Good morning

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 Dental Pulp

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 CONTENTS
• Introduction
• Embryology
• Anatomy
• Structural Organization Of Pulp
• Cells Of Pulp
• Extra Cellular Matrix
• Pulp Vascularization And Regulation By Microenvironment
• Dental pulp innervation

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 • Functions Of Pulp
• Inflammatory Processes In Dental Pulp
• Regressive changes : Fibrosis And Calcospherites
• Conclusion
• References

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 INTRODUCTION:

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 INTRODUCTION:
• The dental pulp has the characteristic of being exclusively the non
mineralized part of a mineralized tooth. This tissue is surrounded by
a robust shell like complex structure that includes dentin and enamel
in the crown and cementum in the root.
• Like most connective tissues, the dental pulp is vascularized and
innervated.
• It is also a reservoir of structural fibroblasts (named pulpoblasts long
ago by Louis Baume). The pulp complexity is increased by the
presence of progenitors (or stem cells) implicated in pulp repair and
regeneration.

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 EMBRYOLOGY
• The induction and the human dentition development takes place
during embryonic, fetal, neonatal, and postnatal childhood stages of
development.
• Human tooth development begins with the induction of the primary
dentition during the fifth week of gestation (embryogenesis). Bio
mineralization starts during the fourteenth week of gestation, and the
permanent dentition is completed at the end of adolescence

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 EMBRYOLOGY
• During the 8th week of IUL, there is condensation of the mesenchyme
under the enamel organ-Dental papilla.
• Pulp develop from ectomesenchymal cells of dental papilla
• Anatomically and functionally, the dentin and dental pulp are
considered a single entity. Both tissues are often associated as the
“dentin-pulp complex.”
• But, biologically, this anatomical entity has no consistency.

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 ANATOMY
• Total of 52 pulp organs 32 in the permanent and 20 in the primary
teeth.
• Total pulp volume in permanent teeth is 0.38cc with means each
pulp is about 0.02CC
• Each of these organs has a shape that conforms to that of the
respective tooth.

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 ANATOMY
Pulp Chamber or coronal pulp, located
in the crown of the tooth.

Root canal or radicular pulp, is the

portion of the pulp located in the root
area.

Accessory canals or lateral canal, extra

canal located on the lateral portions
of the root.

The apical foramen is the opening from

the pulp at the apex of the tooth.

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 Coronal pulp:

• It is the pulp occupying the pulp chamber of the crown of the tooth
• In young teeth it resembles the shape of the outer dentin
• It has six surfaces : occlusal, mesial, distal, buccal, lingual and floor.
• Pulp horns are projections into the cusp
• This pulp constricts at the cervical region where it continues as the
radicular pulp

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 Radicular pulp:
• It is the pulp occupying the pulp canals of the root of the tooth
• In the anterior tooth it is single and in the posterior teeth it is
multiple
• The radicular portions of the pulp is continuous with the
periapical tissues through apical foramen
• As age advances the width of the radicular pulp is reduced, and
so is the apical foramen.

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 Apical foramen:
• Pulp cavity terminates at root apex as small opening called apical
foramen
• Radicular pulp continuous with connective tissue of the periodontium
through this foramen.
• Diameter in an adult- maxillary teeth-0.4mm,
mandibular teeth-0.3mm.
• Cdj does not necessarily occur at the extreme end of the root but may
occur with in the root canal( 1mm short)
• Apical foramen coincide with anatomical apex only in 17-46% of
cases(0.4-0.7mm away)
• There may be 2-3 foramina split by cementum or dentin- APICAL
DELTA.

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 Apical foramen:

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 Accessory canals:

• Leading laterally from the radicular pulp into the periodontal tissue.
• Present in the apical third of the root sheath cells.
• Formed due to premature loss of HERS or when developing root
encounters a blood vessel.
• Overall occurrence is 33%.
• May also be present at the furcation region.

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 Sectioning Of Pulp

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 STRUCTURAL ORGANIZATION OF
PULP

• Odontoblastic zone
• Cell free zone
Odontoblasts layer
• Cell rich zone
dentin
• Pulp proper

Cell free zone

Pulp proper

Cell rich zone

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 Odontoblastic zone

• A layer of odontoblasts are found along the pulp periphery.

• They are dentin forming cells.
• This layer is called an EFFECTOR SYSTEM

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 Cell free zone:

• It is also called weil’s zone

• 40 microns wide &relatively free of cells
• Traversed by
blood vessels
un myelinated nerves
cytoplasmic process of fibroblasts
• This zone is found below the Odontoblastic zone.

• Relatively diminished in younger and older pulps.

• PLEXUS OF RASHKOW is seen

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 Cell rich zone:

• Present in subodontoblastic layer

• Contains more proportions of fibroblast and undifferentiated
mesenchymal cells.
• Also contains macrophages, dendritic cells and lymphocytes.
• Zone formed due to migration of cells from pulp proper
• Mitosis seen when dead odontoblasts are replaced
• Also contain young collagen fibers during early dentiogenis.

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 Pulp proper:
• It is central region of the pulp
• Contains major blood vessels and nerve of the pulp
• Pulpal cells and fibroblasts are seen

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 CELLS OF THE PULP

Cells of pulp

Resident cells NONNon resid

Resident
odontoblasts Un differentiated
mesenchymal cells
stem cells
Immune cells
fibroblasts
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Michel Goldberg: Dental 23
pulp
 Odontoblasts:
• The most distinctive cells of the dental pulp, and therefore the
most easily recognized, are the odontoblasts.
• The post mitotic odontoblasts are implicated in
dentinogenesis.
• A cell body and a cell process form each odontoblast.
• Cell bodies are grouped in four to five rows parallel to the
tooth surface at the periphery of the pulp.
• Odontoblasts in the crown are larger than in the root.
• RER, Golgi apparatus and secretory vesicles.

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 Development Of Odontoblast
• Neural Crest Migrate Toward The First Branchial Arch And
Settle Near The Dental Lamina Of The Mandibular, Maxillary,
An Nasofrontal Buds.

• In front of the epithelial dental lamina, the pre-odontoblasts

divide and migrate from the central to the outer part of the
pulp.

• During the last division of pre-odontoblast, an asymmetric

division occurs.

Odontoblasts Hoehl cells

Goldberg M, Smith A. A biological basis for repair
12/21/2014 and tissue engineering. Crit Rev Oral Biol Med. 25
2004;15:13–27.
 Regressive changes

• Odontoblasts have a limited lifespan and when they mature and

become aged, they start to be loaded by lysosomes and autophagic
vacuoles. Then, they become apoptotic cells.

• The number of odontoblast inside the outer cell layers is gradually

reduced. The cells become smaller, and eventually they are reduced to
a single layer. Differentiating Hoehl’s cells, which behave as
odontoblast second generation, presumably renews them.

Goldberg M, Smith A 2004

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 Junctional complex:

• Numerous junctions such as gap junctions tight junction and

desmosomal junction are found between odontoblasts.
• Indicating exchange of ions and small molecules.
• They promote cell to cell adhesion and play a role in maintaining
polarity of odontoblasts.

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 Odontoblastic process:

• Odontoblasts give off a single process that extends into dentin and
housed within dentinal tubules
• These process devoid of major organelles
• They contain abundance of micro tubular filaments and coated
vesicles
• Mainly composed of protein-tubulin, actin and vimentin, nestin.

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 Odontoblastic process
• Odontoblast processes cross the predentin and penetrate inside
dentin tubules either in the inner third or along the whole dentin
length, up to the dentinoenamel junction.
• The diameter of odontoblast lateral branchings is thinner. They
establish connections between tubules, penetrating in minute tubules
and crossing the whole thickness of the hypermineralized peritubular
dentin.

• The lateral branches do not contain nestin, but only vimentin and
actin.

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 Functions:

• Synthesis of organic matrix mainly type 1 collagen

• Synthesis of non collagenous substances like sialoprotein,
phosphophoryn, osteocalcin, ostenoectin & osteopontin
• Intracellular accumulation of calcium
• Degradation of organic matrix

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 Fibroblasts:

• Cells that occur in greatest number in the pulp

• Function is to form, maintain the matrix that consists of
collagen fibers and ground substance throughout the pulp
• The fibroblasts are stellate shaped cells having extensive
process.
• Young teeth - Fibroblasts have abundant cytoplasm having
numerous cell organels.
• Older pulp - Fibroblasts appear spindle shaped posses
processes having few cytoplasmic or such cells are called
fibrocytes

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 Fibroblasts:

Fibroblasts of the pulp are said to be like “Peter Pan” because they never
really “grow up”. These cells do seem to remain in a relatively
undifferentiated modality when compared with fibroblasts of other
connective tissue of the body

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 Functions:

• Dual function :
a) It has capability of ingesting and degrading the organic matrix.
b) Pathway of both synthesis and degradation in the same cell.

• Synthesize type I III, V VII collagen & ,GAG etc.

• Form and maintain the pulp matrix.

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 Undifferentiated mesenchymal cells:
• These mesenchymal cells are distributed through out the pulp,
frequently around the perivascular area - believed to be toti potent
cell
• They are Polyhedral shaped with peripheral processes and large oval
nuclei
• Under adequate stimulus they may differentiate into odontoblast or
fibroblast or macrophages.
• In older pulp, their number and ability to differentiate comes down

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 Immune defense mechanisms of dental pulp

• Dendritic cells
• Macrophages Antigen presenting cells
• lymphocytes
• Endothelial cells

• They express class II MHC on their surface

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 Immunocompetent cells:
• Macrophages: Described as histiocytes (or) as resting wandering
cells
• Located close to blood vessels.
• In all they constitute 8-9% of the pulpal cell population.
They display prominent phagocytic capacities. They produce
• microbicidal enzymes and reactive oxygen species (ROS);
• several cytokines such as IL-I, IL-6, and tumor necrosis factor
(TNF); and
• growth factors promoting pulp repair.

Jontell M, Bergenholtz G, Scheynius A, Ambrose W. Dendritic cells and macrophages

expressing Class II antigens in the normal rat incisor pulp. J Dent Res. 1988
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• Macrophages are implicated in phagocytosis and are important for
the elimination of antigen immune complexes.
• Macrophages act as phagocytes or antigen- presenting cells,
implicated in the initiation of the immune response.
• Most of the dental pulp macrophages proliferate and differentiate in
the dental pulp without the supply of precursor cells from the blood
stream.
• Myeloid colony- stimulating factor (M-CSF) contributes to stimulate
macrophage development in the dental pulp,

Jontell M, Bergenholtz G, Scheynius A, Ambrose W. Dendritic cells and macrophages

expressing Class II antigens in the normal rat incisor pulp. J Dent Res. 1988
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 Lymphocytes
lymphocytes

B lymphocytes T lymphocytes

T helper cells Cytotoxic t cells

(cd4) (cd8)(NK)
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 Lymphocytes
• After activation,
T cells secrete several cytokines that regulate the intensity and/or
duration of the immune response by stimulating or inhibiting the action
of various target cells.
T helper cells
(cd4)

Th1 cells Th2 cells.

IL-2 and interferon-¥ IL-4, IL-5, and IL-6
. Kawashima N, Wongyaofa I, Suzuki N, Kawanishi HN, Suda H. NK and NKT cells in
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the rat dental pulp tissues. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 41
• Dendritic cells:
• Found in and around the odontoblast layer in non- erupted teeth
• In erupted teeth beneath the odontoblast layer.
• Close relationship to vascular and neural elements.
• They capture and present foreign antigen to the T cells.
• Participate in immunosurveillance.

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 PMNs
• Leucocytes are not found normally in the connective tissue
• They are transported to such sites in response to injury and then
present directly in the involved tissue as well as in blood.
• They phagocyte foreign material .

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 Mast cells:

• Widely distributed in connective tissue where they occur in small

groups in relation to blood vessels.
• seen only in inflammatory pulps.
• Each mast cells contains 80-300 granules.
• Granules contain heparin(anticoagulant) & histamine(inflammatory
mediator)
• Other inflammatory mediators include chymase, tyrptase,TNF,
cathepsin G

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• Plasma cells:
• Plasma cells are seen during inflammation of the pulp
• The plasma cells function in the production of antibodies.
• They have small nuclei with radiating chromatin that appears like a
cart wheel.

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 EXTRA CELLULAR MATRIX:
• Connective tissue fibers
– Collagen
– Elastin

• Ground substance
– Glycoproteins
– Glycosaminoglycans
– Fibronectin

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 PULP METABOLISM:
• Metabolism has been studied by measuring the rate of
O2 consumption & production of Co2 or lactic acid
by pulp tissue
• Radiospriometry is also used to evaluate the
metabolism.
• During dentinogenesis, rate of O2 consumption is
high than after crown completion.
• Greatest metabolic activity is seen in the odontoblast
layer.

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 Reduced pH of pulp causes decreases in O2
consumption as in pulp abscess.
 In addition to the glycolytic pathway, the pulp has the
ability to produce energy through Pentose shunt
pathway, suggesting that the pulp can function under
varying degrees of ischemia

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• Several dental materials have shown to inhibit O2
consumption Eg. ZOE , Ca(OH)2 & silver amalgam
• Pulpal irritation causes increases in cycloxygenase
products, which is inhibited by ZOE
• As cellular composition reduces, the rate of oxygen
consumption decreases.

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 CIRCULATION OF PULP:
• Pulp is extensively vascularized tissue containing
arterioles, venules, lymphatics.
• It lacks true arteries and venules
• Maintains tissue homeostasis.

FUNCTIONS
• Transport.
• Regulation.
• Respond to inflammatory stimuli.
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• Based on morphology

capillaries Post capillary venules

Pre capillary arterioles

Terminal arterioles

Collecting or muscular
Muscular arteries
venules

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Development of vasculature in pulp
• Vasculogenisis
• Angiogenesis: sprouting
Non sprouting

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 vasculogenisis

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Michel Goldberg: Dental 55
pulp
 sprouting Angiogenesis

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Michel Goldberg: Dental 56
pulp
 Response of pulp vasculature to injury

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 Regulation of pulp angiogenesis by
microenvironment

12/21/2014 El Karim etal. Neuropeptides regulate expression of angiogenic

58
growth factors in human dental pulp fi broblasts. J Endod
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 Lymphatics:

• Lymphatic vessels are formed from a fine meshwork of small ,thin

walled lymph capillaries.
• They start as blind openings near the weil’s zone.
• Carries the tissue fluids back to the vascular system.
• Reduces interstitial colloidal osmotic pressure and regulates the
development of edema.
• They provide immunosurveillance by transporting antigens to the
nodal collections of immune cells.

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 Development of pulp innervation

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 INNERVATION OF PULP:
• Dental pulp contains sensory and motor fibers to fulfill the
vasomotor and defense function
• Sensory afferent fibers are branches of maxillary &
mandibular division of trigeminal nerve.
• pulp innervation is dominated by non myelinated nerves

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 INNERVATION OF PULP:
• After entering the foramen, they arborize. Larger fibers are present in
the central zone. They divide as they proceed peripherally and
coronally.
• Subjacent to the cell rich zone, the nerves branch extensively forming
a parietal layer of nerves-NERVE PLEXUS OF RASHKOW. This layer
contains both A and C fibers.
• Above the cell free zone, myelinated fibers begin to lose their myelin
sheath.
• In the cell free zone, they form a rich network responsible for pain

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• Sympathetic fibers from the superior cervical ganglion appear with
blood vessels.
• In adult tooth sympathetic fibers form plexus around arterioles.
• Stimulation of these causes contraction of arteriols and decrease in
blood flow.

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 Classification of nerve fibers:
Type of nerve function diameter conduction
fiber Velocity(m/sec)
Aα Motor, 12-20 70-120
proprioception

Aβ Pressure, touch 5-12 30-70

Aγ Motor, to muscle 3-6 15-30

spindles
Aδ Pain, temperature, 1-5 6-30
touch
B Pre ganglionic <3 3-15
autonomic
C dorsal pain 0.4- 1 0.5-2
root
Post ganglionic 0.3-1.3 o.7-2.3
sympathetic sympathetic
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 Heat
•
cold PAIN
• Pressure
• chemical agents
 Mechanism of pain transmission

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 FUNCTIONS OF PULP
• INDUCTIVE
• FORMATIVE
• NUTRITIVE
• PROTECTIVE
• DEFENSIVE

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 INDUCTIVE

• Induces epithelial differentiation into enamel organ &

dental papilla.

• Induces enamel organ to differentiate into a

particular type of tooth.

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 FORMATIVE
• The cells of Pulp induces dentin formation
• This involves formation of primary and secondary dentin.
• The primary dentin is tubular and regularly arranged. Formed
before root closure
• Secondary dentin contain fewer tubules and is formed after root
closure.

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 NUTRITIVE
• Dental pulp maintains the vitality of dentin by providing O2 and
nutrients to the odontoblasts
• Also provides continuing source of dentinal fluid
• Nutrition made possible by rich peripheral capillary network.

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 PROTECTIVE
• Pulp helps in recognition of stimuli like heat, cold, pressure, chemicals
by way of sensory nerve fibers.
• Vasomotor innervation controls the muscular wall of blood vessels.
This regulates the blood volume and rate of blood flow and hence the
intrapulpal pressure.

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 DEFENSIVE (OR) REPARATIVE

• Pulp as remarkable reparative abilities

• It responds to irritation by producing reparative dentin and
mineralizing and affected dentinal tubules.
• Mild to moderate irritation results in continued peritubular
dentin formation, sclerosis and intratubular calcification-
(Tubular sclerosis).
• Stimuli like operative procedures abrasion, caries can result in
rapid dentin formation (Tertiary dentin)
• Inflamed pulp due to bacterial infection the cells in pulp aid in
the process of repair (macrophages, lymphocycts, neutrophils,
monocytes, plasma , mast cells)

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 SPECIAL ENVIORNMENT OF THE
DENTAL PULP

• Unyielding walls of dentin surrounding a resistant and

a resilient fiber –reinforced ground substance –makes
dental pulp a special organ.

1) A low-compliance environment.
2) Resilience of the connective tissue.
3) An ineffective collateral circulation.
 Inflammatory processes in the dental pulp
• Innate immune response
• Cytokine production
• Phagocytic leucocytes( pro inflammatory response)
• Non compliant & non self cleansing environment
• Lead to chronic information
• T lymphocytes & B lymphocytes
• Further complexes & finally lead to necrosis of tissues

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 Inflammatory processes in the dental pulp

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 Environment sensing ability
• Odontoblast
• Pulp fibroblast
• Endothelial cells

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 Regressive changes
in pulp cavity volume
vascularity
• Cell changes
• Fibrosis
• Pulp stones or denticles
• Diffuse calcifications
 Regressive changes
• PULP CALCIFICATIONS
• It’s a common occurrence of 50-80% of all teeth after 40 yrs of age.
• In the coronal pulp, calcification usually takes the form of discrete,
concentric pulp stones, whereas in the radicular pulp, calcification
tends to be diffuse

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 Pulp Stones(denticles)
• Appearing in either or both coronal and root portions of the pulp
organ
• Develop in teeth that appear to be normal in other respects.
• Asymptomatic unless they impinge on nerves (or)blood vessels
• Seen in functional as well as embedded unerupted teeth.

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 Denticles

According to cohen
laminated
unlaminated

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 True denticles:

Development of true denticles is caused by the inclusion of

remnants of the epithelial root sheath with in the pulp Epithelial
remnants induce the cells of pulp to differentiate into
odontoblasts then form the dentin mass.

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  True denticles are similar in structure to dentin
 They have dental tubules and contain processes of the
odontoblasts
 Usually located close to the apical foramen

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Histological sections of true dentacles
• False Denticles:
– They Do Not Exhibit Dentinal Tubules
– They Appear As Concentric Layers Of Calcified Tissue

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 • An denticles begin as small nodules but increase in size by
incremental growth
• Classified as free, attached (or) embedded depending on their
relation to the dentin
– Free denticles – entirely surrounded by pulp tissue
– Attached denticles – Partly fused with dentin
– Embedded denticles – Entirely surrounded by
dentin
– Incidence as well as the size of pulp stones increase with
age.

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• Diffuse calcifications:
• Appear as irregular calcific deposits in the pulp tissue,
following collagenous fiber bundles, blood vessels.
• These calcifications are usually found in the root canal and
less often in coronal area

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 Diffuse calcification of the pulp,
seen along with pulp fibrosis
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 Calcific metamorphosis
• Luxation of teeth as a result of trauma may result in calcific
metamorphosis, a condition that can, in a matter of months or years,
lead to partial or complete radiographic obliteration of the pulp
chamber.
• The cause of radiographic obliteration is excessive deposition of
mineralized tissue resembling cementum or, occasionally, bone on the
dentin walls, also referred to as internal ankylosis .

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 Calcific metamorphosis
• Clinically, the crowns of teeth affected by calcific metamorphosis may
show a yellowish hue compared with adjacent normal teeth. This
condition usually occurs in teeth with incomplete root formation.
• Trauma results in disruption of blood vessels entering the tooth, thus
producing pulpal infarction.

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 Other changes
• Continued formation of secondary dentin throughout life gradually
reduces the size of the pulp chamber and root canals,. Although the
width of the cement dentinal junction appears to stay relatively the
same.
• There is a gradual decrease in the cellularity and a concomitant
increase in the number and thickness of collagen fibers, particularly in
the radicular pulp.
• As the pulp chamber narrows with age, the collagens inability to
disintegrate to accommodate the smaller lumen results in fibrosis – a
congestion that could be called “CRABGRASS” effect.

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• The thick collagen fibers may serve as foci for pulpal calcification.
The odontoblasts decrease in size and number, and they may
disappear altogether in certain areas of the pulp, particularly on the
pulpal floor over the bifurcation or trifurcation areas of multirooted
teeth.
• With age there is a progressive reduction in the number of nerve and
blood vessels

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 THE PULP TO THE TOOTH IS LIKE THE
HEART TO THE BODY

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 References
Endodontic Practice Grossman 13th edition
Endodontics Y John Ingle 6th edition
The Dental Pulp By S. Seltzer
Cohen Pathway Of Pulp 10th Edition
Orbans Oral Histology 13 Edition
Ten Cates Oral Histology 8th Edition
Wheeler Dental Anatomy
The Dental Pulp Michel Goldberg

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THANK YOU
 Pulp reaction to dental materials
• Beside the periodontal tissues and the oral mucous membrane pulp
is prime local target organ for direct and indirect biological
interaction with dental materials.
• Due to its anatomical characteristics containing tubules with
Odontoblastic processes and lateral processes , the dentin is not only
permeable, but it is also a vital tissue which is biologically responsive.
• Thus any contact of material or substance with the dentin may
possibly interfere with the dental pulp

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 Dentin Sterilizing Agents
• Used to destroy bacteria in the dentinal tubules in deep carious
lesions.
• Phenol – it increased, rather than decreasing the permeability of
dentinal tubules, therefore greater pulpal damage.

• Silver nitrate – silver salts diffuse rapidly through the dentinal

tubules and regardless of the depth of the cavity eventually reach the
pulp tissue resulting in an inflammatory reaction.

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 Dentin Sterilizing Agents
• Camphorated parachlorophenol and penicillin- combination of both
is an effective in deep cavities but cause pulpal inflammation
• Eugenol – when mixed loosely with zinc oxide inhibits the action
potential in the nerve fibers thus reducing pain associated with pulpal
inflammation (anodyne effect).
• When placed on exposed pulp, a marked inflammatory reaction is
seen.
• The presence of an intervening layer of dentin is necessary to prevent
an inflammatory response.

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 Dental cements
SILICATE CEMENT
• Severe pulp irritant
• The pH at the time of insertion is about 2.0 and remains below 7 even
after a month.

ZINC PHOSPHATE CEMENT

• Pulp response is moderate.
• Three minutes after mixing the pH is about 3.0
• It approaches neutrality in 24 to 48 hours.
• Thickness of dentine as great as 1.5mm can be penetrated by the acid.
• Thus very thin mixes should be avoided as they are more acidic.
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 Dental cements
ZINC OXIDE EUGENOL CEMENT
• The pH is 6.6 to 8.0, thus they are the least irritating of all the cements.

ZINC POLYCARBOXYLATE CEMENT

• Pulpal response is mild
• The pH of set cement is 5.0 to 6.0
• Penetration of polyacrylic acid into the dentinal tubules is less because
of the high molecular weight and larger size.

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 Dental cements
GLASS IONOMER CEMENT
 Pulpal response is mild.

CALCIUM HYDROXIDE CEMENT

 Alkaline in nature with pH of 9.2 to 11.7
 This high alkalinity is responsible for the reparative dentin formation

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 Dental cements
COMPOSITES
• Adequately cured composites are relatively biocompatible
• Inadequately curing results in leaching out of components that induce
long term pulpal inflammation.
ACID ETCHING
• It does not cause any irreversible damage to the pulp
• It only causes early inflammatory reaction which subsides

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DENTIN BONDING AGENT
• It seals the tubules and decreases pulpal sensitivity.
• There are fewer voids between the thin adhesive layer and the dentin
which minimizes micro leakage and prevents microbial invasion.
• It removes superficial smear layer but leave plugs in DT
• The collagen framework interacts with priming agent that forms
hybrid layer , thus micromechanical bonding

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 Dental pulp stem cells
• Stem cells are undifferentiated embryonic or adult cells that
continuously divide. A fundamental property of stem cells is self-
renewal or the ability to go through numerous cycles of cell division
while maintaining the undifferentiated state.

• Stem cells can be either embryonic or adult (postnatal)

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 Dental pulp stem cells

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 Dental pulp stem cells
Stem cell potency

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 Dental pulp stem cells
Origin of adult postnatal stem cells
Stem cells permanently present in adult tooth
• Dental pulp stem cells ( DPSCs) isolated from permanent
tooth
• Exfoliated deciduous teeth stem cells ( SHEDs) and immature
dental pulp stem cells ( IDPSCs) from deciduous teeth
• Apical papilla stem cells ( SCAPs)

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 Dental pulp stem cells
Stem cells present in periodontal tissues:
• Periodontal ligament stem cells
• Dental follicle stem cells ( DFSCs) differentiating odontoblast
like cells or endothelial cells.
SM taking origin from other tissues
• Induced pluripotent stem cells (ips)
• Hematopoietic stem cells
• Neuronal stem cells

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 Niches Of Dental Pulp Stem Cells
• Schofield introduced the concept of stem cell “Niche” in 1978
• Stem cells are located in particular environment known as Niches.
• Stem cell behavior is regulated by a local micro environment
referred to as “ the stem cell niche” characterized by three essential
properties
– Anatomic space where the number of stem cell is regulated
– Stem cells are instructed to control the maintenance, quiescence, self renewal
and recruitment toward differentiation etc
– Influence the cell motility

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 Niches Of Dental Pulp Stem Cells
LOCATION
– Young pulp demonstrate the presence of peri vascular cell niche
and a second stem cell niche at the cervical area.
– Adult dental pulp only perivascular niche in cell rich zone could
be observed

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Effects of Growth Factors on Dental
Stem/Progenitor Cells

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 Pulp Regeneration
• There has been no synthetic filling material superior to natural pulp
and dentin which is highly organized and complex.
• Thus the regenerative therapy for dentin/pulp is ideal goal to restore
tooth functions and morphology compromised by pulp injury and /or
inflammation.
• Attempts for regeneration, which started in in 1990s based on
concept of stem cell biology and regenerative medicine were
accelerated by discovery of dental pulp stem cells (DPSCs) and there
potential to ectopic pulp/ dentin formation.

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 Revitalization / Revascularization of
immature teeth

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