DENTIN

QUESTIONS
SHORT NOTES
1. Intertubular dentin and Intra tubular dentin(Feb 12’)
2. Theories of dentinal hypersensitivity.(Aug 12’, July 18’)
OR
Discuss theories of pain sensation in dentin and add a note on interglobular dentin (Aug
17’)
3. Enumerate various types of dentin with neat diagrams. Add a note on clinical importance
(Aug 15’)

BRIEF NOTES
1. Tomes’ granular layer(Aug 11’, Feb 14’,15’,Aug 17’)
2. Interglobular dentin(Feb13’,Aug 13’,14’Jan 19’)
3. Dentinal hypersensitivity( Feb 16’, Aug 16’, Jan 20’)
4. Age changes of dentin(Aug 16’,Jan 19’)
5. Incremental lines of Von Ebner (Feb18’)
6. Tertiary Dentin (Feb 18’, July 19’)
7. Sclerotic dentin(July 18’)
8. Hydrodynamic theory of dentin hypersensitivity (July 18’)
9. Types of dentin (July 18’)
10. Intertubular dentin and Intra tubular dentin(Jan 19’)
11. Dead tracts(Aug 17’, July 19’,Jan 21’)
12. Dentinoenamel junction(July 19’)
13. Dead tract and Tomes granular layer (Jan 20’)
14. Dentinogenesis (Jan 20’)
15. Primary and secondary dentin (Jan 20’)
OTHER POSSIBLE QUESTIONS
1. Describe in detail structure and microscopic features of dentin?
2. Dentinogenesis
3. Chemical composition of Dentin
4. The odontoblast and odontoblastic process
5. Dentinal tubules
6. Peritubular dentin
7. Mantle dentin
8. Predentin
9. Primary dentin
10. Secondary dentin
11. Contour Lines of Owen
12. Neonatal line
13. Dentinal lymph
14. Hyaline layer of Hopewell Smith
15. Physical properties of dentin
16. Circumpulpal dentin

DEFINITION
DENTIN : it is a yellowish mineralized tissue underlying the enamel and cementum and makes
up the bulk of the tooth.
 Classifications and enumerations

I) Classify dentin

A)Based on the time of formation

1.Primary dentin

-Based on location

a) Peritubular/Intratubular

b)Intertubular

c)Mantle

d)Circumpulpal

2.Secondary dentin

3.Tertiary dentin

D)Others

Interglobular dentin

Predentin

Sclerotic dentin

II) Enumerate hypocalcified structures of dentin

a) Interglobular dentin

b) Tomes’ granular layer

c)Contour lines of Owen

d)Neonatal line (may be hypocalcified)

III) Enumerate theories of dentinal hypersensitivity

1.Direct innervation theory

2. Transduction theory

3. Hydrodynamic theory

IV)Enumerate structures arising from DEJ

1.Enamel tuft

2.Enamel spindles

3.Gnarled enamel

V)Incremental lines in dentin

1.Incremental lines of Von Ebner

2.Contour lines of Owen

3.Neonatal line
 1)CLASSIFY DENTIN AND TYPES OF DENTIN

Dentin

(Based on the time of formation)

Primary physiological dentin Secondary physiological dentin Tertiary (pathological) dentin

(Based on location)

Mantle dentin

Circumpulpal dentin

Peritubular dentin/Intratubular dentin

Intertubular dentin

Other types ;

a) Predentin
b) Interglobular dentin
c) Sclerotic /transparent dentin
 1. Primary dentin

→ Dentin formed prior to root completion

a) Mantle dentin

→First formed dentin in the crown

→Outer most part of primary dentin

→20-150 micrometer thickness

→Fibres formed are perpendicular to DEJ

→Fibres →larger diameter ,argyrophilic ,cork screw shaped ,type lll collagen fibres called Von
korff fibres

→Less mineralized
 → Globular mineralization.

b ) Circumpulpal dentin

→Forms remaining bulk of dentin and bulk of tooth

→Fibres →smaller in diameter and more closely packed

→Slightly more mineralized

→Fibres are arranged parallel to pulp dentin border

→Both globular and linear mineralization.

c)Peritubular dentin/ Intratubular dentin

→Dentin which immediately surrounds the dentinal tubules

→They form the walls of dentinal tubules

→ Thickness ; outer dentin - 0.75 micrometer

Inner dentin - 0.4 micrometer

→Highly mineralized and sharply demarcated from intertubular dentin (9% more
mineralized than intertubular dentin).

→Contains very little collagen

→Upon decalcification, this area is lost

d) Intertubular dentin

→Main body of dentin located between the zones of peritubular dentin

→Half of its volume is organic matrix

→Fibres →type l collagen of 50-200nm in diameter

→Fibres oriented at random around the tubules

 →Less mineralized

→Upon decalcification, this area is retained

2. Secondary dentin ( regular secondary dentin)

→Narrow band of dentin bordering the pulp

→Represents dentin formed after root completion

→Contains fewer tubules than primary dentin

→Tubules usually bend when primary and secondary dentin meets

→Formed more slowly ,but formed throughout life.

→Not uniform deposition

→Greater on roof and floor of pulp chamber

3 Tertiary dentin

→Reparative/responsive / reactionary / irregular secondary dentin

→ Localized formation of dentin in response to trauma such as caries /restorative

procedures.

→Rate of deposition depends on degree of injury

2 types

Reactionary Reparative

→By pathologic process or trauma, odontoblasts are cut or exposed

→They may survive or die depending on extent of injury .

→If they survive →reactionary dentin is formed.

→If they die →reparative dentin is formed .

 Reactionary dentin Reparative dentin

Stimulus Milder Harsher

Injury Injury to odontoblast ,but they survive Loss of odontoblast that secreted primary and
secondary dentin

Formative Surviving post mitotic odontoblasts Produced by newly differentiated odontoblast

cells that produce primary and secondary like cells from undifferentiated cells of pulp
dentin.

Structure Change in direction of tubules →Heterogeneous

Low number of tubules
→Irregular sparse tubules
→Osteodentin (odontoblast entrapped in
dentin )
→Atubular dentin (tubular structure absent)
→Vasodentin (entrapped blood vessels)
Other types

a. Predentin

→Located adjacent to pulpal tissue

→First formed dentin which is not mineralized

→Mineralization lags behind matrix deposition

→Thickness : 2-6 micrometer( constant as there is balance between matrix deposition and
mineralization)

→As the matrix undergoes mineralization at the predentin –dentin front ,predentin then becomes
dentin and a new layer of predentin forms circumpulpally

→Consists principally of collagen

→Similar to osteoid in bone

 →Stains less than mineralized dentin

b. Interglobular dentin

→Mineralization in dentin occurs in the form of small globular areas which fuse into homogeneous
mass (globular/ calcospherite mineralization).

→Sometimes these globular zones of mineralization fail to fuse within mature dentin leaving behind
hypocalcified areas .

→ Seen in circumpulpal dentin just below the mantle dentin.

→ > in people with vitamin deficiency or exposed to high levels of

fluoride during dentin formation.

→Defect in mineralization , not matrix formation .

→Dentinal tubules run uninterrupted through the interglobular space.

→ Appears black in transmitted light

→ Crown -> greater in cervical and middle third

→ Root -> cervical third than middle third

→Among hypomineralized areas , they show higher concentration of sulphur.

 c. Sclerotic dentin /transparent dentin

→With age or stimuli due to caries or cavity preparation , lumen of dentinal tubules gets obliterated
with minerals or mineralization of the process itself or mineralization while odontoblastic process still
present takes place.

→Blocking of the tubules is considered as a defense action

→Apatite crystals are initially sporadic , but later fills the tubule with a fine meshwork of crystals

→Refractive index of dentin in which adjacent tubules are occluded are equalized and such areas
become transparent (glossy appearance )

→Amount of sclerotic dentin increases with age

→They appear light in transmitted light and dark in reflected light

→ Sclerosis decreases permeability of dentin and helps to prolong pulp vitality.

→Hardness greater than normal dentin

→80 KHN as compared to 68 KHN in normal dentin .

2.DEAD TRACTS
→In response to caries, attrition, abrasion, or cavity preparation, odontoblastic process may disintegrate
/retract leaving empty dentinal tubules filled with bacteria or air

→ Appears black in transmitted light and white in reflected light.

→Often observed in area of narrow pulpal horns because of crowding of odontoblasts.

→They exhibit decreased sensitivity

→More in older teeth

→Probably initial step is the formation of sclerotic dentin.

Clinical significance:

-allows the spread of caries at a greater speed as the tubules are empty.

3 .TOMES GRANULAR LAYER

→When root dentin is viewed under transmitted light in ground sections a granular appearing area is seen
just below the cementum (minute dark space )

→Granularity progresses from CEJ to apex of the tooth

Interpretations proposed ;

a) Thought to be associated with minute hypomineralized areas of interglobular dentin

b) True spaces , but weren’t seen in Haematoxylin and Eosin section or in electron micrographs.

c) Sections through the coalescing and looping terminal portion of dentinal tubules and seen because of
light refraction in thick ground section

Coalescing and looping is possible as a result of the odontoblasts turning on themselves during early dentin
formation

d) Recent interpretation relate this layer to the special arrangement of collagen and non collagenous
matrix protein at the junction between dentin and cementum

→Unmineralized, like interglobular dentin

→Among hypomineralized areas ,this shows highest concentrations of calcium and phosphorous.
4)THEORIES OF DENTINAL HYPERSENSITIVITY

DEFINITION

→It is characterized by short ,sharp pain arising from the exposed dentin in response to stimuli, typically
thermal ,evaporative, tactile ,osmotic, or chemical and which cannot be ascribed to any other dental
defect or pathology (Holland et al ,1997).

→"It is an transient tooth pain ,characterized by a short ,sharp pain arising from exposed dentin in
response to a stimulus that cannot be attributed to any other form of dental defect or pathology”.(Andy
M , 2002)

→Occurs in middle age

→females> males

→upper premolar followed by 1st molar are affected more

Exposure of dentin may be due to;

→Attrition, abrasion, erosion or abfraction .

→Tooth preparation for crown

→Excessive flossing

→secondary to periodontal disease

Different theories have been proposed regarding the actual mechanism that produces hypersensitivity.

a) Direct innervation theory /Neural theory

b) Transduction /Odontoblast receptor theory
c) Hydrodynamic theory .
 DIRECT INNERVATION THEORY

Mechanical /thermal /chemical /osmotic stimuli

Directly affects nerve ending within the dentinal tubules

They are in direct communication with pulpal nerve fibres

Hypersensitivity

CONS

→No evidence of nerves in outer dentin which is most sensitive

→Plexus of Raschkow and the nerves inside the intratubular dentin do not develop until sometime after
tooth eruption ,but newly erupted teeth are sensitive.

→Application of local anaesthetic on exposed dentin does not work.

→Agents which produce pain on skin do not work on dentin.

TRANSDUCTION THEORY

→Odontoblast is postulated as the receptor

→it is assumed , that as odontoblast has the same origin, that is, from neural crest as nerves ,it should be
able to transduce and propagate impulses.

stimuli

Direct stimulation of odontoblastic process in dentinal tubules

Impulses transmitted towards nerve endings in pulp

Hypersensitivity

CONS

→Absence of synaptic relationship between odontoblast process and nerve terminals

→membrane potential of odontoblasts is too less to permit transduction

HYDRODYNAMIC THEORY (Most accepted theory)

→Developed by Brännstrӧm in 1963

→Dentinal tubules contain odontoblastic process and nerve fibers bathed in dentinal fluid /dentinal
lymph

Stimulus

Centrifugal fluid flow within dentinal tubules

Pressure change throughout entire dentin

Activation of A𝜎 (A delta) intradentinal nerves

Hypersensitivity

Treatment

Depends on extent and severity of the problems

Localized hypersensitivity Application of varnishes or restoration

Generalized hypersensitivity Desensitizing tooth paste

Severe hypersensitivity consider endodontic therapy

2 .basic principles of treatment

→Block or plug the patent tubules preventing fluid flow

→Desensitize the nerves ,making it less responsive to stimulation

METHODS

a) Mode of administration
At home
In –office
b) On basis of mechanism of action
i) Nerve desensitization
Example ; Potassium nitrate
ii) Protein precipitation
Example ; Gluteraldehyde , silver nitrate
iii) Plugging dentinal tubules
Example; Strontium acetate (Sensodyne tooth paste), Sodium fluoride
iv) Dentin adhesive sealers
Example; fluoride varnishes , Composites
v) Periodontal soft tissue grafting
vi) Crown placement
vii) Lasers
Example; Nd-YAG laser( Neodymium –yttrium Aluminium garnet)
Erbium –YAG laser

5)DENTINOGENESIS

• Process of formation of dentin are from ectomesenchymal cells of dental papilla of neural crest
origin called odontoblasts.

• Highly regulated and well controlled process which starts in the bell stage of tooth development

• Series of ectodermal-mesenchymal interactions between the inner enamel epithelium and dental
papilla results in terminal differentiation of the cells

• Differentiation starts at the cusp tips down to the cervical loop.

• Differentiation initiated by a series of signals

• Enamel knot produces atleast 10 different signaling molecules from the BMP ,FGF, Hf and Wnt
families

• Cell-cell signalling pathways and their target nuclear factors are the key mediators between the
epithelium and ectomesenchyme

Odontoblast differentiation

3 stages

• induction
 • competence

• terminal differentiation.

Induction

• The basement membrane of the dental epithelium plays a major role both as a substrate and as a
reservoir of signalling molecules.

• signals from the inner enamel epithelial cells most likely involve members of the TGF-(3 family
(BMP-2and BMP-4; that become partially sequestered in the basal lamina, to which peripheral cells
of the dental papilla become aligned

Competence

• achieved after a predetermined number of cell divisions is complete and cells express specific
growth factor receptors.

• In the final round of cell division, only the most peripheral layer of cells subjacent to the basal
lamina respond to the signals from the internal dental epithelium to become fully differentiated
into odontoblasts. They are the pre-odontoblasts.

Terminal differentiation

• Differentiation starts in the dental papilla cells at then future cusp tip region

• Pre-odontoblasts

-no well developed organelles nor a specific orientation

-Rounded or oval cells with few protrusions or stubs.

-Nucleus to cytoplasmic ratio is high

-RER-scarce with short cisternae

-Golgi apparatus-initial functional stage

-Few lysosomal structures

• This changes rapidly

• When pre-odontoblasts become terminally differentiated, they become polarizing odontoblasts

 -Cells increase in size

-RER develops actively and flattened in the long axis of the cell

-Numerous free ribosomes

-Nucleus comes to lie at the basal part of the cell, ie farthest from IEE. Nuclear repolarization
is one of the hallmarks of odontoblast terminal differentiation.

-Golgi complex becomes pronounced and is positioned above the nucleus

-Mirror images of ameloblasts

-Redistribution of intracellular skeletal proteins like actin, vinculin and vimentin

-Numerous cytoplasmic process rapidly resolve into a single large process

-Sometimes, one of these processes may penetrate the basal lamina and interpose itself

between the cells of the inner enamel epithelium to form enamel spindles

• Intercellular junctions are formed at this stage

• Desmosomal junctions, tight junctions and gap junctions are seen between odontoblasts

Dentine formation takes place in 2 steps

Matrix formation Mineralisation

Matrix secretion

Mantle dentin formation (First formed dentin)

• Odontoblasts actively synthesize and secrete matrix components

• Cell bodies-synthesis occurs

• Cell process-exocytotic and endocytotic activity

• Secrete collagen and non collagenous components

• Collagen I is deposited at the cell-predentin interface along with phosphorin

 • Phosphophorin-2nd most abundant constituent secreted by the odontoblastic process

• Odontoblast is still in last stages of differentiation when first layer of dentin is laid down.

• Type I collagen fibres are laid down at right angles to the future DEJ

• In harshly fixed tissue stained with silver ,fibres take on a ‘corkscrew’ appearance.

Von korff’s fibres

• Argyrophilic, corkscrew like fibres located between cell bodies, fanning into the predentin and
penetrating the dentin where they intermingle with the fibres secreted by the odontoblasts.

• Mainly type III collagen fibres.

• 0.1 -0.2mm in diameter

Circumpulpal dentin formation

• Bulk of circumpulpal dentin is laid down in an incremental pattern

• Collagen fibres are secreted by the odontoblastic cell body as it moves pulpally inward.

• The fibres are arranged parallel to the pulp dentin border.

Dentin mineralization

• Complex process

• Key element-odontoblast

-produces matrix

-controls transport and release of Ca ions

-determines presence and release of matrix components that modulate the process.

• Mineralisation only occurs if odontoblasts are present

• calcium transported by the odontoblasts becomes a crystalline mineral in the dentine by deposition
on to a template formed by type I collagen fibrils

• It is largely under the control of the predominant noncollagenous protein in dentine, Dentine
phosphor protein(DPP).
 • DPP is highly anionic and thus able to bind calcium

• In high concentrations, DPP inhibits crystal formation.

• Thus, by controlling the release and level of DPP, the odontoblast can control the initiation of
mineralization and the rate of deposition

• Evidence of the role of DPP

✓ DPP is absent from non-mineralized matrix and concentrated at the mineralization front

✓ In vitro, it can be shown to bind calcium, induce hydroxyapatite nucleation and control
crystal growth.

✓ It is absent from the dentine of patients with dentinogenesis imperfecta.

• Other proteins involved-Osteopontin, Osteonectin, Bone sialoprotein, Dentin sialoprotein and

chondroitin sulphates 4 and 6

Mantle dentin

• Globular or calcospherite pattern

• Initial crystal formation in 0.1-0.2μm membrane bound matrix vesicles

• Bud off from plasma membrane during dentin matrix formation

• High alkaline phosphatase activity

• Contains phopholipids and annexin II

• Mineral crystals develop within these vesicles

• Matrix vesicles rupture and coalesce

Circumpulpal dentin

• Both globular and Linear pattern

• Odontoblasts transport Ca ions to mineralization front

• Deposited on a template of collagen type I fibrils

• Under the control of DPP

Root dentin formation

 • At the end of crown formation

• HERS

• Predentin is more narrow in root

• Collagen fibres are laid parallel to the long axis of the root.

Rate of dentin deposition

• Several factors

• Age of the cell

• Functional stage of the tooth

• Anatomical location on the tooth

• Average-4μm/day

Secondary dentinogenesis

• Slower paced

• Continues throughout life

• Asymmetric

• tubules continuous with primary dentin-so same odontoblasts

• Down regulation of the secretory activity of the odontoblasts that form the primary dentin

Tertiary dentinogenesis

• By the pathologic process or operative procedures, the odontoblastic process is cut or exposed

• The odontoblasts die or survive based on the extend of injury

• If they survive-reactionary dentin

• If they die-odontoblast like cells form from undifferentiated mesenchymal cells-reparative dentin

6)ODONTOBLAST

• They are the most distinctive cells of the dental pulp

 • Odontoblasts form a layer lining the periphery of the pulp and have a process extending into the
dentin
• They are the cells responsible for the formation of dentin
• In the fully developed tooth the odontoblasts continue to
• lay down secondary dentine throughout life and survive for as long as the
• tooth remains vital.
• The odontoblast is a postmitotic cell and cannot divide:
• insult or injury will result in the death of odontoblasts.

Stages in the life cycle of odontoblast

Active/
Transitional/
synthetic/ Resting
Pre odontoblast intermediate
Secretory odontoblast
odontoblast
odontoblast

Pre-odontoblasts Synthetic Intermediate Resting/aged

odontoblasts - /transitional odontoblasts
odontoblasts

-no well developed -polarizing -shows features of -Stubby cells

organelles nor a odontoblasts synthetic cells but
specific orientation organelles are less in -Scanty cytoplasm
-25-40µm in length and number and less
-Rounded or oval cells 5-7 µm in diameter prominent. -Dark close faced
with few protrusions or nucleus
stubs. -Single cytoplasmic -Nucleus shows
process called condensation of -↓Orgenelles
-Nucleus to
odontoblastic process chromatin with
cytoplasmic ratio is
organelles distributed -Secretory granules are
high
around the nucleus. absent
 -RER-scarce with short -RER develops actively
cisternae and flattened in the -↓secretory granules
long axis of the cell
-Golgi apparatus-
-Autophagic vacuoles
initial functional stage -Numerous free
ribosomes
-Few lysosomal
structures -Nucleus comes to lie
at the basal part of the
cell

-Golgi complex
becomes pronounced
and is positioned above
the nucleus

7))STRUCTURAL LINES IN DENTIN

Source: Oral anatomy, histology,embryology. (B.K.B Berkovitz)

A)Lines originating from curvatures of dentinal tubules

a)Schreger lines

b)Contour lines of Owen

B)Lines originating from incremental deposition of dentin

a)Incremental lines of Von Ebner

b)Andresen lines

c)Neonatal lines

A)Lines originating from curvatures of dentinal tubules

 a)Schreger lines

• In some longitudinal sections, sigmoid primary curvatures coincide to form broad bands
• They are more difficult to see in horizontal sections where they would be seen as broad
concentric bands in the circumpulpal dentine.
• These lines are known as Schreger lines

b)Contour lines of Owen

• These lines arise due to optical effect created when the secondary curvatures coincide.
• They are unusual but can sometimes be seen

B)Lines due to incremental dentin deposition

✓ The lines may be seen in normal ground sections demineralized sections, under polarized light and
in microradiographs.
✓ They can be attributed to circadian fluctuations in acid–base balance that affect both the mineral
content and the refractive index of forming hard tissues.

a)Incremental lines of Von Ebner(short period lines)

• Seen as alternating dark and light bands,each pair reflecting the diurnal rhythm of dentine
formation
• In cuspal dentine, where deposition is most rapid, the amount of dentine formed each day and
the distance between adjacent dark bands is approximately 4 μm
• In the root peripherally the distance between lines is nearer 2 μm

b)Andresen lines (Long period lines)

• The coarser, long-period lines are approximately 16–20 μm apart

• Between each long-period line there are six to 10 pairs of short-period lines
• The cause for the 6–10-day periodicity is unknown.
• The same periodicity exists between the long-period striae of Retzius in enamel and the long-
period Andresen lines in dentine, making it likely that a common mechanism exists
• They are greatly enhanced when viewed in polarized light , suggesting that they are associated
with changes in collagen fibril orientation.
c) Neonatal line

• An exaggerated line is seen at the junction of the dentine formed before and after birth
• It is a prominent incremental line denoting the prolonged period of rest during birth
• It is found only in deciduous teeth and in permanent first molars
• It represents the abrupt change in environment which occurs at birth
• The dentin matrix formed prior to birth is usually of better quality than that formed after birth.
• It may be a zone of hypocalcification.