CLINICAL SIGNIFICANCE

OF
DENTAL ANATOMY,
HISTOLOGY,
PHYSIOLOGY,
AND OCCLUSION
SHARON ISIDRO-ALVAREZ, DMD, PhD

Our Lady of Fatima University

College of Dentistry
DENTIN-PULP COMPLEX
 DENTIN

Dentin and pulp tissues are specialized connective

tissues of mesodermal origin, formed from the
dental papilla of the tooth bud .

• Forms the largest portion of tooth structure.

• Normally, yellow white slightly darker the

enamel.
 DENTIN
DENTIN
Externally,It is covered by enamel on the anatomical crown
and by cementum on the anatomical root.

• Internally, dentin forms the wall

of the pulp cavity (PULP
CHAMBER AND PULP CANAL)
 DENTIN
FUNCTIONS
1. Provides the bulk and
general form of tooth.
2. Determines the shape
of the crown.
3. Protection of the
brittle enamel
 DENTIN
ODONTOGENESIS:

Histodifferentiation,
Matrix Formation
Mineralization
Maturation
 DENTIN
DENTINOGENESIS: HISTODIFFERENTIATION
INITIATION BUD STAGE CAP STAGE
STAGE
Enamel organ
Dental
lamina
Oral epithelium
ectomesenchyme
toothbud
ectomesenchyme

. BELL STAGE

Dental
sac Dental
papilla
 DENTIN
DENTINOGENESIS: HISTODIFFERENTIATION
During bud and cap stages of tooth development:

the ectomensenchymal cells proliferate

 DENTIN
DENTINOGENESIS: HISTODIFFERENTIATION

During bell stage of tooth development

1. Ectomesenchymal cells elongate
2. Organelles increase in the cells
3. Odontoblastic process appears
 DENTIN
DENTINOGENESIS: MATRIX FORMATION
During APPOSITION stage of tooth
development:
PREDENTIN FORMATION
1. COLLAGEN protein synthesis in rER
of odontoblasts
2. The proteins are packaged into
vesicles in golgi complex
3. Vesicles migrate to the area of
odotoblastic process
4. Release of secreted protein outside
the cell through exocytosis
 DENTIN
DENTINOGENESIS: MINERALIZATION
During MINERALIZATION stage of tooth development:

GLOBULAR CALCIFICATION
1. HA in Globules or calcospherules
2. Globules expand and fuse together
LINEAR CALCIFICATION DENTINOGENESIS:
1. Crystals are deposited in Mineralization
linear direction
 DENTIN

PHYSICAL
PROPERTIES OF
DENTIN
 DENTIN

Dentin formation begins at areas subjacent to the cusp tip or

incisal ridge and gradually spreads to the apex of the root.

In contrast to enamel formation, dentin formation continues after

tooth eruption and throughout the life of the pulp.
 DENTIN
PHYSICAL PROPERTIES OF DENTIN
PHYSICAL PROPERTIES
• It is light yellowish in color,
becoming darker with age.

• It is elastic and subject to

slight deformation.

• Harder than bone but softer

than enamel.

• Lower content of mineral

salts in dentin renders it more
radiolucent than enamel.

23
 DENTIN
CHEMICAL PROPERTIES OF DENTIN
35%
Organic matters 65% 30%
and water Inrganic matter: Organic and water
COLLAGEN HYDROXYAPATITE Form the pulp tissue
Non-collagenous Proteins CRYSTALS Exudate. This imparts
GROUND SUBSTANCE: Ca10(PO4)6(OH)2 elasticity to dentin
Mucopolysaccharides
(proteoglycans, GAGs)

ORGANIC INORGANIC WATER

AL PROPERTIES
r and
.

o f
lycans

sts of
o n e ,

n b e
al by
on.
 DENTIN

CLASSIFICATION
AND
TYPES
OF DENTIN
 TYPES OF D E N T I N
PRE DENTIN

• Unmineralized zone of dentin.

• The most recently formed layer of
dentin is always on the pulpal
surface.
• This unmineralized zone of dentin
is immediately next to the cell
bodies of odontoblasts
• Composed primarily of collagen
fibers and water.
 TYPES OF D E N T I N
PRIMARY DENTIN

PRIMARY DENTIN

Dentin forming the initial shape of the tooth

Usually completed after 3 years after tooth erruption.

Primary dentin represents all the dentin that is formed

before the completion of root formation
 TYPES OF D E N T I N
PRIMARY DENTIN

TYPES
1. MANTLE DENTIN
• the first formed dentin in the crown
underlying the dentinoenamel junction.
• It is the outer or most peripheral part
of the primary dentin & is about 20um
thick.
• The fibrils found in this zone are
perpendicular to the dentinoenamel
junction.

2. CIRCUMPULPAL DENTIN
• forms the remaining primary dentin or
bulk of the tooth.
• Represents all of the dentin formed
prior to root completion.
• The fibrils are much smaller in diameter
& are more closely packed together.
• Slightly more mineral content than
mantle dentin.
 PRE DENTIN

• Unmineralized zone of dentin.

PRIMARY DENTIN

Dentin forming the initial shape of the tooth

Usually completed after 3 years after tooth erruption.

 TYPES OF D E N T I N
SECONDARY DENTIN
• A narrow band of dentin bordering the pulp and representing the dentin
formed after root completion.
• Forms on all internal aspect of the pulp cavity, but the pulp chamber in
multi rooted teeth it tends to be thicker on the roof and floor than on the
side walls
• Contains fewer tubules than primary dentin.
• There is usually a bend in the tubules where primary and secondary
dentin interface.
 TYPES OF D E N T I N
SECONDARY DENTIN
• A narrow band of dentin bordering the pulp and representing the dentin
formed after root completion.
• Forms on all internal aspect of the pulp cavity, but the pulp chamber in
multi rooted teeth it tends to be thicker on the roof and floor than on the
side walls
• Contains fewer tubules than primary dentin.
• There is usually a bend in the tubules where primary and secondary
dentin interface.
 TYPES OF D E N T I N
REPARATIVE DENTIN/TERTIARY DENTIN

• Replaced by odontoblast (termed secondary

odontoblast)

• Response to moderate-level irritants such as

attrition, abrasion,errosion and trauma.

• It also appears as a localized dentin on the wall

surface of pulp cavity.
 TYPES OF D E N T I N
REPARATIVE DENTIN/TERTIARY DENTIN

• When moderate stimuli are applied to

dentin, such as caries, attrition, and some
operative procedures, the affected
odontoblasts may die. Replacement
odontoblasts (termed secondary
odontoblasts) of pulpal origin then begin to
form reparative dentin (tertiary dentin)

• formed by replacement odontoblast (termed

secondary odontoblast)

• formed in response to moderate-level irritants

such as attrition, abrasion, errosion and trauma.

• reparative dentin usually appears as a localized

dentin deposit on the wall of the pulp cavity
immediately subjacent to the area on the tooth
that has received the injury
 TYPES OF D E N T I N
CLINICAL CORRELATIONS
• Root completion takes about 3
years

• Dentin formation continuously

forms throughout life at a slower
rate

• Dentin formation depends on the

vital pulp as odontoblasts lie in the
pulp.

• Secondary dentin forms on all

internal aspects of the pulp cavity,
but in the pulp chamber, in multi-
rooted teeth, it tends to be thicker
on the roof and floor than on the
side walls
 DENTIN

GENERAL
ARRANGEMENT
 DENTIN

COMPONENTS
 DENTIN

dentinal tubules
The dentinal tubules are small canals that extend
through the entire width of dentin, from the pulp
to the DEJ
 DENTINAL TUBULES

• The tubule apertures are opened

and widened by acid application
 DENTIN

dentinal tubules
CONTENTS:
1. Odontoblastic process
It is the cytoplasmic cell
process (Tomes fiber) of an
odontoblast.
The cell bodies of odontoblasts
are in the pulp near the dentin-
pulp border
 DENTIN

dentinal tubules
CONTENTS:
2. Dentinal fluid
- the dental lymph
or fluid of dentin
- it is a transudate of
extracellular fluid, mainly
cytoplasm of odontoblastic
processes, from the dental pulp
via the dentinal tubules.
 DENTIN

dentinal tubules
PERITUBULAR DENTIN
It is more highly mineralized
than intertubular dentin.

It is twice as thick in outer

dentin (approx. 0.75um) than in
inner dentin (0.4um).

By its growth, it constricts the

dentinal tubules to a diameter of
1um near the dentinoenamel
junction.
 DENTIN

dentinal tubules
PERITUBULAR DENTIN
Organic matrix is lost along with mineral after
decalcification.The calcified tubule wall has an inner organic
lining termed the lamina limitans, high in glucosaminoglycans
(GAG).
 DENTIN

dentinal tubules
INTERTUBULAR DENTIN
Forms the main body of dentin.

It is located between the dentinal

tubules or, more specifically,
between the zones of peritubular
dentin.

Its organic matrix is retained after

decalcification.
 DENTIN

dentinal tubules
INTERTUBULAR DENTIN
About one-half of its
volume is organic matrix,
specifically collagen fibers.

The fibrils range from 0.5 to

0.2um in diameter.
SCLEROTIC DENTIN

• Result from aging physiological dentin sclerosis and mild

irritation (slowly advancing caries)
• reactive dentin sclerosis
• REACTIVE DENTIN SCLEROSIS
• The peritubular dentin becomes wider, gradually filling the tubules
with calcified material, progressing pulpally from the DEJ
• Can be seen radiographically into the form of radioopaque area
in the s-shape tubule.
SCLEROTIC DENTIN

• harder, denser, less sensitive, and more protective of the pulp

against subsequent irritations.

• PHYSIOLOGIC DENTIN SCLEROSIS: Sclerosis resulting

from aging

• REACTIVE DENTIN SCLEROSIS: sclerosis resulting from a

mild irritation
 DENTINAL TUBULES

• slight s-curve in the tooth crown, but the tuules are straighter in the incisal
ridges, cusp and root areas.

• FIGURE

• S curved in crown but rather straight in incisal tip and root.

• The end tubules are perpendicular to the dentinoenamel junction and

dentinocemental jucntion.
Each tubule is lined with a layer of Peritubular dentin, which is much
more mineralized than the surrounding intertubular dentin
 NUMBER OF TUBULES

• DEJ the # of tubules are

increase from 15,000 to
20,000 mm/2 to 45,000 to
65,000 mm/2 at the pulp.

• Coronal dentin average

diameter of tubules at the dej
is 0.5 to 0.9 um but increases
to 2 to 3 num at the pulp
 DEAD TRACTS

• The odontoblast processes disintegrate, & the empty tubules

are filled with air.

• Appear black in transmitted light & white in reflected light.

• Often observed in the area of narrow pulpal horns because of

crowding of odontoblasts.

• Demonstrate decreased sensitivity.

• Appear to a greater extent in older teeth.

• Probably the initial step in the formation of sclerotic dentin.

 EBURNATED DENTIN

• Referring to the outward (exposed) porton of reactive sclerotic

dentin where slow caries has destroyed formerly overlying tooth
structure , leaving a hard darkened surface.
 Dentin sensitivity

It is encountered whenever odontoblast and their processes are stimulated during operative
procedures

Dentin Permeability

Is primarily dependent on the remaining dentin thickness and the diameter of tubules.

Deep dentin is less effective barrier than is superficial dentin near the dentino enamel
junction and dentinocemental junction
 THEORIES OF PAIN TRANSMISSION
THROUGH DENTIN
1. Direct conduction theory in which
stimuli directly effect the nerve endings in
the tubules.

2. Transduction theory in which the

membrane of the odontoblast process
conducts an impulse to the nerve
endings in the predentin, odontoblast
zone, and pulp.

3. Fluid or hydrodynamic theory in which

stimuli cause an inward or outward
movement of fluid in the tubule, which in
turn produces movement of the
odontoblast and its processes.
 Dentin caries formation, progression and treatment in
dentin
1. Caries formation is a two-step process;
1. Dissolution of hydroxyapatite crystals: demineralization
2. Destruction of exposed collagen: DENATURATION

2. Dentin demineralizes at pH6.2.

3.CARIES REVERSAL: The remineralization of demineralized

dentin relies on intergrity of collagen framework.
 During cavity preparation dentin is usually distinguished
from enamel
1. Color: dentin is opaque and yellow in color.
In older, the dentin is darker, and it become black or brown in case where it
was exposed to oral fluids or slowly advancing caries.
2.Refletance – opaque or dull, less reflective to light than similar enamel
which appear shiny.
3. Hardness- softer than enamel.
4. Sound – in explorer tip, enamel surface provide sharper , and higher pitch
sound than dentin surface
 DENTIN MUST BE TREATED WITH THE
FOLLOWING:

1. Should be not dehydrated by compressed air blast, ideally always having the
dentin with its normal fluid content.

2. Great care during restoration to minimize damage to the odontoblasts and

pulp

3. Air-water spray should be used wherever cutting with high speed handpiece
to heat build up.

4. Protection also provided by the use of cavity liners, bases, dentin bonding
agents , non toxic restorative materials.

5. Restoration must adequately seal the cavity to avoid microleakage and

bacterial penetration.
 Smear layer

• Thin altered surface wherever the

dentin has been cut or abraded

• Few microleakage in thickness and

is composed of denatured collagen,
hydroxyapatite and other cutting
debris.
 Smear Plugs

Dentinal tubules with debris.

Smear layer and smear plugs

greatly reduce permeability of cut
dentin surface.
 DENTIN BONDING
• Most dentin bonding system have acidic “conditioners” that remove
smear layer and partially demineralized the intertubular dentin.
• Dentin without a smear layer provides many opportunities for
micromechanical retention.
• Ideally such etchant would remove the smear layer but leave the
smear plugs since they reduce dentin permeability and sensitivity.
 DENTIN BONDING

• Etchant should not excessively damaged

exposed collagen fibers since much of the bond
strength develops from resin encapsulating the
fibers.

• After the acid conditioner, hydrophilic resin

“bonding gents” are applied that can adapt to the
inherently moist dentin surface and co polymerize
with the coposite resin restoration.

• While some of the bonds form from resin “Tags”

extending to the dentinal tubules.
 DENTIN BONDING

• HYBRID LAYER

• Most dentin bonding system

remove or stabilize smear layer
allowing to penetrate.

• Resultant resin interdiffusion

zone.
 DENTIN

age-related changes
1. the mineral content of dentin
increases with age.
2. Dentin becomes harder with age,
primarily as a result of increases in
mineral content.
3. dentin is darker, and it can
become brown or black when it has
been exposed to oral fluids, old
restorative materials, or slowly
advancing caries.
4. Dentin exhibit less sensitivity
5. Dentin becomes less permeable
PULP
PULP
• Is a soft tissue of mesenchymal
origin that occupies the pulp cavity in
the tooth.
• Dentin and dental pulp are
considered as a single tissue,
which forms the pulp–dentin
complex
• Central area of pulp contains the
large blood vessels and nerve trunks.
PULP
FUNCTIONS OF THE DENTAL PULP
(1) Formative
Odontoblasts from dentin
(2) Nutritive
Nourishment of dentin
(3) sensory or protective
Sensory function is performed by the
nerve fibers within the pulp to mediate
sensation of pain
(4) defensive or reparative
Reaction of pulp to irritation
bymechanical, thermal, chemical, or
bacterial stimuli through inflammation or
formation of dentin
(5) Inductive
Dental papilla, induces IDE cells to
differentiate to ameloblasts
PULP PULP ORGAN
Circumscribed by the dentin and lined
peripherally by a cellular layer of
odontoblast adjacent to the dentin
The shape of each pulp conforms
generaly to the shape of each
respective teeth.

Divided into two

1. Coronal pulp- located in the pulp chamber
in the crown potion of the tooth.
PULP HORNS are conical projections of
coronal pulp directed towards incisal edges
and cusp tips

2. Radicular Pulp- located in the pulp canal in

the root portion of the tooth.
 PULP

HISTOLOGIC ZONES OF THE PULP

1. odontoblast
The pulp is circumscribed peripherally by a
specialized odontogenic area.
This zone is composed of the bodies of
odontoblasts bordering the dentin wall.
2. Cell free zone
Contains few cells.
This area is suggested to be the site for
mobilization of UMC.
3. Cell rich zone
fibroblasts and undifferentiated
mesenchymal cells
4. pulp core
large-caliber blood vessels, nerves and
lymph vessels
PULP

CLINICAL CORRELATIONS
 PULP PULP INFLAMMATION

1. hyperemia/ reversible pulpitis

Increase blood flow and volume.
pain elicited from the irritation and will linger a few seconds.
2. Irreversible pulpitis
when pulpal pain either spontaneous or elicited by an irritant lingers more than 15
seconds.
• The inflammation may become irreversible, however, and can result in the death of the
pulp because the confined, rigid structure of the dentin limits the inflammatory
response and the ability of the pulp to recover.
3. Pulpal Necrosis
typified spontaneous, continous throbbing pain.
pain elicited by heat and can e relieved with a cold then later, no response to any
stimulus.
 PULP CONSIDERATIONS IN OPERATIVE DENTISTRY

Knowledge of the contour and size of the pulp cavity is essential during tooth
preparation.
In general, the pulp cavity is a miniature contour of the external surface of the
tooth. Pulp cavity size varies with tooth size among individuals and even within a
single person.
With advancing age, the pulp cavity usually decreases in size.
Radiographs are an invaluable aid in determining the size of the pulp cavity and
any existing pathologic condition (
A primary objective during operative procedures must be the preservation of the
health of the pulp.
PULP PULP EXPOSURE
An opening through the wall of a tooth, produced by
pathologic processes or accidentally, thereby exposing
the dental pulp.

The characteristics of the dentin surrounding the exposure site which can be
defined as “nature of pulp exposure” may be critical for healing and repair
capacity of the exposed pulp
PULP PULP EXPOSURE
MECHANICAL EXPOSURE

Exposure type determined when the last bit of caries is

removed, with sound dentin surrounding the exposure site
indicating “mechanical exposure” and thus healthy pulp.
PULP PULP EXPOSURE
MECHANICAL EXPOSURE

mechanically exposed pulp has the potential to repair itself.

PULP PULP EXPOSURE
CARIOUS EXPOSURE

When carious dentin is surrounding the exposure site,

indicating “carious exposure” and thus pulpal involvement
PULP PULP EXPOSURE
CARIOUS EXPOSURE

in cases of carious exposure, the risk of bacterial

contamination increases, which can exacerbate pulp
inflammatory status and complicate healing
PULP VITAL PULP THERAPY
designed to preserve and maintain
pulpal health in teeth that have been
exposed to trauma, caries, restorative
procedures, and anatomic anomalies

• involve removal of local irritant and

placement of protective material
directly or indirectly over the pulp

Objective: to induce a physical

protective barrier over pulp to maintain
its vitality and function.
to initiate the formation of tertiary
reparative dentin or calcific bridge
formation
 PULP PULP CAPPING
• A procedure that allows deep caries • This technique is used when a
to remain over the pulp chamber that pulpal exposure occurs, either due
if removed would expose the pulp to caries extending to the pulp
and trigger irreversible pulpitis. chamber, or accidentally, during
• uses a layer of protective liner caries removal.
material which promotes • there is no recent history of
remineralization of the softened spontaneous pain (i.e. irreversible
dentin over the pulp and the laying pulpitis) and a bacteria-tight seal can
down of new layers of tertiary dentin be applied
in the pulp chamber. • involves the placement of protective
• The color of the carious lesion material, followed finally by a dental
changes from light brown to dark restoration which gives a bacteria-
brown, the consistency goes from tight seal to prevent infection.
soft and wet to hard and dry
INDIRECT PULP CAPPING DIRECT PULP CAPPING
THE SUCCESS OF PULP CAPPING PROCEDURE IS DETERMINED AS
EXPOSURE TOOK PLACE IN DRY, CLEAN, WELL-ISOLATED FIELD. Other
factors include size of exposure, degree and extent of inflammation of the pulp
and the time elapsed .