
antibodies.
Plasma cells may be present in coronal pulp
They have small nuclei with radiating chromatin
that appears like a cast wheel.
39

40. Plasma Cell
Peripheral arrangement of chromatin in
nucleus
dr. Blagoja Lazovski
40

41. MAST CELLS
dr. Blagoja Lazovski
Occur in small groups in relation to blood vessels
Present only during pulpal inflammation
Have round nucleus and contain many dark staining
granules in the cytoplasm.
Their number increase during inflammation.
41

42. LYMPHOCYTES,EOSINOPHILS AND
LEUCOCYTES
dr. Blagoja Lazovski
Usually found extravascularly in the normal pulp
During inflammation they increase in number.
Lymphocyte present along the walls of blood vessels
Involved in initial immunodefense
Usually they are not found in uninflamed pulp
42

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

43

44. LYMPHOCYTES IN PULP
dr. Blagoja Lazovski
44

45. dr. Blagoja Lazovski
Leucocytes are not found normally in the
connective tissue
They are transported to such sites in response to
injury and then present directly in the involved
tissue as well as in blood.
They phagocyte foreign material .
45

46. EXTRACELLULAR MATRIX
dr. Blagoja Lazovski
Connective tissue fibers
Collagen
Elastin
Fibronectin
Ground substance
Proteoglycans
Glycosaminoglycans
Basement membrane
46

47. FIBRES (COLLAGEN FIBRES)
dr. Blagoja Lazovski
Extra cellular structural protein,major constituent of
connective tissue
Collagen fibers appear throughout the pulp
young fine fibers ranging in diameter from 10-12mm.
Pulp collagen fibers do not contribute to dentin matrix
production.
47

48. dr. Blagoja Lazovski
After root completion pulp matures and bundles of
collagen fibers increase in number
They scattered throughout the coronal or radicular
pulp,or they appear in bundles.These are termed
diffuse or bundle collagen
Most prevalent in root canals,especially near
apical region.

48

49. Collagen Fiber
Seen in relation with fibroblasts
dr. Blagoja Lazovski
49

50. dr. Blagoja Lazovski
Type I:
 Present as thick striated fibrils
Responsible for pulp architecture
Type III:
 Thinner fibrils,mainly distributed in
cell free and cell rich zones
 Contributes to the elasticity of pulp
50

51. dr. Blagoja Lazovski
Type IV:
Present along the basement membrane of blood
vessels
Type V and VI:
Seen to form dense meshwork of thin microfibrils
through out the stroma
51

52. dr. Blagoja Lazovski
Collagen turnover is maintained by fibroblasts
During bacterial infection &
inflammation,collagenolytic activity is
accelerated following collagenase produced by
bacteria,PMN & fibroblats
Collagen synthesis is accelerated during
reparative dentin formation
52

53. ELASTIC FIBER
dr. Blagoja Lazovski
1.This has the ability to expand and contract
like a rubber band
2.Elastic fibers are first formed in bundles of
thin micro filaments called Oxytalan fibers
3.Elastin is then deposited in between oxytalan
fibers.
4.Always associated with larger blood vessels
53

54. Elastic Fiber
Verhoeff's method stains the fibers black
dr. Blagoja Lazovski
54

55. FIBRONECTIN
dr. Blagoja Lazovski
It plays a role in cell-cell & cell-matrix adhesion
Has a major effect on the proliferation,
differentiation & organization of cells.
Seen around the blood vessels
Also found in odontoblast layer with fibers passing
into predentin
55

56. dr. Blagoja Lazovski
Due to its close interaction with odontoblasts and
extracellular fibers,fibrinoectin helps to maintain cell
morphology and provide a tight seal at this site.
Fibronectin may be involved in cell migration and
anchorage in the wound healing process of the
connective tissue of pulp.
It regulates the migration and differentiation of
secondary odontoblasts
Adherent property of fibronectin is due to cell surface
glycoprotein receptors called Integrins

56

57. GROUND SUBSTANCE
dr. Blagoja Lazovski
It is a structureless mass,makes up the bulk of the
pulp
Consists of complexes of proteins,carbohydrate
and water.
Broadly classified as
 Glycoaminoglycans
 Proteoglycans
57

58. GLYCOSAMINOGLYCANS
dr. Blagoja Lazovski
GAG found in pulp is mainly chondroitin
sulphate,dermatan sulphate & hyaluronic acid
Proteoglycans occupy larger area and they provide
protection against compression.
During dentinogenesis,the ground substance show
affinity for collagen and influence fibrinogenesis
They have capacity to bind with calcium and help in
mineralisation
58

59. BASEMENT MEMBRANE
dr. Blagoja Lazovski
It is a sheet like arrangement of extra cellular
protein matrix at the epithelial-mesenchymal
interface
Composed of 2 layers
 lamina densa-electron dense
 lamina lucida-electrolucent

59

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

60

61. dr. Blagoja Lazovski
Collagen IV provides binding sites for the rest of
basement membrane components
Laminin binds to both cells of connective tissue
and epithelium
In mature pulp,basement membrane forms
interface along endothelial cells & schwann cells
61

62. FUNCTIONS
dr. Blagoja Lazovski
Act as sieve between epithelium and connective
tissue
Helps in organisation and differentiation by
enabling interactions between extra cellular
molecules and cell surface receptors
Eg: Odontoblasts during tooth
development
62

63. CIRCULATION OF THE PULP
dr. Blagoja Lazovski
 The pulp organ is extensively vascularized.
They are supplied by the superior and the
inferior alveolar arteries
The blood vessels gain entry into the pulp through
the apical foramen and at times through
accessory foramen.
63

64. dr. Blagoja Lazovski
The arterioles on entering the pulp show a
reduction in thickness of vessel wall musculature
and therefore luman size increases.
Pulpal blood flow is more rapid than in most area
of the body
So pulpal pressure is highest of body tissues
The flow of blood in asterioles - 0.3 to 1mm/sec
Venules – 0.15mm/sec
Capilaries – 0.08mm/sec
64

65. Organization of Pulp Vasculature
dr. Blagoja Lazovski
⃟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 H
20
65

66. Organization of pulp vasculature
neurovascular bundle
dr. Blagoja Lazovski
66

67. dr. Blagoja Lazovski
ARTERIOLES:
Arterioles
(50µ diameter)

Terminal arterioles

Precapillaries

Metarterioles

Capillaries (8µ)
67

68. dr. Blagoja Lazovski
The branching point of terminal arterioles is
characterized by smooth muscle clumps that act
as sphincters which are under the local cellular &
neuronal control
Thus pulpal inflammation elicits a localised
circulatory response restricted to the area of
inflammation
Arteriolar pressure – 43mm Hg.
68

69. dr. Blagoja Lazovski
Apical third Middle third
PULP VASCULATURE
69

70. Microcirculatory System
Arterioles & venules
dr. Blagoja Lazovski
70

71.  CAPILLARIES
dr. Blagoja Lazovski
Function as exchange vessels regulating the
transport of diffusion of substances between
blood and local interstitial tissue elements
They consists of single layer of endothelium
surrounded by basement membrance
Capillary pressure –35 mmHg
Capillary wall is 0.5µ thick & acts as
semipermeable membrane
71

72. dr. Blagoja Lazovski
Based on the property of semi permeability
capillaries may be grouped as
Class I : Fenestrated capillaries
Class II: Continuous capillaries
(non fenestrated)
Class III : Discontinuous capillaries
Class IV : Tight junction capillaries
Class I & II are present in the dental pulp
72

73. Capillary network is organized in 3 layers
dr. Blagoja Lazovski
1.Terminal capillary network located in the
“odontoblastic layer”
2.“Capillary network” present adjacent to the
odontoblastic layer & consists of pre capillary
& post capillary vessels
3.Venular network of vessels
During aging & decreased metabolism these
layers appear as single layer
73

74. SEM shows extensive arborization of capillaries from the
metarterioles
dr. Blagoja Lazovski
74

75. VENULES
dr. Blagoja Lazovski
Collecting venules receive pulpal blood flow from
the capillaries & transfer it to the venules

Arterio-venous anastomosis permits direct
shunting from arterioles to venules

Venular pressure –19mm Hg
75

76. LYMPHATICS
dr. Blagoja Lazovski
Lymphatic vessels are formed from fine meshwork
of small, thin walled lymph capillaries
Lymph capillaries coalesce to form larger
lymphatic vessels with valves
They start as blind openings near Weil’s zone &
odontoblastic layer
The larger lymphatic vessels run along the blood
vessels & nerves
76

77. dr. Blagoja Lazovski
Multiple collecting lymph vessels exit though the
apical foramen & drain lymph from pulp into
the periodontium
Role in pulp:
They remove high molecular
solutes from the interstital fluids thus
maintain interstitial COP
They transport lymph to the
regional lymph node before it enters into
the blood vessels. This provides an
immuno surveillance function.
77

78. METABOLSIM
dr. Blagoja Lazovski
Metabolism has been studied by measuring the
rate of O
2 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 CO
2 is measured.
During dentinogenesis, rate of O
2 consumption is
high than after crown completion.
78

79. dr. Blagoja Lazovski
Greatest metabolic activity is seen in the
odontoblast layer.

Reduced pH of pulp causes decreases in O
2
consumption as in pulp abscess.
In addition to the glycolytic pathway, the pulp
has the ability to produce energy through
Pentose shunt pathway, suggesting that the pulp
can function under varying degrees of ischemia
79

80. dr. Blagoja Lazovski
Several dental materials have shown to inhibit O
2
consumption Eg. ZOE , Ca(OH)
2 & silver amalgam
Pulpal irritation causes increases in
cycloxygenase products, which is inhibited by
ZOE
As cellular composition reduces, the rate of
oxygen consumption decreases.


80

81. INNERVATION
dr. Blagoja Lazovski
Principles role is to help in conscious recognition
of irritants to the pulp, which gives the
opportunity to have the problem corrected
before irreversible effects can occur
Nerve fibers, mylinated & unmyelinated, enter
the tooth through the apical foramen
81

82. INNERVATION
dr. Blagoja Lazovski
Dental pulp contains sensory and motor fibers to
fulfill the vasomotor and defense function
Sensory afferent fibers are branches of
maxillary & mandibular division of trigeminal
nerve.
82

83. dr. Blagoja Lazovski
After entering the foramen, they arborize. Larger
fibers are present in the central zone. They
divide as they proceed peripherally and
coronally.
Subjacent to the cell rich zone, the nerves branch
extensively forming a parietal layer of nerves-
NERVE PLEXUS OF RASHKOW. This layer
contains both A and C fibers.
83

84. Types of nerve fibers
dr. Blagoja Lazovski
84

85. dr. Blagoja Lazovski
Above the cell free zone, myelinated fibers begin
to lose their myelin sheath.
In the cell free zone, they form a rich network
responsible for pain
In the cell free zone, they form a rich network
responsbile for pain.
Many of these fibers pass between the
odontoblastic zone.
85

86. dr. Blagoja Lazovski
Nerve endings may also enter the dentinal
tubules
incidence - 10-20% in cusp tips
1% at the level of CEJ
Motor nerves are supplied by the sympathetic
division of autonomic nervous system.
86

87. dr. Blagoja Lazovski
They wrap around the arteries and terminate in
the tunica media.
They control the diameter of the vascular lumen &
therefore blood flow & volume & ultimately the
intrapulpal pressure.
87

88. Table 3.2 Classification and function of fibers in peripheral nerves


Fiber
Diameter
(m)
Conduction velocity
(speed of impulse,
m/sec)
Function
A-alpha ()
A-beta()
6-20
5-12
15-80 (myelinated)
30-70
Afferent fibers for touch, pressure
proprioception, vibration
(mechanorecptors)
A-gamma()
A-delta ()
B

1-5
1-3


2-30 (myelinated)
3-15 (myelinated)

Afferent fibers for pain and temperature
Visceral afferent fibers preganglionic
visceral efferent fibres
C 04-1.0 0.4-2(unmyelinated) Afferent fibers for pain and tempature;
post ganglionic visceral efferent fibers dr. Blagoja Lazovski 88

89. Neuropeptides in Pulp
dr. Blagoja Lazovski
Neuropeptides are proteins that have been
associated with central & peripheral nervous
system
Following are the neuropeptides demonstrated in
pulp :
Originate from trigeminal ganglion (C fibres)
Substance P
CGRP
Neurokinin A
89

90. FUNCTIONS OF DENTAL PULP
dr. Blagoja Lazovski
INDUCTIVE
FORMATIVE
NUTRITIVE
PROTECTIVE
DEFENSE
90

91. INDUCTIVE
dr. Blagoja Lazovski
It induces oral epithelial differentiation into
dental lamina and enamel organ
It also induces the enamel organ to
differentiate into a particular type of
tooth morphology
91

92. FORMATIVE
dr. Blagoja Lazovski
The cells of Pulp induces dentin formation
This involves formation of primary and secondary
dentin.
The primary dentin is tubular and regularly
arranged.Formed before root closure
Secondary dentin contain fewer tubules and is
formed after root closure.
92

93. NUTRITIVE
dr. Blagoja Lazovski
Dental pulp maintains the vitality of dentin by
providing O
2 and nutrients to the odontoblasts
Also provides continuing source of dentinal fluid
Nutrition made possible by rich peripheral
capillary network.
93

94. PROTECTIVE
dr. Blagoja Lazovski
Pulp helps in recognition of stimuli like
heat,cold,pressure,chemicals by way of
sensory nerve fibres.
Vasomotor innervation controls the muscular wall
of blood vessels.This regulates the blood volume
and rate of blood flow and hence the intrapulpal
pressure.
94

95. DEFENSIVE (OR) REPARATIVE
dr. Blagoja Lazovski
 Pulp as remarkable reparative abilities
It responds to irritation by producing reparative
dentin and mineralizing and affected dentinal
tubules.
Mild to moderate irritation results in continued
peritubular dentin formation, sclerosis and
intratubular calcifiction-(Tublar sclerosis)
95

96. dr. Blagoja Lazovski
Stimuli like operative procedures abrasion, caries
can result in rapid dentin formation (Tertiary
dentin)
Inflamed pulp due to bacterial infection the cells
in pulp aid in the process of repair
(macrophages, lymphocycts, neutrophils,
monocytes, plasma , mast cells)
96

97. PULP OF DECIDUOUS TEETH
dr. Blagoja Lazovski
Overall dimensions smaller
Pulp chambers larger
Roots are long and slender and root canals
narrower and follow a tortuous course
Pulp horns at a higher level, especially mesial
horns of primary molars
Resorption starts soon after root completion
Root resorption and dentin deposition changes size
shape and number of root canals.
97

98. PRIMARY PULP ORGAN
dr. Blagoja Lazovski
Primary pulp functions for a mean of 8.3 years.
This time can be divided into three periods
Pulp organ growth
Time of crown and root development
Pulp maturation (3 years, 9 months)
Time after root completion to beginning
of root resorption
Pulp regression (3 Years , 6 months)
Beginning of root resorption to exfoliatin

98

99. REGRESSIVE CHANGES (AGING)
dr. Blagoja Lazovski
Cell Changes
Appearance of fewer cells in aging pulp
Cells are characterized by a decrease in size
and no of cytoplasmic organelles
Active pulpal fibrocyte (or) fibroblast has
abundant rough-surfaced endoplasmic reticulum
notable golgi complex, numerous mitochondria
99

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

100

101. FIBROSIS
dr. Blagoja Lazovski
Diffuse fibrillar components
Accumulation of both
Bundles of collagen fibres
Fiber bundles may appear arranged longitudinally
in the radicular pulp and more diffuse in coronal
pup
Collagen accumulation also occurs in some older
pulps
Increase in fibers in the pulp organ is gradual and
generalized
101

102. dr. Blagoja Lazovski
External trauma such as dental caries (or) deep
restorations cause a localized fibrosis (or) scarring
effect

Increase in collages fibers decrease in the size of
the pulp

Vascular changes occur in aging pulp
102

103. Pulp Fibrosis
dr. Blagoja Lazovski
103

104. dr. Blagoja Lazovski
Atherosclerotic plaques may appear in pulpal
vessels.
Calcifications are found that surround vessels.
Calcification is found most often in the region
near the apical foramen.

104

105. Pulp Stones(denticles)
dr. Blagoja Lazovski
Appearing in either or both coronal and root
portions of the pulp organ
Develop in teeth that appear to be normal in
other respects.
Asymptomatic unless they impinge on nerves
(or)blood vessels
Seen in functional as well as embedded
unerupted teeth.

105

106. Classification
dr. Blagoja Lazovski
1.True denticles
2.False denticles
3.Diffuse calcifications
106

107. dr. Blagoja Lazovski
True denticles
True denticles are similar in structure to dentin
They have dental tubules and contain processes of
the odontoblasts
Usually located close to the apical foramen
107

108. dr. Blagoja Lazovski
Development of true denticles is caused by the
inclusion of remnants of the epithelial root sheath
with in the pulp
Epithelial remnants induce the cells of pulp to
differentiate into odentoblasts then form the dentin
mass.
108

109. True Denticle


H&E section of
true denticle



Higher
magnification
dr. Blagoja Lazovski
109

110. False denticles
dr. Blagoja Lazovski
They do not exhibit dentinal tubules
They appear as concentric layers of calcified tissue
Some cases these calcification sites appear within
a bundle of collagen fibers.
Some cases they appear in pulp free of collagen
accumulations
110

111. dr. Blagoja Lazovski
Some cases arises around vessels
Center of these concentric layers of calcified tissues
there may be remnants of necrotic and calcified
cells
Calcification of thrombi in blood vessels called
phleholiths, may also serve as nidi for false
denticles


111

112. dr. Blagoja Lazovski
An denticles begin as small nodules but increase
in size by incremental growth
Classified as free, attached (or) embedded
depending on their relation to the dentin
a)Free denticle – entirely surrounded by
pulp tissue
b)Attached denticle – Partly fused with the
dentin
c)Embedded denticles – Entirely surrounded by
dentin
Incidence as well as the size of pulp stones increase
with age.
112

113. False Denticle
False calcification seen along the walls of the blood
vessel
dr. Blagoja Lazovski
113

114. Diffuse Calcifications
dr. Blagoja Lazovski
Appear as irregular calcific deposits in the pulp
tissue, following collagenous fiber bundles, blood
vessels,
Sometimes they develop into larger mass, persist as
calcified spicules

114

115. dr. Blagoja Lazovski
These calcifications are usually found in the root
canal and less often in coronal area
These calcification surrounds blood vessels
These calcifications may be classified as
dystrophic calcification
115

116. Diffuse calcification
Diffuse calcification of the pulp, seen along with
pulp fibrosis
dr. Blagoja Lazovski
116

117. Dystrophic Mineralization
dr. Blagoja Lazovski
Ground substance alterations in the dental pulps
occurs on aging, such charges may contribute to
cellular degeneration and increase dystrophic
mineralization.
Circulatory disturbances may be the initiating
factor
Mineralizations also seen in the myelin sheaths of
nerves.
117

118. dr. Blagoja Lazovski
Their beginnings are also found in the vessel
walls as in arteriosclerosis.
Older, fibrotic pulp attract mineral salts more
readily.
A mineralized pulp when extirpated, feels
wooden hard.
118

119. Dystropic mineralization due to caries and
periodontal disease
dr. Blagoja Lazovski
DM also increase as result of disease processes
such as caries and periodontal diseases
Teeth whose pulps one chronically inflammed
contain DM in regions of previous liquefaction
necrosis.
119

120. dr. Blagoja Lazovski
Alkaline phosphate in odontoblasts may function
as a calcium pyso phosphatus, there by
stimulating ca2 uptuke in pulps.
Teeth with periodontal disease, DM increase in
both cornonal and radicular pulp.
120

121. AGE CHANGES
dr. Blagoja Lazovski
Formation of secondary dentin through out life,
reduces the size of the pulp chamber and root
canals
Decrease in cellularity
Odontoblast decrease in size & number, & may
disappear in certain areas. Especially on pulpal
floor over bifurcation & trifurca
121

122. dr. Blagoja Lazovski
Increase in number & thickness in collagen fibers
particularly radicular pulp
Reduction in the nerve fibers & blood vessels
Increase resistance of pulp against action of
enzymes
In dentin,
Increase in peritulular dentin
Dentinal sclerosis, reduces permeability
Increase in dead tracts
122

123. Factors infulencing Tertiary
Dentinogenesis
dr. Blagoja Lazovski
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.
123

124. Tertiary Dentinogenesis
dr. Blagoja Lazovski
124

125. CLINICAL CONSIDERATIONS
dr. Blagoja Lazovski
1.Anatomic considerations
2.Factors to be considered during endodontic
treatment.
3.Effect of Operative Procedures
4.Effect of dental materials on pulp
5.Effects subsequent to restoration
125

126. ANATOMIC CONSIDERATIONS
dr. Blagoja Lazovski
Pulp Chamber with stone Cervical horns
126

127. OPERATIVE PROCEDURES
dr. Blagoja Lazovski
Anatomic considerations
1)Shape of the pulp chamber and its extensions into
the cusps pulpal horns is important.
2)Wide pulp chamber into tooth of young person
will make a deep cavity preparation hazardous
127

128. dr. Blagoja Lazovski
3) The pulpal horns project high into the cusps
exposure of pulp can occur
4) If opening a pulp chamber for treatment its size
and variation in shape must be taken into
consideration
128

129. dr. Blagoja Lazovski
FACTORS TO BE CONSIDERED DURING
ENTODONTIC TREATMENT
5) Age advance , the pulp chamber becomes
smaller difficult to locate the root canals.
6) Shape of the apical foramen and its location
may play an important part in treatment of root
canals.
7) Accessory canals, and multiple canals are rarely
seen in roentgenograms.

129

130. FACTORS TO BE CONSIDERED DURING OPERATIVE
PROCEDURES
dr. Blagoja Lazovski
8) The pulp is highly responsive to stimuli, even slight
stimulus cause inflammatory cell infiltration.
9) Dehydration causes pulpal damage operative
procedures producing this condition should be
avoided.
130

131. dr. Blagoja Lazovski
Filling material contain harm ful chemicals
Silicate cement - acid
Composites - monomer
Vital pulp is essential to good dentition.
Now vital tooth becomes brittle and is subject to
fracture.
131

132. EFFECT OF DENTAL MATERIALS ON PULP
dr. Blagoja Lazovski
GIC – Well tolerated by pulp
Calcium hydroxide – includes dentin bridge formation.
Zine oxide – eugenol- has an anti-bacterial effect.
Formocresol – Cause chronic inflammation of the pulp.
Dentin bonding agent – can irritate the pulp causing
inflammation
132

133. DETECTION OF PULP VITALITY
dr. Blagoja Lazovski
Electric pulp testing
More accurate than some of the tests used to
detamine pulp vitality
Heat testing
Thermal testing
Cold
Anesthetic testing
133

134. dr. Blagoja Lazovski
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.
134

135. CONCUSION
dr. Blagoja Lazovski
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.
135

136. dr. Blagoja Lazovski 136