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 Introduction
 Development of pulp
 Disturbances in formation of pulp
 Methods of detecting of detecting anatomy
 Ana...
 Pulp is a connective tissue which is present in
central portion of the tooth
 As it is central portion it is also known...
 Due to all these features it is also referred to as an
“Organ”
 So let us know more in depth about this organ
 The tooth pulp is initially called as the dental
papilla
 Tissue is designated only as “pulp” only after
dentin forms a...
 The enamel organ enlarge to enclose the dental
papilla in their central portion which is the future
pulp
 The cell dens...
 These cells develop into stellate shaped
fibroblasts
 When inner enamel epithelium differentiate into
ameloblasts, the ...
 Dense invaginatus (Dense in Dente):
 It results from an infolding of enamel organ during
proliferation and is an error ...
 They show varying degree of severity and
complexity
 Maxillary laterals are frequently involved and
lingual pit is the ...
 Dense evaginatus:
 It appears as an accessory cusp or “globule of
enamel” on the occlusal surface of teeth
 These are ...
 Lingual groove:
 It appears as a surface infolding of dentin oriented
from cervical towards apical direction, usually
p...
 Dilacerations:
 It is a severe or a complex curvature or a bend in the
root or the crown portion
 During development, ...
 Taurodontism:
 It represents an increase in proportion of crown to
the roots
 Crown is more in length than the roots
...
 Textbook knowledge:
 Gaining knowledge from textbook is most important
and most useful method
 Radiographic evidence:
...
 Exploration:
 Additional determination of pulp anatomy can be made
during access preparation and when searching canals
...
 The dental pulp occupies the center of each tooth
and consists of sift connective tissue
 Every person normally has 52 ...
Coronal pulp- central
portion of crown
 Each pulp organ
Radicular pulp- root
portion
 Coronal pulp in young individuals resembles the
outer portion of the crown dentine
 It has 6 surfaces – the roof or occ...
 In a young tooth pulp horns are at an higher level
than the older teeth
 It may be necessary to take a radiograph for t...
 Because of continuous deposition the pulp
becomes smaller with age
 This is not uniform throughtout the coronal pulp
bu...
 The radicular or the root pulp is the pulp entering
from the cervical region of crown to root apex
 In anterior teeth t...
 Usually two closely lying canals in a single root may
have communication
 This kind of communication is known as isthmu...
 Communication between
pulp and PDL is not limited
to apical foramen
 Accessory are one arising
from the radicular pulp
...
 The mechanism of formation is not known clearly
 They are likely to occur in areas where there is
premature loss of roo...
 They are most commonly and numerously found
in the regions of apical root
 In molars or premolars they also occur near
...
 Concept of apical root
anatomy is based upon three
anatomic and histologic
landmarks in the apical region
of root
 Apic...
 The root apex has root canal tapering from the
canal orifice to the AC
 The AC generally is considered the part of root...
 Generally it is not in the area of apical constriction and
is approximately 1 mm from the apical foramen
 From the apic...
 The AF is not always located at the center of root apex
 It may exit from mesial, distal, labial or lingual surfaces
of...
Primary pulp Permanent pulps
Relative volume of pulp is more Relative volume of pulp is less
Pulp horns are more prominent...
 In young persons pulp horns are long, pulp chambers
are large, root canals are wide, apical foramens are
broad
 With in...
 Clues in locating extra canals:
 Prominent cingulum of mandibular incisor – an
extra canal may be present lingually
 P...
 Prominent buccal cusp, wide crown buccolingually
on mesial half in maxillary molar, second mesial
buccal canal be found ...
 A young permanent usually takes 2-3 years for
completion of root formation after eruption
 So an young permanent tooth ...
 After apex is matured definite endodontic
treatment is done
 This procedure is referred to as “ apexogenesis”
 If radi...
 Agents such as calcium hydroxide, mineral
trioxide aggregate(MTA), or a mixture of MTA and
paste of camphorated monochlo...
 Pulp is only vital that caries blood and nerve
supply as well as nourishes the tooth
 All these features are necessary ...
 It is also an organ which when destroyed cannot
be regenerated
 So it is necessary to know the anatomy of the pulp
to c...
The dental pulp
Seltzer, Samuel …3rd
ed.
 Endodontic practice
Grossman …5th
ed.
 Endodontics
Ingle …3rd
ed.
 Pathways o...
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
Anatomy of Dental Pulp
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Anatomy of Dental Pulp

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ANATOMY OF DENTAL PULP

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Anatomy of Dental Pulp

  1. 1.  Introduction  Development of pulp  Disturbances in formation of pulp  Methods of detecting of detecting anatomy  Anatomy of pulp  Pulps of maxillary teeth  Pulps of mandibular teeth  Differences in primary and permanent  Age changes  Clinical considerations  Conclusion
  2. 2.  Pulp is a connective tissue which is present in central portion of the tooth  As it is central portion it is also known as “Heart of the tooth”  This connective tissue is highly vascularised and unique and dose not resemble any of the tissues in the human body
  3. 3.  Due to all these features it is also referred to as an “Organ”  So let us know more in depth about this organ
  4. 4.  The tooth pulp is initially called as the dental papilla  Tissue is designated only as “pulp” only after dentin forms around it  In the earliest stage of tooth development it is an area of proliferation future papilla that causes oral epithelium to invaginate and form enamel organ
  5. 5.  The enamel organ enlarge to enclose the dental papilla in their central portion which is the future pulp  The cell density of dental papilla is greater because of proliferation of cells within it  Young dental papilla is highly vascularised  Cells of dental pulp appear as undifferentiated mesenchymal cells
  6. 6.  These cells develop into stellate shaped fibroblasts  When inner enamel epithelium differentiate into ameloblasts, the odontoblasts then differentiate from peripheral cells of dental papilla, when dentin production begins the tissue is no longer called as dental papilla, now designated by dental pulp organ
  7. 7.  Dense invaginatus (Dense in Dente):  It results from an infolding of enamel organ during proliferation and is an error in morphodifferentation  Causes may be increased localized external pressure, focal growth retardation, focal stimulation in certain areas of tooth bud  Often results in an early pulp-oral communication which requires early root canal treatment
  8. 8.  They show varying degree of severity and complexity  Maxillary laterals are frequently involved and lingual pit is the mildest form
  9. 9.  Dense evaginatus:  It appears as an accessory cusp or “globule of enamel” on the occlusal surface of teeth  These are common in mandibular premolars between buccal & lingual cusps  They often contain an extension of pulp  If fragile tubercles fracture or wear off, the pulp may get exposed and there may be a necessity pulp treatment accordingly
  10. 10.  Lingual groove:  It appears as a surface infolding of dentin oriented from cervical towards apical direction, usually present on maxillary laterals  It results in a deep narrow periodontal defect that occasionally communicates with pulp causing an endo-perio problem  Treatment is difficult, and usually requires extraction
  11. 11.  Dilacerations:  It is a severe or a complex curvature or a bend in the root or the crown portion  During development, structures such as cortical bone of maxillary sinus or mandibular canal or nasal fossa may deflect epithelial diaphragm  Another cause might be trauma during development of root  Modification of type of instrument may be necessary for preparation of these canals  Roots having severe curvature or bend cannot be negotiated
  12. 12.  Taurodontism:  It represents an increase in proportion of crown to the roots  Crown is more in length than the roots  Pulp chambers of molars might be below the middle thirds of the tooth also  Pulp horns might be also at an higher level than expected, a radiographic evaluation might be necessary during restorative procedure also
  13. 13.  Textbook knowledge:  Gaining knowledge from textbook is most important and most useful method  Radiographic evidence:  Radiographs can be termed as great pretenders as they often are misleading and helpful  They are certainly useful, particularly conventional periapical films  Radiographs tend to make canals look uniform in shape and tapered. In fact aberrations are often found and generally not visible
  14. 14.  Exploration:  Additional determination of pulp anatomy can be made during access preparation and when searching canals  Newer technology:  Newer techniques such as digital radiography, digital subtraction radiography, tomography  Micro CT – it is very accurate and has ability to determine morphology not visible on conventional radiographs. Creates a 3 dimensional image
  15. 15.  The dental pulp occupies the center of each tooth and consists of sift connective tissue  Every person normally has 52 pulp organs – 32 permanent & 20 deciduous  Each pulp organ resides in pulp chamber which is surrounded by dentin  Total volumes of all pulp organs is 0.38cc, mean volume is 0.02cc  Molar pulps are 3-4 times more larger than incisor pulps
  16. 16. Coronal pulp- central portion of crown  Each pulp organ Radicular pulp- root portion
  17. 17.  Coronal pulp in young individuals resembles the outer portion of the crown dentine  It has 6 surfaces – the roof or occlusal, mesial, distal, buccal, lingual and floor  Pulp horns are protrusions that extend into cusp of each crown  No. of pulp horns depends on no. of cusps  Cervical region of pulp is constricted
  18. 18.  In a young tooth pulp horns are at an higher level than the older teeth  It may be necessary to take a radiograph for the extent of caries weather it is closer to pulp which may lead to an unintentional exposure  Factors such as physiologic ageing, pathosis and occlusion all modify the dimensions of pulp chamber by production of secondary and tertiary dentin
  19. 19.  Because of continuous deposition the pulp becomes smaller with age  This is not uniform throughtout the coronal pulp but progresses faster on the floor than on roof or side of walls
  20. 20.  The radicular or the root pulp is the pulp entering from the cervical region of crown to root apex  In anterior teeth they are single and in posterior are multiple  They are not always straight and vary in size, shape and number  Variations may be as follows
  21. 21.  Usually two closely lying canals in a single root may have communication  This kind of communication is known as isthmus  Isthmus is a narrow ribbon shaped communication between two root canals that contain pulp or pulpally derived tissue  Isthmi must be found, prepared and filled, because they can function as bacterial reservoirs  A root with two or more canals may have an isthmus
  22. 22.  Communication between pulp and PDL is not limited to apical foramen  Accessory are one arising from the radicular pulp laterally through root dentin at any level through the root end has a communication with periodontal space
  23. 23.  The mechanism of formation is not known clearly  They are likely to occur in areas where there is premature loss of root sheath cells as these cells from odontoblasts which form dentin  They may also occur where developing root encounters a blood vessal, the vessel may be locked in an area where dentin is forming and the hard tissue may develop around it
  24. 24.  They are most commonly and numerously found in the regions of apical root  In molars or premolars they also occur near bifurcation or trifurcation areas of root  They are clinically significant in spread of infection , either from pulp to PDL or vice versa
  25. 25.  Concept of apical root anatomy is based upon three anatomic and histologic landmarks in the apical region of root  Apical constriction (AC)  Cement dentinal junction (CDJ)  Apical foramen (AF)
  26. 26.  The root apex has root canal tapering from the canal orifice to the AC  The AC generally is considered the part of root canal with smallest diameter  The CDJ is point in the canal where cementum meets dentin  This is point where pulp tissue ends and periodontal tissue begins  Location of CDJ in the root canal varies considerably
  27. 27.  Generally it is not in the area of apical constriction and is approximately 1 mm from the apical foramen  From the apical constriction or the minor apical diameter canal widens as it approaches AF, or major apical diameter  The average size of AF of maxillary teeth in adult is 0.4mm in mandibular teeth slightly smaller being 0.3mm diameter  The shape between major and minor diameters has been described as funnel shape or hyperbolic
  28. 28.  The AF is not always located at the center of root apex  It may exit from mesial, distal, labial or lingual surfaces of root usually slightly eccentrically  The mean distance between major and minor apical diameters 0.5mm in young persons and 0.67mm in older individuals  Distance is greater in old, because of build of cementum  The AF is the circumference or rounded edge, like a funnel or crater that differentiates termination of the cemental canal from the exterior surface of root
  29. 29. Primary pulp Permanent pulps Relative volume of pulp is more Relative volume of pulp is less Pulp horns are more prominent and are placed at higher level Pulp horns are initially prominent but are reduced with age and at a lower level Because of this position of pulp horns cavity preparation is at a limited depth Due to lower position of pulp horns adequate depth is maintained Accessory canals are frequently found in the bifurcation areas of molars Accessory canals are commonly found in the apical 3rds The position of apical foramen varies as they undergo resorption Position of apical foramen is fixed Canals are flaring due to flaring roots Canals are usually straight
  30. 30.  In young persons pulp horns are long, pulp chambers are large, root canals are wide, apical foramens are broad  With increasing age pulp horns recede, pulp chambers become smaller in height rather than in width  Root canals also become narrower due to deposition of dentin  Apical foramina also deviate from exact anatomic apex  Their minor diameter becomes narrower and major diameter becomes wider from deposition of dentin and cementum
  31. 31.  Clues in locating extra canals:  Prominent cingulum of mandibular incisor – an extra canal may be present lingually  Prominent lingual cusp of mandibular bicuspid – an extra canal may be present lingually  Prominent buccal cusp and wide crown mesio- distally, a mesial buccal canal or root may be found in maxillary 1st premolar
  32. 32.  Prominent buccal cusp, wide crown buccolingually on mesial half in maxillary molar, second mesial buccal canal be found roof is wider buccolingually  An extra canal be found in mandibular molar distal root if distal cusps are prominent
  33. 33.  A young permanent usually takes 2-3 years for completion of root formation after eruption  So an young permanent tooth posses an immature apex initially and then matures due to deposition of dentin and cementum  If endodontinc intervention is done in these kind of teeth then treatment varies according to the condition of pulp  If radicular pulp is vital then, only coronal pulp is treated so as to form a physiological and anatomical mature apex
  34. 34.  After apex is matured definite endodontic treatment is done  This procedure is referred to as “ apexogenesis”  If radicular pulp is non-vital and apex is immature, then both coronal and radicular pulp are treated an agents will form a definitive barrier between apical foramen and surrounding tissues should be applied
  35. 35.  Agents such as calcium hydroxide, mineral trioxide aggregate(MTA), or a mixture of MTA and paste of camphorated monochlorophenol may help to form such a definitive barrier  This kind of procedure is reffered to as “apexification”  Certain clinical studies have also shown continued development of root to form mature apex even after the raducular pulp is treated
  36. 36.  Pulp is only vital that caries blood and nerve supply as well as nourishes the tooth  All these features are necessary for the tooth to respond to and kind of stimulus which will protect the tooth or alarm the tooth that something is wrong with the tooth  If pulp tissue is removed completely, tooth becomes “non-vital” and hence is insensible to any kind of stimulus
  37. 37.  It is also an organ which when destroyed cannot be regenerated  So it is necessary to know the anatomy of the pulp to carry out any procedures on the tooth and to make every attempt to save the pulp
  38. 38. The dental pulp Seltzer, Samuel …3rd ed.  Endodontic practice Grossman …5th ed.  Endodontics Ingle …3rd ed.  Pathways of pulp Cohen, Stephan …9th ed.  Endodontics C. Stock, K. Gulabiwala…3rd ed.  Endodontic therapy Weine …6th ed.

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