PULP
ANATOMY
INTRODUCTION
• The total volume of all the permanent teeth pulp is 0.38 cm3
• The mean volume of a single adult human pulp is 0.02 cm3.
• Molar pulps are three to four times larger than incisor pulps.
• The coronal pulp in young individuals resembles the shape of
the outer surface of the crown dentin.
• The coronal pulp has six surfaces:
• the roof or occlusal, the mesial, the distal, the buccal, the lingual,
and the floor.
Structures Common To all teeth
• It has pulp horns, which are protrusions that extend
into the cusps of each crown.
• The number of these horns thus depends on the cuspal
number.
• The radicular or root pulp is that pulp extending from
the cervical region of the crown to the root apex.
• In the anterior teeth, the radicular pulps are single and
in posterior ones multiple.
Anatomy of the “Pulp Space”
Pulp Chamber
Pulp Horn
Orifice
• The radicular portions of the pulp are continuous with the
periapical connective tissues through the apical foramen or
foramina.
• During root formation, the apical root end is a wide opening
limited by an epithelial diaphragm.
• As growth proceeds, more dentin is formed, the radicular pulp is
narrower & apical pulp canal becomes smaller also because of
apical cementum deposition.
• Accessory canals, mainly in apical 3rd – act as a source of spread
of infections
ZONES OF PULP
• 4 ZONES
• Odontoblastic zone
• Cell free zone
• Cell rich zone
• Core of the pulp
• Dental papilla gives rise to pulp during development of teeth.
Odontoblastic zone
• Consists of the cell bodies of odontoblasts.
• Cell bodies in the pulp and cell processes in the dentinal tubules.
• Many nerve fibers enter this zone and terminate between the odontoblasts.
• Active cell & resting cell
• While the active cell is rich in organelles, the resting cell is
devoid of organelles
CELL FREE ZONE
• This layer is called zone of Weil or sub-odontoblastic layer.
• The major components of this zone are ground substance with
reticular fibers and it appears to be relatively free of cells.
• The cell free zone diminishes in size or temporarily disappears with
the dentin formation.
• This zone contains network of nerve fibers that have lost their myelin
sheath and are known as sub-odontoblastic plexus or plexus of
Rashkow.
• These terminal, naked, free fibers are dendrites of sensory nerves and
are specific receptors of pain.
CELL RICH ZONE
• Cell rich zone is situated just below the cell free zone.
• It is a narrow zone with increased density of cells and rich capillary
network.
• it is more prominent in coronal pulp.
• It consists of fibroblasts, undifferentiated mesenchymal cells,
macrophages, immunocompetent cells and young collagen fibers.
• It serves as a reservoir for replacing the destroyed odontoblasts.
PULP CORE
• The connective tissue located in the center of the coronal and
radicular pulp is referred to as pulp core.
• It is a core of loose connective tissue with abundant cellular elements
which also contains the larger nerves and blood vessels that branch
out towards the peripheral pulp area.
• Young pulp- more cells
• older pulp-more of fibrous components.
Endodontics, Ingle’s, 2002
COMPONENTS OF PULP
1. Cells
• Odontoblasts
• Fibroblasts
• Undifferentiated mesenchymal cells
• Pulpal stem cells
• Immunocompetent cell-
• Macrophage
• Dendritic Cell
• Lymphocyte
2. Extracellular components
• Fibers: Collagen
• Intercellular ground substance- glycoproteins, proteoglycans
3. Connective tissue structures
• Blood vessels
• Lymphatic channels
• Nerve fibers
GROUND SUBSTANCE
• Composed of both
• acid mucopolysaccharides and
• protein polysaccharide compounds (glycosaminoglycans and proteoglycans).
During early development, the presence of chondroitin A, chondroitin B, and
hyaluronic acid is seen.
• Glycoproteins are also present in the ground substance.
• Glycosaminoglycans being hydrophilic, forms a gel and contributes to high tissue fluid
pressure of the pulp.
• Hyaluronan, in addition to mechanical function helps in cell migration.
• Versican forms the bulk of the proteoglycans.
• Syndecan, another important proteoglycan, attaches to the cell and acts as an adhesion
molecule between fibroblast and collagen. It also binds signaling molecules like fibroblastic
growth factor.
• Tenascin and Fibronectin, which promote cell adhesion and cell migration are absent in areas
of inflammation.
• Laminin, which is present in the basement membrane of blood vessels, also coats the
odontoblast cell membrane.
• Integrins, the glycoproteins, which interact to form cell surface adhesion receptors were
found in pulp to get attached to biologically active molecules like laminin and fibronectin
BLOOD SUPPLY
• Arteries and veins thin walled
• Subodontoblastic plexus of capillaries seen
• Presence of arteriole venous anastomosis
• Pericytes in relation to smaller arterioles control blood flow
• Sympathetic nerves also control blood flow
• Higher capillary pressure
• Rapid blood flow & fenestrated capillaries facilitate rapid metabolite
transport
• Lymphatics follow course of blood vessels
NERVES
• Nerves follow the course of blood vessels
• Very little branching in radicular pulp
• Myelinated nerves lose myelin sheath and form plexus: plexus
of Raschkow
• Nerve fibers terminate adjacent to odontoblast
• Only free nerve endings in pulp- therefore only pain sensation is felt
• Myelinated/ fast conducting: ‘a’ delta fibers mediate sharp pain
• Nonmyelinated/ slow conducting: ‘c‘ fibers mediate dull pain
• Sympathetic fibers end in blood vessels to control blood flow
FIND-P
FUNCTIONS
• 1. Inductive- pulpal anlage interacts with oral epithelial cells that leads to
differentiation of dental lamina and enamel organ formation
• 2. Formative- pulp odontoblasts produce dentin that surrounds & protects the
pulp.
• [Link]- pulp nourishes dentin through the odontoblasts , their processes &
blood vascular system
• 4. Protective- sensory nerves in tooth respond with pain to various stimuli. It also
initiate reflexes that control the circulation of pulp.
• 5. Defensive or reparative-
• Reparative dentin formation by odontoblasts,
• calcification of tubules to wall off pulp from source of irritation.
PRIMARY VS PERMANENT PULP
• PRIMARY DENTITION- Relatively larger pulp chamber, pulp horns rise
high in cusp region
• PERMANENT DENTITION-Relatively smaller pulp chamber, pulp horns
are lower
REGRESSIVE CHANGES OF PULP
• Pulpal calcification
• Change in size
• Change in blood supply and innervation
• Cellular and fibrous components
• Reduction in sensitivity and healing
REGRESSEVIVE CHANGES OF PULP
• 1. PULP STONES/ Denticles
• The calcifications may be diffuse or nodular, termed as pulp
stones or denticles.
• Pulp stones may lie
• free in the pulp,
• attached to dentinal wall, or
• embedded in it.
• If pulp stones has the structure of dentin, it is called true
denticles, if not, false denticles.
• True denticles- formed by odontoblasts, have dentinal tubules - rare
• False denticles- Do not posess dentinal tubules, appear as concentric layers of
calcified tissue.
True denticles
• A theory suggests true denticle is caused by inclusion of remnants of
HERS within pulp.
• These induce cells of pulp to differentiate into odontoblasts & forms
dentin masses.
FREE- entirely surrounded by pulp
tissue
ATTACHED: partially fused with
dentin
EMBEDDED: completely surrounded
by dentin
Pulp Stone
Endodontics, Ingle’s, 2002
Pulp Stones
Pulp Stones
• Significance of pulp stone:
• Reduce reparative Potential
• NOT a Cause of Pain
• Interference with RCT
[Link] in size of pulp
• Reduction in pulp chamber size occurs due to secondary and
reparative dentin formation
[Link] and fibrous
changes
More Fibrous, Less Cellular
Endodontics, Ingle’s, 2002
3. Vascular changes
• Atherosclerotic plaques may appear in pulp blood vessels
• Calcifications may also be formed
• This reduces diameter and blood flow eventually reduce with age
• Outer diameter may increase due to increased collagen deposition in
blood vessel wall.
Age Changes
In Blood Vessels
Endodontics, Ingle’s, 2002
CLINICAL IMPLICATION
• In young teeth pulp chambers are large with high pulp horns.
Therefore care should be taken while cavity preparation to avoid
inadvertent pulpal exposure.
• Presence of multiple
accessory canals in some
teeth may cause failure of
endodontic treatment.
• Similarly, presence of pulp
stones also may cause
difficulty in endodontic
treatment
• Pulpal tissue is highly sensitive to various types of trauma which may
be thermal, chemical or mechanical.
• Permanent damage to the pulp causes death of pulp and therefore
loss of vitality of the tooth.
• Vital teeth respond to thermal and electric stimuli and vitality testing
is a basic procedure carried out in dental clinic to diagnose pulpal
diseases.
• Pulp is connective tissue and any type of insult resulting from dental
caries or trauma can cause the inflammation as in case of any other
tissues of the body.
• Inflammation of dental pulp is called pulpitis. Pulpitis may be
reversible or irreversible.
• Irreversible pulpitis results in permanent damage to the pulp and if
not treated, progresses further to infection of periapical tissue.
• As pulpal tissue is located in a closed chamber, surrounded by rigid
dentin, pressure built up in pulp due to inflammation result in intense
pain.
• Chronic mild infection of pulp may
induce a proliferative reaction of pulp
which is referred to as pulp polyp.
• A pulp polyp will present as a pink
globular soft tissue mass filling a large
carious cavity.
• Once the pulpal tissue is involved in
disease process, the tooth needs root
canal treatment.
DENTAL PULP STEM CELLS
• Dental pulp stem cells
• 1. dental pulp stem cells (DPSCs)
• [Link] cells from human exfoliated deciduous teeth (SHED).
• These cells exhibit multipotency due to their embryonic origin, from
neural crests.
• found within the cell rich zone of dental pulp has gained significant
importance as a potential resource of stem cells which may be used
for regeneration and repair of various diseased organs and tissues.