A tooth without a vital pulp, however, can remain clinically functional. These cells have the ability to generate a highly vascularized and a conjunctive rich living tissue. Vital pulp therapycurrent progress of dental pulp regeneration and revascularization. The nerve supply of the dentinpulp complex is mainly made up of. The dental pulp is a mesenchymal con juctive tissue situated in a cavity in the cen tral area of the tooth the pulp chamber. Dental pulp revascularization of necrotic permanent teeth with immature apices article pdf available in the journal of clinical pediatric dentistry 405. Regenerative potential of dental pulp martin trope, dmd abstract the regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. Blood flow changes in permanent maxillary canines during retraction. At pulp dt 27%at dej dt 19% so, if asking about dentinedt surface area at the pulp 70%.
Blagoja lazovski introudction2 the pulp is a soft mesenchymal connective tissue. After plating at a low density, dpscs are able to attach to the culture dish and form a single. However, it is not clear yet if the same conclusion is also valid for adult subjects. The purpose of this study was to investigate the effects of various concentrations of ca ions on the growth and osteogenic differentiation of human dental pulp. It is generally accepted that the effect of orthodontic tooth movement on the dental pulp in adolescents is reversible and that it has no longlasting effect on pulpal physiology. The dental pulp is sensitive to external factors such as microbial infection from dental caries andor mechanicalchemical irritations during.
Pulp becomes more fibrotic with age the odontoblastis the most specialized and distinctive cell of the dental pulp and is responsible for the formation of primary, secondary, and reparative dentine. Inflammatory processes in the dental pulp springerlink. Editorial inflammation of the dental pulp sanghyukpark, 1 lingye, 2 robertm. Traditionally, the management of dental pulp pain has mostly been pharmacological, using nonsteroidal antiinflammatory drugs nsaids and opioids, or restorative i. Inflammatory processes associated with the innate and adaptive immune defense systems occur in the dental pulp following carious and other injury. After disinfection by local triple antibiotics, a broach is inserted into the root canal beyond its length in order to make the blood arise from the vessels of the surrounding bone to the root. Pdf vital pulp therapycurrent progress of dental pulp. Guideline on pulp therapy for primary and immature. The cells slide from the apical cellrich zone to the apical papilla mesenchyme. H a rg r e a v e s, d d s, p h d, f i c d, fac d professor and chair department of endodontics. There is a small deposit of osteodentin arrow in the pulp cavity. Figure 1 tooth, pulp osteodentin in a male f344n rat from a chronic study. What to do about a damaged pulp there are three forms of dental treatment available for a tooth with damaged pulp. It is often the end result of many cases of dental trauma, caries and irreversible pulpitis in the initial stage of the infection, the pulp chamber is partially necrosed for a period of time and if left untreated, the area of cell death.
A thorough knowledge of deep caries histomorphology proved to be essential in the evaluation of clinical results obtain after indirect pulp caping procedures using different materials in order to maintain dental pulp vitality. The vitality of the dentinpulp complex, both during health and after injury, depends on pulp cell activity and the signaling processes that regulate the cells behavior. Therefore, pulp preservation is a primary goal for treatment of the young permanent dentition. The shorter pulses reach the high ablation threshold of hard dental tissues faster, and consequently less energy is transformed into heat. The dental pulp is a part of the dentinpulp complex called endodontium. Different pulp capping materials can release various concentrations of ca ions leading to different clinical outcomes. Pulp necrosis is a clinical diagnostic category indicating the death of cells and tissues in the pulp chamber of a tooth with or without bacterial invasion. The color and consistency of the demineralized dentin in active progressing lesions.
Hard tissue is difficult to repair especially dental structures. Indirect pulp treatment without reentry in a permanent. The diameter and density of dentinal tubules dt are greatest near the pulp. The radicular dental pulp is located in the root, and this is the place where pulp cells differentiate into odontoblasts and in the subodontoblastic layer the socalled hoehls layer figures 9,10,14. Ramazanzadeh ba, sahhafian aa, mohtasham n, hassanzadeh n, jahanbin a, shakeri mt. Dental pulp defence and repair mechanisms in dental caries ncbi. The dental pulp is a specialised connective tissue entirely enclosed by dentine consisting of the pulp periphery and pulp proper. In the near future, it will probably be possible to generate a complete vital tooth from a single stem cell. The second part is devoted to pulp pathology and includes descriptions of the differences between reactionary and reparative dentin, the genetic alterations leading to dentinogenesis imperfecta and dentin dysplasia, the pulp reaction to dental materials, adverse impacts of bisphenol a and the effects of fluorosis, dioxin and other toxic agents. Aetiology and pathogenesis of pulp disease basicmedical key. Nevertheless, cell homing currently represents the most clinically viable pathway for dental pulp. The pulp and dentin form a functional complex that is protected from exogenous substances in the oral cavity by the overlying enamel or cementum.
However, when the enamel layer crumbles, bacterial invasion of the demineralized enamel occurs fig. Introudction2 the pulp is a soft mesenchymal connective tissue that occupies pulp cavity in the central part of the teeth. Dental follicle cells secrete collagen fibers that are embedded into the cementum matrix and form the periodontal ligament. The temperature changes in the pulp chamber during cavity. Love, 3 jeanchristophefarges, 4 andhiromichiyumoto 5 department of conservative dentistry, college of dentistry, kyung hee university, seoul, republic of korea e state key laboratory of oral diseases, west china school of stomatology, sichuan university, sichuan, china. R bachelor of dental surgery, saveetha dental co llege and hospital, chennai, tamil nadu, india. The c fibres are located in the core of the pulp, or the pulp proper, and extend into the cellfree zone underneath the odontoblastic layer. Currently at least five different types of mesenchymal stem cells have been isolated from the dental tissues, including dental pulp stem cells dpsc, stem cells of human exfoliated deciduous teeth shed, stem cells of the apical papilla scap, dental follicle progenitor. Also, trpv1 appears to be upregulated in inflamed human dental pulp 97, 98.
Inflammatory processes in the dental pulp pocket dentistry. Coronal pulp a lab image 3 occupies the crown of the tooth and has six surfaces. The dental pulp is the part in the center of a tooth which is made up of living connective tissue and cells called odontoblasts. There are blood vessels, nerves, and odontoblasts lining the predentine in the dental pulp, which could help supply nutrients, react to infection, and form reactionary dentin, thus maintaining pulp homeostasis ricucci et al. Active nanomaterials to meet the challenge of dental pulp. However, our improved understanding of pulpal inflammation. The regenerative potential of dental pulp is very limited in mature teeth. Pdf dental pulp revascularization of necrotic permanent. The dental pulp is that loose delicate connective tissue occupying the cavity lying in the center of dentin. Dental tissue behaves differently to the other connective tissues. When pulp is under threat, so also is the tooth around it, and care is urgently needed. Tooth enamel is incapable of selfrepairing whereas dentin and cememtum can regenerate with limited capacity. Pulp revascularization can be considered as a current alternative treatment to apexification, recommended for immature teeth cases, requiring endodontic treatment. Bacterial, mechanical or physicchemical factors are powerful enough to.
The pulp is the part in the center of a tooth made up of living connective tissue and cells called odontoblasts. Six weeks after induction of the condition, the researchers introduced dpsc into two study groups. The peripheral pulp can be distinguished into three further zones including the pseudo stratified layer of the highly differentiated dentine producing odontoblast cells, a subodontoblastic 40. Histological changes in human dental pulp following application of intrusive and extrusive orthodontic forces. Professor departments of pharmacology, physiology graduate school, and surgery medical school. For complete tooth healing the formation of a reactionaryreparative dentin barrier to distance and protect the pulp from infectious agents and. These responses of the dental pulp to irritation of dentin demonstrate the. Pulp revascularization on permanent teeth with open apices. However, our improved understanding of pulpal inflammation and repair and improved dental materials and technologies make vital pulp therapy a viable alterna. The dental pulp is a unique tissue and its importance in the longterm prognosis of the tooth is often ignored by clinicians. Eastman dental center hether the presence of various forms of calcification within the dental pulp may be considered within the normal range of the biologic variation of the pulp is questionable. Dental pulp has long been recognized to show fibrinolytic activity and the fibrinolytic system may contribute to early wound organization during pulp healing.
Regenerative medicine for dental pulp for dental pulp regeneration, a very promising procedure is root revascularization. Dental pulp and dentin tissue engineering and regeneration. The dental pulp ebook por 9783642551604 rakuten kobo. Figure 5 illustrates the regions where the two types of dental pulp are located 1. However, the specialized environment of the pulp, in terms of its relatively noncompliant nature and the bathing of the tooth surface with oral secretions containing bacteria, poses significant. Dental pulp stem cells trigger functional recovery from dn in a study recently published in cytotherapy, researchers in bengaluru, india induced dn in rats. Dental pulp stem cells may alleviate diabetic neuropathy. Untreated necrosis may lead to a localized abscess or a spreading infection into the surrounding soft tissue that. Regenerating dental tissue with stem cells from baby teeth national dental pulp laboratory in a phase 1 clinical trial, a group of researchers has successfully transplanted human dental pulp stem cells into the injured teeth of children. Development3 during the 8th week of iul, there is condensation of the mesenchmye under the enamel organdental papilla. As known, dental pulp is a loosely connective tissue enclosed within rigid dentine walls. Pulp and periodontal anatomy and physiology essential.
The intercellular substance consists of fibers and an amorphous ground substance of gelatinous consistency. The pulp is a part of the dentinpulp complex endodontium. Regions of the pulp cavity the pulp cavity can be divided into two main regions. Dental pulp tissues can be easily collected from clinically extracted human teeth and the individual cells can be enzymatically released from the pulp tissue gronthos et al. It is unique in that it resides in a rigid chamber which provides strong mechanical support and protection from the microbial rich oral environment. Pulp revascularization of immature permanent teeth. Thus, in two groups of rats, aged 6 and 40 weeks respectively, 3 molars at one side of the maxilla were moved together in a mesial. Apexification involves longterm periodic exchanges of a calcium hydroxide paste into the root canal to induce the. Enamel and dentin are commonly under the attack by caries. It is a special organ because of the unique environment dr. Structure of the dental pulp 1 the pulp tissue consists of 25% organic material by weight 75% water by weight as any connective tissue, the pulp is composed of cells and intercellular substance.
With age, pulp horns diminish and the coronal pulp decreases in. Article information, pdf download for dynamics of the pulpodentin complex open. Non vital pulpotomy anaesthesia is compulsory to prevent pain from. Finally, as capsaicin, a specific agonist for trpv1, can stimulate the release of neurotransmitters such as cgrp from rodent and human dental pulp, the trpv1 receptor is clearly functional in the dental pulp 99, 100. Figure 2 tooth, pulp osteodentin in a male f344n rat from a chronic study higher magnification of figure 1. The individual bacteria are still far too large to penetrate the demineralized rod and interrod enamel fig. Hundreds of axons enter the tooth from the apical foramen to provide it with its sensory supply.
These include repair, root canal treatment, a tooth extraction and a finally a replacement. Cell homing strategies for pulp regeneration need further understanding and improvement if they are to become a reliable and effective approach in endodontics. Pulp revascularization is dependent on the ability of residual pulp and apical and periodontal stem cells to differentiate. Pdf pulp revascularization of immature permanent teeth. Cohens pathways of the pulp editors tenth edition ke n n e t h m.
491 1223 737 1163 828 1076 132 928 1147 526 832 244 207 947 1193 1022 1316 1418 1205 1494 1272 1220 1184 130 1400 440 1529 939 689 692 152 686 813 581 1316 423 12 251 761 517 1238 95