Pulp

Presented by :
Dr. Kush Pathak
 INTRODUCTION
2

 The Pulp is a soft mesenchymal connective tissue

that occupies pulp cavity in the central part of
the teeth.

 It is a special organ because of the unique

environment
 DEVELOPMENT
3

 During the 8th week of Intrauterine life, there is

condensation of the mesenchyme under the enamel
organ-Dental papilla.

 The enamel organ enlarges and encloses the dental

papilla in their central portion.
 Dental papilla controls the morphology & type of
tooth to be formed.

 Dental papilla shows :

Extensive proliferation of cells of high
vascularity
 First the differentiation of the inner enamel
4


epithelium into ameloblasts.

 Odontoblasts differentiate from the peripheral cells

of dental papilla

 Well organized capillaries are found at beginning of

dentinogenesis
5
 Capillary crowd is present around the odontoblast
during active dentinogenesis.

 Rim of the enamel organ (IEE & OEE) is the cervical

loop.

 Root formation is carried out by the proliferation of

cells at the cervical loop.
 Dental Papilla
6

Dental papilla capped by the enamel organ

 GENERAL FEATURES
7

 Total of 52 pulp organs are present

 32 in the permanent and 20 in the primary teeth.

 Total pulp volume in permanent teeth is 0.38cc with mean

being 0.02 cc
 Each of these organs has a shape that conforms
to that of the respective tooth.

 Has ability to form dentin throughout life

8

The pulp cavity is divided into :-

1. Coronal pulp
2. Radicular pulp
 CORONAL PULP
9

 It is the pulp occupying the pulp chamber of the

crown of 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.
 RADICULAR PULP
10

 It is the pulp occupying the pulp canals of 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.
 APICAL FORAMEN
1
1

1. Pulp cavity terminates at root apex as small

opening called apical foramen

2. Radicular pulp continues with connective

tissue of the periodontium through this
foramen.
3. Diameter in an adult-
Maxillary teeth- 0.4m
Mandibular teeth- 0.3mm

Wide open during development of root

5. Undergoes changes
• Tooth when tipped from horizontal pressure causes apex
to tilt in opposite direction.
• Pressure exerted on one wall of the foramen causes
resorption.

6. Same time cementum is laid down on opposite side

resulting relocation of the original foramen
13

7. Sometimes apical opening is found on the lateral

side of the apex.

8. There may be 2-3 foramina split by cementum or

dentin- APICAL DELTA
 Apical Foramen
14

Neurovascular
bundle entering
pulp through the
foramen
 ACCESSORY CANAL
15

 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

 Accessory Canals
16
Structural Organization of pulp
 Histological zones of pulp
18

1. Odontoblastic zone
2. Cell Free Zone
3. Cell Rich Zone
4. Pulp Proper
 Odontoblastic Zone
19

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

• They are dentin

forming cells.
 Cell free zone
20

It is also called zone of weil

40 microns wide &relatively free of cells

Traversed by
1. Blood vessels
2. Unmyelinated nerves
• Cytoplasmic process of fibroblasts
 This zone is found
below the odontoblastic
zone

 Represents the space

into which
odontoblasts move
during tooth
development.
 Cell rich zone
21

• Present in Sub odontoblastic layer.

• Contains more proportions of fibroblast and

undifferentiated mesenchymal cells.

• Also contains macrophages, dendritic cells and

lymphocytes.
• This zone is formed due to migration of cells from
pulp proper.

• Mitosis is seen when dead odontoblasts are

replaced.

• Also contains young collagen fibres during early

dentinogenesis.
 Pulp core
22

It is central region of the pulp

Contains major blood vessels and nerves of the pulp

Pulpal cells and fibroblasts are also seen

 CELLS OF
23
PULP

 Odontoblasts
 Fibroblasts
 Undifferentiated cells
 Defence cells
 ODONTOBLASTS
24

 A Peripheral area of the pulp where the

odontoblasts reside is termed odontogenic
zone.
 Arranged in Palisading pattern
 Tall columnar cells
 Shape may vary:
Coronal pulp- columnar
Mid portion - cuboidal
Apical region - Flattened
25
 These cells have large process extending into
dentin.

 Average no. of odontoblasts estimated to be 45,000

per Sq.mm of odontogenic zone.

 Odontoblasts in the crown are larger than that in

the root.
  Shape of the odontoblasts also reflect the functional
26
activity of the cell.

 During active phase, there is increase in cell organelles.

 Resting (or) Non active phase cells are flattened,

scanty cytoplasm, and decrease in cell organelles.
 JUNCTIONAL COMPLEX
27

 Numerous junctions such as gap junctions, tight

junction and desmosomes 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
• Focal tight junctions - Parallel to the axis of the cell

• Desmosomes - sites of cell-to-cell adhesion between

lateral plasma membranes.

• At the distal end of the cell bodies, zonular tight

junctions and gap junctions are present.
• These zonular tight junctions, contribute to the
pseudo-epithelial organization of the odontoblastic
layer.
• They constitute a predentin-pulp barrier.
 JUNCTIONAL COMPLEXES
28
 ODONTOblastic PROCESS
29
 Odontoblasts give off a single process that extends
into dentin and housed within dentinal tubules.
 These process are devoid of major organelles.

 They contain abundance of micro tubular filaments

and coated vesicles.
 Mainly composed of protein-tubulin, actin and
vimentin.
 FUNCTIONS OF ODONTOBLASTS
30

Synthesis of organic matrix

Synthesis of non collagenous substances like sialoprotein,

phosphophoryn, osteocalcin, ostenoectin & osteopontin

Intracellular accumulation of calcium.

Degradation of organic matrix
 FIBROBALSTS
31

 Cells that occur in greatest number in the pulp.

 Function is to form and maintain the matrix that

consists of collagen fiber and ground substance
throughout the pulp.

 The fibroblasts are stellate shaped cells having

extensive process.
 Fibroblast
32

H&Estain

Immunohistochemical
method
 Young teeth - Fibroblasts have
abundant cytoplasm having numerous cell
organelles.
 Older pulp - Fibroblasts appear spindle shaped,
possess short processes having few cytoplasmic
organelles. Such cells are called fibrocytes
34  Dual function :

a) It has capability of ingesting and

degrading the organic matrix.

b) Pathway of both synthesis and degradation

present in the same cell.
 UNDIFFERENTIATED MESENCHYME
• These mesenchymal cells are distributed through
35

out the pulp, frequently around the perivascular

area - believed to be totipotent cell.

• They are Polyhedral shaped with peripheral

processes and large oval nuclei.

• Difficult to differentiate from fibroblast under

light microscopy.
• Under adequate stimulus they may differentiate
into odontoblast or fibroblast or macrophages.

• In older pulp, their number and ability to

differentiate comes down.
 IMMUNOCOMPETENT CELLS
36
• They play a major role in local inflammation and immunity.
• Recruited from blood stream and remain as transient
inhabitants in pulp
• These cells are
1. Macrophages
2. Mast cells,
3. Plasma Cells
4. Lymphocytes, Neutrophils, Eosinophils basophils and
monocytes.
 MACROPHAGES IN PULP
37

Described as histiocytes (or) as resting wandering

cells.

Located close to blood vessel.

Have several phenotypes

Macrophages are phagocytes

• During inflammation they appear in large no. to aid
in defense.

• In all, they constitute 8-9% of the pulpal cell

population
 Macrophages
38

Dark staining nucleus with cytoplasmic granules

 PLASMA CELLS
39

Plasma cells are seen during inflammation of the pulp.

Produce antibodies.

May be present in coronal pulp.

They have small nuclei with radiating chromatin that

appears like a cart wheel.
 Plasma Cell
40

Peripheral arrangement of chromatin in nucleus

 MAST CELLS
41

Occur in small groups in relation to blood vessels

Present only during pulpal inflammation

Have somewhat round nucleus and contain many dark

staining granules in the cytoplasm.

Their number increase during inflammation.

 Lymphocytes, Eosinophils and leucocytes
42

Usually found extravascularly in the normal pulp

During inflammation they increase in number.

Lymphocyte are involved in initial immune defense.

Usually they are not found in uninflamed pulp.

43

Eosinophils are present in some

allergic types of inflammation

In pulp,they are found in an inflammatory

exudate.
 LYMPHOCYTES IN PULP
44
45

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 phagocytose foreign material .
 Extracellular matrix
46

• Collagen fibers
• Elastin, Fibronectin
• Proteoglycans
• Glycosaminoglycans
• Basement membrane
• Ground substance
 Fibres (collagen fibres)
47

• Extra cellular structural protein, major

constituent of connective tissue
• Collagen fibers appear throughout the pulp
• Young fine fibers ranging in diameter from 10-
12mm.
• Pulp collagen fibers do not contribute to dentin
matrix production.
48 After root completion pulp matures and bundles of
collagen fibers increase in number

• They are scattered throughout the coronal or

radicular pulp, or they appear in bundles. These are
termed as diffuse or bundle collagen
• Most prevalent in root canals, especially near apical
region.
 Collagen fibers
49

Seen in relation with

 Type I:
Present as thick striated fibrils
50

Responsible for pulp architecture

Type III:

Thinner fibrils, mainly distributed in cell free and

cell rich zones

Contributes to the elasticity of pulp

 Type IV:
51

Present along the basement membrane of blood

vessels

Type V and VI:

Seen to form dense meshwork of thin microfibrils
throughout the stroma
52

Collagen turnover is maintained by fibroblasts

• Collagen synthesis is accelerated during

reparative dentin formation
 Elastic fibers
53

1. This has the ability to expand and contract like a

rubber band.
2. Elastic fibers are first formed in bundles of thin
micro filaments called Oxytalan fibers
3. Elastin is then deposited in between oxytalan fibers.
4. Always associated with larger blood vessels
 Elastic fibers
54

Verhoeff's method stains the fibers

 Fibronectin
Seen around the blood vessels

Also found in odontoblast layer with fibers passing into

predentin.

It plays a role in cell-cell & cell-matrix adhesion

Has a major effect on the proliferation, differentiation &

organization of cells.
 Fibrnoectin helps to maintain cell morphology and
56
provide a tight seal at this site.

May be involved in cell migration and anchorage in the

wound healing process of the connective tissue of pulp.

It regulates the migration and differentiation of secondary

odontoblasts

Adherent property of fibronectin is due to cell surface

glycoprotein receptors called Integrins.
 Ground substance
57

It is a Structureless mass, makes up the bulk

of the pulp
Consists of complexes of proteins,
carbohydrate and water.
Broadly classified as
 Glycoaminoglycans
 Proteoglycans
 Glycosaminoglycans
58
GAG found in pulp is mainly chondroitin
sulphate, dermatan sulphate & hyaluronic acid
Proteoglycans occupy larger area and they provide
protection against compression.
During dentinogenesis, the ground substance
show affinity for collagen and influence
fibrinogenesis They have capacity to bind with
calcium and help in mineralisation
 Basement membrane
59

It is a sheet like arrangement of extra cellular

protein matrix at the epithelial-mesenchymal
interface
Composed of 2 layers
lamina densa-electron dense

lamina lucida-electrolucent
60 BASEMENT MEMBRANE IS A PRODUCT OF
CONNECTIVE TISSUE AND EPITHELIUM

It is composed of
Collagen type IV

Laminin-adhesive glycoprotein

Fibronectin

Heparin sulfate
61
Collagen iv provides binding sites for the rest of
basement membrane components

Laminin binds to both cells of connective tissue and

epithelium
In mature pulp, basement membrane forms interface
along endothelial cells & schwann cells
 Functions
62

Act as sieve between epithelium and connective tissue

Helps in organization and differentiation by enabling

interactions between extra cellular molecules and cell
surface receptors
Eg: Odontoblasts during tooth development
 Circulation of the pulp
63

• The pulp organ is extensively vascularized.

• They are supplied by the

• superior and the inferior alveolar arteries.
64
 Pulpal blood flow is more rapid than in most area of
the body

 So pulpal pressure is highest of body tissues

The flow of blood in

Arterioles- 0.3to 1mm/sec
Venules– 0.15mm/sec
Capilaries – 0.08mm/sec
 Pulp vasculature
69

Apical third Middle third

 Innervation
81
•Nerve fibers, myelinated & unmyelinated, enter the tooth
through the apical foramen.

•Principle role is to help in recognition of irritants to the

pulp.

• This gives the opportunity to have the problem corrected

before irreversible effects can occur.
 INNERVATION
82

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.
 NERVE PLEXUS OF RASHKOW.
83
Subjacent to the cell rich zone, the nerves, branch
extensively forming a parietal layer of nerves.

Monitors the pain sensation

It is seperated from odontoblasts by a cell free zone

(lies between cell free and cell rich zones of pulp.)

This layer contains both A and C fibers.

 Types of nerve fibres
84
 Functions of dental pulp
90

Inductive
formative
nutritive
protective
defense
Inductive
• It induces
oral epithelial differentiation into dental lamina and
enamel organ

• It also induces
Enamel organ to differentiate into a particular type of
tooth morphology
 Formative
92

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.
Nutritive
• Dental pulp maintains the vitality of dentin
by providing O2 and nutrients to the odontoblasts.

• Also provides continuous source of dentinal fluid

• Nutrition made possible by rich peripheral

capillary network.
Protective
• Pulp helps in recognition of stimuli like heat, cold,
pressure, chemicals through sensory nerve fibres.

• Vasomotor innervation controls the muscular wall

of blood vessels.

• This regulates the blood volume and rate of

blood flow and hence the intrapulpal pressure.
 Defensive (or) reparative
95

 Pulp as remarkable reparative abilities.

 It responds to irritation by producing reparative

dentin and mineralizing the affected dentinal tubules.

 Mild to moderate irritation results in continued

peritubular dentin formation, sclerosis and
intratubular calcifiction-(Tublar sclerosis)
• Stimuli like operative procedures abrasion, caries
can result in rapid dentin formation (Tertiary
dentin)

• When pulp is Inflamed due to bacterial infection-

the cells in pulp aid in the process of repair
(macrophages, lymphocycts, neutrophils,
monocytes, plasma , mast cells)
 Regressive changes (Aging)
99

Cell Changes

 Appearance of fewer cells in aging pulp.

Cells are characterized by a decrease in size and

number of cytoplasmic organelles
100

 Fibroblast exhibit less perinuclear cytoplasm, long

thin cytoplasmic processes.
 Fibrosis
 External trauma such as dental caries (or) deep
restorations cause a localized fibrosis (or) scarring
effect

 Increase in collages fibers & decrease in the size of

the pulp.

 Vascular changes occur in aging pulp.

104

 Atherosclerotic plaques may appear in pulpal

vessels.
 Calcifications are found that surround vessels.

 Calcification is found most often in the region

near the apical foramen.

 Pulp stones(denticles)

105
Appearing in either or both coronal and root portions of the
pulp organ

 Develop in teeth that appear to be normal in other aspects.

 Asymptomatic unless they impinge on nerves (or)blood

vessels
 Seen in functional as well as embedded unerupted teeth.
 Classification
106

1. True denticles
2. False denticles
3. Diffuse calcifications

Contain Calcium Phosphat crystals

107
True
denticles

 True denticles are similar in structure to dentin.

 They have dentinal tubules and contain odontoblastic

processes.

 Usually located close to the apical foramen

108

 Formed due to inclusion of remnants of the

epithelial root sheath (HERS) within the pulp

 Epithelial remnants induce the cells of pulp to

differentiate into odontoblasts, then form the
dentin mass.
 True
denticle
109
 False denticles
110

 They do not exhibit dentinal tubules.

 Appear as concentric layers of calcified tissue.

 In Some cases these calcification sites appear within

a bundle of collagen fibers.

 In Some cases they appear in pulp, free of collagen

accumulations
 In some cases, they arise around vessels.

 In center of these concentric layers of calcified

tissues there may be remnants of necrotic and
calcified cells.

 Calcification of thrombi in blood vessels called

phleboliths, may also serve as nidus for false
denticles
 Classification on the basis of relation with dentin:
112
a) Free denticle – entirely surrounded by
pulp tissue

b) Attached denticles – Partly fused with the

Dentin
c) Embedded denticles – Entirely surrounded by
dentin
Incidence as well as the size of pulp stones increase
with age.
 False denticle
113

False calcification seen along the walls of the blood vessels

 Diffuse calcifications
114

 Appear as irregular calcific deposits in the pulp

tissue, following collagenous fiber bundles, blood
vessels.

 Sometimes they develop into larger mass, persist as

calcified spicules.

 Occurs in damaged tissues

 These calcifications are usually found in the root canal and
less often in coronal area.

 These calcifications surround blood vessels.

 These calcifications may be classified as

dystrophic calcification
 Diffuse calcification
116

Diffuse calcification of the pulp, seen along

with
 Dystrophic mineralization

• Ground substance alterations in the dental pulp occurs

on aging.
• Such changes may contribute to cellular degeneration
and increase dystrophic mineralization.

Circulatory disturbances may be the initiating factor.

Mineralization also is seen in the myelin sheaths of nerves.

Dystropic mineralization due to caries and
periodontal disease

•It also increases as a result of disease processes

such as caries and periodontal diseases.
•Pulp which is chronically inflamed contains
mineralization in regions of previous liquefaction
necrosis.
120

Alkaline phosphate in odontoblasts may function

as a calcium pyso phosphatus, there by
stimulating ca2 uptake in pulps.
Teeth with periodontal disease, DM increase in
both cornonal and radicular pulp.
 Age changes
121

 Formation of secondary dentin through out life,

reduces the size of the pulp chamber and root
canals
 Decrease in cellularity

 Odontoblast decrease in size & number, & may

disappear in certain areas. Especially on

pulpal floor over bifurcation & trifurcation
122
 Increase in number & thickness in collagen fibers
particularly radicular pulp
 Reduction in the nerve fibers & blood vessels

 Increase resistance of pulp against action of

enzymes.
 In dentin,

Increase in peritubular dentin

Dentinal sclerosis, reduces permeability Increase in
dead tracts
 Clinical considerations
125

1. Anatomic considerations
2. Factors to be considered during endodontic
treatment.
3. Effect of Operative Procedures
4. Effect of dental materials on pulp
5. Effects subsequent to restoration
 Anatomic considerations
126

Pulp Chamber with stone Cervical horns

 Operative procedures
127

Anatomic considerations
1)Shape of the pulp chamber and its extensions into the
cusp's pulpal horns is important.

Wide pulp chamber into tooth of young person will

2)
make a deep cavity preparation hazardous
3) pulpal horns projecting high into the cusps can lead
to exposure of pulp.

4) If opening a pulp chamber for treatment, its size

and variation in shape must be taken into
consideration