Husain Keylani R1 endo board Dentin-pulp complex ? E mbryologically, histologically and functionally; dentin and pulp should be considered the same.

Structure and Functions of the Dentin-Pulp Complex

Husain KeylaniR1 endo board

Dentin-pulp complex ?

Embryologically, histologically and functionally; dentin and pulp should be considered the same. This entity is exemplified by the classic functions of the pulp.

The transition to pulp occurs with the initiation of dentin formation.

The pulp

The pulp incompressible, the total volume within the pulp chamber cannot be greatly increased.

Thus Inflammatory reaction results in an increase in pulp tissue pressure instead of volume.

(Heyeraas et al,1992)

DevelopmentThe Primary oral

cavity or stomodeum (lined with ectoderm )is a depression between the brain and the pericardium in an embryo,

It is separated from the upper end of the foregut by (bucco-pharyngeal membrane ,27 days)

stomodeumbucco-pharyngeal membrane

Mid-brain

pericardium

Development Most of the C.T. cells underlying the oral ectoderm are

neural crest cells or ectomesenchyme in origin

Development Neural crest travel down the sides of the head into the

maxilla and mandible to form the tooth germ

DevelopmentDuring sixth week ,tooth formation begin as

localized proliferation of ectoderm to form two horseshoe-shaped structures called primary epithelial band or primary dental laminae which split into

vestibular & dental lamina Oral vestibule Dental organ

&

Stage of development

Formation of the teeth is a continuous process has been divided in to three stages:

(1bud stage

)2 Cap stage

)3 bell stage

Cont.

1-The bud stage: the initial stage ,

dental lamina proliferate

to the adjacent ectomesenchyme

Cont.

2- Cap stage : the dental lamina cont. proliferate- aconcavity.

The outer cellscuboidal and constitute the

outer enamel epithelium . The inner cells elongated and represented

the inner enamel epithelium .

Between them is network

of cells termed (the stellate reticulum)

Cont.

3-bell stage (18):The last period of growth

is also known as histodifferentiation

In the cervical loop where the outer and the inner enamel epithelia are joined continue to proliferate.

The tooth development enters the bell stage

During (BV) become established in the dental papilla

A tooth germ consists of 3 parts:

form Origin tooth germ

enamel ectoderm A-Enamel organ

dentin and pulp. ectomesenchyme B- Dental papilla

cementum, PDL, and alveolar bone.

ectomesenchyme C-dental sac =tooth follicle

Cell differentiation mechanisms

Embryonic development of any tissue is prompted by interaction with an adjacent tissue.

Complex epithelial and mesenchymal interactions occur which direct the ameloblasts and odontoblasts diff. by changes in gene expression.

Cont.Epithelial- ectomesenchymal inductive

interaction during normal odontogenesis lead to :

1 -Cytodifferentiation of dentin and enamel forming

cells. 2-dental hard tissue formation

Mechanisms of interaction

A: cell-to-cell interaction 1-Direct cell-to-cell contact. 2-The transmission of

molecules synthesized and secreted by one cell and then captured by surface receptors of another cells.

CAMs(cell adhesion molecule )mediate morphogenesis. through contrall cell proliferation

Cell contian membrane protein called (integrin)receptor for CAMs.

integrin CAMs

Cont…

B:Cell-to-ECM interaction.Carry by substrate adhesion molecule

(SAMs) the best study of the ECM are fibronectins.

G.factors are polypeptides produced by cells that initiate proliferation, migration and diff. of a variety of cells.

Cont… Dental basement membrane: It exists between IDE(inner dental epithelium

and the underneath dental mesenchyme It consist of (thin basal lamina & layer of ECM)

Cont… Dental basement membrane: It exists between IDE(inner dental epithelium

and the underneath dental mesenchyme It consist of (thin basal lamina & layer of ECM)

BL is compsed of type IV collagen (as areceptors) which

has binding sites for other BM consituents. (like laminin ,fibrinoctin ,proteoglycan) Laminin is the CAM in the basement membrane

Cont…

Odontoblast cell surface proteoglycans act as receptors for matrix molecules .signals from matrix components influence migration and diff. of odontoblasts.

Differentiation of Odontoblasts

occurs during the bell stage.

Preameloblasts diff. at a faster rate than odontoblasts, but dentin matrix is formed before enamel matrix.

There is still mitotic activity among the relatively immature cells of the inner enamel epithelium., mitotic activity ceases and the cells elongate.

Cont.Differentiation of Odontoblasts

With the onset of differentiation a single layer of cell(preodontoblasts) align themselves along the basement membrane separating the inner enamel epithelium from the dental papilla.

PO

BMDP

IEE

Cont.Differentiation of Odontoblasts

These cells stop dividing and elongate into short columnar cells with basally situated nuclei

Several cytoplasmic projections from each of these cells extend toward the basal lamina.

Cont.Differentiation of Odontoblasts

As the odontoblasts continue to differentiate, they become progressively more elongated

And cytoplasmic processes from these cells extend through the BM toward the basal lamina, and more and more collagen fibrils appear within the ECM .

Cont.Differentiation of Odontoblasts

More odontoblastic diff elongation with characteristic of protein-secreting cells more collagen fibrils appear in the ECM and more defined large odontoblastic process toward BL.

Cont.Differentiation of Odontoblasts

The odontoblasts reach full maturity and become tall columnar cells

Production of the initial dentin matrix involves the formation, organization, and maturation of collagen fibrils and proteoglycans.

As more collagen fibrils accumulate subjacent to the basal lamina,(The lamina becomes discontinuous and eventually disappears. )

Cont.Differentiation of Odontoblasts

The odontoblasts reach full maturity and become tall columnar cells

Production of the initial dentin matrix involves the formation, organization, and maturation of collagen fibrils and proteoglycans.

As more collagen fibrils accumulate subjacent to the basal lamina,(The lamina becomes discontinuous and eventually disappears. )

Some of Odon. processes extend toward the ameloblasts

Some of these become interposed between the processes of ameloblasts, resulting in the formation of enamel spindles

Cont.Differentiation of Odontoblasts

At the onset of dentinogenesis the dental papilla becomes the dental pulp

As predentin matrix is formed, the odontoblasts commence to move toward the central pulp, depositing matrix.

Within this matrix a process from each odontoblast becomes accentuated and remains to form the primary odontoblast process.

It is around these processes that the dentinal tubules are formed.

Root

Develop after completion of enamel formation.

Proliferateion (inner and outer enamel epithelia) ,

and form a structure known as the Hertwig epithelial root sheath (HERS)

(HERS )determine the size and shape of root of

the tooth.

Root

The first layer of the dentin matrix mineralizes gap appear in the root sheath allowing mesenchymal cells from the dental sac to move into contact with the newly formed dentine .

These cells then differntiation into cementoblast and deposit cementum matrix on the root dentine.

tooth development.flv

Epithelial Rests of Malassez

Persistant of epithelial cells of the root sheath in the PDL after tooth development.

Some of them retain & under go division

Later produce periapical cyst.

(Trowbridge,1967)

Accessory CanalsDuring root formation:

a break develops in the continuity of the sheath , producing a small gap ,dentinogenesis does not take place opposite the defect.

The result is small “accessory “ canal between the dental sac and the pulp.

If periodontal tissue lose their integrity , m/o go pulp

Cont.

DENTINComposition of fully mature dentin :

INORGANIC MATERIAL

ORGANIC MALTERIAL

WATER

70%

Hydroxyapatite

20%~91%(collagen) I,V.

~9%(non-collagen)

*phosphoproteins

*proteoglycans

*Gla proteins

*acidic glycoproteins

*Gr. Factors+lipids

10%

Types of the dentin

1-Developmental dentin : is forms during tooth developmet &classified as: A-orthodentin: - the tubular form of dentin

Cont. Types of the dentinB-mantle dentin -is the first formed dentin and is situated

immediately subjacent to the enamel or cementum. -( 150μm, less mineralized and softer). (Herr P et al,1986)

Cont. Types of the dentin

C-Circumpulpal dentin : - it constitutes the major part

of developmental dentin. - oriented at right angles to the long axis of the dentinal

tubules. -500nm in diameter

Cont. Types of the dentin

2-Secondary dentin: -Regular dentin which forms phisiologically after

the root is fully developed.A-Primary physiological dentin

B-Secondary physiological dentin

Cont. Types of the dentin

3-Tertiary dentin: -Irregular dentin forms in response to abnormal

stimuli Reparative D filling Reactionary D irritant

Predentin

*Is unmineralized organic matrix of dentin between the odontoblast layer and the mineralized dentin

type I , II collagens.Noncollagenous

elements (proteoglycans, Phosphophoryn)

growth factors (Roberts-Clark D,2000)

Dentin

Predentin

Odontoblasts

Pulp cells

Mineralization .ACaph.accomu. In vesicle (prd) grow

.B Rupsure release mix

.C the mix adjoin to form advance crystl merge to form small globules

.DThe globule expand and fuse with other untill become mineraized

E. Cont. in growing and increase mineral content.

Mineralization

A B

C D

E

Cont.Mineralization

Mineralized dentin

Mineralization front

Predentin

Odontoblasts

Dentinal tubules

Dentinal tubules occupy from 1% )superficial dentin( to 30% )deep dentin( of the volume of

intact dentin .

)Garberoglio,Brannstrom 1976(

It slightly tapered , wider portion toward the pulp.(no pretubular d)

Garberoglio R, Brännström M: 1976 .  Number of Tubules (1000/mm2) Tubule Diameter (μm)

DISTANCE FROM PULP (mm) MEAN RANGE MEAN RANGE

Pulpal wall 45 30-52 2.5 2.0-3.2

0.1-0.5 43 22-59 1.9 1.0-2.3

0.6-1.0 38 16-47 1.6 1.0-1.6

1.1-1.5 35 21-47 1.2 0.9-1.5

1.6-2.0 30 12-47 1.1 0.8-1.6

2.1-2.5 23 11-36 0.9 0.6-1.3

2.6-3.0 20 7-40 0.8 0.5-1.4

3.1-3.5 19 10-25 0.8 0.5-1.2

Cont.Dentinal tubules

S shape DEJ- pulp. b/c (crowding of

odontoblasts) It converge ? the surface

of the pulp chamber has a much smaller area than the surface of dentin along the DEJ.

This results in a progressive increase in dentin permeability

Coronal dentin

Cont.Dentinal tubules

Near the DEJ the dentinal tubules ramify into one or more terminal branches.

Peritubular and intertubular dentin

Peritubular Dentin: is dentin lining the tubule , whereas that between the tubules is known as intertubular dentin

minir+hard< collagn

Dentinal Sclerosis

Partial or complete obturation of dentinal tubules. as result of aging or develop in response to stimuli such as attrition or caries

It helps the pulp from irritation

Cont.Dentinal Sclerosis It is either: Physiologic: acceleration of peritubular

dentin formation in the apical third of the root.

Pathologic: Dentinal tubules are blocked by hydroxyapatite and whitlockite crystals )carious dentin, attrited dentin(

Cont.Dentinal Sclerosis

If dentin is damaged the odontoblastic processes die leaving empty dentinal tubules which form areas of dead tracts (A).

Dead tracts become filled with mineral and are called blind tracts (B).

The dentin of blind tracts is known as sclerotic dentin.

Interglobular Dentin Refer to organic

matrix that remains unmineralized. This occurs most often

in the circumpulpal dentin just below the mantle dentin.

Vit D-resistant rickets, hypophosphatasia

Inter-globuler dentin

Dentinal Fluid

volume: 1% of superficial dentin , about 22% of

the total of deep dentin.

Cont.Dentinal FluidOutward movement of fluid is blocked

peripherally by enamel or cementum.In case of d.tubules exposureoutward

movements to the exposed area is in the form of tiny droplets.

(Itthagarum,2000)

Pressure gradient exists between pulp (14 cm H2O =10.3 mm Hg) and O. cavity that

accounts for the slow outward flow of fluid.

Cont.Dentinal Fluid

Dehydrating ?the dentin can accelerate outward Rapid flow stimulates pulpal nociceptors that innervate DT =dentin sensitivity= dentinal permeability (the hydrodynamic mechanism of dentin sensitivity)

Dental pulp(14 cm H2O / 10.3 mm Hg)

Dentin

Predentin

Odontoblastprocess

Outwardfluid

movement

Ingressof

irritants

Desmosome

Odontoblast

Dentin permeability

Dentinal tubules are the major channels for fluid diffusion across dentin.

Fluid permeation is proportion to tubule diameter and number

The permeation of the radicular dentin <coronal dentin .

Fogel HM et al,1988

deep cavity vs shallow

Cont.Dentin permeability

The functional or physiologic diameter of the tubules is only about 5% to 10% of the anatomic diameter.

bc(od process+collagen fiber )

(Michelich et al,1978)

It is small enough to remove bacteria from dentinal fluid permitting sterile fluid to enter the pulp chamber

(Michelich et al,1980)

Cont.Dentin permeability The smear layer is capable of physically preventing

bacteria from penetrating dentin.

(Michelich et al,1980)

In nonvital teeth bacterial invasion of dentinal

tubules occurred more rapidly. ( Due to no permeability) (Nagaoka et al,1995)

But in vital pulps. increa .permeab +antibodies in dentinal fluid. (Hahn et al,1997)

Dentin sclerosis beneath a carious lesion reduce the permeation by obstruction the tubules

(Pashley,1990);(Tagami et al,1992)

Cont.Dentin permeability

The cutting during cavity preparation or

root canal theory

smear layer

by acid etching or EDTA

increases the permeability of the

dentin

incidence of pulpal inflammation may be

increased

MECHANICAL PROPERTIES OF ROOT DENTIN

Endodontically treated teeth showed only a 14% reduction in dentin toughness compared with vital dentin (Carter et al,1983)

Endodontic therapy was shown not to change the

Vickers hardness of human root dentin. (Lewinstein et al,1981)

MECHANICAL PROPERTIES OF ROOT DENTIN

Much of the increased incidence of tooth fractures of endodontically treated teeth can be attributed to:

1 -The loss of tooth structure access opening

(Howe et al,1990)

2-Physical weakening of roots by post spaces. (Isidor et al,1996)

MECHANICAL PROPERTIES OF ROOT DENTIN

Age,dehydration and fatigue crack growth in dentin: -old pts has a much shorter fatigue life than dentin from young teeth -it increase incidence of root fractures of RCT actually reflect reduction in the fracture toughness

of old dentin. (Arola D,2004)

MECHANICAL PROPERTIES OF ROOT DENTIN

Other factorsCollagenolytic activity and gelatinolytic activity

have measured in mineralized dentin powder .

(Pashley et al,2004).

These enzymes may slowly attack the

collagenous matrix of dentin, thereby weakening it over many decades.

MECHANICAL PROPERTIES OF ROOT DENTIN

Other factors

Mineralized dentin surrounding post spaces that had been under function for more than 10 years , the functional stresses may cause microcracking of dentin

( Ferrari M et al,2004)