DOCSLIB.ORG

Pulp Space Anatomy and Access Cavities

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pulp Space Anatomy and Access Cavities Pulp Space Anatomy and Access Cavities Sumamry This lesson will help you to visualise where the root canal system is and will therefore aid your endodontic access. Key words¹ Orifice - the opening to the canal Overview It is essential to know the pulp space anatomy in order to achieve a high level of standard of endodontic treatment. Understanding access cavity design allows for conservative cavity preparation and prevents excessive tooth destruction. Magnification and enhanced illumination are extremely helpful during access cavity preparation and allow detailed examination of the pulp space. General pulp space anatomy The pulp space is split into two parts: Pulp chamber: within the crown ReviseDental.comThe outline follows the shape of the crown Root canal: within the root The outline follows the shape of the roots The canals have a similar tapering form to the roots Pulp space is surrounded by dentine Dentinal tubules make up 20-30% of the total volume of dentine² The concentration of tubules increase from the amelodentinal junction to the pulp Therefore the permeability of dentine is significantly larger closer to the pulp The tubules are an important reservoir for microorganisms and these microorganisms may persist even after root canal treatment Shape Since the roots tend to be broader buccolingually than they are mesiodistally, the pulp space is usually oval in cross-section Deposition of minerals With age, the pulp space becomes smaller, with an increase in deposition of fibrous and mineral components In response to irritation from caries, restorations or tooth wear, tertiary dentine is produced by odontoblasts. This causes the pulp space to become smaller and canal orifices difficult to locate The use of magnification and illumination will reveal the different colours of circumpulpal and tertiary dentine to aid access The pulp space is complex The root canals may divide and re-join Eight separate pulp space configurations were identified by Vertucci (1984)³ (See drawing below), however it is now known that even more categories also exist (Gulabivala). Diagrams to show eight separate pulp space configurations ReviseDental.com Apical foramina and constriction The foramina Is the opening at the apex of the root of a tooth Rarely opens at the exact anatomical or radiographic apex of the tooth The apical constriction Is where the canal constricts at the end, before emerging at the apical foramina, near the root end The apical constriction should ideally be used as the natural end point in root canal treatment, however in apical periodontitis cases, this has often been resorbed The integrity of the constriction should be maintained to avoid complications This position can be accurately located with an apex locator Drawing to demonstrate the location of apical foramen and apical constriction Accessory and lateral canals:³ Lateral canal are found anywhere along the length of the root and they tend to be at right angles to the main root canal Patent lateral canals are present in the coronal or middle third of 59% of molars Accessory canals usually branch off the main root canal somewhere in the apical region The presence of lateral canals in the furcation areas of molar teeth is well documented, andReviseDental.com their incidence is relatively high A total of 76% molars are reported to have openings in the furcation Variations in Pulp Space Variations are likely to occur and can include: Multiple roots e.g. mandibular first molar can present with three roots (a mandibular molar may have an additional disto-lingual root, known as radix entomolaris) Dens invaginatus Malformation where there is an infolding of enamel into dentine There is a deep pit into the pulp space which can be a route of infection into the pulp Dens evaginatus A protuberant cusp develops There is a high risk of this cusp fracturing creating a route for infection into the pulp Access Cavities Access cavities vary between each tooth You must ensure that you have detailed knowledge of each tooth and cavity morphology before cutting an access cavity As well as avoiding unnecessary removal of tooth tissue, you must ensure that caries removal is complete, all restorations removed to assess restorability and must ensure that the roof of the pulp chamber is completely removed It is important to ensure that you achieve straight line access in order to prevent complications and achieve the best preparation possible There have been a number of laws produced to guide clinicians with cutting access cavities and locating root canal orifices Krasner andReviseDental.com Rankow's Anatomic Laws:⁴ Anatomic laws relating to the pulp chamber: Law of centrality: the floor of the pulp chamber is always located in the centre of the tooth at the level of the CEJ Law of concentricity: the walls of the pulp chamber are always concentric to the external surface of the tooth at the level of the CEJ The diagram demonstrates the centrality of the pulp chamber and how the walls of the pulp chamber follow the pattern of the external wall whilst having the same central point ReviseDental.com Law of the CEJ: the CEJ is the most consistent, repeatable landmark for locating the position of the pulp chamber The diagram demonstrates how the distance from the external surface of the clinical crown to the wall of the pulp chamber is the same throughout the circumference of the tooth at the level of the CEJ Anatomic laws regarding the pulp chamber floor: Law of symmetry 1: except for maxillary molars, the orifices of the canals are equidistant from a line drawn in a mesial distal direction through the pulp-chamber floor The diagram demonstrates how the mesial canals are the same distance from the line drawn ReviseDental.com Law of symmetry 2: except for the maxillary molars, the orifices of the canals lie on a line perpendicular to a line drawn in a mesial-distal direction across the center of the floor of the pulp chamber The diagram demonstrates the the two lines drawn are perpendicular to each other Law of Colour Change: the colour of the pulp-chamber floor is always darker than the walls Law of orifice location 1: the orifices of the root canals are always located at the junction of the walls and the floor The diagram demonstrates the darker colour of the pulpal floor and the junction between the wall and the floor ReviseDental.com Law of orifice location 2: the orifices of the root canals are located at the angles in the floor- wall junction Law of orifice location 3: the orifices of the root canals are located at the terminus of the root developmental fusion lines The diagram shows the developmental fusion lines and demonstrates that the orifices are located at the angle of the floor-wall junction and at the end of the fusion lines ReviseDental.com Specific pulp space anatomy Average length and number of canals specific to each tooth:⁵ Maxillary teeth Maxillary tooth Average length (mm) Number of roots Number of canals Central incisor 22.5 1 1 Lateral incisor 22.0 1 1 Canine 26.5 1 1 1 (6%) First premolar 20.6 2-3 2 (95%) 3 (1%) 1 (75%) Second premolar 21.5 1-3 2 (24%) 3 (1%) 4 (93%) First molar 20.8 3 3 (7%) 4 (37%) Second molar 20.0 3 3 (63%) Third molar 17.0 1-3 Mandibular teeth Mandibular tooth Average length (mm) Number of roots Number of canals 1 (58%) Central incisor 20.7 1 2 (42%) 1 (58%) Lateral incisor 20.7 1-2 2 (42%) 1 (94%) Canine 25.6 1 2 (6%) 1 (73%) First premolar 21.6 1 2 (72%) 1 (85%) Second premolar 22.3 1 2 (15%) 3 (67%) First molar 21.0 2-3 ReviseDental.com4 (33%) 2 (13%) Second molar 19.8 2 3 (79%) 4 (8%) Third molar 18.5 1-2 Pulp space anatomy and access cavities specific to each tooth Maxillary teeth Maxillary Incisors: An abnormality is most likely to occur with maxillary lateral incisor and may present with:Dens invaginatus, germination or fusion Pulp Chambers The central incisors of young patients normally have three pulp horns The canals of lateral incisors are often curved distally/ palatally at the apex Root Canals Extremely rare to have more than one root or canal Oval shape in cross-section, only round near the apex Access cavities Triangular in shape, prepared from the palatal aspect An access cavity that is too small and close to the cingulum leads to Severe stresses on the instrument Instrument binding against the access cavity walls Risks of ledge formation apically The access cavity should extend far enough incisally without excess removal of tooth tissue Sometimes the incisal edge may be involved if access is to be adequate Once initial access has been carried out, the cervical constriction should be removed and the dentine lip adjacent to the pulp horns should be removed Maxillary Canines: Pulp Chamber Quite narrow The canals of canines may have a distal apical curvature Root Canal Oval shape in cross-section Circular in the apical third Access cavity Prepared from the palatal aspect, from the cingulum to the edge Narrow mesio-distally Maxillary Premolars PulpReviseDental.com Chambers Wide buccopalatally, narrow mesiodistally with two pulp horns Root Canals First premolars: Two canals within two roots Many configurations (described above) can be found Prevalence of lateral canals can be as high as 49%² Root canal orifices lie buccally and palatally Second premolars: One canal within one root Variation of configurations with the most prevalent being Types II and III (25%) and IV and VII (25%)² Ribbon shaped Access cavities Cut occlusally Wider buccolingually Maxillary Molars Pulp Chambers First molars: Four pulp horns Root Canals First molars: Usually
Load more

Recommended publications
  • Teeth What Do I Need to Know?
    Teeth What do I Need to Know? Enamel Enamel is a semitranslucent, highly mineralized crystalline solid which covers the crowns of teeth and acts as a barrier to protect the teeth. Dentin Dentin is less mineralized than enamel, but more mineralized than bone; it acts as a cushion for the enamel and a further barrier to the pulp. Pulp Questions? The pulp is the area in the middle of the tooth containing the blood vessels and nerves for that tooth. If you would like more Pulp Horns information or have any The projections of the pulp underneath the taller parts of the tooth, or the “cusps.” specific questions, contact*: These are the areas of the pulp which are closest to the functional (or “occlusal”) part of the tooth which is used to chew food. Leslie Blackburn Cementum XLH [email protected] Protects the dentin and pulp of the roots the and way enamel protects it in the crown. or [email protected] My Teeth XLH Network contact: Raghbir Kaur, DMD; [email protected] Scientific Advisory Board *Please include XLH in the subject line of the email. Challenges Yale-New Haven Pediatric Dental Center 1 Long Wharf Dr, Suite 403, New Haven, CT 06510 Suggestions http://www.ynhh.org/medical-services/dental_pediatric.aspx What is the Most Important Thing to Know? It is not your fault. People with XLH have unique dental challenges. Sometimes even when you are doing everything right you may still have dental problems. While it is important to do everything you can to keep your mouth healthy, it is also important to remember that you some things about your oral health are out of your control.
    [Show full text]
  • Pulpotomy Treatment for Primary Teeth
    2010 National Primary Oral Health Conference October 24-27 Gaylord Palm, Orlando, Florida Pulpotomy treatment for primary teeth Enrique Bimstein Professor of Pediatric Dentistry University of Florida College of Dentistry. Pulpotomy treatment for primary teeth Goal The participants will become familiar with the basic knowledge and procedures required for the performance of the pulpotomy treatment in primary teeth. Pulpotomy treatment for primary teeth Topics Introduction Definition and rationale. Indications and contraindications. Materials and techniques. Pulpotomy technique (clinical procedures). Pulpotomy follow up. Summary and conclusions. Pulpotomy treatment for primary teeth Topics Introduction Definition and rationale. Indications and contraindications. Materials and techniques. Pulpotomy technique (clinical procedures). Pulpotomy follow up. Summary and conclusions. Preservation of the primary teeth until their time of exfoliation is required to: a. Maintain arch length, masticatory function and esthetics. Preservation of the primary teeth until their time of exfoliation is required to: a. Maintain arch length, masticatory function and esthetics. Preservation of the primary teeth until their time of exfoliation is required to: a. Maintain arch length, masticatory function and esthetics. b. Eliminate pain, inflammation and infection. Preservation of the primary teeth until their time of exfoliation is required to: a. Maintain arch length, masticatory function and esthetics. b. Eliminate pain, inflammation and infection. c. Prevent any additional pain or damage to the oral tissues. Despite all the prevention strategies, childhood caries is still a fact that we confront every day in the clinic. The retention of pulpally involved primary teeth until the time of normal exfoliation remains to be a challenge. Primary teeth with cariously exposed vital pulps should be treated with pulp therapies that allow for the normal exfoliation process.
    [Show full text]
  • 1 – Pathogenesis of Pulp and Periapical Diseases
    1 Pathogenesis of Pulp and Periapical Diseases CHRISTINE SEDGLEY, RENATO SILVA, AND ASHRAF F. FOUAD CHAPTER OUTLINE Histology and Physiology of Normal Dental Pulp, 1 Normal Pulp, 11 Etiology of Pulpal and Periapical Diseases, 2 Reversible Pulpitis, 11 Microbiology of Root Canal Infections, 5 Irreversible Pulpitis, 11 Endodontic Infections Are Biofilm Infections, 5 Pulp Necrosis, 12 The Microbiome of Endodontic Infections, 6 Clinical Classification of Periapical (Apical) Conditions, 13 Pulpal Diseases, 8 Nonendodontic Pathosis, 15 LEARNING OBJECTIVES After reading this chapter, the student should be able to: 6. Describe the histopathological diagnoses of periapical lesions of 1. Describe the histology and physiology of the normal dental pulpal origin. pulp. 7. Identify clinical signs and symptoms of acute apical periodon- 2. Identify etiologic factors causing pulp inflammation. titis, chronic apical periodontitis, acute and chronic apical 3. Describe the routes of entry of microorganisms to the pulp and abscesses, and condensing osteitis. periapical tissues. 8. Discuss the role of residual microorganisms and host response 4. Classify pulpal diseases and their clinical features. in the outcome of endodontic treatment. 5. Describe the clinical consequences of the spread of pulpal 9. Describe the steps involved in repair of periapical pathosis after inflammation into periapical tissues. successful root canal treatment. palisading layer that lines the walls of the pulp space, and their Histology and Physiology of Normal Dental tubules extend about two thirds of the length of the dentinal Pulp tubules. The tubules are larger at a young age and eventually become more sclerotic as the peritubular dentin becomes thicker. The dental pulp is a unique connective tissue with vascular, lym- The odontoblasts are primarily involved in production of mineral- phatic, and nervous elements that originates from neural crest ized dentin.
    [Show full text]
  • Pulp Therapy for Primary and Young Permanent Teeth: Foundational Articles and Consensus Recommendations, 2021
    Pulp Therapy for Primary and Young Permanent Teeth: Foundational Articles and Consensus Recommendations, 2021 Alqaderi H, Lee CT, Borzangy S, Pagonis TC. Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis. J Dent. 2016;44:1-7. American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. Reference Manual, 2014. Available at: https://www.aapd.org/globalassets/media/policies_guidelines/bp_pulptherapy. pdf. Accessed, March 1, 2020. Barros MMAF, De Queiroz Rodrigues M, Muniz FWMG, Rodrigues LKA. Selective, stepwise, or nonselective removal of carious tissue: which technique offers lower risk for the treatment of dental caries in permanent teeth? A systematic review and meta-analysis. Clin Oral Investig. 2020;24:521-32. Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamali S, Graham L. Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-analysis. Pediatr Dent. 2017;39:16-123. Coll JA, Vargas K, Marghalani AA, Chen CY, Alshamali S, Dhar V, Crystal Y. A Systematic Review and Meta-Analysis of Non-vital Pulp Therapy for Primary Teeth. Pediatr Dent 2020;42(4):256-272. Cushley S, Duncan HF, Lappin MJ, Tomson PL, Lundy FT, Cooper P, Clarke M, El Karim IA. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review. J Dent. 2019;88:103158. El Meligy OA, Allazzam S, Alamoudi NM. Comparison between biodentine and formocresol for pulpotomy of primary teeth: a randomized clinical trial. Quintessence Int. 2016;47:571‐80. Farsi DJ, El-Khodary HM, Farsi NM, El Ashiry EA, et al.
    [Show full text]
  • Insight Into the Role of Dental Pulp Stem Cells in Regenerative Therapy
    biology Review Insight into the Role of Dental Pulp Stem Cells in Regenerative Therapy Shinichiro Yoshida 1,* , Atsushi Tomokiyo 1 , Daigaku Hasegawa 1, Sayuri Hamano 2,3, Hideki Sugii 1 and Hidefumi Maeda 1,3 1 Department of Endodontology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; [email protected] (A.T.); [email protected] (D.H.); [email protected] (H.S.); [email protected] (H.M.) 2 OBT Research Center, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; [email protected] 3 Department of Endodontology and Operative Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan * Correspondence: [email protected]; Tel.: +81-92-642-6432 Received: 20 May 2020; Accepted: 5 July 2020; Published: 9 July 2020 Abstract: Mesenchymal stem cells (MSCs) have the capacity for self-renewal and multilineage differentiation potential, and are considered a promising cell population for cell-based therapy and tissue regeneration. MSCs are isolated from various organs including dental pulp, which originates from cranial neural crest-derived ectomesenchyme. Recently, dental pulp stem cells (DPSCs) and stem cells from human exfoliated deciduous teeth (SHEDs) have been isolated from dental pulp tissue of adult permanent teeth and deciduous teeth, respectively. Because of their MSC-like characteristics such as high growth capacity, multipotency, expression of MSC-related markers, and immunomodulatory effects, they are suggested to be an important cell source for tissue regeneration.
    [Show full text]
  • Deciduous Tooth and Dental Caries
    Central Annals of Pediatrics & Child Health Short Note *Corresponding author Michel Goldberg, Faculté des Sciences Fondamentales et Biomédicales, Université Paris Deciduous Tooth and Dental Descartes, Sorbonne, Paris Cité, 45 rue des Saints Pères, 75006 Paris, France, Tel : 33 1 42 86 38 51 ; Fax : 1 42 86 38 68 ; Email : Caries Submitted: 07 December 2016 Accepted: 08 February 2017 Michel Goldberg* Published: 13 February 2017 Faculté des Sciences Fondamentales et Biomédicales, Université Paris Descartes, Copyright France © 2017 Goldberg OPEN ACCESS THE DIFFERENCES BETWEEN DECIDUOUS AND PERMANENT TEETH numerical density of enamel was higher in the deciduous teeth In humans, deciduous tooth development begins before birth than recorded in the permanent teeth, mainly near the dentino- and is complete by about the fourth postnatal year. They are lost enamel junction (DEJ) [5]. when the patient becomes 11 years old. The permanent teeth Variations are detected in the chemical composition of the appear by 6-7 years (and later for the wisdom teeth). Most are deciduous and permanent enamel types. These differences successional, and a few are non successional. The coronal part may be one of the several factors contributing to faster caries of the human tooth is composed of two hard tissues: enamel progression in deciduous teeth. The carbonate ion occupies two and dentin, and this part includes the dental pulp, located in the different positions: (A) the hydroxide position, and compared crown. to (B), the phosphate position. The deciduous enamel contains more type A carbonate than B in permanent enamel. The total Enamel and dentin differ in composition in terms of type and quantity of organic and/or inorganic phases, amount of in permanent enamel.
    [Show full text]
  • Primary Tooth Vital Pulp Therapy By: Aman Bhojani
    Primary Tooth Vital Pulp Therapy By: Aman Bhojani Introduction • The functions of primary teeth are: mastication and function, esthetics, speech development, and maintenance of arch space for permanent teeth. • Accepted endodontic therapy for primary teeth can be divided into two categories: vital pulp therapy (VPT) and root canal treatment (RCT). The goal of VPT in primary teeth is to treat reversible pulpal injuries and maintaining pulp vitality. • The most important factor that affects the success of VPT is the vitality of the pulp, and the vascularization which is necessary for the function of odontoblasts. • VPT includes three approaches: indirect pulp capping, direct pulp capping, and pulpotomy. Indirect Pulp Capping • Recommended for teeth that have deep carious lesions and no signs of or symptoms of pulp degeneration. • The premise of the treatment is to leave a few viable bacteria in the deeper dentine layers, and when the cavity has been sealed, these bacteria will be inactivated. Based on the studies, after partial caries removal, when using calcium hydroxide or ZOE, there was a dramatic reduction in the CFU of bacteria. • The success of indirect pulp capping has been reported to be over 90%; hence this approach can be used for symptom-free primary teeth provided that a proper leakage free restoration can be placed. Direct Pulp Capping (DPC) • Used when healthy pulp has been exposed mechanically/accidentally during operative procedures. The injured tooth must be asymptomatic and free of oral contaminants. The procedure involves application of a bioactive material to stimulate the pulp to make tertiary dentine at the site of exposure.
    [Show full text]
  • Tooth Anatomy
    Tooth Anatomy To understand some of the concepts and terms that we use in discussing dental conditions, it is helpful to have a picture of what these terms represent. This picture is from the American Veterinary Dental College. Pulp Dentin Crown Enamel Gingiva Root Periodontal Ligament Alveolar Bone supporting the tooth Crown: The portion of the tooth projecting from the gums. It is covered by a layer of enamel, though dentin makes up the bulk of the tooth structure. The crown is the working part of the tooth. In dogs and cats, most teeth are conical or pyramidal in shape for cutting and shearing action. Gingiva: The gum tissue surrounds the crown of the tooth and protects the root and bone which are subgingival (below the gum line). The gingiva is the first line of defense against periodontal disease. The space where the gingiva meets the crown is where periodontal pockets develop. Measurements are taken here with a periodontal probe to assess the stage of periodontal disease. When periodontal disease progresses it can involve the Alveolar Bone, leading to bone loss and root exposure. Root Canal: The root canal contains the pulp. This living tissue is protected by the crown and contains blood vessels, nerves and specialized cells that produce dentin. Dentin is produced throughout the life of the tooth, which causes the pulp canal to narrow as pets age. Damage to the pulp causes endodontic disease which is painful, and can lead to infection and loss of the tooth. Periodontal Ligament: This tissue is what connects the tooth root to the bone to keep it anchored to its socket.
    [Show full text]
  • Root Canal Treatment
    Root Canal Treatment Following up on your dentist’s recommendations What is root canal treatment? Root canal treatment usually involves the removal of the tooth’s pulp, a small thread-like tissue that was important for tooth development. The pulp is the soft tissue that contains the blood vessels, nerves, and connective tissue of a tooth. It lies in a canal that runs through the center of the dentin – the hard tissue on the inside of the tooth that supports the outer layer of tooth enamel. The crown (the portion of the tooth visible above the gums) contains the pulp chamber. The pulp extends from this chamber down through the root canal to the tip of the root that lies in the bone of the jaws. Teeth have only one pulp chamber but may have more than one root and several root canals. Why might the dental pulp need to be removed? If the pulp is diseased or injured and unable to repair itself, it loses its vitality. The most common causes of pulp death are a deep cavity, a crack, or traumatic injury to the tooth, all of which can allow bacteria and their products to leak into the pulp. If the injured or diseased pulp is not removed the tissues surrounding the root of the tooth can become infected and an abscess can form, resulting in pain and swelling. Even if there is no pain, certain substances released by bacteria can damage the cone that anchors the tooth in the jaw. Without treatment, the tooth may have to be removed.
    [Show full text]
  • Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth
    Journal of Clinical Medicine Review Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature 1, 2, 2, 1 Maurizio Bossù y, Flavia Iaculli y, Gianni Di Giorgio *, Alessandro Salucci , Antonella Polimeni 1 and Stefano Di Carlo 1 1 Department of Oral and Maxillofacial Science, “Sapienza” University of Rome, 00185 Rome, Italy; [email protected] (M.B.); [email protected] (A.S.); [email protected] (A.P.); [email protected] (S.D.C.) 2 Pediatric Dentistry School, Department of Oral and Maxillofacial Science, “Sapienza” University of Rome, 00185 Rome, Italy; fl[email protected] * Correspondence: [email protected]; Tel.: +39-349-547-7903 These Authors contributed equally to this work. y Received: 27 January 2020; Accepted: 16 March 2020; Published: 19 March 2020 Abstract: Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars.
    [Show full text]
  • The Dental Pulp: Composition, Properties and Functions
    Central JSM Dentistry Review Article *Corresponding author Michel Goldberg, INSERM UMR-S 1124 and Université Paris Descartes, Sorbonne, Paris Cité, Cellules souches, The Dental Pulp: Composition, Signalisation et Prions 75006 Paris, France, 45 rue des Saints Pères, Paris 75006, Email: Properties and Functions Submitted: 09 December 2016 Michel Goldberg1* and Azumi Hirata2 Accepted: 10 February 2017 Published: 12 February 2017 1Faculty of Fundamental and Biomedical Sciences, René Descartes University, France 2Department of Anatomy and Cell Biology, Osaka Medical College, Japan ISSN: 2333-7133 Copyright Abstract © 2017 Goldberg et al. Derived from neural crests, the mature pulp is due to the proliferation and condensation OPEN ACCESS of apical cells implicated in root lengthening. Adult cells are bound together by intercellular junctions (desmosomes and gap junctions), forming a network. They are further transported to Keywords the crown. Root lengthening is associated to tooth eruption and to vertical sliding. Composed • Dental pulp by type I and III collagens, fibronectin, tenascin, and other non-collagenous proteins that • Programed cell death include a series of proteoglycans, the extracellular matrix is favoring the sliding of pulp cells. • Stem cells A micro-vascular network differing in the root and crown, supply the blood flow. Endothelial cells, pericytes and lymphatic vessels are contributing to direct the vascular implication to pulp development. Inflammatory and immunocompetent cells are present with in the pulp, namely dendritic cells, macrophages, lymphocytes and endothelial cells. They add to the different forms of the immune response of the dental pulp implicated in the different types of programed cell death. Nerves play role in the neutrophin family, identified within the pulp.
    [Show full text]
  • FACT SHEET: ROOT CANAL TREATMENT What Is a Root Canal? Underneath Your Tooth’S Outer Enamel and Within the Dentin Is an Area of Soft Tissue Called the Pulp Tissue
    FACT SHEET: ROOT CANAL TREATMENT What is a root canal? Underneath your tooth’s outer enamel and within the dentin is an area of soft tissue called the pulp tissue. While a tooth’s pulp tissue does contain nerve fibers, it is also composed of arteries, veins, lymph vessels, and connective tissue. Each tooth’s nerve enters the tooth at the very tip of its roots. From there, the nerve runs through the center of the root in small “root canals,” which join up with the tooth’s pulp chamber. Why do I feel pain? When the pulp becomes infected or inflamed due to a deep cavity or fracture, the blood supply to the tooth may be lost and the tooth pulp may die. Damaged or dead pulp causes increased blood flow and activity in the tooth’s cells. Pressure may build within a tooth that cannot be relieved, causing pain that is commonly felt when biting down, chewing, or consuming hot or cold foods and drinks. Why might I need treatment? Without treatment, the infection will spread and bone around the tooth will begin to degenerate, possibly causing the tooth to fall out. Pain usually worsens until you are forced to seek dental attention. What is root canal therapy? Root canal therapy is a procedure that removes the damaged or dead pulp. The canal is reshaped and filled with gutta percha, a rubber-like material, to prevent recontamination of the tooth. The tooth is then permanently sealed. What is involved in root canal therapy? If your general dentist recommends a root canal, he or she will perform the treatment or refer you for treatment to an endodontist, which is a specialist who treats injuries, diseases, and infections of the tooth pulp.
    [Show full text]