Pulp-Dentin Complex

Dentin Pulp Specialized connective tissues of mesodermal origin formed from the dental papilla

Dentin
Formed by cells called odontoblasts Forms the

largest portion of the tooth structure

Physical Properties:
Hard tissue portion of the pulp-dentin complex

and forms the bulk of the tooth. Yellowish in color. Is subject to slight deformation and is highly elastic It is somewhat harder than bone but softer than enamel

Chemical composition:
Composed of 70% inorganic material

(hydroxyapatite); 20% organic material (collagen & mucopolysaccaride ground substance); 5% water & other materials

Basic Anatomy
Dentin is

characterized by the presence of multiple closely packed dentinal tubules that traverse its entire thickness and contain the cytoplasmic extensions of odontoblasts.

Dentin comprises the following three distinct areas:

1.

2.

3.

Dentinal tubule a long tube, running from the DEJ or DCJ to the pulp. Each dentinal tubule contains an odontoblastic process. Peritubular (intratubular) dentin an area of higher crystalline content immediately surrounding the dentinal tubules Intertubular dentin the bulk of the dentinal material

 The course of the dentinal tubules is a slight S-curve in the tooth crown but the tubules are straighter in the incisal ridges, cusps and root areas.

S-shaped primary curvature of dentinal tubules

 Dentinogenesis begins

with the odontoblasts laying down a collagen matrix moving from DEJ toward the pulp. Formed layer of dentin is always on the pulpal surface. Predentin is a layer that lines the innermost (pulpal) portion of the dentin. It is unmineralized zone of dentin next to the cell bodies of the odontoblasts.

 Unlike enamel, dentin formation continues

after tooth eruption & throughout the life of the pulp.

Three Types of Dentin

1.

2.

3.

Primary dentin outlines the pulp chamber; forms the initial shape of the tooth Secondary dentin forms on all internal aspects of the pulp cavity. Represents the continuing, but much slower, deposition of dentin by the odontoblasts after root formation has been completed. Tertiary dentin (also referred to as reactive, reparative, or irregular secondary dentin) is produced in reaction to noxious stimuli, such as caries or a restorative dental procedure

 Dead tracts are areas of dentinal tubules that are empty &

are black when viewed microscopica lly.

 Sclerotic dentin results from aging or mild irritation & causes change in the composition of the primary dentin. Sclerosis resulting from aging is physiologic dentin sclerosis. Sclerosis resulting from a mild irritation is reactive dentin sclerosis.

Eburnated dentin refers to the outward (exposed) portion of reactive sclerotic dentin where slow caries has destroyed formerly overlying tooth structure, leaving a hard, darkened cleanable surface.

Dentin is less mineralized than enamel but more mineralized than cementum or bone.
Mineral content of dentin increases with age.

Dentin becomes harder with age due to the increase in mineral content.
The mineral phase is composed of hydroxyl apatite crystallites The organic phase consists of collagen. The hardness of dentin near the DEJ is three times greater near the pulp. Dentinal crystallites are smaller than enamel crystallites.

Dentin is distinguished from enamel by:

1. Color normally yellow white; slightly darker than enamel 2. Reflectance dentin surfaces are more opaque & dull being less reflective to light than similar enamel surfaces which appear shiny. 3.Hardness enamel surface provide a sharper, higher pitched sound than dentin surfaces.

Dentin Sensitivity
Sensitivity is encountered whenever odontoblasts & their processes are stimulated during operative procedures. The most accepted theory of pain transmission is the HYDRODYNAMIC THEORY. - This accounts for pain transmission by the small rapid movement of fluids that occur within the dentinal tubules arising from cutting, drying, pressure changes, osmotic shifts & changes in temperature.

Dentin permeability is not uniform throughout the tooth. Coronal dentin is much more permeable than root dentin. Deep dentin is a less effective pulpal barrier than superficial dentin near the DEJ or dentinocemental junction.

Dentin must be treated with care during restorative procedures to minimize damage to the odontoblasts & pulp. Air water spray should be used whenever cutting with high speed hand pieces to avoid heat build up. Dentin should not be dehydrated by compressed air blasts, it should always maintain its normal fluid content. Protection is provided by use of liners, bases & dentin bonding & non toxic restorative materials. Restorations must be adequately seal the preparation to avoid microleakage & bacterial penetration.

Whenever the dentin has been cut or abraided, a thin layer is created on the surface called the smear layer composed of denatured collagen, hydroxyapatite & other cutting debris. Smear layer serves as a natural bandage over the cut dentinal tubules because it occludes many of the dentinal tubules with debris called the smear plugs. Plugs are formed from cutting debris forced into the tubules.

Pulp
Soft connective tissue that occupies the central portion of the tooth Anatomically the pulp organ is divided: 1. Coronal pulp located in the pulp chamber in the crown portion of the tooth, including the pulp horns that are directed toward the incisal ridges & cusp tips. 2. Radicular pulp located in the pulp canal/s in the root portion of the tooth.

Pulp is composed of myelinated & unmyelinated fibers, arteries, veins, lymph channels, connective tissue cells, intercellular substance, odontoblasts, fibroblasts, macrophages, collagen & fine fibers. Central area contains the large vessels & nerve trunks.

Functions of the pulp:

1. Formative production of primary & secondary dentin by the odontoblasts 2. Nutritive supplies nutrients & moisture to the dentin through the blood vascular supply to the odontoblasts & their processes 3. Sensory provides sensory nerve fibers within the pulp to mediate the sensation of pain 4. Defensive related to its response to irritation by mechanical, thermal, chemical or bacterial stimuli - such irritants can cause the degeneration & death of the affected odontoblastic processes & the formation & replacement of odontoblasts - deposition of reparative dentin acts as a protective barrier against caries & various other irritating factors

Knowledge of the contour & size of the pulp cavity is essential during tooth preparation.

With advancing age, the pulp cavity usually decreases in size & becomes more fibrous.

Cementum
Is a hard connective tissue that covers the roots of the teeth.
Formed by cells known as cementoblasts which develop from undifferentiated mesenchymal cells in the connective tissue of the dental follicle

Slightly softer than dentin; composed of 45% to 50% inorganic material (hydroxyapatite) by weight & 50% to 55% organic matter & water by weight

Organic portion is composed primarily of collagen & protein polysaccharides. Sharpeys fibers are portions of the collagenous principal fibers of the periodontal ligament embedded in both the cementum & alveolar bone.

Cementum is avascular; light yellow & slightly lighter in color than dentin It has the highest fluoride content of all mineralized tissue

Two kinds of cementum: a. Acellular is living tissue that does not incorporate cells into its structure & usually predominates on the coronal half of the root b. Cellular occurs on the apical half Cementum joins the enamel to form the cementoenamel junction which is referred to as the cervical line