Griffith University Oral Biology 2 1009 DOH

Dentino-pulp Complex
Dr. Mahmoud Bakr Lecturer in General Dental Practice B.D.S, M.D.S (Cairo University), ADC (Australia) Member of the Australian Dental Association (ADA), the Australian Biology Institute Inc. (ABI) and the Egyptian Dental Union (EDU)

Learning objectives:
After completing this lecture you should be able to: 1- Name, classify, identify and describe the structure and function of the components of Dentin. 2- Describe age related changes to Dentin and their effects. 3- By observing the histological details of cells and tissues, you should be able to use a microscope to identify different histological structures of Dentin and understand the histological processes involved in preparing slides.

 All Microscopic images are taken from the Digital Library of the Oral Biology Department (Cairo University).

Dentin: is the mineralized tissue that forms the main bulk of the tooth In crown it is covered by enamel In root it is covered by cementum (about 3-10mm thick or more)

TOOTH DESIGN: Spear me

Blade Shaft DENTINE Grip

ENAMEL

CEMENTUM

Refinements ENAMEL DENTINE

Shaft is hollow for PULP CEMENTUM

Hand represented by PERIODONTAL LIGAMENT & ALVEOLAR BONE Closer to true proportions

Dentin consists of large number of small parallel tubules in mineralized collagen matrix. Tubules process process Fiber). contain long (odontoblastic or Tomes is dentin

Odontoblast forming cell.

Two major properties differentiate dentin from enamel Dentin is sensitive Dentin is formed throughout life.

Physical Characteristics
Light yellowish in color. Visco-Elastic. Hard ( less than enamel but more than cementum and bone). By X-ray : more radiolucent (darker) than enamel and more radio-opaque (lighter) than cementum. Dentin is semi-permeable to certain ions.

Chemical Characters Of Dentin

70% inorganic material 20% organic material

Collagen Hydroxyappatite type I Proteoglycans & crystals

phosphoproteins

10% water

glycoproteins and lipids

Inorganic materials
They are in the form of calcium hydroxyappatite crystals which consist of important elements. calcium 26.9%. Phosphorus 13.2%. Carbonate 4.6%. Sodium 0.6%. Magnesium 0.8% Some trace elements as copper, iron, fluoride & zinc. The crystals are plate like shape. The crystal about o.o5-o.o6um in length may reach up to 0.1um.

Organic matrix
Collagen fibers embedded in an amorphous ground substance. Collagen type I& traces of type III & V. Most of the collagen fibers run parallel to the pulpal surface.

Dentinogenesis
Dentin is formed by odontoblastic cells. Odontoblastic cells originate from *ectomesenchymal cells of the dental papilla, following an organizing influence of the inner dental epithelium. *The odontoblasts produce an organic matrix that becomes mineralized to form dentin. Thus the dental papilla is the formative organ of dentin, so dentin formation is connective tissue in origin.

Life Cycle Of Odontoblasts

1- Differentiation of odontoblasts.
Ameloblasts

IDE
Basement membrane
Differentiate from At first become the peripheral short columnar dental papilla cell with many cells (UMC) stubby processes

The cells grow in length (40u) and closely packed together

1- Odontoblast differentiation:
In early bell stage *The cells of the inner dental epithelium are short & columnar and supported by basement membrane that separated the epithelium from the dental papilla. *The dental papilla is formed of Spindle shaped cell, uniform in size Separated by loose intercellular substance.
*The cells of dental papilla are separated from the inner dental epithelium by the cell free zone

*The inner dental epithelium cells changes from short cuboidal to tall columnar and their nuclei migrate toward the pole away from the dental papilla.

Under the influence of the IDE the peripheral cells of dental papilla become short columnar shape & arranged in a single layer below the basement membrane. Cell free zone separate dental papilla from the basement membrane. *The acellular zone between the dental papilla &IDE is gradually decreased as odontoblasts differentiate & increase in size .
*As differentiation progresses the cell grow in length and reach about 40 UM in height & 7 UM in width

Differentiation of odontoblasts
Epithelial cells Odontoblast

The undifferentiated ectomesenchymal cell

The UDMS of the dental papilla divides with the mitotic spindle perpendicular on the BM

Two daughter cells

Subodontoblast cell

2- Formation of the predentin

Odontoblast become a protein forming and secreting cell. R E R , Mitochondria and Golgi bodies Ribonucleic acid and alkaline phosphatase
Large open faced N
RER Mitochondria Golgi bodies

Inner dental epith side

Predentin

3- Odonotblastic process formation:

At first more than one process

As more D is laid down, the cells receed and leave single process ( Tomes fiber)

4- Quiescent state of odontoblasts

The odontoblasts decrease in size and form dentin in a slowly diminishing rate until stimulated to form reparative dentin.

To conclude:

Life cycle of odontoblasts

Pre-odontoblasts Small, ovoid cells, high nucleus / cytoplasmic ratio, Rudimentary rough endoplasmic reticulum, poorly developed Golgi apparatus. Secretory odontoblasts (Cell body & odontoblastic process) Large plump cell, open face nucleus situated basaly & basophilic cytoplasm. Pronounced Golgi complex, RER, intercellular skeletal proteins actin, vinculin & vimentin, as well as cytokeratin. junctional complexes and gap junctions. Resting odontoblasts: The cell inter quiescent state after dentin formation and mineralization is completed & the dentin formed in very slow rate. Reduction in length & cytoplasmic organelles and increase in number and size of lysosomes& phagosomes.

preodontoblast Small Ovoid Rudimentary RER

Cell

Poorly developed Golgi apparatus

Odontoblastic process

Secretory odontoblast
Junctional complex

predentin

Secretory granules

Golgi apparatus

Centriole Mitochondria Nucleus Nucleolus

Transitional odontoblast

Aged odontoblast

Reduction In length & cytoplasmic organelles.

Increase in number & size of lysosomes and phagosomes

Vacuole

Dentinogenesis
1 Matrix formation (Predentin) 2 Maturation (mineralization)

Collagen fibers

Ground substance

Hydroxyapatite crystals

1- Matrix formation
A- Mantle dentin
The first formed dentin layer in crown and root Fibers are perpendicular to D E J

Fibers are parallel to basement membrane

B) Circumpulpal dentin
Mantle dentin Circumpulpal dentin. The fibers are parallel to DEJ ( right or oblique angle to DT)

Crowding of the cells and appearance of junctional complex

Root Crown Mantle dentin Circumpulpal dentin Thickness: 10-20 um Thickness: bulk of the tooth Diameter of collagen Diameter of collagen fibers: fibers: large (0.1-0.2 um) small (0.05um) Direction of collagen Direction of collagen fibers : fibers : have right angle have right or oblique angle to to DEJ and parallel to dentinal tubules (parallel to basement membrane in dentin surface) root Ground substance: from Ground substance: from odontoblasts odontoblasts and the Mineralization: Globular cell free zone below mantle dentin then Mineralization: linear become mixed in the form (contains matrix remaining circumpulpal vesicles). dentin (no M V ).

2- Mineralization
Budding of matrix vesicles Rupture of matrix vesicles Mineralization of the mantle dentin

Matrix vesicle

Has membrane rich in alkaline phosphatase

Calcium and phosphate ions undergo crystallization

Pattern Of Mineralization
1- Linear at the mantle dentin area 2- Globular in circumpulpal dentin just below mantle dentin 3- Combination in the remaining circumpulpal dentin of the crown and root

M V in matrix

Crystal lization

Lodgment of crystals

Rupture

How To Study The Histological Structures Of Dentin

Ground section (inorganic part) Decalcified section (Organic part)

Types Of Dentin
Mantle dentin Dentin Predentin
Odontoblasts

Sec. Ir D

Sec. RD

Circumpulpal dentin Primary dentin Predentin

Secondary dentin

Histological Structure Of Dentin

1- Dentinal tubules. 2- Inter-tubular dentin. 3- Peri-tubular dentin. 4-Interglobular dentin. 5- Tomes granular layer. Incremental lines: a - Incremental line of Von Ebner. b - Contour line of Owen. c - Neonatal line.

Histological Structure Of Dentin

Dentinal tubules Dentin

Predentin Odontoblasts

Odontoblasts And Dentinal Tubules

Mantle D DEJ Odontoblastic process Preodontoblastic space Peritubular dentin Intertubular dentin

Predentin

Circumpulpal D

Odontoblasts

Dentinal tubules are tapered structures

900 Um near the DEJ. No. of D.T. 30,000/mm

1.2 Um in diameter at midpoint of dentin. No. of D.T. 40,000/mm

Ratio between number of tubules/ unit area on the pulpal and outer surface is 4:1

2.5 Um in diameter near the pulp. No. of D.T.76,000/mm

Enamel spindle

Terminal branches

Lateral branches or canaliculi

Ground Section Of D. Ts.

At the cusp tip or (incisal edge) At cervical area Secondary curvatures Mid portion of root and apically
Straight

S shape

Straight

Dentinal Tubules
Odontoblasts Dentin Predentin Terminal branches

Sec. curvatures

T.S. In Dentinal Tubules

Odontoblastic process (Tomes fiber)

Periodontobl astic space

Ground section Scanning microscope

Neumanns sheath Decalcified section

Contents of dentinal tubules

1- The odontoblastic processes. 2- Afferent nerve terminals. 3- Dentinal fluid or dentinal lymph. Structure of the odontoblastic process A- microtubules& intermediate filaments run longitudinally throughout the odontoblastic process. B- mitochondria in odontoblastic process present in predentin. C- strands of RER & lysosomal element occasionally seen. D- vesicles of variety of sizes are present denser near the cell membrane.

Inter tubular dentin

Dentin located between the dentinal tubules. Represent the primary secretory product of odontoblasts. It consists of tightly interwoven network of type I collagen fibers in which apatite crystal are deposited. It forms the main bulk of dentin.

Peri - tubular dentin (Intra- tubular dentin)

Highly calcified dentin. It is about 40% more mineralized than inter-tubular dentin. Width of the peri-tubular dentin at pulp end 0.4U and 0.7 U at the DEJ. It is deposited on the internal walls of the dentinal tubules narrowing the size of the lumen. In ground section passing transversally through the dentinal tubules shows that the peri-tubular dentin seen as translucent rings. It was previously thought that, the sharp boundary of this ring was due to present special structure known as Neumann sheath. E/M failed to prove the present of this sheath and the organic fibers of peri-tubular dentin continuous with the fiber of the inter tubular dentin.

Interglobular Dentin
Calcification of dentin in some areas occurs in a form of globular pattern. These globules fuses together to form homogenous substance. Sometimes globules in some areas failed to fuse. Area of organic matrix between the globules remain uncalcified or partially mineralized. These areas bonded by the curved outlines of the adjacent globules.

Tomes Granular Layer

Tomes granular layer

Cementum

 Interglobular dentin
(Size) Large (Cause) Areas of unmineralized or hypomineralized dentin (sometimes present). (Site) Appear in the crown just below mantle dentin. (D T) Dentinal tubules cross the IGD without the peritubular dentin (IL) Follow incremental line pattern In badly formed tooth it appear in the root dentin

Tomes granular layer

(Size) Small granular in appearance (Cause) Areas of minute IGD, but recent studies indicate that it result from the looping of the terminal portions of DT which is a result different orientation of odontoblastic process (always present) . (Site) Appear in the root adjacent to the cementum. (DT) Dentinal tubules do not cross this layer (IL) Does not follow any incremental pattern.

Incremental lines of dentin

1-Incremental line of Von Ebner: A 5 day rhythmic pattern of dentin deposition, represented as increment lines separated by 20Um intervals. It can best be seen in longitudinal ground section. It runs at right angles to dentinal tubules It marks the normal rhythmic pattern of dentin deposition in an inward and root ward direction. 2-Contour line of Owen. Result from a coincidence of secondary curvature between neighboring D.T. 3-Neonatal line.

Incremental Lines Of Dentin

Incremental lines of von Ebner
Neonatal line

Contour line of Owen

Age Changes Of Dentin

Regular secondary dentin- Mild stimulus
Occurs on the entire pulpal surface. In multirooted teeth it is thicker on the roof and floor of pulp chamber. The size of the pulp cavity decrease and obliteration of the pulp horns (pulp recession) The dentinal tubules change their direction to a more wavy course The no of dentinal tubules are fewer Line of demarcation (dark).

Primary dentin: dentin which formed to produce the typical form of the root.

Secondary dentin: dentin develops after root formation has been completed and represent the continuing deposition of dentin by odontoblast.

Irregular Secondary Dentin

(Reparative or tertiary dentin)
Severe stimulus The dentin is formed at a localized area. The dentinal tubules are less in number and irregular in arrangement. UMC from the subodontoblastic layer will differentiate and replace the degenerated odontoblasts to form reparative dentin

Irregular D T

Types Of Reparative Dentin

Osteodentin (entrapped cells).

Atubular dentin ( area without dentinal tubules)

Vasodentin (entrapped b.v.)

Secondary Dentin
Regular
Cause: Mild stimuli (slow attrition, slowly progressing caries& the early stages of cervical cavities) Site of formation: Occurs on the entire pulpal surface of the tooth ( thicker on the roof and floor of the pulp chamber in multirooted teeth). Dentinal tubules: - Change their direction and have more wavy course - They decrease in number per unit area. Line of demarcation Present and stained dark.

Irregular
Severe stimulus (abrasion, erosion, severe attrition and deep caries)

Formed at the area corresponding to the pulpal end of the exposed dentin.
Have irregular or twisted course They decrease in number and some areas may have no tubules (a tubular dentin).

May or may not present

Clinically:

The decrease of the The localized area of dentin formation pulp chamber height increase the time and obliteration of taken by caries to the pulp horns make reach the pulp the liability of pulp (barrier) exposure during cavity preparation much less likely to occur

Mild stimulus leads to changes for the dentin already present. It occurs in primary dentin.

Transparent (Translucent OR Sclerotic )Dentin

1- Odontoblast and its process undergo fatty degeneration. 2- Then there will be calcification of dentinal tubules. First become narrow by widening of the 3- Then the DT peritubular dentin. become obliterated.

The affected area have occluded dentinal tubules, so the dentin have uniform refractive index. So this area of dentin appear translucent by transmitted light.

Transparent (Translucent OR Sclerotic )Dentin

Transparent dentin occurs as a normal aging process as well as slow caries or abrasion. The most likely source of calcium salts of dentinal sclerosis is the fluid of dental lymph within the tubules. Transparent dentin: appear translucent when seen with transmitted light. Appear dark by reflected light.

Sclerotic dentin most common seen in the apical third of the root and in the crown midway between DEJ & the pulp.

Dead Tracts
Severe stimulation to dentin leads to destruction of the odontoblastic process and odontoblasts. This leads to empty and wide dentinal tubules. These areas appear black with transmitted light. Under the dead tracts from the pulpal surface , reparative dentine will be formed. The dead tract surrounded by sclerotic dentin.

Innervations Of Dentin
The nerve will loose its schwann coating then pass between the odontoblasts bodies and enter the dentinal tubules ( In crown and fewer in the root )

Plexus of Raschkow (subodontoblastic layer)

High at D E J

Less sensitive area

High near the pulpal surface

Theories Of Pain Transmission Through Dentin.

Direct neural stimulation

Odontoblastic transduction theory

Fluid or hydrodynamic theory

Direct neural stimulation

Dentin contains nerve endings which respond when dentin is stimulated. No evidence has been found for nerves in the outer dentin, which is the most sensitive. The plexus of Raschkow and the intra-tubular nerves do not establish themselves until some time after the tooth erupted. However the newly erupted teeth are sensitive. The application of local anesthetics to exposed dentin not eliminate dentin sensitivity. And pharmacological agents cause pain when applied to skin do not cause pain when applied to dentin.

Odontoblastic transduction theory

The odontoblasts serve as receptors and are coupled to nerves of the pulp. The odontoblast is of neural crest origin, It retains ability to transduce and propagates an impulse. But the synaptic relation between odontoblast and pulpal nerves was missing.

Fluid or hydrodynamic theory

The tubular nature of dentin permits fluid movement to occur within the tubule when stimulus is applied, a movement registered by pulpal free nerve endings in the plexus of Raschkow close to the dentin. The increased sensitivity at DEJ is explain by the profuse branching of tubules in this region.

Clinical considerations
Permeability of dentin: the tubular structure of dentin allows the possibility of substances applied to its outer surface able to reach and affect the dental pulp. This depend on number of factors: 1- The dentin surface exposed by caries, attrition, abrasion or trauma. 2-The tubules being patent. Tubules may occluded by peritubular dentin or sealed off from the pulp by reparative dentin. 3- Outward movement of dentinal fluid. 4- The substances are able to pass through the odontoblast layer which presents a barrier to molecules of higher molecular weight.

The most significant materials to travel down the tubules are:

1-The bacteria of dental caries and the toxins they produce.

2- Components of dental materials or etchings used to prepare their placement. Coronal dentin is more permeable over the pulp horn. While the outer radicular dentin has low permeability.

Adhesion of dental materials to dentin *Adhesion of restorative material to dentin is more complex than to enamel because the high organic content of the tissue and its tubular structure.

Dentin is etched with strong acid to remove the smear layer and provide porous surface that can infiltrated by the bond agent.
The bond agent then penetrate the dentinal tubules and exposed collagen in the intertubular dentin.

The dental pulp is that loose delicate connective tissue occupying the cavity lying in the center of dentin.

Morphology
*The coronal pulp: it is present in the pulp chamber. *The radicular pulp: it is that part of the pulp extending from the cervical region of the crown to the root apex.

Accessory canals:
They are commonly seen to extend from radicular pulp laterally through the root dentin to the periodontal ligament. They are numerous in the apical third of the root.

Accessory canals

Mechanism of formation accessory canals

1- it occurs in areas, where the developing root encounters a large blood vessel, where dentin will be formed around it.
2- Early degeneration of the epithelial root sheath of Hertwig before the differentiation of the odontoblasts.

3-Lack of complete union of the epithelial diaphragm at the floor of the pulp chamber.

*Apical foramen: The pulp organs are continuous with the periapical tissue through the apical foramen.

lingual

The average size of the apical foramen:

maxillary teeth : 0.4 mm mandibular teeth : 0.3mm

Pulp Exposure

Infected pulp

Abcess

Dental pain

(acute pulpitis)

Dental pain occurs in 12% of the population.

The origin of the dental pain is difficult to localize. (referred pain)

Dental pain is the most un-killing acute pain

affecting human being.

By 1910 root canal therapy had reached its zenith and no self respecting dentist would extract a tooth.
(T.R.Pitt Ford 2004)

Loss of the pulp results in loss of the pulp functions, but the tooth is still functioning

Histological structure of the pulp

The dental pulp is formed of specialized loose connective tissue: cells
fibers

intercellular substances

blood vessels and nerves

Zones of the pulp

peripheral zone Central zone (odontogenic zone). (pulp core).

Dentin

odontogenic zone:
a- odontoblasts: Location: Adjacent to the predentin with the cell bodies in the pulp and cell processes in the dentinal tubules.

Dentin

B- cell free zone (the zone of Weil): *It is present beneath the odontoblastic layer.
*It is suggested to be the area of mobilization and replacement of odontoblasts.
C- cell rich zone:
It is present beneath the cell free zone. It is composed of fibroblasts and undifferentiated mesenchymal cells.

odontogenic zone

Cell free zone & cell rich zone might be artifacts.

Cells of the pulp

1- Synthetic cells (formative cells):
odontoblasts and fibroblasts.

2- Defensive cells:
Macrophages, lymphocytes, eosinophils, mast cells and plasma cells.

3- Progenitor cells:
Undifferentiated mesenchymal cells.

a- Odontoblasts
Length: 25-40u Diameter: 5-7u
In the early stages of development odontoblasts consist of a single layer of columnar cells .

In the later stages of development, the

odontoblasts appeared piriform where the broadest part of the cell contains the nucleus

Odontoblasts are
longer in the crown

cuboidal rootwise,

flat at the root apex

The cell membranes of adjacent odontoblasts exhibit junctional complexes. The clear terminal part of the cell body and the adjacent intercellular junction is known as terminal bars.
Gap junction

desmosome

b- Fibroblasts
*These are the most numerous type of pulp cells.

*They are

spindle in shape.

*They have elongated processes which are link up with those of other pulpal fibroblasts (stellate appearance).
*The nucleus stains deep with basic dye and the cytoplasm is highly stained and homogenous.

These cells have a dual function: synthesize and degradation of fibers and ground substances in the same cell . mitochondria
In young pulp, they are : *large cells . *with large multiple processes *centrally located oval nucleus, *numerous mitochondria, *well developed Golgi bodies *well developed RER

Fibroblast

protein secreting cell

In periods of less activity and aging they appear smaller and round or spindle-shaped with few organelles, they are termed fibrocytes.

fibrocyte

fibroblast

Infected pulp

L L

2- Defensive cells: A- Histiocyte (macrophage):

They appear irregular in shape with short blunt processes.

The nucleus is small, more rounded & darker in staining than fibroblast.

Their presence is disclosed by intra-vital dyes such trypan blue.

They are distributed around the odontoblasts and small blood vessels and capillaries.

In case of inflammation: *Nuclei increase in size and exhibit a prominent nucleolus. *It exhibits granules and vacuoles in their cytoplasm. Ultastructurally, invaginations of plasma membrane with aggregation of vesicles or phagosomes .

*Macrophages are involved in the elimination of dead cells. *Macrophages remove bacteria and interact with other inflammatory cells to protect the pulp during inflammation.

Phagocytosis

Hydrolytic enzymes

b- Plasma cells:
These cells are seen during inflammation. The nucleus of this cell is small and appears eccentric in the cytoplasm. The arrangement of chromatin in the nucleus gives the cell a cart wheel appearance, The plasma cells are known to produce antibodies.

c- Lymphocytes
They are found in normal pulp and they increase during inflammation.

Eosinophils
They are found in normal pulp and they increase during inflammation.

They have the characteristic bi-lobed nuclei (like headphones).

d- Mast cells:
*They have a round nucleus and their cytoplasm contains many granules. *They are demonstrated by using specific stains as toluidine blue.

*They produce histamine& heparin.

3- Progenitor cells:
(UMC): They are smaller than fibroblasts but have a similar appearance. They are usually found along the walls of blood vessels. These cells have the potentiality of forming other types of formative or defensive cells.

The ground substances of the pulp:

*The ground substances consists of acid mucopolysaccharides and neutral glycoprotein. *These substances are the environment that promotes life of the cells.
*Glycoseaminoglycans are bulky molecules and hydrophilic, they form gels that fill most of the extracellular space, They contribute to the high tissue fluid pressure of the pulp.

III-Blood vessels
*The pulp is highly vascular. It is supplied by the inferior and superior alveolar arteries. *As the vessels enter the tooth, their walls become considerably thinner than those surrounding the tooth.
D

*Along their course they give numerous branches in the radicular pulp that pass peripherally to form a plexus in the odontogenic region.

The normal hydraulic system of the tooth is important because the dentin requires an active transport, without which its rate of metabolism would not be possible.
The pulp is designed to support this hydraulic system: 1-The rate of blood flow in the pulp of the tooth is four time the rate of blood flow in resting muscle.

Laser Doppler Flowmeter It measures the rate of pulpal blood flow

2-The capillaries adjacent to the odontoblasts are fenestrated. Such capillaries are found in areas of rapid exchange.

Assessment of pulp vitality

Current pulp tests assess the function of nerves in the pulp, by the application of electric current or a rapid change in temperature. Recently, blood flow rate in the pulp is used to measure the degree of the pulp vitality.

Nerves of the pulp

The pulp has an abundant nerve supply which follows the distribution of the blood vessels. Two types of nerve fibers are present: Nonmyelinated nerves: *Sympathetic in nature. *They control the contraction of the smooth muscles of the blood vessels. Myelinated fibers which are sensory parasympathetic nerves.

*The peripheral non mylinated axons form a network of nerves located adjacent to the cell-rich zone. This is termed the parietal layer of nerves or plexus of Raschkow.
*More nerve endings are found in the pulp horns than in other peripheral areas of the coronal or radicular pulp.

Sensory response in the pulp cannot differentiate between heat, touch, pressure or chemicals. This is because the pulp organs lack those types of receptors.

Heat, Touch, Pressure, Chemicals

Pain

Functions of the pulp

1- Inductive:
Dental papilla induces the enamel organ formation and also determines the morphology of the tooth.

2- Formative :
Pulp organ produces dentin. Odontoblasts develop the organic matrix and function in its calcification.

3- Nutritive :
The pulp nourishes the dentin. Nutrition is mediated through the odontoblasts and their processes.

Dentin

4- Protective:
The sensory nerves in the tooth respond with pain to all stimuli, Pain sensation is a useful alarm system of the pulp.

5- Defensive or reparative:
The pulp responds to irritation by producing reparative dentin and mineralizing any affected dentinal tubules. These reparative reactions are an attempt to wall off the pulp from the source of irritation. The presence of macrophages, lymphocytes and leucocytes aid in the process of repair of the pulp.

Age changes in the pulp

The size of the pulp The apical foramen The cellular elements The bl. vessels & n. Vitality

decreased

Reticular atrophy: The total affect is the production of a lessened vitality of the pulp tissue and a lessened response to stimulation.

Pulp clacification
localized (pulp stones ) diffuse

True denticle

False denticle

True denticles
True denticles are rare & small in size& found near the apical foramen.

They consist of irregular dentin containing traces of dentinal tubules and few odontoblasts. Remnants of the epithelial root sheath invade the pulp tissues causing UMC of the pulp to form this irregular type of dentin.

odontoblast dentinal tubules

False denticles
*They are evidence of dystrophic calcification of the pulp tissue . *They contain no dentinal tubules. *They are formed of degenerated cells or areas of hemorrhage which act as a central nidus for calcification. *Overdoses of vit. D, may favor the formation of numerous denticles.

*Pulp stones are classified according to their location into: free, attached and embedded. *They continue to increase in size and in certain cases they fill up the pulp chamber completely. *If pulp stones come close enough to a nerve bundle pain may be elicited. *The close proximity of pulp stones to blood vessels may cause atrophy of it.

attached

free

Diffuse pulp calcification

*Commonly occurs on top of hyaline degeneration in the root canal and not common in the pulp chamber. *They are irregular calcified depositions in the pulp tissue following the course of blood vessels or collagen bundles. *Advancing age favors their development.