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INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
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CONTENTS
   Introduction
   Embryology
   Anatomy
   Innervations in pulp
   Pathways of pain
   Structural Organisation
   Cells of Pulp
   Extracellular matrix
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   Microvasculature of pulp
   Vitality tests
   Achieving anaesthesia
   Functions
   Clinical considerations
   conclusion

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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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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.
   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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DENTAL PAPILLA




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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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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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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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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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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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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.
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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CLASSIFICATION




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A fibres                        C fibres



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Saltatory conduction
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.
   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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PATHWAYS OF PAIN




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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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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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PULP – A CONNECTIVE TISSUE
                        ECM




       FIBRILLAR PROTEINS   GROUND SUBSTANCE




COLLAGEN         ELASTIN PROTEOGLYCANS
       FIBRONECTIN               GLYCOSAMINIGLYCANS

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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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   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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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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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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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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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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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.
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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MORPHOLOGIC ZONES OF PULP

   ODONTOBLAST LAYER
   CELL POOR ZONE ( WEIL’S ZONE)
   CELL RICH ZONE
   PULP PROPER




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HISTOLOGICAL FEATURE




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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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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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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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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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CELLS OF THE PULP
   ODONTOBLASTS
   FIBROBLASTS
   UNDIFFERENTIATED CELLS
   MACROPHAGES
   LYMPHOCYTES          IMMUNOCOMPETENT CELLS
   DENTRITIC CELLS
   MAST CELLS



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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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   Quiescent odontoblasts are shorter and
    Contain autophagic vacuoles. These
    vacuoles mediate a reduction in the
    no of cell organelles.




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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
   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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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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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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   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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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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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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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.
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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MICROVASCULATURE IN PULP
 Pulp is extensively vascularised tissue containing
arterioles, venules, lymphatics.
   Maintains tissue homeostasis.


    FUNCTIONS
   Transport.
   Regulation.
   Respond towww.indiandentalacademy.com
               inflammatory stimuli.
   Initiate the immunologic reactions.
BRANCHING NETWORK
   Arterioles(50μ)


  Terminal arterioles


   Pre capillaries



  Meta arterioles

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  capillaries(8μ)
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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TERMINAL
CAPILLARY
NETWORK
CAPILLARY
NETWORK
VENULAR
NETWORK


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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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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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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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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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REGULATION OF PULPAL BLOOD FLOW




METABOLIC           NEURONAL      ENDOCRINAL/
                                  PARACRINAL




SYMPATHETIC     PARASYMPATHETIC    PEPTIDERGIC


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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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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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PARASYMPATHETIC NERVES

    Major neurotransmitters

   Acetyl choline.
   Vasoactive intestinal polypeptide .

   Causes    blood flow.


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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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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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VITALITY TESTS
   Thermal tests :
           Heat tests.
           Cold tests.
   Electric pulp tester.
   Test cavity.
   Anaesthesia test.
   Laser doppler flowmetry.
   Pulse oximetry.
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THERMAL TESTS



        HEAT TEST                   COLD TEST


   Isolated                     Ice sticks, CO2 snow.
   Gutta percha,hot water       -77.7 degrees
   65 degrees


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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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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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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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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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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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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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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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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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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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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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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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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.
ACHIEVING ANAESTHESIA
   Pain during access cavity preparation in a vital tooth
    can be managed by administering intrapulpal
    injection.




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   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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FUNCTIONS OF PULP

   INDUCTIVE
   FORMATIVE
   NUTRITIVE
   PROTECTIVE
   DEFENSIVE




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INDUCTIVE

 Induces epithelial differentiation into enamel organ
& dental papilla.
Induces enamel organ to differentiate into a
particular type of tooth.




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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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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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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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DEFENSIVE

   When irritated or injured pulp will respond by
                   Dentinal pain
                  Tubular sclerosis
                   Irritation dentin formation
                  Inflammation of connective tissue.



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CLINICAL CONSIDERATIONS

   Developmental.
   Anatomical.
   Calcifications.
   Age changes.
   Dental materials.

         www.indiandentalacademy.com
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.



            www.indiandentalacademy.com
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.




           www.indiandentalacademy.com
PERMANENT TEETH
   The mesio distal view of the root canal is only seen in
the radiograph.The bucco lingual anatomy must also be
considered.




               www.indiandentalacademy.com
 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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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
                 www.indiandentalacademy.com
    than placing it coronally.
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.

               www.indiandentalacademy.com
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
         www.indiandentalacademy.com
are found in the root apex. chamber.
www.indiandentalacademy.com
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.




              www.indiandentalacademy.com
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.


                www.indiandentalacademy.com
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.
                www.indiandentalacademy.com
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.

              www.indiandentalacademy.com
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.
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.




             www.indiandentalacademy.com
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.
               www.indiandentalacademy.com
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.




               www.indiandentalacademy.com
REFERENCES

   DENTAL PULP     Seltzers and benders
   .PATHWAYS OF PULP Cohen 6th&8thedition.
   ENDODONTIC PRACTICE Weine 6thedition.
   ORAL HISTOLOGY Tencate 6th edition.
   ORAL HISTOLOGY & EMBRYOLOGY
                           Orban 11th edition.
   ENDODONTICS Ingle 4th edition
           www.indiandentalacademy.com
   LOCAL ANAESTHESIA Stanley f malamed 5thedition
   ENDODONTIC PRACTICE Grossman
   RESTORATIVE MATERIALS Craig
   COLOUR ATLAS OF ENDODONTICS
                         walkher & Goodman 2nd edition

               www.indiandentalacademy.com
THANK YOU FOR
WATCHING




    www.indiandentalacademy.com

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Dental pulp /certified fixed orthodontic courses by Indian dental academy

  • 1. INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  • 2. CONTENTS  Introduction  Embryology  Anatomy  Innervations in pulp  Pathways of pain  Structural Organisation  Cells of Pulp  Extracellular matrix www.indiandentalacademy.com
  • 3. Microvasculature of pulp  Vitality tests  Achieving anaesthesia  Functions  Clinical considerations  conclusion www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 15. CLASSIFICATION www.indiandentalacademy.com
  • 16. 68.jpg A fibres C fibres www.indiandentalacademy.com 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 www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 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) www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 22. PULP – A CONNECTIVE TISSUE ECM FIBRILLAR PROTEINS GROUND SUBSTANCE COLLAGEN ELASTIN PROTEOGLYCANS FIBRONECTIN GLYCOSAMINIGLYCANS www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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.  www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 31. MORPHOLOGIC ZONES OF PULP  ODONTOBLAST LAYER  CELL POOR ZONE ( WEIL’S ZONE)  CELL RICH ZONE  PULP PROPER www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 37. PULP PROPER  Form the central mass of pulp  Contain larger blood vessels & nerves  Fibroblasts are the only connective tissue cells in this zone. www.indiandentalacademy.com
  • 38. CELLS OF THE PULP  ODONTOBLASTS  FIBROBLASTS  UNDIFFERENTIATED CELLS  MACROPHAGES  LYMPHOCYTES IMMUNOCOMPETENT CELLS  DENTRITIC CELLS  MAST CELLS www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 40. Quiescent odontoblasts are shorter and Contain autophagic vacuoles. These vacuoles mediate a reduction in the no of cell organelles. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 45. Large polyhedral cells with a large nucleus and high nucleus : cytoplasmic ratio.  May differentiate into either fibroblasts or odontoblasts depending on the stimulus. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 50. MICROVASCULATURE IN PULP  Pulp is extensively vascularised tissue containing arterioles, venules, lymphatics.  Maintains tissue homeostasis. FUNCTIONS  Transport.  Regulation.  Respond towww.indiandentalacademy.com inflammatory stimuli.  Initiate the immunologic reactions.
  • 51. BRANCHING NETWORK Arterioles(50μ) Terminal arterioles Pre capillaries Meta arterioles www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 59. REGULATION OF PULPAL BLOOD FLOW METABOLIC NEURONAL ENDOCRINAL/ PARACRINAL SYMPATHETIC PARASYMPATHETIC PEPTIDERGIC www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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% www.indiandentalacademy.com
  • 62. PARASYMPATHETIC NERVES Major neurotransmitters  Acetyl choline.  Vasoactive intestinal polypeptide .  Causes blood flow. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 66. VITALITY TESTS  Thermal tests : Heat tests. Cold tests.  Electric pulp tester.  Test cavity.  Anaesthesia test.  Laser doppler flowmetry.  Pulse oximetry. www.indiandentalacademy.com
  • 67. THERMAL TESTS HEAT TEST COLD TEST  Isolated  Ice sticks, CO2 snow.  Gutta percha,hot water  -77.7 degrees  65 degrees www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 75. RESORPTION  A condition associated with either a physiologic or a pathologic process resulting in the loss of cementum dentin or bone . INTERNAL EXTERNAL www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com ligament.
  • 80. ACHIEVING ANAESTHESIA  Pain during access cavity preparation in a vital tooth can be managed by administering intrapulpal injection. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 82. FUNCTIONS OF PULP  INDUCTIVE  FORMATIVE  NUTRITIVE  PROTECTIVE  DEFENSIVE www.indiandentalacademy.com
  • 83. INDUCTIVE  Induces epithelial differentiation into enamel organ & dental papilla. Induces enamel organ to differentiate into a particular type of tooth. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 87. DEFENSIVE  When irritated or injured pulp will respond by Dentinal pain Tubular sclerosis Irritation dentin formation Inflammation of connective tissue. www.indiandentalacademy.com
  • 88. CLINICAL CONSIDERATIONS  Developmental.  Anatomical.  Calcifications.  Age changes.  Dental materials. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 105. REFERENCES  DENTAL PULP Seltzers and benders  .PATHWAYS OF PULP Cohen 6th&8thedition.  ENDODONTIC PRACTICE Weine 6thedition.  ORAL HISTOLOGY Tencate 6th edition.  ORAL HISTOLOGY & EMBRYOLOGY Orban 11th edition.  ENDODONTICS Ingle 4th edition www.indiandentalacademy.com
  • 106. LOCAL ANAESTHESIA Stanley f malamed 5thedition  ENDODONTIC PRACTICE Grossman  RESTORATIVE MATERIALS Craig  COLOUR ATLAS OF ENDODONTICS walkher & Goodman 2nd edition www.indiandentalacademy.com
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