UTE UNIVERSITY

FACULTY OF HEALTH SCIENCES 'EUGENIO ESPEJO'

DENTISTRY PROGRAM
ENDODONTICS I

MICROCIRCULATION
PULPAR
Members: 4th
Micaela's Abode Nicolalde Karol
Vanesa Calero Andhy Well "A"
Martín Hill Taco Andres
 GENERAL
Describe the processes and elements that participate in
the microvascularization of the pulp

SPECIFIC
Identify the vascular components as well as their portions and
extensions in the pulp

Analyze the physiological factors and processes such as their regulation, control.
humoral and lymphatic system that affect pulp vascularization
 Introduction
Pulp microcirculation refers to the system of
small blood vessels that supply the pulp
dental, these are responsible for supplying oxygen
and nutrients, as well as eliminating the byproducts of
metabolic waste, which is crucial for health
and the proper functioning of the dental pulp
VASCULARIZATION
Pulp
 Venous Circulation

In the venous return system, the

capillaries merge into a sequence of
venules whose walls are still more
thinner and more delicate than those of
the arterioles.
Arterioles (intima layer and tunica
media).
Pulp vessels.
Subodontoblastic capillary plexus.
Periendothelial cells.
Metabolites through the endothelium.
Pulp capillaries.
The pulp microvascularization.
Vascular flow.
CIRCULATORY SYSTEM
AND LYMPHATIC
 CIRCULATION
Blood vessels are made of
small caliber, the arterioles
they take an almost tour
rectilinear

The smooth muscles in the vessels

pulps have alpha receptors and
(1) beta adrenergics
 The pulp in response to an injury behaves in a biphasic manner.

In the coronary region, the vessels

they branch out, decrease from
they measure and form the capillary plexus
Both the continuous capillaries
as they are fenestrated
subodontoblastic
surrounded by cells
Presents predominance of capillaries of periendothelial (pericytes or
continuous type and only a small one adventitial cells
percentage is of fenestrated type
(2)
The passage of metabolites through the endothelium is
It is carried out by two mechanisms:
through pores, in the case of capillaries
fenestrated
2. transcytosis, mediated by pinocytic vesicles
that move from one surface to another
endothelial (often in capillaries
continuous) (2)
 The pulp microvascularization has the
function of regulating blood flow

The speed is from 0.31 to 1 mm/s in the arterioles,

0.15mm in the venules and 0.8mm in the capillaries

(2)
Vascular flow disorders are associated with a
alteration of sensitivity, when the flow increases,
it decreases the pain threshold of the pulp nerves
larger and this produces an increase in the
response to thermal stimuli such as in cold and the
heat
 LYMPHATIC CIRCULATION

Numerous vessels are found

lymphatic in the central part of the
pulp and in smaller numbers in the area
peripheral, close to the layer
odontoblastic
(1)
Lymphatic drainage Lymph nodes
submental

Lymph nodes
submandibulars and
deep cervical
CIRCULATION OF THE PULP
INFLAMED
The inflammation of the pulp is
produce in a low environment
distensibility with walls
rigid dentinarias.

Distensibility is defined as
the relationship between changes of
volume and interstitial pressure.
 As a consequence, in the pulp
poorly distensible, an increase in
blood or interstitial volume
will produce an increase in pressure
pulp hydrostatics.

Acute vascular reactions to a

stimulus
inflammatory are vasodilation and
an increase in permeability
vascular.
 The application of dental restorations can cause increases or decreases.
important factors of pulp blood flow, according to the treatment and the intervals of time.

Acute inflammation of the dental pulp causes an increase

immediate of the blood flow and can reach a magnitude of
up to almost 200% of the control flow, followed by an increase of
vascular permeability
A common consequence of pulpal inflammation is the development of tissue necrosis.
the study found a circulatory dysfunction of the pulp after exposure to
lipopolysaccharide, from gram-negative bacteria
The set of changes of the function o
endothelial disturbance.

A reduced pulpal perfusion due to

endothelial disturbance could be the
consequence of an infection
bacterial that alters the mechanisms
of pulp defense and promotes the
necrosis.
 The role of the vessels is unknown.
lymphatic in dental inflammation, but
Pimenta et al. found a number
elevated lymphatic vessels in pulps
inflamed teeth with cavities in
comparison with non-inflamed pulps.
Aspects
Clinics
In humans, the influence of the
posture in the pulpal blood flow. The flow
pulp blood flow increases significantly
when subjects change position from standing to
spread out
 The supine position increases venous return from all tissues.
below the heart, increasing cardiac output and producing a
transient elevation of systemic blood pressure
that stimulates the baroreceptors that decrease
vasoconstriction and, therefore,
thus, it increases peripheral blood flow
 Patients with pulpitis often cannot
sleep at night due to a throbbing dental pain.

When these patients lie down at the end of

day, the pulp blood flow probably
increases due to postural responses
cardiovascular described before
 Therefore, this 'pulsating' sensation of pain
dental is due to the pulsation in the pulp that
follows the heart contractions (systole),
causing intermittent increases in pressure
in the pulp tissue.
REPAIR
PULPAR
 Pulp Repair
Its intrinsic healing potential begins
with the cleaning of the lesion by macrophages.
Proliferation of fibroblasts, formation of
new blood vessels and collagen synthesis.
The dental pulp has collateral circulation.
limited.
Young teeth recover better than those.
old teeth
 INTERVENTION OF DENTIN

The formation of reparative dentin is a

adaptive response of the pulp tissue to the
inflammation and injury.
It is influenced by various factors, such as the
mitotic activity of fibroblasts, the
cell differentiation and the responses
inflammatory and immune.
 MOLECULAR BIOLOGY AS A TOOL
REPAIRER

If the odontoblasts could be stimulated to

that form excess peritubular dentin
through the application of a molecule
biological marker, the dentin tubules
podrían [Link] resultaría en una
waterproof dentin that would protect the pulp
from the internal diffusion of harmful substances.
When small exhibitions are held
pulp mechanics, it is usually recommended
place a thin layer of Ca(OH)2 over the
lesion. After the setting, the dentin
surrounding can be joined using a system
self-adhesive that implies not having to
to wash
Just like Ca(OH)2, it has also been shown that
the addition of mineral trioxide aggregate (MTA) favors the
hard tissue formation
The formation of atubular fibrodentin involves the
secondary induction of odontoblastic differentiation
whenever a capillary plexus develops below the
fibrodentin
The newly formed dentin bridge was composed of 1st
of a thin layer of tubular dentin on which
then a relatively thick layer was deposited
of tubular dentin.
 Does reparative dentin protect the pulp?

To perform a protective function, this form

dentin should provide a barrier
relatively waterproof, capable of preventing passage
irritants, and compensate for the loss of dentin
primary.
In the union between primary and reparative dentin
it can be observed: tubeless area located between the two
forms of dentin and reduction of the number of tubules
The border between primary and reparative dentin
es una zona atubular con permeabilidad baja.
Teeth with periodontal disease have
root canals of smaller diameter than the
healthy teeth without periodontal lesions.
The root canals are compressed.
for the deposition of large amounts of dentin
repairing along the dentin walls.
The decrease in the diameter of the root canal
with advanced age, in the absence of disease
periodontal, is probably due to the formation of
secondary dentin.
 SUMMARY
VASCULARIZATION
PULPAR
 SUMMARY
Loose connective tissue (the only soft tissue)
It is located in the pulp chamber inside the tooth.
DENTAL PULP
Composed of living cells, fibers, blood vessels,
nerves and connective tissue.
Contains the vascular nerve bundle
It plays important roles in training and
dental repair, the immune response and sensitivity
dental.

Process that gives it the characteristic of being a

VASCULARIZATION tissue to the dentin-pulp complex
PULPAR Blood supply to the dental pulp
 Vascularization SUMMARY
Dental Artery or Art.
ORIGIN Inferior alveolar

1.- From larger cups to smaller cups (Gauge)

2.- Apical foramen or foramina
3.- Root canals
4.- Coronal trajectory of arterioles:
PRIMER
ROUTE ROOT
Passes through the central portion of the pulp
It branches laterally (capillary tuft)
CORONA
Disposition like a fan upon reaching the crown
Decrease in caliber

EXTENSION Subodontoblastic region and

Odontoblastic
 VASCULARIZATION SUMMARY
Subodontoblastic region and Region of great importance in microcirculation
Odontoblastic dental, provides nutrients, oxygen for the
metabolic activity of odontoblasts and response
inflammatory in case of injuries

The microcirculatory organization of

the subodontoblastic region:

Major Arteries
Arteriole
Terminal arteriole
4) Capillary Plexus
5) Postcapillary venules
6) Collecting venule
Larger Venules
 FACTORS THAT INFLUENCE AND
SUMMARY
MODIFYING THE VASCULARIZATION

PROCESSES FACTORS
PHYSIOLOGICAL STRUCTURAL

CAPILLARIES
BLOOD VOLUME Arterioles and Venules
3% net pulp weight
Endothelium
Blood flow Blood flow
(Systemic/ Humoral) (Local)

Regulates Hemodynamics
LYMPHATICS
 BLOOD FLOW SUMMARY
Blood Flow
(Systemic/ Humoral) MODIFICATIONS
(Local)
Flowmetry/ Laser Doppler
Average Capillary Density
1400 mm2
REGULATION

ENDOTHELIUM - Vascular Tone Endothelin 1

LOCATIONS
Less blood flow and local pressure
2 times greater in the
coronal portion that in Electric stimulus
VASODILATATION
the root CGRP
Sympathetic adrenergic receptors
Greater in horns
pulpers Muscarinic Receptors + Acetylcholine
Alpha adrenergic receptors
Higher in the periphery of NPY
the pulp Vasoconstriction Angiotensin II
dihydroxyphenylalanine
 Vascularization SUMMARY
Network of vessels in the interstitium

LYMPHATIC Drained liquid and filtered proteins

Important role in immune defense of
organism.
Eliminate foreign elements such as bacteria and agents
infectious.

It occurs in a low distensibility environment.

EXCHANGE with rigid dentin walls
TRANSCAPILLARY Distensibilidad : C = V/ P.
 VASCULARIZATION SUMMARY
Acute vascular reactions to a stimulus
CIRCULATION IN inflammatory are vasodilation and an increase in
Inflamed pulp vascular permeability.

They will increase the pressure of the interstitial fluid of the pulp
and they can tend to constrict blood vessels.

interruption of blood flow (theory of

the pulp strangulation.

After an inflammatory aggression, they are released

local vasoactive mediators

Prostaglandin E2, bradykinin, SP, and histamine

Vascular Permeability
 CONCLUSIONS
Dental pulp is a soft and connective tissue located inside the
tooth, within its composition are cells, fibers, and the bundle
vasculonervous, which gives it the ability to perform its
important functions such as the formation and repair of dentin, the
immune response and dental sensitivity.

Pulp vascularization refers to the blood supply to the pulp.

dental, being the main artery that supplies blood to the dental pulp
it is the dental artery, which originates from a branch of the maxillary artery.

The dental artery enters the tooth through the apical foramen and branches out.
in smaller arterioles within the dental pulp. These arterioles are
they distribute along the dental pulp, providing oxygen and nutrients
to the pulp cells.
 CONCLUSIONS
There are different conditions and factors that regulate or alter the
pulp vascularization, among them we find flow and volume
blood and the tissue characteristics specific to blood vessels
blood.

The microvascular characteristics of the pulp will be influenced by

biochemical components such as receptors, molecules, and ions in the bloodstream
sanguineous that will act either as vasodilators or
vasoconstrictors depending on the pulp need

Finally, it is of utmost importance to understand the process of vascularization.

of the pulp since it is the basis for its function and survival. In addition
to provide nutrients and oxygen, the pulp vascularization is also
important for the exchange of waste products and for the
immune response in case of infection or injury.
 Bibliography
1. Segura Egea JJ, Martín González J, Sánchez Domínguez B, Martín Jiménez M, Sauco
Márquez JJ, Luisa M, et al. Endodontics • Volume 32 • Number 2 • April-June. Endodontics
(Mex). 2014;32(2):85-96.
2. Dental pulp: characteristics and functions | Adeslas Dental [Internet]. [cited June 5]
from 2023]. Available at: [Link]
3. Venous pulp circulation [Internet]. [Link]. [cited on June 7, 2023]. Available
en:[Link]

Berman, L. H., & Hargreaves, K. M. (2022). Cohen. Vías de la pulpa. Elsevier Health Sciences.
Thank you!