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Pulp  dentin complex /certified fixed orthodontic courses by Indian dental academy
 

Pulp dentin complex /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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    Pulp  dentin complex /certified fixed orthodontic courses by Indian dental academy Pulp dentin complex /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • www.indiandentalacademy.com
    • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • INTRODUCTION DENTIN PULP CLINICAL IMPLICATIONS  INITIAL REACTION TO TOOTH PREPARATION  PULPAL INFLAMMATION AND ITS SEQUELAE  DENTAL CARIES  REACTION TO RESTORATIVE MATERIALS REFERENCES CONCLUSION www.indiandentalacademy.com
    • INTRODUCTION www.indiandentalacademy.com
    •  DENTIN IS THE HARD TISSUE PORTION OF THE PULP – DENTIN COMPLEX & FORMS BULK OF THE TOOTH .  PHYSICALLY DENTIN HAS AN ELASTIC QUALITY WHICH IS IMPORTANT FOR PROPER FUNCTIONING OF THE TOOTH BECAUSE IT PROVIDES FLEXIBILITY & PREVENTS FRACTURE OF OVERLYING BRITTLE ENAMEL. www.indiandentalacademy.com
    •  INORGANIC 70 %  ORGANIC  WATER 20 % 10 % www.indiandentalacademy.com
    •  MANTLE DENTIN & CIRCUMPULPAL DENTIN  IT IS DEPOSITED FIRST AT THE DEJ & EXTENDS APPROXIMATELY FROM THE JUNCTON PULPWARD TO THE ZONE OF INTERGLOBULAR DENTIN .  CIRCUMPULPAL DENTIN DIRECTLY UNDERLIES MANTLE DENTIN & COMPRISES THE BULK OF THE TOOTH PRIMARY DENTIN .  GLOBULAR DENTIN CONTAINS HYPOMINERALIZED AREAS BETWEEN THE GLOBULES , TERMED INTERGLOBULARSPACE. www.indiandentalacademy.com
    •  FORMS INTERNALLY TO PRIMARY DENTIN OF THE CROWN & ROOT .  DEVELOPS AFTER THE CROWN HAS COME IN TO CLINICAL OCCLUSAL FUNCTIONS & THE ROOTS ARE NEARLY COMPLETED .  IN MOLAR TEETH , FOR eg MORE SECONDARY DENTIN IS DEPOSITED ON THE ROOF & FLOOR OF CORONAL PULPCHAMBER THAN ON THE LATERAL WALL .  THIS LEADS TO PROTECTION OF THE PULP HORN AS OCCLUSAL FUNCTION OCCURS . www.indiandentalacademy.com
    •  TERTIARY DENTIN ALSO REFERED TO AS REACTIVE , REPARATIVE OR IRREGULAR SECONDARY DENTIN .  TERTIARY DENTIN RESULT FROM PULPAL STIMULATION & FROM ONLY AT THE SITE OF ODONTOBLASTIC ACTIVATION .  FORMATON DUE TO ATTRITION , ABRASION CARIES OR RESTORATIVE PROCEDURES .  THIS DENTIN IS DEPOSITED UNDERLYING ONLY THOSE STIMULATED AREAS . www.indiandentalacademy.com O
    •  TERTIARY APPEARS IRREGULAR WITH SPARSE & TWISTED TUBULES & POSSIBLE CELL INCLUSION .  ODONTOBLAST , FIBROBLAS & BLOOD CELLS HAVE BEEN FOUND .  REPARATIVE DENTIN AT TIMES RESEMBLES BONE MORE THAN DENTIN & IS THEN TERMED OSTEODENTIN  ITS ALSO APPEARS COMBINATION OF SEVERAL TYPES . www.indiandentalacademy.com
    •  BAND OF NEWLY FORMED , UNMINERALIZED MATRIX OF DENTIN AT THE PULPAL BORDER OF THE DENTIN .  DENTIN FORMS TWO STAGES 1. ORGANIC MATRIX IS DEPOSITED 2. INORGANIC MINERAL SUBSTANCE IS ADDED .  MINERALIZATION OCCUR AT THE PREDENTIN – DENTIN JUNCTION .  4 MICROMETER PER DAY AFTER OCCLUSION & FUNCTION . THIS ABILITY IS REDUCED TO 1.0 TO 1.5MM PER DAY www.indiandentalacademy.com
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    • PRIMARY & SECONDARY DENTIN  DENTIN IS FORMED BY ODONTOBLAST, SPACE IS PROVIDED FOR THE LENTHENING PROCESS OF THE OD THAT MOVES PULPWARD FROM THE AMELODENTINAL JUNCTION .  THIS PROCESS BEGINS FORMING BEFORE EITHER ENAMEL OR DENTINAL MATRIX FORMATION BEGINS .  THE PROCESS ELONGATED , IT BRANCHES & SECONDARY PROCESS APPEAR AT THE MAIN BRANCHES  THESE CELLS & THEIR PROCESSES GIVES THE DENTIN VITALITY www.indiandentalacademy.com
    •  THE DENTINAL MATRIX THAT IMMEDIATELY SURROUNDED THE DENTINAL TUBULES IS TERMED INTRATUBULAR OR PERITUBULAR DENTIN  PD ALSO FOUND IN THE PERIPHERAL TUBULES OF THE ROOT NEAR THE CEMENTUM THESE ARE VERY SMALL TUBULES & AREAS WHERE EXTERNAL STIMULATION MAY PLAY A ROLE cf THE INTERTUBULAR DENTIN IS LOCATED BETWEEN [or] AROUND THE DENTINAL TUBULE. THIS DENTIN CONSISTS OF TYPE 1 COLLAGEN FIBERS & INORGANIC CRYSTALS OF HYDROXYAPPATITE . THE COLLAGEN FIBERS OF THE MATRIX FORM A MESHWORK ORIENTED NEARLY PERPENDICULAR TO THE INTRATUBULAR DENTIN www.indiandentalacademy.com
    •  INCREMENTAL LINE MARKS THE NORMAL RHYTHMIC LINEAR PATTERN OF DENTIN DEPOSITION DAILY IN AN INWARD & ROOTWARD DIRECTION & IT RUN AT RIGHT ANGLES TO DENTINAL TUBULES  ALTHOUGH DAILY LINES ARE DIFFICULT TO DISTINGUISH , THE LINES FORMED BY INCREMENTS OVER SEVERAL DAYS POSSIBLY EVERY 5 DAYS RESULTING IN 20 microns DESCRIBED BY VON EBNER, THEN IT WAS KNOWN AS INCREMENTAL LINES OF VON EBNER .  IN PRENATAL & POST NATAL DENTIN ARE SEPERATED BY AN ACCENTUATED CONTOUR LINE KNOWN AS NEONATAL LINE www.indiandentalacademy.com
    •  A LAYER OF DENTIN IS SEEN UNDERLYING THE CEMENTUM THAT COVERS THE ROOT IS KNOWN AS GRANULAR LAYER OF TOMES .  THE ZONE IS BELIEVED TO BE RESULT OF COALESCING & LOOPING OF THE TERMINAL PORTION OF THE DENTINAL TUBULES . E S O  DEJ ARE ENAMEL SPINDLES & FINE BRANCHING OF TERMINAL DENTINAL TUBULES IN THE DENTINE DT DEJ D  THE ODONTOBLAST PROCESSES EXTEND TO THE DEJ . www.indiandentalacademy.com
    • DEAD TRACT DENTIN UNDERLYING A RESTORATION . LOSS OF TUBULAR CONTENTS RESULT IN DEAD TRACT . DUE TO LOSS OF OD , ATTRITION , CARIES , OD MAY DIE , OPEN TUBULES & SPACES & BACTERIA MAY MIGRATE . THIS LEADS TO BLCKISH APPEARANCE .  BELOW THE DEAD TRACT AREA IN IS SCLEROSED DENTIN , WHICH PROTECTS THE PULP FROM BACTERIA . www.indiandentalacademy.com
    •  THE SYSTEM OF BRANCHING TUBULES INCREASES THE PERMEABILITY.  THE ONLY FEATURE THAT PROTECTS THE PULP IS THAT IT HAS HIGHER OSMATIC PRESSURE THAN THE AREA OF THE DEJ .  FLUID IS CONSTANTLY BEING FORCED OUTWARD BY THIS INCREASED PRESSURE OF THE PULP . www.indiandentalacademy.com
    •  DENTAL PULP IS THE SOFT CONNECTIVE TISSUE LOCATED IN THE CENTRAL PORTION OF EACH TOOTH.  PULP HAS PERIPHERAL ZONE & CENTRAL ZONE.  PERIPHERAL ZONE [ODONTOGENIC ZONE ] CONSISTS OF ODONTOBLAST , CELL-FREE ZONE &CELL RICH ZONE .  CENTRAL ZONE - LARGE ARTERIES , VEINS & NERVE TRUNKS THAT ENTER THE PULP FROM APICAL CANAL & PROCEEDS TO THE CORONAL PULP CHAMBER www.indiandentalacademy.com
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    • ODONTOBLAST FIBROBLAST www.indiandentalacademy.com
    • SCHWANN CELLS FORMS THE MYELIN SHEATH OF THE NERVES & ARE ASSSOCIATED WITH ALL PULP NERVES. ENDOTHELIAL CELLS LINING THE CAPILLARIES , VEINS ,& ARTERIES OF THE PULP CAN BE VISUALISED. OTHER CELLS INCLUDE MACROPHAGES , LYMPHOCYTES, ERYTHROCYTES , LEUKOCYTES EOSINOPHILS & BASOPHILS FOUND IN PULP BLOOD VESSELS. www.indiandentalacademy.com
    • Spare & delicate Cf diffuse ♠ COLLAGEN ORIGINATES FROM THE PULPAL FIBROBLASTS THROUGH OUT PULP.BOTH TYPE I & II COLLAGEN HAVE BEEN FOUND IN PULP. ♠ TYPE I - PROBABLY PRODUCED BY ODONTOBLASTS BECAUSE THIS IS THE TYPE OF COLLAGEN FOUND IN DENTIN. ♠ TYPE II - PROBABLY PRODUCED BY PULP FIBROBLASTS. ♠ GROUND SUBSTANCE IS PRESENT AROUND THE FIBERS WHICH SERVES AS THE ENVIRONMENT THAT PROVIDE LIFE FOR CELLS IN THE PULP. www.indiandentalacademy.com
    • THIN – WALLED ARTERIES & ARTERIOLES ENTER THE APICAL CANAL & PURSUE A DIRECT ROUTE UP THE ROOT PULP TO THE CORONAL AREA. ULTRA STRUCTURE OF PULP ARTERIOLE . CENTRAL LUMEN IS SURROUNDED BY ENDOTHELIAL CELLS FORMS INTIMA LAYER , SURROUNDING THE INTIMA IS LAYER OF MUSCLE CELLS THAT FORMS THE MEDIA.SURROUNDING THE MEDIA IS EXTERNAL ADVENTITIAL LAYER www.indiandentalacademy.com
    • MOST PULPAL NERVE ENDINGS ARE IN THE ODONTOGENIC REGION OF THE PULP HORN . SOME TERMINATE WITH ODONTOBLASTS. THESE NERVE ENDINGS ARE PERSUMED TO FUNCTION IN PAIN RECEPTION. www.indiandentalacademy.com
    • ☺ INDUCTIVE . ☺ FORMATIVE . ☺ PROTECTIVE . ☺ NUTRITIVE . ☺ REPARATIVE . www.indiandentalacademy.com
    • REGRESSIVE CHANGES  NUMEROUS REGRESSIVE CHANGES IN THE PULP & DENTIN ARE RELATED TO ENVIRONMENTAL STIMULI & AGING.  AS THE TOOTH AGES, PULP DECREASES IN SIZE BECAUSE OF THE CONTINUED DEPOSITION OF THE DENTIN. IN ADDITION, CELL ACTIVITY IS ALSO REDUCED PULP STONES TRUE FALSE [ CONCENTRIC ] www.indiandentalacademy.com EMBEDDED
    • www.indiandentalacademy.com
    • ♣ ADEQUATE COOLING OF BUR CUTTING AT HIGH SPEED IS ESSENTIAL TO PREVENT HISTOLOGIC CHANGES IN DENTIN & INJURY TO UNDERLYING ODONTOBLASTIC REGION OF THE PULP. ♣ TEMPERATURE INCREASE CAN CAUSE SEVERE INJURY TO PULP , CARE MUST BE EXERCISED TO ENSURE WATER SPRAY EFFECTIVELY COOLS THE BUR AT THE CUTTING SURFACE. ♣ SHADOWING EFFECT BY THE TOOTH MAY PREVENT THE WATER SPRAY FROM REACHING THE BUR. www.indiandentalacademy.com
    • DEMINERALISED SECTION SHOWING ODONTOBLASTIC NUCLEI [ON] DISPLACED IN TO DENTIN AS A RESULT OF CAVITY PREPARATION WITH INADEQUATE COOLING OF THE BUR. DEMINERALISED SECTION SHOWING ODONTOBLASTIC NUCLEI [ON] DISPLACED IN TO TUBULES OF THE PREDENTIN . www.indiandentalacademy.com
    • DEMINERALISED SECTION SHOWING ALTERED STAINING [ RED ] OF THE CAVITY [ CA ] MARGIN THAT RESULTED WHEN INADEQUATE COOLING OF THE BUR LED TO BURNING OF THE DENTIN. www.indiandentalacademy.com
    • HARM LESS CAVITY PREPARATION [ DONE WITH ADEQUATE COOLING ] ☻ [DOTTED LINE] EXTENT OF THE TUBULES OPENED BY THE CAVITY PREPARATION. ☻ O - AN INTACT ODONTOBLASTIC LAYER IS PRESENT SUBJACENT TO THE CAVITY. ☻ HIGHER MAGNIFICATION OF THE SEPERATION [S] BETWEEN THE PREDENTIN [ PD ] & THE ODONTOBLASTIC [ O ] LAYER AS A RESULT OF CAVITY PREPARATION. ☻ IT MAY BE DUE TO SOME INJURIOUS CHANGES THAT PREDISPOSE TO THE SEPERATION IN THE DENTIN. www.indiandentalacademy.com ☻ S - THE SEPERATION BETWEEN THE PREDENTIN & THE ODONTOBLASTIC LAYER IS PROBABLY HISTOLOGIC ARTIFACT.
    • DEMINERALISED SECTION SHOWING TUBULAR CONTENT PROTRUDING IN TO THE CAVITY [ CA ] PREPARATION ♣ THE POSITION OF THESE REACTIVE COMPONENTS AFTER PREPARATION INDICATES OUTWARD MOVEMENT or DISPLACEMENT OF THE TUBULAR CONTENTS. ♣ SUCH MOVEMENT OCCUR EVEN IF SO – CALLED NON TRAUMATIC PREPARATION TECHNIQUE IS USED. ♣ THE OUTWARD MOVEMENT OF THE CONTENT OF THE TUBULES IS PROBABLY A RESULT OF EXPOSURE OF UNAFFECTED DENTIN IN THE TOOTH. ♣ THE DISTURBANCE & REDISTRIBUTION OF THESE CELLULAR CONSTITUENT WILL RESULT IN DEGENERATION OF OD PROCESS www.indiandentalacademy.com
    • o cf c  DAMAGED & DISORGANISED CYTOPLASMIC COMPONENTS FROM ODONTOBLASTS DISPLACED IN TO THE PREDENTIN [PD ]  DT – DENTINAL TUBULE WITH REMAINS OF A DISTINTEGRATED ODONTOBLASTIC PROCESS.  DT- DENTINAL TUBULE WITH CELLULAR FRAGMENTS UNDERGOING NECROSIS. CLINICAL SIGNIFICANCE OF ANY CHANGE FOLLOWING DISPLACEMENT OF CELLULAR CONTENTS HAS NOT BEEN FULLY ESTABLISHED BUT IT IS LIKELY TO HAVE EFFECT ON PHYSIOLOGY OF THE AFFECTED DENTIN. www.indiandentalacademy.com
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    • SLIGHT REACTION f c MOST STRIKING CHANGE FROM NORMAL STRUCTURE IS THE INCREASED NUMBER OF CELLS IN THE LOCATIONS OF THE ‘’CELL FREE ZONE ‘’ IN THE CORRESPONDING TO THE ‘’CAVITY TUBULES’’ THOSE TUBULES EXPOSED BY THE CAVITY PREPARATION. FIBROBLAST , UNDIFFERENTIATED CELLS,FEW INFLAMMATORY CELLS INVOLVED. INCREASED NUMBER OF CAPILLARIES NOTED. www.indiandentalacademy.com
    • MODERATE REACTION o dt c MANY CELLS HAVE ACCUMULATED SUBJACENT TO THE AFFECTED TUBULES ,BUT THEY ARE WELL DELIMITED TO THE CAVITY TUBULES.  NO ODONTOBLASTIC LAYER CAN BE IDENTIFIED.  SOME ODONTOBLASTIC NUCLEI HAS BEEN DISPLACED IN TO THE DENTINAL TUBULES.  MANY CAPILLARIES ARE PRESENT. www.indiandentalacademy.com
    • SEVERE REACTION AB CELLULAR INFILTRATION LOCALISED TO THE CAVITY TUBULES IS INTENSE & CORRESPONDS TO THAT OF AN ABSCESS FORMATION.  NO ODONBLAST & NO PREDENTIN CAN BE IDENTIFIED.  PMN & MONONUCLEAR LEUKOCYTES PREDOMINATE IN THE AFFECTED AREA.  EVIDENCE OF CHEMOTAXIS IS VISIBLE . www.indiandentalacademy.com
    • www.indiandentalacademy.com
    • ♣ IMMEDIATE RESPONSE – [15 – 60 min ] DISPLACEMENT OF OD NUCLIE TO THE DENTINAL TUBULES & DISTURBANCE IN SUB ODONTOBLASTIC TISSUE. ♣ 6 Hrs POST OPERATIVELY NL  NEUTROPHILIC LEUKOCYTES INFILTRATED THE ODONTOBLASTIC LAYER. MORE BLOOD VESSELS FOUND.  MARKED DEGENERATIVE & NECROTIC CHANGES BOTH IN THE NUCLEI & IN THE CYTOPLASM.  EXUDATES SEPERATES THOSE ODONTOBLAST THAT HAVE NOT BEEN DISPLACED.  NUCLEI DISPLAY PERIPHERAL ACCUMULATION OF CHROMATIN & CYTOPLASMIC ORGANELLES. LIKE ROUGH SURFACE ENDOPLASMIC RETICULUM & MITOCHONDRIA .  THE SUBODONTOBLASTIC CELLS HAS A LARGE VACUOLE FILLED WITH GRANULAR www.indiandentalacademy.com MATERIAL.
    • AFTER 12 – 24 Hrs  NE – NECROTIC TISSUE SEPERATES THE DENTIN FROM THE PULP.  MP - MACROPHAGES AT THE BORDER BETWEEN NECROTIC & VITAL PULPAL TISSUE CONSTITUTE A PART OF THE INFLAMMATORY INFILTRATION.  ENGORGED BLOOD VESSELS ARE ALSO PRESENT. PC  ACTIVE PHAGOCYTOSIS WAS SEEN AT THE BORDER BETWEEN VITAL & NECROTIC TISSUE.  NECROTIC , ENGULFED CELL [ EC ] IS BEING DIGESTED WITHIN THE LARGE VACUOLE [ VA ] IN THE CYTOPLASM OF MACROPHAGE. www.indiandentalacademy.com
    • AFTER 48 HOUR CF O B RI M RER N GM LY  PREDOMINANCE OF SPINDLE – SHAPED CELLS , DIFFERENTIATING IN TO ‘’OD’’ LIKE CELLS. HIGH VASCULARITY IN THE AREA.  CYTOPLASM HAS ABUNDANCE OF RI, RER , LY , M,NUCLEUS OF MITOCHONDRIA . LARGER AREAS OF GRANULAR MATERIAL & NEWLY FORMED COLLAGEN FIBERS.  EVIDENCE OF COLLAGEN SYNTHESIS BY NEW ODONTOBLASTS NOTED AFTER 48 Hrs. www.indiandentalacademy.com
    • AFTER 3 – 8 DAYS PD  NEWLY DEVELOPED SECONDARY ODONTOBLAST WITH LARGE AREAS OF GRANULAR MATERIAL WITH IN THE CELL.  ODONTOBLAST WITH AN ABUNDANCE OF INTRACELLULAR GRANULAR MATERIAL GM 1 ] & RIBOSOMES .GRANULAR MATERIAL ALSO FOUND OUTSIDE THE CELL [ GM 2 ]  COLLAGEN FIBERS HAVE FORMED CORRESPONDING TO PREDENTIN & THEY BECAME INCORPORATED IN TO MINERALISED TERTIARY DENTIN.  HEALING PHASES PREDOMINATED , INCLUDING CONTINUED COLLGEN SYNTHESIS & MINERALISATION OF THE INTERTUBULAR MATRIX OCCURRED.  THUS INFLAMMATION THAT RESULTED FROM THE INFLICTED TRAUMA RESOLVED. www.indiandentalacademy.com [
    • INTERACTION BETWEEN DENDRITIC CELLS IN THE OD REGION & T - LYMPHOCYTES IN THE INDUCTION OF A PRIMARY IMMUNE RESPONSE. www.indiandentalacademy.com
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    • www.indiandentalacademy.com
    • ACTIVE NONCAVITATED CARIES LESION  CELLULAR CHANGES IN THE PULP ARE NOTED  AS THE ENAMEL LESION APPROACHES EVEN BEFORE ALTERATION IN DENTINAL MINERALISATION. DENTIN,HYPERMINERALISED DENTIN [ GRAY AREA ] IS OBSERVED CORRESPONDING TO THE CENTRAL TRANSVERSE LINE.  INSET ; YELLOW CELLS – DENDRITIC LIKE CELLS PRESENT, THEY ARE ALSO FOUND IN UNAFFECTED AREAS.  INSET ; CHANGES IN THE OD- PREDENTIN & SUBODONTOBLASTIC REGION. AS DENTINAL DEMINERALISATION STARTS [ORANGE AREA ] FORMATION OF TERTIARY DENTIN IS INITIATED. www.indiandentalacademy.com
    • SLOWLY PROGRESSING CARIES LESION  DURING THE EARLY STAGES OF THE ENAMEL LESION , NO CHANGES ARE VISIBLE IN THE DENTIN & NO CELLULAR CHANGES ARE PRESENT IN THE PULP.  AS THE ENAMEL LESION APPROACHES THE DENTIN , HYPERMINERALISED DENTIN IS OBSERVED SUBJACENT TO THE DEEPEST PART OF THE LESION [ CT ]  CHANGES ARE ALSO TAKING PLACE IN THE ODONTOBLAST - PREDENTIN REGION BUT SUBODONTOBLASTIC REGION APPEAR UNAFFECTED. www.indiandentalacademy.com
    • RAPIDLY PROGRESSING - CAVITATED CARIES LESION  ODONTOBLAST ARE ABSENT SUBJACENT TO THE LESION & ACCUMULATION OF IMMUNOCOMPETENT CELLS , INCLUDING DENDRITIC CELLS [ YELLOW ]  ACTIVE CARIES LESION HAS REACHED INTO THE DENTIN & BACTERIA PENETRATE THE DENTIN.  INSET; TERTIARY DENTIN DEVELOPED WITH NO DDENTRITIC – LIKE CELLS PRESENT.  FOLLOWING RAPID , EXTENSIVE CAVITATION OF ENAMEL & DENTIN ,SPREAD OF THE LESION OCCURS ALONG DEMINRALISED DEJ . INCREASED ACCMULATION OF INFLAMMATORY CELLS NOTED  BLACK DESCRIBED THIS PHENOMENON AS ‘’BACKWARD DECAY ‘’ OF THE ENAMEL. BECAUSE THE ENAMEL BECOMES DEMINERALISED BOTH FROM THE ADVANCING DENTINAL LESION & FROM THE OUTSIDE. www.indiandentalacademy.com
    •  IF THE ENAMEL BREAKS DOWN DURING ANY STAGE IN THE DEVELOPMENT OF A CAVITATED LESION , THE ENVIRONMENT OF THE LESION CHANGES DRAMATICALY. THE SOFTEST PART OF THE DEMINERALISED DENTIN MAY THEN BE LOST AS A RESULT OF FUNCTION & WEAR. THE REMAINING PART MAY REMINERALISE .  CLINICALY THIS SITUATION PRESENT ITSELF AS EXPOSED , SHINY ,DARK HARD DENTIN. www.indiandentalacademy.com
    • REMOVAL OF CARIES LESION www.indiandentalacademy.com
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    • DIRECT NON ADHESIVE RESTORATION REACTION TO DENTIN ; www.indiandentalacademy.com
    •  BISECTED TOOTH WITH AN EXPERIMENTAL BUCCAL CAVITY [ L ] THAT HAD BEEN RESTORED WITH ZNOE & A LINGUAL CAVITY [ R ] THAT HAD BEEN RESTORED WITH CAOH WITH PERMANENT RESTORATION.  DIFFERENCE IN PERMIABILITY NOTED IN DENTIN COVERED WITH ZNOE & DENTIN COVERED WITH CAOH.  THE EXPALANATION MAY BE THAT PRECIPITATION OF CRYSTASLLINE MATERIAL IN THE TUBULES REDUCE THE PERMIABILITY OF CAOH TO AN EXTENT THAT MAY PREVENT ANY ADVERSE REACTION IN THE PULP. www.indiandentalacademy.com
    • HEALING CAPACITY OF DIFFERENT RESTORATIVE MATERIALS EXPERIMENTALLY PREPARED CAVITY IN A MONKEY TOOTH IN WHICH SOFT , HUMAN CARIOUS DENTIN HAS BEEN KEPT IN PLACE FOR 7 DAYS . SEVERE LOCALIZED PULPITIS WAS NOTED THAT WAS ALLOWED TO HEAL FOR 7 DAY. CALCIUM HYDROXIDE WAS PLACED ON THE PULPAL FLOOR & THE CAVITY WAS RESTORED WITH AMALGAM . SEVERE PULPAL INFLAMMATON PERSISTS , BUT TERTIARY DENTIN FORMATION HAS BEEN INITIATED . PULPAL HEALING WAS NOTED AFTER 3 MONTHS IN WHICH ZOE CEMENT COVERED THE DENTIN. INFLAMMATORY RESPONSE HAS RESOLVED . www.indiandentalacademy.com
    • PULPAL REACTIONS  SEVERE INFLAMMATION IN THE PULP SUBJACENT TO A DEEP CAVITY RESTORED WITH SILICATE CEMENT FOR 7 DAYS.  THE TEETH WITH SEVERE INFLAMMATION WAS RESTORED WITH ZNOE CEMENT . AFTER 1 MON PULPAL REACTION REDUCED COMPARATIVELY. www.indiandentalacademy.com
    • EFFECTS OF OVER EXTENDED CAVITY. CA1 - CAVITY TREATED WITH ZNOE.  CA2 – INADVERENTLY EXTENDED APICALLY REMOVAL OF ZNOE CEMENT DURING  PULPAL REACTIONS ARE MINIMAL SUBJACENT TO CA1, BUT SEVERE SUBJACENT TO CA2 WHERE UNAFFECTED TUBULES HAVE BEEN EXPOSED.  CA – CAVITY TREATED WITH THE SAME WAY BUT INADVERENTLY EXTENDED OCCLUSALY DURING REMOVAL OF ZNOE CEMENT.  PULPAL REACTION ARE MINOR UNDER THE MAIN PART OF THE CAVITY , BUT SEVERE WHERE THE CAVITY WAS EXTENDED OCCLUSALY IN TO UNAFFECTED DENTIN www.indiandentalacademy.com
    •  THE TOOTH HAD BEEN REPEATEDLY RESTORED WITH BUCCAL CLASS V RESTORATIONS  THE THIN LAYER OF REMAINING DENTIN & ABSENCE OF TERTIARY DENTIN.  NO ODONTOBLASTIC LAYER OR PREDENTIN IS PRESENT. www.indiandentalacademy.com
    • • CLINICAL EXPERIENCE WITH THE DIFFERENT SYSTEMS GENERALLY SUPPORTS THE VIEW THAT THESE MATERIALS ARE SAFE WHEN USED ACCORDING TO THE MANUFACTURES INSTRUCTIONS . • HOWEVER , SOME CONCERN REMAIN ABOUT PULPAL REACTIONS , HYPERSENSTIVITY , LONGEVITY OF RESTORATIONS AND HANDLING CHARACTERISTICS OF THESE MATERIALS. www.indiandentalacademy.com
    • PHOSPHORIC ACID ETICHING  ENAMEL ETCHED WITH 37% PHOSPHORIC ACID FOR 15 SEC .THE RODS & INTERROD SUBSTANCE ARE UNEVENLY DEMINERALIZED , GIVING THE SURFACE AN IRREGULAR STRUCTURE WHERE RESIN MAY PHYSICALLY ATTACHED TO THE ENAMEL .  DENTIN ETCHED WITH PHOSPHORIC ACID , WASHED WITH WATER , & OVER DRIED WITH COMPRESSED AIR FROM AN AIR SYRINGE . THE EXPOSED COLLAGEN LAYER HAS COLLAPSED & NO DETAILED STRUCTURE IS DESCERNIBLE  CLINICALY THE COLLAGEN IN THE PREPARATION SHOULD HAVE A SHINY , WET SURFACE & THE ENAMEL SHOULD HAVE A FROSTY APPERANCE.. www.indiandentalacademy.com
    • SELF ETCHING PRIMER  DENTIN TREATED WITH SELF ETCHING PRIMER. THE BONDING SYSTEM HAS MODIFIED THE SMEAR LAYER WITH OUT REMOVING IT.  THE RESIN TAGS ARE LESS UNIFORMED COMPARED TO ETCHING WITH PHOSPHORIC ACID WHICH PRESENTS A MORE AGGRESSIVE DEMINERALIZATION PROPERTIES . ALL IN ONE BONDING  DENTIN TREATED WITH ALL IN ONE BONDING SYTEM WITH AGGRESSIVE DEMINERALISATION PROPERTIES . THE SMEAR LAYER HAS BEEN DISSOLVED & THE RESIN TAG SHOWS THE CHARACTERISTICS STRUCTURE WITH A REVERSE CONE SHAPE TOWARDS THE CAVITY SURFACE. www.indiandentalacademy.com
    • DENTINAL SUBSTRATE  DIFFERENCES IN THE STRUCTURE & PHYSIOLOGY OF THE DENTIN PRESENT ON PREPARED SURFACES PLAY A FUNDAMENTAL ROLE IN THE QUALITY OF THE BOND THAT CAN BE ACHIEVED BY THE DIFFERENT TYPES OF BONDING SYSTEMS. COMMON CLINICAL CONDITION WHERE ALL MINERALISED TISSUES ARE INVOLVED AS SUBSTRATES IN THE TREATEMENT OF CLAS 5 CAVITIES www.indiandentalacademy.com
    • A PREPARATION WITH REMAINING DENTINAL THICKNESS OF ABOUT 0.5 mm WILL ALLOW FORMATION OF RESIN TAGS WITH LATERAL BRANCHES & A HYBRID LAYER. SCANNING ELECTRON MICROGRAPH SHOWING UNIFORM , SHORT , CLOSELY PACKED RESIN TAGS NEAR THE PULP. www.indiandentalacademy.com
    •  WHENEVER CERVICAL MARGIN OF A PREPARATION IS BELOW THE CEMENTO ENAMEL JUNCTION. THE CEMENTUM WHICH HAS HIGHER ORGANIC CONTENT THAN DENTIN , IS TAKEN IN TO CONSIDERATION.  UNLIKE DENTIN , THE CEMENTUM SUBSTRATE WILL EXIHIBIT LESS RESIN TAG FORMATION , BECAUSE OF THE PRESENCE OF THE GRANULAR LAYER & THE LACK OF TUBULES IN THE PERIPHERAL ROOT DENTIN. SHOWING CERVICAL MARGIN OF A RESTORATION 1mm BELOW CEJ , LESS RESIN TAG FORMATION IS EVIDENT . www.indiandentalacademy.com
    • GLASS – IONOMER MATERIALS MINIMAL PULPAL REACTION SUBJACENT TO A CAVITY IN A TOOTH RESTORED WITH GIC . WHEN DEBONDING OF GIC OCCURS , THE FAILURE IS USUALLY COHESIVE , FRACTURE IS WITHIN THE GIC RESTORATION THE BONDING OF GIC TO DENTIN INVOLVES CHEMICAL & MECHANICAL BONDS . INTERFACE BETWEEN A CONVENTIONAL GLASS-IONOMER MATERIAL & THE CONDITIONED DENTIN IS NOTED . www.indiandentalacademy.com
    • IMPRESSION OF PREPARED TEETH  A REVIEW OF A SERIES OF PHYSIOLOGIC STUDIES OF PULPAL BLOOD FLOW AFTER VARIOUS CLINICAL PROCEDURE ON DOG & RAT TEETH INDICATES THAT RUBBER – BASED IMPRESSION OF PREPARATION CAUSE SIGNIFICANTLY LESS DAMAGE THAN DO IMPRESSION MADE WITH HOT WAX IN A COPPER BAND .  THE USE OF A GINGIVAL RETRACTION CORD WITH A VASOCONSTRICTOR ALSO RESULTS IN SIGNIFICANT CHANGES IN THE PULPAL BLOOD FLOW .  USE OF LOCAL ANAESTHESIA ALSO RESULTS I N SIGNIFICANT REDUCTION IN THE PULPAL BLOOD FLOW.  ALTHOUGH SOME OF THESE CHANGES IN THE PULP DENTIN COMPLEX ARE TRANSIENT ,CARE MUST BE TAKEN TO AVOID DELETERIOUS EFFECT ON PULP . www.indiandentalacademy.com
    • REFERENCES www.indiandentalacademy.com
    •  PULP – DENTIN BIOLOGY IN RESTORATIVE DENTISTRY [ IVAR A . MJOR ] .  ORAL HISTROLOGY 5TH EDITION [ A .R .TEN CATE ] .  ESSENTIALS OF ORAL HISTROLOGY & EMBRYOLOGY 2rd EDITION [ JAMES K . AVERY ] .  ORAL HISTROLOGY & EMBRYOLOGY 12th EDITION ORBAN’S . www.indiandentalacademy.com
    • PULPAL - DENTINAL COMPLICATIONS INVOLVING INFLAMMATION , DEGRADATION & NECROSIS ARE THE RESULT OF A SERIES OF TRAUMATIC INJURY. IT IS THEREFORE RESPONSIBILITY OF THE RESTORATIVE DENTIST TO MINIMISE THE TRAUMA TO DENTIN & PULP INFLICTED DURING ALL CLINICAL PROCEDURES . NOT ONLY WILL IT BENEFIT PATIENT BUT IT WILL MAKE RESTORATIVE DENTISTRY MORE INTERESTING & CHALLENGING THEN IT IS TODAY , WHEN ATTENTION IS FOCUSED MOSTLY ON TECHNICAL ASPECTS. www.indiandentalacademy.com
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