Pulp dentin complex /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


INTRODUCTION

DENTIN
PULP
CLINICAL IMPLICATIONS
 INITIAL REACTION TO TOOTH PREPARATION

 PULPAL INFLAMMATION AND ITS SEQUELAE
 DENTAL CARIES
 REACTION TO RESTORATIVE MATERIALS
REFERENCES
CONCLUSION


INTRODUCTION


 DENTIN IS THE HARD TISSUE PORTION OF THE
PULP – DENTIN COMPLEX & FORMS BULK OF THE TOOTH .
 PHYSICALLY DENTIN HAS AN ELASTIC QUALITY WHICH IS
IMPORTANT FOR PROPER FUNCTIONING OF THE TOOTH
BECAUSE IT PROVIDES FLEXIBILITY & PREVENTS
FRACTURE OF OVERLYING BRITTLE ENAMEL.


 INORGANIC 70 %

 ORGANIC
 WATER

20 %

10 %


 MANTLE DENTIN & CIRCUMPULPAL DENTIN

 IT IS DEPOSITED FIRST AT THE DEJ &
EXTENDS APPROXIMATELY FROM THE JUNCTON
PULPWARD TO THE ZONE OF INTERGLOBULAR
DENTIN .

 CIRCUMPULPAL DENTIN DIRECTLY
UNDERLIES MANTLE DENTIN & COMPRISES
THE BULK OF THE TOOTH PRIMARY DENTIN .

 GLOBULAR DENTIN CONTAINS
HYPOMINERALIZED AREAS BETWEEN THE
GLOBULES , TERMED INTERGLOBULARSPACE.




FORMS INTERNALLY TO PRIMARY DENTIN
OF THE CROWN & ROOT .



DEVELOPS AFTER THE CROWN HAS
COME IN TO CLINICAL OCCLUSAL
FUNCTIONS & THE ROOTS ARE NEARLY
COMPLETED .



IN MOLAR TEETH , FOR eg MORE
SECONDARY DENTIN IS DEPOSITED ON THE
ROOF & FLOOR OF CORONAL PULPCHAMBER
THAN ON THE LATERAL WALL .
 THIS LEADS TO PROTECTION OF THE PULP
HORN AS OCCLUSAL FUNCTION OCCURS .


 TERTIARY DENTIN ALSO REFERED TO AS
REACTIVE , REPARATIVE OR IRREGULAR
SECONDARY DENTIN .

 TERTIARY DENTIN RESULT FROM PULPAL
STIMULATION & FROM ONLY AT THE SITE
OF ODONTOBLASTIC ACTIVATION .

 FORMATON DUE TO ATTRITION , ABRASION
CARIES OR RESTORATIVE PROCEDURES .

 THIS DENTIN IS DEPOSITED UNDERLYING
ONLY THOSE STIMULATED AREAS .


O

 TERTIARY APPEARS IRREGULAR WITH SPARSE & TWISTED TUBULES &
POSSIBLE CELL INCLUSION .

 ODONTOBLAST , FIBROBLAS & BLOOD CELLS HAVE BEEN FOUND .

 REPARATIVE DENTIN AT TIMES RESEMBLES BONE MORE THAN DENTIN &
IS THEN TERMED OSTEODENTIN

 ITS ALSO APPEARS COMBINATION OF SEVERAL TYPES .


 BAND OF NEWLY FORMED ,
UNMINERALIZED MATRIX OF DENTIN AT
THE PULPAL BORDER OF THE DENTIN .

 DENTIN FORMS TWO STAGES
1. ORGANIC MATRIX IS

DEPOSITED

2. INORGANIC MINERAL SUBSTANCE IS
ADDED .

 MINERALIZATION OCCUR AT THE
PREDENTIN – DENTIN JUNCTION .

 4 MICROMETER PER DAY AFTER OCCLUSION & FUNCTION . THIS
ABILITY IS REDUCED TO 1.0 TO 1.5MM PER DAY

PRIMARY & SECONDARY DENTIN

 DENTIN IS FORMED BY ODONTOBLAST, SPACE IS
PROVIDED FOR THE LENTHENING PROCESS OF THE
OD THAT MOVES PULPWARD FROM THE
AMELODENTINAL JUNCTION .
 THIS PROCESS BEGINS FORMING BEFORE EITHER
ENAMEL OR DENTINAL MATRIX FORMATION BEGINS .
 THE PROCESS ELONGATED , IT BRANCHES &
SECONDARY PROCESS APPEAR AT THE MAIN
BRANCHES
 THESE CELLS & THEIR PROCESSES GIVES THE
DENTIN VITALITY




THE DENTINAL MATRIX THAT IMMEDIATELY
SURROUNDED THE DENTINAL TUBULES IS
TERMED INTRATUBULAR OR PERITUBULAR
DENTIN

 PD ALSO FOUND IN THE PERIPHERAL
TUBULES OF THE ROOT NEAR THE CEMENTUM
THESE ARE VERY SMALL TUBULES & AREAS
WHERE EXTERNAL STIMULATION MAY PLAY A
ROLE

cf

THE INTERTUBULAR DENTIN IS LOCATED BETWEEN [or] AROUND THE DENTINAL TUBULE.
THIS DENTIN CONSISTS OF TYPE 1 COLLAGEN FIBERS & INORGANIC CRYSTALS OF
HYDROXYAPPATITE .
THE COLLAGEN FIBERS OF THE MATRIX FORM A MESHWORK ORIENTED NEARLY
PERPENDICULAR TO THE INTRATUBULAR DENTIN

 INCREMENTAL

LINE MARKS THE NORMAL RHYTHMIC LINEAR
PATTERN OF DENTIN DEPOSITION DAILY IN AN INWARD &
ROOTWARD DIRECTION & IT RUN AT RIGHT ANGLES TO DENTINAL
TUBULES

 ALTHOUGH DAILY LINES ARE DIFFICULT TO DISTINGUISH , THE
LINES FORMED BY INCREMENTS OVER SEVERAL DAYS POSSIBLY
EVERY 5 DAYS RESULTING IN 20 microns DESCRIBED BY VON
EBNER, THEN IT WAS KNOWN AS INCREMENTAL LINES OF VON
EBNER .

 IN PRENATAL & POST NATAL DENTIN ARE
SEPERATED BY AN ACCENTUATED CONTOUR
LINE KNOWN AS NEONATAL LINE


 A LAYER OF DENTIN IS SEEN UNDERLYING
THE CEMENTUM THAT COVERS THE ROOT IS
KNOWN AS GRANULAR LAYER OF TOMES .

 THE ZONE IS BELIEVED TO BE RESULT OF
COALESCING & LOOPING OF THE TERMINAL
PORTION OF THE DENTINAL TUBULES .

E
S
O

 DEJ ARE ENAMEL SPINDLES & FINE
BRANCHING OF TERMINAL DENTINAL TUBULES
IN THE DENTINE

DT
DEJ
D

 THE ODONTOBLAST PROCESSES EXTEND
TO THE DEJ .


DEAD

TRACT

DENTIN UNDERLYING A RESTORATION . LOSS OF TUBULAR
CONTENTS RESULT IN DEAD TRACT .
DUE TO LOSS OF OD , ATTRITION , CARIES , OD MAY DIE , OPEN
TUBULES & SPACES & BACTERIA MAY MIGRATE . THIS LEADS TO
BLCKISH APPEARANCE .
 BELOW THE DEAD TRACT AREA IN IS SCLEROSED DENTIN ,
WHICH PROTECTS THE PULP FROM BACTERIA .


 THE SYSTEM OF BRANCHING TUBULES INCREASES THE
PERMEABILITY.
 THE ONLY FEATURE THAT PROTECTS THE PULP IS THAT
IT HAS HIGHER OSMATIC PRESSURE THAN THE AREA OF
THE DEJ .

 FLUID

IS CONSTANTLY BEING FORCED OUTWARD BY THIS INCREASED PRESSURE
OF THE PULP .


 DENTAL

PULP IS THE SOFT CONNECTIVE
TISSUE LOCATED IN THE CENTRAL PORTION
OF EACH TOOTH.

 PULP HAS PERIPHERAL ZONE & CENTRAL
ZONE.

 PERIPHERAL ZONE [ODONTOGENIC ZONE ]
CONSISTS OF ODONTOBLAST , CELL-FREE
ZONE &CELL RICH ZONE .

 CENTRAL ZONE - LARGE ARTERIES , VEINS & NERVE TRUNKS THAT ENTER THE
PULP FROM APICAL CANAL & PROCEEDS TO THE CORONAL PULP CHAMBER


ODONTOBLAST

FIBROBLAST


SCHWANN CELLS FORMS THE
MYELIN SHEATH OF THE NERVES &
ARE ASSSOCIATED WITH ALL PULP
NERVES.

ENDOTHELIAL CELLS LINING THE
CAPILLARIES , VEINS ,& ARTERIES OF THE
PULP CAN BE VISUALISED.

OTHER CELLS INCLUDE MACROPHAGES ,
LYMPHOCYTES, ERYTHROCYTES ,
LEUKOCYTES EOSINOPHILS & BASOPHILS
FOUND IN PULP BLOOD VESSELS.

Spare
&
delicate

Cf

diffuse

♠ COLLAGEN ORIGINATES FROM THE PULPAL FIBROBLASTS THROUGH
OUT PULP.BOTH TYPE I & II COLLAGEN HAVE BEEN FOUND IN PULP.
♠ TYPE I - PROBABLY PRODUCED BY ODONTOBLASTS BECAUSE THIS
IS THE TYPE OF COLLAGEN FOUND IN DENTIN.
♠ TYPE II - PROBABLY PRODUCED BY PULP FIBROBLASTS.

♠ GROUND SUBSTANCE IS PRESENT AROUND THE FIBERS WHICH
SERVES AS THE ENVIRONMENT THAT PROVIDE LIFE FOR CELLS IN
THE PULP.

THIN – WALLED ARTERIES & ARTERIOLES
ENTER THE APICAL CANAL & PURSUE A
DIRECT ROUTE UP THE ROOT PULP TO THE
CORONAL AREA.

ULTRA STRUCTURE OF PULP ARTERIOLE .
CENTRAL LUMEN IS SURROUNDED BY
ENDOTHELIAL CELLS FORMS INTIMA LAYER ,
SURROUNDING THE INTIMA IS LAYER OF MUSCLE
CELLS THAT FORMS THE MEDIA.SURROUNDING THE
MEDIA IS EXTERNAL ADVENTITIAL LAYER

MOST PULPAL NERVE ENDINGS ARE IN THE ODONTOGENIC REGION OF
THE PULP HORN . SOME TERMINATE WITH ODONTOBLASTS.
THESE NERVE ENDINGS ARE PERSUMED TO FUNCTION IN PAIN
RECEPTION.


☺ INDUCTIVE .

☺ FORMATIVE .

☺ PROTECTIVE .
☺ NUTRITIVE .
☺ REPARATIVE .


REGRESSIVE CHANGES
 NUMEROUS REGRESSIVE CHANGES IN THE PULP & DENTIN ARE
RELATED TO ENVIRONMENTAL STIMULI & AGING.
 AS THE TOOTH AGES, PULP DECREASES IN SIZE BECAUSE OF
THE CONTINUED DEPOSITION OF THE DENTIN. IN ADDITION, CELL
ACTIVITY IS ALSO REDUCED

PULP STONES

TRUE

FALSE [ CONCENTRIC ]


EMBEDDED

♣

ADEQUATE COOLING OF BUR CUTTING AT HIGH SPEED IS ESSENTIAL TO PREVENT
HISTOLOGIC CHANGES IN DENTIN & INJURY TO UNDERLYING ODONTOBLASTIC REGION
OF THE PULP.
♣ TEMPERATURE INCREASE CAN CAUSE SEVERE INJURY TO PULP , CARE MUST BE
EXERCISED TO ENSURE WATER SPRAY EFFECTIVELY COOLS THE BUR AT THE CUTTING
SURFACE.
♣ SHADOWING EFFECT BY THE TOOTH MAY PREVENT THE WATER SPRAY FROM
REACHING THE BUR.

DEMINERALISED SECTION SHOWING
ODONTOBLASTIC NUCLEI [ON] DISPLACED
IN TO DENTIN AS A RESULT OF CAVITY
PREPARATION WITH INADEQUATE
COOLING OF THE BUR.

ODONTOBLASTIC NUCLEI [ON]
DISPLACED IN TO TUBULES OF THE
PREDENTIN .


ALTERED STAINING [ RED ] OF THE
CAVITY [ CA ] MARGIN THAT
RESULTED WHEN INADEQUATE
COOLING OF THE BUR LED TO
BURNING OF THE DENTIN.


HARM LESS CAVITY PREPARATION [ DONE WITH ADEQUATE COOLING ]

☻ [DOTTED LINE] EXTENT OF THE
TUBULES OPENED BY THE CAVITY
PREPARATION.
☻ O - AN INTACT ODONTOBLASTIC LAYER
IS PRESENT SUBJACENT TO THE CAVITY.

☻ HIGHER MAGNIFICATION OF THE
SEPERATION [S] BETWEEN THE
PREDENTIN [ PD ] & THE
ODONTOBLASTIC [ O ] LAYER AS A
RESULT OF CAVITY PREPARATION.

☻ IT MAY BE DUE TO SOME
INJURIOUS CHANGES THAT
PREDISPOSE TO THE SEPERATION IN
THE DENTIN.

☻ S - THE SEPERATION BETWEEN THE
PREDENTIN & THE ODONTOBLASTIC LAYER
IS PROBABLY HISTOLOGIC ARTIFACT.

DEMINERALISED SECTION SHOWING TUBULAR CONTENT
PROTRUDING IN TO THE CAVITY [ CA ] PREPARATION
♣ THE POSITION OF THESE REACTIVE COMPONENTS AFTER PREPARATION
INDICATES OUTWARD MOVEMENT or DISPLACEMENT OF THE TUBULAR
CONTENTS.
♣ SUCH MOVEMENT OCCUR EVEN IF SO – CALLED NON TRAUMATIC
PREPARATION TECHNIQUE IS USED.
♣ THE OUTWARD MOVEMENT OF THE CONTENT OF THE TUBULES IS
PROBABLY A RESULT OF EXPOSURE OF UNAFFECTED DENTIN IN THE
TOOTH.
♣ THE DISTURBANCE & REDISTRIBUTION OF THESE CELLULAR CONSTITUENT
WILL RESULT IN DEGENERATION OF OD PROCESS


o

cf

c

 DAMAGED &
DISORGANISED
CYTOPLASMIC
COMPONENTS FROM
ODONTOBLASTS DISPLACED
IN TO THE PREDENTIN [PD ]

 DT – DENTINAL TUBULE
WITH REMAINS OF A
DISTINTEGRATED
ODONTOBLASTIC
PROCESS.

 DT- DENTINAL TUBULE
WITH CELLULAR
FRAGMENTS
UNDERGOING NECROSIS.

CLINICAL SIGNIFICANCE OF ANY CHANGE FOLLOWING DISPLACEMENT OF
CELLULAR CONTENTS HAS NOT BEEN FULLY ESTABLISHED BUT IT IS LIKELY
TO HAVE EFFECT ON PHYSIOLOGY OF THE AFFECTED DENTIN.


SLIGHT REACTION

f

c

MOST STRIKING CHANGE FROM NORMAL
STRUCTURE IS THE INCREASED NUMBER
OF CELLS IN THE LOCATIONS OF THE
‘’CELL FREE ZONE ‘’ IN THE
CORRESPONDING TO THE ‘’CAVITY
TUBULES’’ THOSE TUBULES EXPOSED BY
THE CAVITY PREPARATION.

FIBROBLAST , UNDIFFERENTIATED
CELLS,FEW INFLAMMATORY CELLS
INVOLVED.

INCREASED NUMBER OF
CAPILLARIES NOTED.


MODERATE REACTION

o

dt

c

MANY CELLS HAVE ACCUMULATED
SUBJACENT TO THE AFFECTED
TUBULES ,BUT THEY ARE WELL
DELIMITED TO THE CAVITY TUBULES.

 NO ODONTOBLASTIC LAYER CAN
BE IDENTIFIED.

 SOME ODONTOBLASTIC NUCLEI HAS
BEEN DISPLACED IN TO THE
DENTINAL TUBULES.
 MANY CAPILLARIES ARE PRESENT.


SEVERE REACTION

AB

CELLULAR INFILTRATION LOCALISED
TO THE CAVITY TUBULES IS INTENSE
& CORRESPONDS TO THAT OF AN
ABSCESS FORMATION.

 NO ODONBLAST & NO PREDENTIN
CAN BE IDENTIFIED.

 PMN & MONONUCLEAR
LEUKOCYTES PREDOMINATE IN THE
AFFECTED AREA.

 EVIDENCE OF CHEMOTAXIS IS
VISIBLE .

♣ IMMEDIATE RESPONSE – [15 – 60 min ]

DISPLACEMENT OF OD NUCLIE TO
THE DENTINAL TUBULES & DISTURBANCE IN SUB ODONTOBLASTIC TISSUE.

♣ 6 Hrs POST OPERATIVELY

NL

 NEUTROPHILIC LEUKOCYTES INFILTRATED THE ODONTOBLASTIC LAYER. MORE BLOOD
VESSELS FOUND.
 MARKED DEGENERATIVE & NECROTIC CHANGES BOTH IN THE NUCLEI & IN THE
CYTOPLASM.
 EXUDATES SEPERATES THOSE ODONTOBLAST THAT HAVE NOT BEEN DISPLACED.
 NUCLEI DISPLAY PERIPHERAL ACCUMULATION OF CHROMATIN & CYTOPLASMIC
ORGANELLES. LIKE ROUGH SURFACE ENDOPLASMIC RETICULUM & MITOCHONDRIA .
 THE SUBODONTOBLASTIC CELLS HAS A LARGE VACUOLE FILLED WITH GRANULAR
MATERIAL.

AFTER 12 – 24 Hrs

 NE – NECROTIC TISSUE SEPERATES THE DENTIN FROM THE
PULP.

 MP - MACROPHAGES AT THE BORDER BETWEEN NECROTIC &
VITAL PULPAL TISSUE CONSTITUTE A PART OF THE
INFLAMMATORY INFILTRATION.
 ENGORGED BLOOD VESSELS ARE ALSO PRESENT.

PC

 ACTIVE PHAGOCYTOSIS WAS SEEN AT THE BORDER
BETWEEN VITAL & NECROTIC TISSUE.

 NECROTIC , ENGULFED CELL [ EC ] IS BEING DIGESTED
WITHIN THE LARGE VACUOLE [ VA ] IN THE CYTOPLASM OF
MACROPHAGE.


AFTER 48 HOUR
CF
O

B

RI
M

RER

N
GM
LY

 PREDOMINANCE OF SPINDLE – SHAPED CELLS , DIFFERENTIATING IN TO ‘’OD’’ LIKE
CELLS. HIGH VASCULARITY IN THE AREA.
 CYTOPLASM HAS ABUNDANCE OF RI, RER , LY , M,NUCLEUS OF MITOCHONDRIA . LARGER
AREAS OF GRANULAR MATERIAL & NEWLY FORMED COLLAGEN FIBERS.
 EVIDENCE OF COLLAGEN SYNTHESIS BY NEW ODONTOBLASTS NOTED AFTER 48 Hrs.

AFTER 3 – 8 DAYS
PD

 NEWLY DEVELOPED SECONDARY ODONTOBLAST WITH LARGE AREAS OF GRANULAR
MATERIAL WITH IN THE CELL.
 ODONTOBLAST WITH AN ABUNDANCE OF INTRACELLULAR GRANULAR MATERIAL
GM 1 ] & RIBOSOMES .GRANULAR MATERIAL ALSO FOUND OUTSIDE THE CELL [ GM 2 ]
 COLLAGEN FIBERS HAVE FORMED CORRESPONDING TO PREDENTIN & THEY BECAME
INCORPORATED IN TO MINERALISED TERTIARY DENTIN.

 HEALING PHASES PREDOMINATED , INCLUDING CONTINUED COLLGEN SYNTHESIS &
MINERALISATION OF THE INTERTUBULAR MATRIX OCCURRED.
 THUS INFLAMMATION THAT RESULTED FROM THE INFLICTED TRAUMA RESOLVED.

[

INTERACTION BETWEEN DENDRITIC CELLS IN THE
OD REGION & T - LYMPHOCYTES IN THE INDUCTION
OF A PRIMARY IMMUNE RESPONSE.

ACTIVE NONCAVITATED CARIES LESION

 CELLULAR CHANGES IN THE PULP ARE NOTED

 AS THE ENAMEL LESION APPROACHES

EVEN BEFORE ALTERATION IN DENTINAL
MINERALISATION.

DENTIN,HYPERMINERALISED DENTIN
[ GRAY AREA ] IS OBSERVED CORRESPONDING TO
THE CENTRAL TRANSVERSE LINE.

 INSET ; YELLOW CELLS – DENDRITIC LIKE CELLS
PRESENT, THEY ARE ALSO FOUND IN UNAFFECTED
AREAS.

 INSET ; CHANGES IN THE OD- PREDENTIN &
SUBODONTOBLASTIC REGION.

AS DENTINAL DEMINERALISATION STARTS [ORANGE
AREA ] FORMATION OF TERTIARY DENTIN IS
INITIATED.


SLOWLY PROGRESSING CARIES LESION

 DURING THE EARLY STAGES OF
THE ENAMEL LESION , NO
CHANGES ARE VISIBLE IN THE
DENTIN & NO CELLULAR
CHANGES ARE PRESENT IN THE
PULP.

 AS THE ENAMEL LESION APPROACHES
THE DENTIN , HYPERMINERALISED DENTIN
IS OBSERVED SUBJACENT TO THE
DEEPEST PART OF THE LESION [ CT ]
 CHANGES ARE ALSO TAKING PLACE IN
THE ODONTOBLAST - PREDENTIN REGION
BUT SUBODONTOBLASTIC REGION
APPEAR UNAFFECTED.


RAPIDLY PROGRESSING - CAVITATED CARIES LESION

 ODONTOBLAST ARE ABSENT SUBJACENT TO
THE LESION & ACCUMULATION OF
IMMUNOCOMPETENT CELLS , INCLUDING
DENDRITIC CELLS [ YELLOW ]

 ACTIVE CARIES LESION HAS REACHED
INTO THE DENTIN & BACTERIA PENETRATE
THE DENTIN.
 INSET; TERTIARY DENTIN DEVELOPED WITH
NO DDENTRITIC – LIKE CELLS PRESENT.

 FOLLOWING RAPID , EXTENSIVE CAVITATION OF
ENAMEL & DENTIN ,SPREAD OF THE LESION
OCCURS ALONG DEMINRALISED DEJ . INCREASED
ACCMULATION OF INFLAMMATORY CELLS NOTED
 BLACK DESCRIBED THIS PHENOMENON AS
‘’BACKWARD DECAY ‘’ OF THE ENAMEL. BECAUSE
THE ENAMEL BECOMES DEMINERALISED BOTH
FROM THE ADVANCING DENTINAL LESION & FROM
THE OUTSIDE.

 IF THE ENAMEL BREAKS DOWN DURING ANY STAGE IN THE DEVELOPMENT OF
A CAVITATED LESION , THE ENVIRONMENT OF THE LESION CHANGES
DRAMATICALY.
THE SOFTEST PART OF THE DEMINERALISED DENTIN MAY THEN BE LOST AS A
RESULT OF FUNCTION & WEAR.
THE REMAINING PART MAY REMINERALISE .
 CLINICALY THIS SITUATION PRESENT ITSELF AS EXPOSED , SHINY ,DARK HARD
DENTIN.

REMOVAL OF CARIES LESION


DIRECT NON ADHESIVE RESTORATION
REACTION TO DENTIN ;


 BISECTED TOOTH WITH AN EXPERIMENTAL BUCCAL CAVITY [ L ] THAT
HAD BEEN RESTORED WITH ZNOE & A LINGUAL CAVITY [ R ] THAT HAD
BEEN RESTORED WITH CAOH WITH PERMANENT RESTORATION.
 DIFFERENCE IN PERMIABILITY NOTED IN DENTIN COVERED WITH ZNOE
& DENTIN COVERED WITH CAOH.
 THE EXPALANATION MAY BE THAT PRECIPITATION OF CRYSTASLLINE
MATERIAL IN THE TUBULES REDUCE THE PERMIABILITY OF CAOH TO AN
EXTENT THAT MAY PREVENT ANY ADVERSE REACTION IN THE PULP.

HEALING CAPACITY OF DIFFERENT RESTORATIVE MATERIALS
EXPERIMENTALLY PREPARED CAVITY IN A MONKEY
TOOTH IN WHICH SOFT , HUMAN CARIOUS DENTIN
HAS BEEN KEPT IN PLACE FOR 7 DAYS .

SEVERE LOCALIZED PULPITIS WAS NOTED THAT WAS
ALLOWED TO HEAL FOR 7 DAY. CALCIUM HYDROXIDE WAS
PLACED ON THE PULPAL FLOOR & THE CAVITY WAS
RESTORED WITH AMALGAM . SEVERE PULPAL INFLAMMATON
PERSISTS , BUT TERTIARY DENTIN FORMATION HAS BEEN
INITIATED .

PULPAL HEALING WAS NOTED AFTER 3 MONTHS IN WHICH
ZOE CEMENT COVERED THE DENTIN. INFLAMMATORY
RESPONSE HAS RESOLVED .

PULPAL REACTIONS

 SEVERE INFLAMMATION
IN THE PULP SUBJACENT
TO A DEEP CAVITY
RESTORED WITH SILICATE
CEMENT FOR 7 DAYS.

 THE TEETH WITH SEVERE
INFLAMMATION WAS
RESTORED WITH ZNOE
CEMENT .
AFTER 1 MON PULPAL
REACTION REDUCED
COMPARATIVELY.

EFFECTS OF OVER EXTENDED CAVITY.
CA1 - CAVITY TREATED WITH ZNOE.
 CA2 – INADVERENTLY EXTENDED APICALLY
REMOVAL OF ZNOE CEMENT

DURING

 PULPAL REACTIONS ARE MINIMAL SUBJACENT TO CA1, BUT
SEVERE SUBJACENT TO CA2 WHERE UNAFFECTED TUBULES
HAVE BEEN EXPOSED.

 CA – CAVITY TREATED WITH THE SAME WAY BUT
INADVERENTLY EXTENDED OCCLUSALY DURING REMOVAL OF
ZNOE CEMENT.
 PULPAL REACTION ARE MINOR UNDER THE MAIN PART
OF THE CAVITY , BUT SEVERE WHERE THE CAVITY WAS
EXTENDED OCCLUSALY IN TO UNAFFECTED DENTIN


 THE TOOTH HAD BEEN REPEATEDLY RESTORED WITH BUCCAL
CLASS V RESTORATIONS
 THE THIN LAYER OF REMAINING DENTIN & ABSENCE OF
TERTIARY DENTIN.
 NO ODONTOBLASTIC LAYER OR PREDENTIN IS PRESENT.

• CLINICAL EXPERIENCE WITH THE DIFFERENT SYSTEMS GENERALLY
SUPPORTS THE VIEW THAT THESE MATERIALS ARE SAFE WHEN USED
ACCORDING TO THE MANUFACTURES INSTRUCTIONS .
• HOWEVER , SOME CONCERN REMAIN ABOUT PULPAL REACTIONS ,
HYPERSENSTIVITY , LONGEVITY OF RESTORATIONS AND HANDLING
CHARACTERISTICS OF THESE MATERIALS.


PHOSPHORIC ACID ETICHING

 ENAMEL ETCHED WITH 37% PHOSPHORIC ACID FOR
15 SEC .THE RODS & INTERROD SUBSTANCE ARE
UNEVENLY DEMINERALIZED , GIVING THE SURFACE
AN IRREGULAR STRUCTURE WHERE RESIN MAY
PHYSICALLY ATTACHED TO THE ENAMEL .

 DENTIN ETCHED WITH PHOSPHORIC ACID , WASHED
WITH WATER , & OVER DRIED WITH COMPRESSED AIR
FROM AN AIR SYRINGE . THE EXPOSED COLLAGEN
LAYER HAS COLLAPSED & NO DETAILED STRUCTURE
IS DESCERNIBLE
 CLINICALY THE COLLAGEN IN THE PREPARATION
SHOULD HAVE A SHINY , WET SURFACE & THE ENAMEL
SHOULD HAVE A FROSTY APPERANCE..


SELF ETCHING PRIMER
 DENTIN TREATED WITH SELF ETCHING PRIMER.
THE BONDING SYSTEM HAS MODIFIED THE SMEAR
LAYER WITH OUT REMOVING IT.
 THE RESIN TAGS ARE LESS UNIFORMED COMPARED
TO ETCHING WITH PHOSPHORIC ACID WHICH
PRESENTS A MORE AGGRESSIVE DEMINERALIZATION
PROPERTIES .

ALL IN ONE BONDING
 DENTIN

TREATED WITH ALL IN ONE BONDING
SYTEM WITH AGGRESSIVE DEMINERALISATION
PROPERTIES .
THE SMEAR LAYER HAS BEEN DISSOLVED &
THE RESIN TAG SHOWS THE CHARACTERISTICS
STRUCTURE WITH A REVERSE CONE SHAPE
TOWARDS THE CAVITY SURFACE.

DENTINAL SUBSTRATE

 DIFFERENCES IN THE STRUCTURE & PHYSIOLOGY OF THE
DENTIN PRESENT ON PREPARED SURFACES PLAY A FUNDAMENTAL
ROLE IN THE QUALITY OF THE BOND THAT CAN BE ACHIEVED BY
THE DIFFERENT TYPES OF BONDING SYSTEMS.

COMMON CLINICAL CONDITION WHERE
ALL MINERALISED TISSUES ARE
INVOLVED AS SUBSTRATES IN THE
TREATEMENT OF CLAS 5 CAVITIES


A PREPARATION WITH REMAINING DENTINAL
THICKNESS OF ABOUT 0.5 mm WILL ALLOW
FORMATION OF RESIN TAGS WITH LATERAL
BRANCHES & A HYBRID LAYER.

SCANNING ELECTRON MICROGRAPH
SHOWING UNIFORM , SHORT ,
CLOSELY PACKED RESIN TAGS
NEAR THE PULP.


 WHENEVER CERVICAL MARGIN OF A PREPARATION IS
BELOW THE CEMENTO ENAMEL JUNCTION. THE CEMENTUM
WHICH HAS HIGHER ORGANIC CONTENT THAN DENTIN , IS
TAKEN IN TO CONSIDERATION.
 UNLIKE DENTIN , THE CEMENTUM SUBSTRATE WILL
EXIHIBIT LESS RESIN TAG FORMATION , BECAUSE OF THE
PRESENCE OF THE GRANULAR LAYER & THE LACK OF
TUBULES IN THE PERIPHERAL ROOT DENTIN.

SHOWING CERVICAL MARGIN OF A
RESTORATION 1mm BELOW CEJ , LESS
RESIN TAG FORMATION IS EVIDENT .


GLASS – IONOMER MATERIALS
MINIMAL PULPAL REACTION SUBJACENT TO A CAVITY IN
A TOOTH RESTORED WITH GIC .

WHEN DEBONDING OF GIC OCCURS , THE FAILURE IS
USUALLY COHESIVE , FRACTURE IS WITHIN THE GIC
RESTORATION

THE BONDING OF GIC TO DENTIN INVOLVES CHEMICAL &
MECHANICAL BONDS . INTERFACE BETWEEN A
CONVENTIONAL GLASS-IONOMER MATERIAL & THE
CONDITIONED DENTIN IS NOTED .

IMPRESSION OF PREPARED
TEETH
 A REVIEW OF A SERIES OF PHYSIOLOGIC STUDIES OF PULPAL BLOOD FLOW
AFTER VARIOUS CLINICAL PROCEDURE ON DOG & RAT TEETH INDICATES THAT
RUBBER – BASED IMPRESSION OF PREPARATION CAUSE SIGNIFICANTLY LESS
DAMAGE THAN DO IMPRESSION MADE WITH HOT WAX IN A COPPER BAND .

 THE

USE OF A GINGIVAL RETRACTION CORD WITH A VASOCONSTRICTOR ALSO
RESULTS IN SIGNIFICANT CHANGES IN THE PULPAL BLOOD FLOW .
 USE OF LOCAL ANAESTHESIA ALSO RESULTS I N SIGNIFICANT REDUCTION IN THE
PULPAL BLOOD FLOW.
 ALTHOUGH SOME OF THESE CHANGES IN THE PULP DENTIN COMPLEX ARE
TRANSIENT ,CARE MUST BE TAKEN TO AVOID DELETERIOUS EFFECT ON PULP .


REFERENCES




PULP – DENTIN BIOLOGY IN RESTORATIVE
DENTISTRY [ IVAR A . MJOR ] .



ORAL HISTROLOGY 5TH EDITION [ A .R .TEN CATE ] .



ESSENTIALS OF ORAL HISTROLOGY &
EMBRYOLOGY 2rd EDITION [ JAMES K . AVERY ] .



ORAL HISTROLOGY & EMBRYOLOGY 12th EDITION
ORBAN’S .


PULPAL - DENTINAL COMPLICATIONS
INVOLVING INFLAMMATION , DEGRADATION &
NECROSIS ARE THE RESULT OF A SERIES OF
TRAUMATIC INJURY.

IT IS THEREFORE RESPONSIBILITY OF THE RESTORATIVE DENTIST
TO MINIMISE THE TRAUMA TO DENTIN & PULP INFLICTED DURING
ALL CLINICAL PROCEDURES . NOT ONLY WILL IT BENEFIT PATIENT
BUT IT WILL MAKE RESTORATIVE DENTISTRY MORE INTERESTING &
CHALLENGING THEN IT IS TODAY , WHEN ATTENTION IS FOCUSED
MOSTLY ON TECHNICAL ASPECTS.


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