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10-Dentin-Pulp Complex

Talk about the dentin within the enamel on the teeth and the pulp of which consists of nerves and tissues

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kamophasha789
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18 views

10-Dentin-Pulp Complex

Talk about the dentin within the enamel on the teeth and the pulp of which consists of nerves and tissues

Uploaded by

kamophasha789
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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The Dentine-

Pulp Complex
Oral Biology
Outcomes
Name name the structural components of dentin-pulp complex

List list the cellular components of the pulp

Describe describe the microscopic zones of the pulp

Explain explain the hydrodynamic theory of dentinal hypersensitivity

Explain explain the effect of age changes on dentinal hypersensitivity

Explain explain age changes which can be observed in the dentin-pulp complex
• Shape of the pulp chamber
matches
• the shape of the tooth
• Pulp chamber divided :

• Coronal portion
• Radicular portion

• Posterior teeth the pulp horns


extend from the coronal portion
into the cusps
Pulp-dentin
complex
• Integral developmental,
functional and anatomical
integration and relationship
between dentin and pulp

• Should be studied
simultaneously
Development of the Pulp-Dentin complex
Stages of odontogenesis
Structure and composition
The pulp has 4 microscopic zones:

2 1
3

4
Core of
pulp
Microscopic Zones in Pulp
Zones-from outer to inner Description
zone
Odontoblastic layer Lines the outer pulpal wall and
consists of the cell bodies of
odontoblast. Secondary dentin
may form in this area from the
apposition of odontoblast.

Cell-free zone Fewer cells than odontoblastic


layer. Nerve and capillary plexus
located here.

Cell-rich zone Increased density of cells as


compared to cell-free zone and
also a more extensive vascular
system.
Pulpal-core Located in the center of the pulp
chamber, which has many cells
and an extensive vascular supply,
similar to cell-rich zone
Dentin
Odontoblasts layer

Predentin
Cell rich zone
Pulp core

Cell free zone


Structure and composition
• Principle cells of the pulp:

• Odontoblasts
• Fibroblasts
• Undifferentiated mesenchymal cells
• Immunocompetent cells
Odontobla
sts

• Most distinctive cell: tall


elongated cells that border
the pulp and form a tight
layer against the predentin
that extend cell processes

• Morphology represents
functional activity

• Cell-cell junctions between


adjacent cells to maintain
polarity
Odontoblasts
Line the periphery of the adult pulp

PULP

http://medic.med.uth.tmc.edu/inline/inlnimg/00000679.jpg
Odontoblasts- types of tertiary dentin
Fibroblasts
• Cells occurring in greatest numbers in pulp, especially in
the coronal portion of the pulp where they form the cell-
rich zone.
• Form and maintain the pulp matrix

• Morphology varies with functional state


• Synthetic
• Resting
• Degradation of ECM components

• Resting cells may be stimulated by appropriate stimuli


• Decrease in size with age
Undifferentiated
mesenchymal cells

• Cell pool from which cells of the


pulp are derived

• Depending on stimulus
• Odontoblasts
• Fibroblasts

• Diminishes with age


Immune
cells
• Lymphocytes
• B- and T-cells scattered
along blood vessels

• Macrophages
• Primary defense against
intracellular pathogens
• Phagocytose and digest
foreign and self particles
• Located mostly near
blood vessels
Immune
cells
•Dendritic cells
• Process and present antigens
to
immunocompetent T-cells

• Especially rich in periphery


of pulp were they compete
with odontoblasts for space

• Sometimes extend processes


into tubules
Vascular supply of the pulp:

• Enter and exit via apical and


accessory foramina
• 1-2 arterioli enter apex with
sensory and sympathetic
nerves
Neural innervation of the pulp:
• Late bell stage

• Nerves bundles
(myelinated and
unmyelinated) enter apical
foramen

• Terminal branches forms


the subodontoblastic
plexus of Raschkow in the
cell-free zone of Weil
(Unmyelinated)-silver
nitrate stained sections
Neural
innervation:

• Sensory innervation terminates


in:

• Odontoblast layer,
• Predentin
• Inner dentin
Neural
Innervation
:
• Some fibres infiltrate into the
dentinal tubules

• Nerve bundles that enter the


pulp:
• V cranial nerve
• Sympathetic branches from
superior cervical ganglion
• Neural innervation:
Raschkow plexus is absent in
radicular pulp, branches are
given off at intervals that
further divide and supply
specific regions of the root.
Types of nerve
fibres in pulp:

• Sensory
• Majority unmyelinated, slowly
conducting C-fibers activated mostly by
pulp damage (Pain)

• Small proportion of myelinated A-beta,


most sensitive for hydrodynamic
mechanical stimulation of dentin
(Pressure and touch)

• 25-50% A-delta (small myelinated)


(Pain,temperature & touch)
Types of nerve fibres in pulp:
• Autonomic
• Sympathetic for vasoconstriction in deep pulp along blood vessels
• Very little parasympathetic activity (sensory for vasodilatation)
Structure and composition
• Lymphatic drainage of the
pulp:
• Arise as small, thin-walled
vessels in the coronal region
of pulp
• Pass apically through middle
and radicular regions of the
pulp to exit via larger vessels
through the apical foramen
• Dominant mechanism for
removal of high-molecular
weight solutes from interstitial
fluid into vascular system
Sensitivity of teeth/ dentin
• Enamel not sensitive

• Dentine very sensitive for all stimuli

• All dentinal stimuli “interpreted” as pain

• Enamel-dentinal junction most sensitive


Dentine sensitivity:
• 3 possible mechanisms have been proposed:

• Nerves in dentine- Direct innervation theory


• Hydrodynamic theory
• Odontoblasts as pain receptors- Odontoblast
receptor theory
• Dentinal hypersensitivity is defined
as: pain arising from exposed dentin,
in response to thermal, chemical,
tactile and osmotic stimuli. This
sharp transient pain cannot be
ascribed to any other pathology.
Nerves in dentin
• There is little evidence to prove this
theory:
1-there is no evidence that can
support the existence of nerves in the
superficial dentin (where dentin is the
most sensitivity)
2- the plexus of Rashkov do not
become mature until complete tooth
eruption. However, the newly
developed teeth can be sensitive too
Hydrodynamic
theory

• Still the most widely accepted theory of


dentinal sensitivity.
• Changes in fluid movement in the pulp/ tubuli
and open tubules
• Changes in osmotic pressure (e.g. sugar)
• drying, cause by rotary instruments or
blowing with 3 in 1 syringe will also
influence fluid movement
• The local pulpal environment changes are
sensed by the nerve complexes of Raschkow,
transmitted to the A-delta nerve fibers.
Hydrodynamic
theory
• Increased sensitivity at DE junction
due to extensive branching of
tubules in this areas Image source: www.jaypeedigital.com

• This theory will explain why LA does


not block sensitivity when applied
directly to exposed dentine and it
also explains the pain produced by
local thermal changes, mechanical
probing and dehydration.
Nerves Odontoblast Hydrodynamic
s theory
Odontoblast receptor theory

• Increasing evidence that


odontoblasts function as sensory
cells for the detection of
nociceptive signals
• Odontoblastic processes act as
sensors that can detect various
signals
• Odontoblasts posses several ion
channels that participate in pain
perception and signal
propagation voltage-gated
sodium channels (Byers and
Westenbroek 2011)
Response to
injury !!
• Mild injury:
• Odontoblasts stimulated to form
reactionary dentin

• Severe injury without exposure:


• Odontoblasts destroyed: cascade of
inflammatory and healing events
• New generation of odontoblast-like cells
differentiate and form reperative tertiary
dentin

• Pulp exposure:
• Healing or necrosis depends on bacterial
contamination, haemodynamic changes
and extent of defense reactions
Bioactive properties of the dentin-
pulp complex

• Traditionally, dentin has been regarded as a


relatively inert mineralized connective tissue
that shows minimal remodeling after
formation and in the absence of disease.

• The inertness of dentin reflects the


immobilization and sequestration or
“fossilization” of the bioactive molecules
within the matrix. In health, these molecules
will largely remain in their “fossilized” state,
and it is only when injury and disease occur
that matrix dissolution can be observed,
leading to local release of these bioactive
molecules.
Bioactive properties of the dentin-
pulp complex
• Demineralized dentin matrix had been demonstrated
to induce pulpal repair and apical closure due to the
release of growth factors from dentin during
demineralization:
• Bone morphogenetic protein (BMP) and
• (TGF-b), VEGF, IGF and other BMP family members

induce odontoblast differentiation (like that in tooth


development)  stimulate tertiary dentin formation.
TGF-β1 23, 24 Involved in primary odontoblastic differentiation 25, 26 and in promoting tertiary
dentinogenesis (20)

TGF-β2 (23) Its expression is upregulated on differentiation of DPSCs into a mineralizing phenotype (27)

TGF-β3 Promotes odontoblastic differentiation 28, 29

BMP-2 (30) Promotes odontoblastic differentiation in both in vitro and in vivo models (31) and the
induction of DSPP and increases alkaline phosphatase activity (32)

BMP-4 (30) Increases odontoblastic differentiation (33)

BMP-7 (34) Promotes mineralizing phenotype in DPSCs 35, 36

Insulin growth factor-1 37, 38 Promotes proliferation and differentiation of DPSCs and SCAP into a mineralizing phenotype
39, 40

Hepatocyte growth factor (41) Promotes migration, proliferation, and survival of MSCs (42)

VEGF 24, 43 Potent angiogenic factor 44, 45, 46 that has been shown to promote blood vessel formation
in tooth slices implanted subcutaneously in SCID mice (47)
Age changes of the pulp

• With increased age the pulp becomes more


fibrous and there is a decrease in cell content
leading to a reduction in the regenerative
capacity of the pulp. The reduction in
regenerative capacity of the pulp is also due to
the deposition of secondary and tertiary dentin
which reduces the size of the pulpal cavity.

• Pulp stones, small calcifications, especially central


pulp
• Blood vessels
• Arteriosclerotic changes
• Decreased number of blood vessels
• Nerve fibers
• Dystrophic mineralisation of nerve fibers
• Degeneration of axons

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