This document provides information about the dental pulp. It begins with an introduction to the pulp and its unique environment as a soft connective tissue within teeth. The document then covers topics like the embryology, anatomy, innervation, pathways of pain, structural organization, cells, extracellular matrix, microvasculature, vitality tests, achieving anesthesia, functions, and clinical considerations of the dental pulp. It provides details on each topic with sections devoted to development, features, anatomy of coronal and radicular portions, innervation, neuropeptides, pathways of pain, extracellular matrix components like collagen and proteoglycans, morphological zones, cell types, and odontoblastic processes.
4. INTRODUCTION
Pulp is a soft mesenchymal connective tissue
that occupies in the central mass of the teeth.
It’s a special organ because of it’s unique
environment.
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5. DEVELOPMENT
During the 8th week of IUL, there is condensation of
the mesenchmye under the enamel organ- Dental
papilla.
The enamel organ enlarge and enclose the dental
papilla in their central portion.
Dental papilla controls the morphology & type of tooth
to be formed.
It shows:
extensive proliferation of cells.
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high vascularity.
6. 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.
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.
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8. SALIENT FEATURES
Enclosed within the dentin.
Resembles embryonic connective tissue.
Houses a number of tissues.
Microcirculatory system with no collateral
branches.
Retains the ability to form dentin throughout
life.
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9. ANATOMY
Pulp cavity is divided into coronal and
radicular portion.
Total pulp organ – 20+ 32= 52.
Total pulp volume in permanent teeth is
0.38cc with the mean being 0.02cc per
teeth.
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10. CORONAL PORTION
It occupies the pulp chamber of the crown of the
teeth.
Pulp horns are projections into the cusp.
It has six surfaces : occlusal,mesial,distal,buccal,
lingual, floor.
It constricts at the cervical region where it continues
as the radicular portion.
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11. RADICULAR PORTION
It is the pulp occupying the pulp canals of the tooth.
In the anterior tooth, it is single and the posterior tooth it
is multiple.
The radicular portion of the pulp is continous with the
periapical tissues.
It is fibrous and protects the neurovascular bundle.
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12. APICAL FORAMEN
It forms the portal of entry & exit of the pulp tissue.
Mean size :
maxillary teeth - 0.4mm.
mandibular teeth - 0.3mm.
There may be 2 or 3 apical foramen split by cementum
or dentin – APICAL DELTA.
Subject to change in case of migration.
Largest in the palatal root of maxillary teeth
and distal root of mandibular teeth.
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13. PULP – DENTIN COMPLEX
The dentinal tubules composed of dentinal fluid & the processes
of the odontoblasts that respond to noxious stimulus together
constitute the P-D complex.
The length of the odontoblasts in the tubules – 0.1 – 1mm.
There is outflow or inflow of the dentinal fluid due to the stimulus
that excites the Od. Processes.
Hypersensitivity is well explained by
Hydrodynamic theory.
Processes have paracrine regulation
With the nerve endings in the tubules
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there by causing pain.
14. INNERVATION OF PULP
AFFERENT FIBRES AUTONOMIC FIBRES
SYMPATHETIC FIBRES
(Sensory) ( Neurogenic modulation Of
(appear with blood vessels
microcirculation-dentinogenesis)
at the time of devpt.)
Adrenergic & cholinergic fibres: regulate dentinogenesis.
Neuropeptides.
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16. 68.jpg
A fibres C fibres
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Saltatory conduction
17. FEATURES OF A & C FIBRES
A-beta fibres innervate the dentin & dentin-pulp border , most sensitive
fibres to hydrodynamic stimulation of dentin.
25% - 50% are A-delta fibres ,contain CGRP.They Innervate dentin,
predentin,Od.layer, concentrated in pulp horn.
A paracrine signaling mechanism exists between A-delta fibres and
odontoblastic processes.
C fibres are polymodal and respond to capsaicin and infl . Mediators
- histamine ,bradykinin.
They express NGF receptors and neuropeptides,they terminate in peripher
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pulp along the blood vessels and are activated by pulpal damage.
18. The nerve bundle from radicular pulp loose their myelin
and branch into smaller bundles, finally ramify into plexus
of single nerve axons – PLEXUS OF RASCHKOW.
Each nerve fibre entering the canal gives about 8 branches
to the plexus.
Many of these fibres pass between the odontoblastic
processes in the dentinal tubule.
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20. NEUROPEPTIDES
They are proteins associated with the terminals of
afferent sensory neurons,sym.fibres,Para sym fibres.
CGRP (calcitonin gene related peptide)
Neuropeptide K
Substance P
Neuropeptide Y,Neurokinin A
VIP (Vasoactive intestinal polypeptide)
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21. FUNCTIONS
Increased production of NP – in initiating and propagating
pulpal inflammation.
Maintain pulpal pressure by vasodilatation and constriction.
Stimulate lymphocytes.
Regulate the growth of connective tissue.
Stimulate leukochemotaxis.
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23. COLLAGEN
Major constituent of all connective tissue.
Characterised by the presence of triple helical domain
formed by an assembly of three polypeptide chains.
Collagen fibres are made up of fibrils in which the
collagen molecules are arranged in a highly organised
structure.
Synthesized by fibroblasts in pulp and odontoblasts in
dentin – pulp complex.
The fibrils display striation at intervals of 67 nm –
characteristic of collagen fibrils.
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24. Collagen fibres are inelastic but have high tensile
strength.
About 19 types of collagen from 30 genes has been
identified.
Type I and Type III are predominantly found in pulp.
Type V and VI are also present.
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25. COLLAGEN IN PULP
TYPE I
Present as thick striated fibrils.
Responsible for pulp architecture.
TYPE III
Thinner fibrils, mainly distributed in cell free and cell rich
zone.
Contributes to the elasticity of the pulp.
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26. TYPE IV
Present along the basement membrane of blood vessels.
TYPE V & VI
Form a dense meshwork in the form of a thin fibril in the entire
stroma of the pulp.
Collagen fibres arising from the pulp passing spirally between
odontoblasts, enter the predentin - KORFF FIBRES.
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27. ELASTIN
Formed in bundles of thin microfibrils called Oxytalan
fibres.
Elastin is then deposited between Oxytalan fibres to
form elastic fibres.
They are joined to form a random coil like structure
that expands & contracts.
Always associated with larger blood vessels.
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28. FIBRINONECTIN
A glycoprotein seen around the blood vessels.
Regulates the migration and differentiation of
secondary odontoblasts.
Helps in the migration of cells in the wound healing of
connective tissue of pulp.
Helps to maintain cell morphology and tight seal of
the odontoblasts with the ECM.
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29. GROUND SUBSTANCE
PROTEOGLYCANS
Central protein core with side chains of GAG and
they are hydrophilic.
They carry –ve charge and prevent diffusion of larger
molecules.
GLYCOSAMINOGLYCANS
They are long unbranched polymers of repeating
disaccharides units.
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Four main types are seen in pulp.
30. ROLE IN PULP
The ground substance show affinity for collagen and
influence fibrinogenesis.
Regulate tissue organisation and help in
mineralisation.
Play a major role in dentinogenesis.
Maintain the polarity of the odontoblasts.
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31. MORPHOLOGIC ZONES OF PULP
ODONTOBLAST LAYER
CELL POOR ZONE ( WEIL’S ZONE)
CELL RICH ZONE
PULP PROPER
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34. ODONTOBLAST LAYER
It outermost stratum of pulp,located subadjacent to
predentin.
Contain cellbodies of odontoblasts, capillaries, nerve
fibres & dentritic cells
Shape : coronal portion- tall columnar.
mid portion - cuboidal.
near apical foramen - flattened.
Because in the radicular portion , there are fewer
dentinal tubules compared with the coronal part, so the
odontoblasts cells spread out laterally.
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35. CELL POOR ZONE ( weil’s zone)
Layer subadjacent to odontoblast layer.
40µ wide and relatively free of cells.
Traversed by blood vessels, unmyelinated
nerves and cytoplasmic process of fibroblasts.
Relatively diminished in younger and older
pulps.
PLEXUS OF RASHKOW is seen
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36. CELL RICH ZONE
Composed of fibroblasts, macrophages, dentritic
cells, lymphocytes.
Layer subadjacent to cell poor zone.
Zone formed due to migration of cells from pulp
proper.
Prominent in coronal pulp.
Mitosis is seen when dead odontoblasts are
replaced.
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37. PULP PROPER
Form the central mass of pulp
Contain larger blood vessels & nerves
Fibroblasts are the only connective tissue cells
in this zone.
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39. ODONTOBLASTS
Odontoblasts are highly differentiated which derived from
neural crest cells.
40μ tall and 5-7μ wide.
The shape of the odontoblasts depends on the density of
the dentinal tubules.
They have a polarised nucleus, RER, golgi apparatus
and secretory vesicles.
There is decrease in the no of cell organelles after primary
and secondary dentin formation.
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40. Quiescent odontoblasts are shorter and
Contain autophagic vacuoles. These
vacuoles mediate a reduction in the
no of cell organelles.
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41. JUNCTIONAL COMPLEXES
Neighbouring odontoblasts exhibit a series of junctional
complexes.
They promote cell to cell adhesion and play a role in
maintaining the polarity of the odontoblasts.
Junctional complexes include
Zonula adherens - desmosomes
Nexuses - gap junctions
Zonula occludens - tight junctions.
Spot desmosomes present in the apical part join the cells
together. www.indiandentalacademy.com
42. Tight junctions seen in
the apical part are
responsible for
permeability between
predentin & pulp.
Gap junctions provide
low resistance pathway
for the passage of
electric signals.
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43. ODONOTBLASTIC PROCESSES
Direct extension of cell bodies into the tubules.
Has a well developed cytoskeleton with macro tubules and
microtubules ,no cell organelles present.
Diameter – 3 – 4 microns.
Composed of protein – vimentin, tubulin, actin.
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44. UNDIFFERENTIATED MESENCHYMAL CELLS
TOTIPOTENT CELLS – the cells that have the ability
to form any kind of tissue. Usually formed – 4 days of
fertilization.
PLURIPOTENT STEM CELLS are the cells which are
capable of developing into any type of germ layer.
The UMC in the cell rich zone adjacent to the
odontoblasts are called as PROGENITORS.
The mesenchymal cells are distributed throughout the
pulp, the maximum is in the perivascular area.
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45. Large polyhedral cells with a large nucleus and high
nucleus : cytoplasmic ratio.
May differentiate into either fibroblasts or odontoblasts
depending on the stimulus.
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46. FIBROBLAST
Numerous in cell rich zone
Tissue specific cells that are capable of giving rise to
cells that are committed to differentiation.
Synthesize type I,type III collagen & PEG’s ,GAG.
Form and maintain the pulp matrix.
The activity preceding the differentiation of
replacement odontoblasts appears to occur primarily
among fibroblasts.
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47. MACROPHAGES (Histiocytes)
Constituents of mononuclear phagocyte system
derived from bone marrow.
Majority of macrophages are involved in endocytosis
& phagocytosis.
Act as scavengers, removing RBC dead cells &
foreign bodies.
Also participate in immune reactions.
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48. DENTRITIC CELLS (antigen presenting cells)
accessory cells of immune system.
present subadjacent to odontoblastic layer.
Characterised by dentritic cytoplasmic process and
the presence of cell surface class II MHC antigens.
MAST CELLS
Widely distributed in connective tissue where they
occur in small groups in relation to blood vessels.
seen only www.indiandentalacademy.com
in inflammatory pulps.
Granules contain heparin & histamine.
49. LYMPHOCYTES
T lymphocytes are scattered along the blood vessels
in the pulp proper.
Take part in the initial defense of the pulp.
B lymphocytes are rarely found.
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51. BRANCHING NETWORK
Arterioles(50μ)
Terminal arterioles
Pre capillaries
Meta arterioles
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capillaries(8μ)
52. ARTERIOLES
Branching point of terminal arteriole & capillaries are
Characterised by the presence of clumps of smooth
muscles – precapillary sphincters.
Pulpal inflammation elicits a localised circulatory
response restricted to the area of inflammation.
Under neuronal and local cellular control it regulate
local blood flow through a capillary bed.
Arteriolar pressure- 43mm Hg.
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54. CAPILLARIES
Function as exchange vessels regulating the transport or
diffusion of substances between blood and local interstitial
tissue elements.
Consists of single layer of endothelium surrounded by
basement membrane.
Capillary is 0.5μ thick and it acts as semi permeable
membrane
Capillary pressure — 35 mm Hg.
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55. Types
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.
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56. VENULES
Collecting venules receive pulpal blood flow from
capillary bed and transfer it to venules.
AVA shunt permits the regional control of blood
flow from capillary to venules.
Venular pressure – 19 mm hg
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57. LYMPHATIC VESSELS
Lymphatic vessels are formed from a fine meshwork of
small ,thin walled lymph capillaries.
They start as blind openings near the weil’s zone.
Carries the tissue fluids back to the vascular system.
Reduces interstitial colloidal osmotic pressure and
regulates the devpt. Of edema.
They provide immunosurvilence by transporting
antigens to the nodal collections of immune cells.
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60. METABOLIC
Pulp has a lower basal metabolic rate.
in metabolic activity such as dentinogenesis causes
localised in pulpal blood flow.
Not a major regulatory mechanism for the entire pulp.
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61. NEURONAL
SYMPATHETIC NERVES
The distribution of sympathetic fibres is highest in blood
vessels in the pulp horns and lowest in apical region.
Activation of SNS Neurotransmitters
Epinephrine
Local release of Nor epinephrine
Neurotransmitters Neuropeptide Y
Pulpal blood flow – 80%
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63. PEPTIDERGIC AFFERENT FIBRES
Sensory fibres( A & C ) also have afferent action by
releasing neuropeptides.
These include
Substance P.
Calcitonin gene related peptide(CGRP).
Neurokinin A.
Released from C fibres and Aδ fibres.
Cause vasodilation and increases blood flow.
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64. PARACRINE / ENDOCRINAL REGULATION
Endocrinal regulation is through circulating hormones
adrenalin and nor adrenalin.
C afferent fibres play a major role in mediating pulpal
inflammation.
Paracrine regulation is through
Bradykinin
Prostaglandin
Histamine.
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67. THERMAL TESTS
HEAT TEST COLD TEST
Isolated Ice sticks, CO2 snow.
Gutta percha,hot water -77.7 degrees
65 degrees
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68. RESPONSE TO THERMAL TESTS
RESPONSE INFERENCE
No response. Non vital or false +ve
result.
Mild to moderate response that Healthy pulp.
subsides with in 1-2 seconds after the
removal of the stimulus.
Strong,momentary painful response Reversible pulpitis.
that subsides within 1-2 seconds after
the stimulus is removed.
Moderate to strong painful response Irreversible pulpitis.
that subsides after several seconds of
the removal of stimuli.
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69. ELECTRIC PULP TESTER
Designed to stimulate a response of the sensory fibres(A
delta) within the pulp by electric stimulation.
It does not provide any information of the vascular
integrity of the pulp.
Not reliable in young permanent teeth.
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70. TEST CAVITY
Involves the slow removal of enamel and dentin without
anaesthesia with a small round bur.
ANAESTHESIA TEST
In case of pain of vague origin, LA is given in blocks or
infiltrations in order to localise the symptomatic tooth.
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71. PULSE OXIMETRY
Used for recording blood oxygen saturation levels
during the administration of intravenous
anaesthesia.
May be able to detect pulpal inflammation or partial
necrosis in teeth that are still vital.
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72. LASER DOPPLER FLOWMETRY
Uses a laser beam of known wavelength that is directed
through the crown of the tooth to the blood vessels in the
pulp.
Moving RBC cause some of the laser beam to be
reflected and this is detected by the photocell on the tooth
surface.
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73. PATHOSIS OF PULP
REVERSIBLE PULPITIS
The pulp is stimulated to the extent that
thermal stimulus usually cold cause a quick,sharper
response that subsides as soon as the stimulus is
removed.
IRREVERSIBLE PULPITIS
The pulp is stimulated chronically by noxious
stimulus so that it causes permanent changes in the
pulp that are irreversible.
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74. CHRONIC HYPERPLASTIC PULPITIS (PULP POLYP):
An asymptomatic irreversible inflammatory condition.
Characterised by a reddish cauliflower like growth due to
chronic irritation (caries exposure) to the vascular tissue
of the pulp.
More prevalence in young people.
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75. RESORPTION
A condition associated with either a physiologic or a
pathologic process resulting in the loss of cementum
dentin or bone .
INTERNAL EXTERNAL
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76. INTERNAL RESORPTION (asymptomatic irreversible pulpitis)
Rare in permanent teeth.
Characterised by oval shaped enlarged enlargement of RC
space
Presence of chronic inflammatory cells.
Commonly diagnosed only in radiograph showing internal
expansion of pulp with dentinal destruction.
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77. EXTERNAL RESORPTION (inflammatory)
The inflammatory stimulators in the pulp space, diffuse
through the dentinal tubules and stimulate an inflammatory
response over large areas of periodontal ligament.
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78. IN THE RADIOGRAPH
INTERNAL EXTERNAL ( infl.)
RESORPTION RESORPTION
Margins are smooth. Margins are rough.
Symmetrical Asymmetrical
The rel.ship of the canal The canal shifts with
is unaltered regardless respect to
of change in angulation change in angulation
Outline of the canal is RC appears normal &
altered. running through the
defect is seen
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79. NECROSIS
A histologic condition resulting from an untreated
irreversible pulpitis, traumatic injury or long term
interruption of blood supply.
TOTAL NECROSIS will be symptomatic only it affects
the periodontal ligament.
PARTIAL NECROSIS is difficult to diagnose because it
produces some of the symptoms associated with the
irreversible pulpitis.
The bacterial toxins pass through the apical foramen
resulting in an inflammatory reaction in the periodontal
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ligament.
80. ACHIEVING ANAESTHESIA
Pain during access cavity preparation in a vital tooth
can be managed by administering intrapulpal
injection.
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81. IPI require a bulk of vital tissue to transport
throughout the canals. It must be administered in the
roof of the chamber with a 25 or 26 gauge needle
before any tissue is extirpated. In molars, the solution
is deposited in largest canal.
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83. INDUCTIVE
Induces epithelial differentiation into enamel organ
& dental papilla.
Induces enamel organ to differentiate into a
particular type of tooth.
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84. FORMATIVE
Pulp induces dentin formation that surrounds & protects
the pulp.
This involves formation of primary & secondary dentin.
The primary dentin is tubular & regularly arranged. It is
formed before root closure.
Secondary dentin contain fewer tubules & is formed after
root closure.
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85. NUTRITIVE
Dental pulp maintains the vitality of dentin by providing
O2 & nutrients to the odontoblasts.
Also provides continous source of dentinal fluid.
Nutrition made possible by rich peripheral capillary
network.
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86. PROTECTIVE
Pulp helps in recognition of stimuli like heat, cold,
pressure, chemicals by way of sensory nerve fibres
.
Motor innervation controls the muscular wall of blood
vessels. This regulates the blood volume & rate of blood
flow and hence the intrapulpal pressure.
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87. DEFENSIVE
When irritated or injured pulp will respond by
Dentinal pain
Tubular sclerosis
Irritation dentin formation
Inflammation of connective tissue.
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89. DEVELOPMENTAL
TAURODONTISM
More frequently in molars
Longer crowns and shorter RC system.
Great difficulty in locating canal orifices during
endodontic treatment and may also be associated with
additional root canals.
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90. ANATOMY
DECIDUOUS TEETH
Pulp chambers are larger and pulp horns are at a
higher level.
Roots are long and have slender root canals.
Resorption starts soon after root completion.
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91. PERMANENT TEETH
The mesio distal view of the root canal is only seen in
the radiograph.The bucco lingual anatomy must also be
considered.
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92. Presence of lateral and accessory canals may
cause failure of endodontic treatment.
Periodontal pocket in a tooth with accessory canals
may lead to influx of microorganisms to the pulp
through the accessory foramens.
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93. APICAL FORAMEN
According to schilder’s ,
Apical foramen must be kept as small as practical.
Must never be transported.
PULPECTOMY
The greatest concentration of collagen is in its apical region
than the coronal.so engaging the pulp with a broach
apically helps to remove the pulp tissue in a singe piece
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than placing it coronally.
94. CALCIFICATIONS
It’s a common occurrence of 50% of all teeth.
Size may range from microscopic particle to
Stones that may occlude the pulp chamber.
composed of carbonated hydoxy appatite crystals.
Pulp calcifications :
Pulp stones.
Diffuse calcifications.
Calcific metamorphosis.
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95. PULP STONES
TRUE DENTICLE FALSE DENTICLE
Round or ovoid with Rough and have no
smooth surfaces and particular shape.
concentric lamellae.
By addition of collagen to By mineralisation of
their surfaces. collagen fibres.
The remnants of HERS Cause may be
induce differentiation of degenerating cells,blood
odontoblast during thrombi & collagen fibrils.
formation.
Contain dentinal tubules & Usually in the pulp
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are found in the root apex. chamber.
97. DIFFUSE CALCIFICATIONS
They appear as irregular deposits in the pulp.
The pulp organ may be free of any pathology but may
exhibit these changes in the roots.
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98. CALCIFIC METAMORPHOSIS
Results in partial or complete obliteration of pulp chamber.
Luxation of the teeth as a result of trauma is the major
cause.
Teeth may present with a yellowish hue.
Resembles cementum or bone along the walls.
Disruption of blood flow leads to pulpal infarct and the cells
from periodontium proliferates and replaces the infarct
tissue.
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99. AGE CHANGES
Formation of SECONDARY DENTIN throughout life causes
reduction in size of the pulp chamber and root canals.
The ‘drop in’ feel of the bur is not felt in older teeth.
ODONTOBLAST decrease in size and number and
sometimes disappear in certain areas .
Increase in the number and thickness of COLLAGEN
FIBRES particularly in radicular pulp.
Decrease in cellularity.
Increase in the resistance of pulp against action of
enzymes.
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100. DENTAL MATERIALS
AMALGAM
High thermal conductivity,irritates pulp in deeper cavities.
Needs an insulating base.
GLASS IONOMERS
Biocompatible to pulp.
RMGIC can used as pulp capping agent.
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101. ZINC OXIDE EUGENOL
Has an antibacterial and anodyne effect.
Higher concentration leads to chronic inflammation &
thrombosis of blood vessels.
ZINC PHOSPHATE
Irritates the pulp (low ph) in deeper cavities.
Must be used with a liner.
DENTING BONDING AGENTS
Monomer www.indiandentalacademy.com
molecules present cause irritation of pulp when
they come in contact with odontoblastic processes.
102. RESIN BASED ADHESIVES
The formation of hybrid layer secures the enamel - resin
interface with a continous seal that acts as biometic barrier.
FORMOCRESOL
High degree of diffusion causes a chronic inflammation of
pulp.
Mutagenic and carcinogenic.
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103. Pulp capping agent
CALCUIM HYDROXIDE
Intracanal medicament
PULP CAPPING AGENT
Introduced by Hermann in 1930.
When it is applied directly over pulp, coagulative necrosis
occurs in the adjacent tissue and inflammation of contigious
tissue.
It maintains a local state of alkalinity that is necessary for
dentin formation.
Beneath the region of coagulative necrosis, UEM cells
differentiate into odontoblasts dentin formation occurs.
Available as Dycal, Prisma VLC, Life, Nucap.
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104. The root canal system is very complex and also
subjected to a number of variations.so understanding the
form, physiology, and function of pulp is necessary in the
selection of treatment and the type of material to be
used.
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