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DENTINOGENESIS & DENTIN HYPERSENSITIVITY
- 1. 1 Dr. Manoranjan Mahakur 1st year MDS Department of Pedodontics & Preventive Dentistry
- 2. 2 PREDENTIN Metadentin 1- PRIMARY 2-SECONDARY 3- TERTIARY 1-MANTLE 2-CIRCUMPULPAL 1-PERITUBULAR 2- INTERTUBULAR 1- INTERGLOBULAR 2-TOMES GRANULAR LAYER DENTIN ODONTOBLAST HOEHLS 1-VON EBNER 2-OWEN 3-NEO NATAL 1-DEAD TRACT 2-SCLEROTIC DENTIN Recap ………
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- 5. 5 DENTINOGENESIS content at a glimpse…… Introduction Stages of Dentinogenesis 1-Odontoblast and its differentiation. 2- Deposition of organic matrix 3-Mineralization modification of organic matrix. 4- MantL dentin formation 5-Circumpulpal dentin formation 6-Peritubular dentin formation
- 6. 6 Introduction….. Dentinogenesis = the process of dentine formation Starts after tooth germ has reached the bell stage EARLY BELL STAGE LATE BELL STAGE HISTO DIFFERENTIATION MORPHO DIFFERENTIATION
- 7. 7 Odontoblast and its differentiation… Dentin forming cell Origin- ectomesenchymal LIFE CYCLE OF ODONTOBLAST QUIESCENT STAGE Decreased in size Decreased dentin formation FORMATIVE STAGE Odontoblast process Increase length DIFFERENTIATION STAGE Form Preodontoblast Attached to BM TGF, BMP, IGF MAP 1B
- 9. 9 DEPOSITION OF ORGANIC MATRIX ORGANIC MATRIX PREDENTIN GROUND SUBSTANCE Ca ,Po4 DENTIN
- 10. 10 COLLAGEN MATRIX FORMATION……. MANTLE DENTIN GROUND SUBSTANCE LARGE FIBERS 90 degree to BM SMALL FIBERS ORGANIC MATRIX MANTLE DENTIN Ca2 Po4
- 11. 11 COLLAGEN MATRIX FORMATION……. CIRCUMPULPAL DENTIN GROUND SUBSTANCE SMALL FIBERS = TO BM ORGANIC MATRIX Ca2 Po4
- 12. 12 COLLAGEN MATRIX FORMATION……. MANTLE & CIRCUMPULPAL DENTIN
- 13. 13 FORMATION OF PERITUBULAR DENTIN……. New dentin formed changed the previous dentin Diameter of odontoblast process Create a space More mineralized dentin deposited PERITUBUAR DENTIN
- 14. 14 2.MINERALIZATION OF DENTIN MATRIX FORMATION MATRIX VESICLE RUPTURE OF VESICLE DEPOSITION OF Ca2 and PO4 MINERALIZATION OF DENTIN ODONTOBLAST MOVE TO CENTER
- 15. 15 COLLAGEN MATRIX FORMATION……. MANTLE & CIRCUMPULPAL DENTIN
- 16. 16 PATTERN OF MINERALIZATION LINEAR GLOBULAR SLOW RATE UNIFORM (CIRCUMPULPAL DENTIN) RAPID NON UNIFORM MANTLE DENTIN MIXED
- 17. 17 CONTROL OF MINERALIZATION……… • INITIATIONCACLIUM • INHIBIT GROWTH OF HYDROXY APPETITE • PROMOT BINDING OF Ca2 &Po4OSTEONECTIN • MINERALIZATIONOSTEOPECTIN • PREVENT PREMATURE CALCIFICATIONPROTEOGYCAN • Transport of ca, • Aggregation of fiber,stabilization of crysytalDPP • ATTRACT AND CONCENTRATE CALCIUMGLA PRTEIN
- 18. 18 GENES & REGULATION OF DENTINOGENESIS….. • REGULATE SIALOPHOSPHOPROTEIN mRNA.Wnt10a • REGULATE DENTIN MATRIX PROTEINM06-G3 • REGULATE SIGNALING AND DEVELOPMENT HEPARAN SULPHATE • MINERALIZATIONTGF,BSP
- 21. 21 REDENTINOGENESIS……… EXPOSED PULPCA(OH)2 MTA ATTACHED PULP CELL INCREASED BIOSYNTHESIS OF PULP CELL DYSTROPIC LAYER
- 22. 22 DIFFERENTIATION OF ODONTOBLAST EXPRESS DSP REPARATIVE DENTIN DEPOSITION OF FIBRONECTIN RICH MATRIX BSP 2,6 OPN TGF ß 1 Ca
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- 24. 24 LESION LOCALIZATION LESION INITIATION Incidence range 4-74% Female>>> male Age prevalence 20-50yrs Mostly involved premolar and canine Mostly left side
- 26. 26 DESENSITIZING AGENT PROTEIN PRECIPITATION PLUGGING DENTINAL TUBULES NERVE DESENSITIZATION MECHANISM OF ACTION POTASSIUM NITRATE Silver nitrate Zinc chloride Sodium fluoride Stannous fluoride Potassium oxalate Calcium hydroxide Sodium monofluoro phosphate
- 27. 27 SOME COMMERCIALLY AVAILABLE toothpaste COMMERCIAL NAME COMPOSITION Senquel, sensodent k Sensodyne Potassiun nitrate 5% Senquel f Sensodent kf Nitra Thermoseal RA Thermokind f Potassium nitrate 5% Sodium monofluoro phosphate.7% F-917 ppm Sensoform Strontium chloride 10%
- 28. 28 Desensitizing Mouth rinse COMMERCIAL NAME COMPOSITION SENQUEL –AD NITRA OR SENSOWASH Potassium nitrate 3% Sodium fluoride 0.2%
- 29. 29 OTHER METHOD Fluoride varnishes Oxalic acid and resin Glass ionomer cements Composites Dentin bonding agents DENTIN ADHESIVE Dentin bonding agent are used Micro mechanical bonding through formation of an interdiffusion hybrid layer
- 30. 30 NOVAMIN in DH It is Bio active glass ceramic MOA Calcium sodium phosphosilicate Aqueous medium Release calcium and phosphate ion Form hydroxy-carbonate appetite SEAL DT
- 31. 31 Recaldent Is a complex of Casein Phosphopeptide (CPP) and Amorphous Calcium Phosphate (ACP) MAO Binds readily to surfaces within the oral cavity Delivers calcium and phosphate ions to the enamel and into the oral environment Works with fluoride in toothpaste (for MI Paste & MI Paste Plus users)
- 32. 32 Laser in DH Example- Nd:YAG laser, CO2 LASER MOA- 1-Coagulation and precipitation of plasma protein in dentinal tubules (Goodies et al 1994) 2-thermal energy liberated alter intra-dental nerve activity (Orcharelous et al 1998)
- 33. 33 IONTOPHORESIS… Electrical potential is used to transfer the ion into body for therapeutic purpose Used sodium fluoride. MOA- Current may produce reparative dentin or nerve paresthesia. Fluoride ion precipitation may occlude by calcium fluoride formation. Method… Place a negative electrode on the dentin & positive Electrode on the patients arm Chemical is applied to tooth surface & current is passed through –ve electrode using 0.5mA current
- 34. 34 Advanced THERAPY FOR DH The PILP system- The polymer-induced liquid precursor (PILP) system created by Laurie Gower, PhD, an associate professor in the department of materials science and engineering at the University of Florida in Gainesville.(June 2, 2011) (study performed at the University of California, San Francisco (UCSF))
- 35. 35 MOA… Poly- L-aspartic acid delivers calcium phosphate to the fibrils and releases it inside the collagen fibril so minerals form within them. Its occurs too shortly Full recovery will occurs.
- 36. 36 ICON DMG….. Features and Benefits Micro invasive technique No drilling or anesthesia required Prevents lesion progression Treated lesions lose whitish appearance and look like healthy enamel Easy treatment only one visit
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- 38. 38 FUTURE THERAPY FOR DH Gene therapy…… Blocking the nerve growth factor (NGF) by pulpal fibroblast near the lesion .
- 39. 39 HERBAL THERAPY FOR DH
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- 44. 44 REFERENCE JOURNA F CONSERVATIVE DENTISTRY 2010 OCT-DEC Dentin hypersensitivity: Recent trends in management Sanjay Miglani, Vivek Aggarwal, and Bhoomika Ahuja International Journal of Dentistry Volume 2009 (2009), Article ID 464280, 12 pages http://dx.doi.org/10.1155/2009/4642 80Review Article Reparative Dentinogenesis Induced by Mineral Trioxide Aggregate: A Review from the Biological and Physicochemical Points of View Takashi Okiji and Kunihiko Yoshiba Orban’s Oral histology and Embryology Ten cate’s oral histology Shafer’s Text book of oral pathology
- 45. 45 REFERENCE……. 1.Shen P, Cai F, Nowicki A, Vincent J, Reynolds EC. Remineralization of enamel subsurface lesions by sugar–free chewing gum containing casein phosphopeptideamorphous calcium phosphate. J Dent Res. 2001 Dec;80(12):2066–70. 2.Morgan MV, Adams GG, Bailey DL, Tsao CE, Reynolds EC. CPP–ACP gum slows progression and enhances regression of dental caries. J Dent Res 2006; 85 (Sp. Iss. B): 2445. 3.Walsh LJ. Tooth Mousse: Anthology of Applications. GC Asia Dental, 2007. 4.Cochrane NJ, Cai F, Reynolds EC. QLF and TMR analysis of CPP–ACFP remineralized enamel in vitro. J Dent Res 2006; 85 (Sp. Iss. B): 0192.
- 46. 46 “I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism”. (Hippocratic Oath) Upcoming Seminar ……….. TOOTH MORPHOLOGY (the architect……..)
Editor's Notes
- GF- TGF ,IGF,BMP found in IEE induced differentiatio of odontoblast. MAP 1B GENE
- Reciprocal cell and matrix interactions are believed to play a key role for the terminal differentiation of odontoblasts and ameloblasts
- Collagen fibril small dm 0.05 micro m Closedly packed
- Rate of coronal dentin4-8micro m/day
- 3 theory are there 1- booster mechanism 2- seeding mechanism 3-matrix vehicle theory
- Schematic drawing of the odontoblast-predentin region during dentinogenesis (Linde, 1989). Macromolecules are synthesized within the odontoblast cell bodies. The constituents of predentin, primarily collagen and proteoglycan (PG), are secreted close to the odontoblast cell bodies (lower set of arrows) to form the extracellular, nonmineralized predentin matrix; some of this PG is metabolized in predentin. Uptake into the cells of degradation products from such metabolism in predentin seems to occur along the odontoblast process membrane (arrows). Several noncollagenous components are transported within the odontoblast process and secreted at the mineralization front, i.e., in predentin, just before the advancing mineralized dentin, where mineral formation is initiated. Among these are the highly phosphorylated phosphoprotein (PP-H), y-carboxyglutamatecontaining proteins of the osteocalcin type (Gla-protein), as well as a second pool of PG.
- Schematic representation, showing different calcium ion transport pathways in dentinogenically active odontoblasts. Ca2+ ions are transferred from the blood across the odontoblast cell layer, either through the cells, between the cells, or by both pathways (left). If the Ca2+ ions migrate between the cells by diffusion, they would have to penetrate through the intercellular junctions between the odontoblasts and into the predentin layer (arrows). If, on the other hand, Ca2+ ions are actively transported by intracellular pathways, some extrusion mechanism from the odontoblast process and into the predentin space has to be postulated (arrows upper left). The cell to the right illustrates the transmembraneous Ca2+-transporting mechanisms shown to be present in odontoblasts. (From Linde and Lundgren, 1990.)
- The PILP remineralization solutions were prepared following a slightly modified procedure [9]. Poly-L-aspartic acid (Pasp) with a molecular weight of 27 KDa was used as the polymeric process-directing agent. Calcium chloride dihydrate was dissolved in Tris buffered saline (TBS) at a 9mM concentration and Pasp was added to a final concentration of 100 μg/mL. An equal volume of dipotassium phosphate solution was added to the calcium-polymer mix, resulting in a calcium-to-phosphate ratio of 2.14 (mol/mol). Specimens were incubated at 37°C under continuous stirring for 7, 14, or 28 days. pH of the PILP system was 7.4 at the start of mineralization experiments and at the end of experiments was typically 7.1–7.2.