CONTENTS

INTRODUCTION DEVELOPMENT ANATOMY o General features o Pulps of maxillar teet! o Pulps of man"i#ular teet! o Coronal pulp o Ra"i$ular pulp o Api$al foramen o A$$essor $anals %TRUCTURAL &EATURE% &UNCTION% o In"u$ti'e o &ormati'e o Nutriti'e o Prote$ti'e o Defensi'e VA%CULAR %UPPLY INNERVATION CLINICAL CON%IDERATION% T(E &UTURE CONCLU%ION RE&ERENCE%

INTRODUCTION :
Rapi" a"'an$es in t!e #asi$ s$ien$es an" t!e "e'elopment of sop!isti$ate" instrumentation !a'e !a" a profoun" effe$t on one )no* le"+e of e'er or+an in t!e #o" , T!e "ental pulp is no ex$eption, T!ere are some te$!ni$al "iffi$ulties in "eri'in+ information on t!e "ental pulp an or+an or tissue t!at is "iffi$ult to see #e$ause it is en$ase" # t!e !ar"est materials in t!e #o" , -.(Y MA/E %UC( A 0IG I%%UE A0OUT A LITTLE TI%%UE1 T!is is #e$ause t!is little tissue !as $reate" a #i+ issue, T!e #est root fillin+ is t!e !ealt! pulp, T!e pulp is a soft tissue of mesen$! mal ori+in *it! spe$iali2e" $ells3 t!e o"onto#lasts arran+e" perip!erall matrix, It is en$lose" # t!e ri+i" minerali2e" "entin an" t!is a"mits its a#ilit to in$rease in 'olume "urin+ episo"es of 'aso"ilatation an" in$rease" tissue presen$e, &ollo*in+ toot! "e'elopment3 pulp retains its a#ilit to pro"u$e in "ire$t $onta$t *it! t!e "entin

"entin t!rou+!out life, T!is ena#les 'ital pulp to partiall $ompensate for t!e losses of enamel or "entin $ause" # me$!ani$al trauma or "isease et$, T!us3 )no*le"+e a#out pulp pro'i"es a firm #iolo+i$al #asis for $lini$al "e$ision ma)in+,

DEVELOPMENT
Pulp is #asi$all "eri'e" from t!e $ep!ali$ neural $rest, Durin+ t!e sixt! *ee) of em#r oni$ life3 toot! formation #e+ins *it! t!e "e'elopment of t!e primar epit!elial #an"s in t!e upper an" lo*er 4a*s, T!is $ontinuous !orse5s!ape" #an"s of t!i$)ene" epit!elium $r 6ui$)l "i'i"es into o Vesti#ular lamina o Dental lamina .it!in t!e "ental lamina3 $ontinue" an" lo$ali2e" proliferati'e a$ti'it lea"s to t!e formation of series of epit!elial in+ro*t!s into t!e e$tomesen$! me, 7primiti'e 8 or 9 $ell t!i$) la ere" epit!elial $o'erin+ an em#r oni$ $onne$ti'e tissue: at sites $orrespon"in+ to future "e$i"uous teet!, &rom t!is point3 toot! "e'elopment pro$ee"s in 9 sta+es 0u" Cap an" 0ell

Bud stage

Cap stage

Bell stage

Bud stage : Is represente" # t!e first epit!elial in+ro*t!s ; or in$ursions into t!e e$tomesen$! me of t!e 4a*, Cap stage : &urt!er proliferation into t!e e$tomesen$! me an" $ellular "ensit in$reases imme"iatel a"4a$ent to t!e epit!elial in+ro*t!, T!is pro$ess is $lassi$all referre" to as -$on"ensation< of t!e e$tomesen$! me, T!e epit!elial in+ro*t!3 *!i$! superfi$iall forms enamel of t!e toot!, T!e #all of $on"ense" e$tomesen$! me $ells $alle" DENTAL PAPILLA ; forms "entin an" pulp, resem#les a -$ap< sittin+ on a #all of $on"ense" e$tomesen$! me is $alle" enamel or "ental or+an ; e'entuall

DENTAL PAPILLA

Bell stage : Continue" +ro*t! lea"s to t!e enamel or+an resem#lin+ a #ell as t!e un"ersurfa$e "eepens, T!e $ells *it!in t!e "entin papilla un"er+o $ to"ifferentiation into a perip!eral la er of o"onto#lasts an" a $entral mass of fi#ro#lasts, T!is $!an+e is in"u$e" # si+nals ori+inatin+ in t!e internal enamel epit!elium, On$e t!e o"onto#lasts #e+in to la "o*n "entin3 t!e "ental papilla #e$omes # $on'ention3 t!e "ental pulp, Vas$ulari2ation of t!e "e'elopin+ pulp also starts "urin+ t!is sta+e3 *it! #ran$!es enterin+ t!e #ase of t!e papilla, T!e 'as$ulari2ation of t!e o"onto#last la er in$reases as "entin is pro+ressi'el lai" "o*n, Pioneer ner'e fi#ers approa$! t!e "e'elopin+ toot! "urin+ #u"5$ap sta+e #ut t!e penetrate t!e "ental papilla after "entin #e+ins, (ere3 *e see t!e life $ $le of t!e amelo#last relate" to t!at of t!e o"onto#last,

=: T!e amelo#last #e+ins to "ifferentiate first 8: T!e perip!eral e$tomesen$! mal $ells "i'i"e3 *it! some "au+!ter $ells mi+ratin+ #elo* t!e o"onto#last la er, 9: A$tin+ from a si+nal from t!e amelo#last3 t!e pre5o"onto#lasts #e+ins to "ifferentiate, >: % nt!eti$ or+anelles #e+in to in$rease in si2e an" num#er, ?: Cell #e$omes polari2e"3 nu$leus mo'es #asall , Num#er of o"onto#lasti$ pro$ess #e+in to form an" #e+ins to se$rete matrix, @: O"onto#last retra$ts as matrix is #ein+ lai" "o*n3 lea'in+ #e!in" a sin+le main pro$ess, A: On$e t!e first la er of "entin is lai" "o*n3 t!e "ifferentiate" amelo#last #e+ins to "eposit matrix,

ANATOMY :
General eatures : T!e "ental pulp o$$upies t!e $enter of ea$! toot! an" s!apes itself to a miniaturi2ation of t!e toot!, E'er person normall !as a total of ?8 pulp or+ans3 98 in t!e

permanent teet! an" 8B in "e$i"uous "entition, T!e resi"en$e of t!e pulp is $alle" t!e pulp $a'it surroun"e" # "entin on all si"es ex$ept at t!e api$al foramen, Total 'olumes of all t!e permanent teet! pulp or+ans is B,9C$$, Mean 'olume of a sin+le a"ult !uman pulp is B,B8$$, Molar pulps are 95> times lar+er t!an in$isor pulps,

T!e pulp $a'it ma #e "i'i"e" into a $oronal portion ; t!e pulp $!am#er an" a ra"i$ular portion ; t!e root $anal, In sin+le roote" teet!3 t!e pulp $!am#er +ra"uall mer+es into t!e root $anal3 #ut in multiroote" teet!3 t!ere is a sin+le pulp $!am#er an" more t!an one root $anal, T!ere are $anal orifi$es *!i$! are openin+s in t!e floor of t!e pulp $!am#er lea"in+ into t!e root $anals, T!e are not separate stru$tures #ut are $ontinuous *it! #ot! t!e pulp $!am#er an" root $anals, C!r!nal pulp : T!e pulp $!am#er !as a roof3 floor3 mesial3 #u$$al3 lin+ual an" "istal surfa$es, T!ere are pulp !orns *!i$! are a$$ exten"in+ of t!e pulp $!am#er "ire$tl un"er a $usp or "e'elopmental lo#e, T!e num#er of t!ese of t!ese !orns3 t!us "epen"s on t!e $uspal num#er, Rad"#ular pulp : Or t!e root $anal is t!at portion of t!e pulp $a'it from t!e $anal orifi$e to t!e api$al foramen, T!e are not al*a s strai+!t3 an" 'ar in si2e3 s!ape an" num#er, It ma "i'i"e" for $on'enien$e into t!e $oronal3 mi""le an" api$al t!ir" portions, T!e ra"i$ular portions of t!e pulp are $ontinuous *it! t!e periapi$al $onne$ti'e tissue t!rou+! t!e api$al foramen, Ap"#al !ra$en : Is an aperture at or near t!e apex of a root t!rou+! *!i$! t!e #loo" 'essels an" ner'es of t!e pulp enter or lea'e t!e pulp $a'it , T!e anatom of t!is is partiall "etermine" # t!e num#er an" lo$ation of api$al #loo" 'essels present at t!e time of formation of t!e apex, T!e a'era+e si2e of t!e api$al foramen of maxillar teet! in a"ults is B,>mm3 in man"i#ular teet! it is B,9mm, In oun+3 in$ompletel "e'elope"

teet! t!e api$al foramen is funnel s!ape"3 *it! t!e *i"er portion exten"in+ out*ar", T!e mout! of t!e funnel is fille" *it! perio"ontal tissue t!at is later repla$e" # "entin an" $ementum, As t!e root "e'elops3 t!e api$al foramen #e$omes narro*er, T!e inner surfa$e of t!e root apex #e$omes line" *it! $ementum3 *!i$! ma exten" for a s!ort "istan$e into t!e root $anal 7=mm5=,?mm:, Also3 t!e api$al foramen is not al*a s t!e most $onstri$te" portion of t!e root $anal, Constri$tions $an an" "o o$$ur #efore t!e extremit of t!e root is rea$!e", An" t!e api$al foramen is not al*a s in t!e $enter of t!e root apex, It ma exit on t!e mesial3 "istal3 la#ial or lin+ual surfa$e of t!e root3 usuall sli+!tl e$$entri$all , Anatomi$ stu"ies !a'e s!o*n t!at t!e api$al foramen $oin$i"es *it!in t!e anatomi$ apex in onl =A to >@D of t!e $ases an" it is lo$ate" on an a'era+e of B,> to B,Amm a*a anatomi$ apex, As a +eneral rule3 t!e root apex is $ompletel forme" a#out 859 ears after eruption of t!e toot!, A##ess!r% #anals : O$$asionall 3 "urin+ formation of t!e root s!eat!3 a #rea) "e'elops in t!e $ontinuit of t!e s!eat!3 pro"u$in+ a small +ap, .!en t!is o$$urs3 "entino+enesis "oes not ta)e pla$e opposite t!e "efe$t, T!e result is a small -a$$essor $anal<, T!e $an #e$ome esta#lis!e" an *!ere alon+ t!e root #ut are foun" to #e most numerous in t!e api$al t!ir", T!e $reate a perio"ontal5en"o"onti$ pat!*a of $ommuni$ation an" a possi#le portal of entr in to t!e pulp if t!e perio"ontal tissues lose t!eir inte+rit 7in $ase of perio"ontal "isease: A$$essor foramina are also present3 *!i$! are openin+s of t!e from t!e

a$$essor an" lateral $anals in t!e root surfa$e,

Pulps ! $a&"llar% teet' : In t!e $entral in$isor ; pulp is some*!at s!o'el s!ape" *it! 9 pulp !orns *!i$! are s!ort lateral in$isor !as 8 pulp !orns an" t!e lon+est pulp is $uspi" *it! an ellipti$al $ross se$tion #u$$olin+uall 3 *it! = pulp !orn, &irst premolar !as lar+e pulp $!am#er o$$luso$er'i$all "i'i"in+ into 8 smoot! funnel s!ape" root, T!e se$on" premolar is similar #ut !as onl one root *!i$! tapers at a#out its mi"point, M!lars : T!e pulp $!am#er of maxillar first molar is t!e lar+est in t!e "ental ar$!3 *it! > pulp !orns ; mesio#u$$al3 "isto#u$$al3 mesiopalatal an" "isto palatal, T!e arran+ement of t!e pulp !orns +i'es t!e pulpal root a r!om#oi"al s!ape is $ross se$tion3 *!ile t!e pulpal floor is trian+ular in $ross se$tion, T!ere are usuall mesio#u$$al3 "isto#u$$al "iameter of t!e t!ree, Maxillar se$on" molars !a'e a pulp $!am#er similar to t!e first molar ex$ept t!at it is narro*er mesio"istall an" t!e 9 root $anals are more $losel +roupe", Pulps ! $and"(ular teet' : T!e pulp $!am#er of $entral in$isors in small an" flat mesio"istall , T!e t!ree "istin$t pulp !orns present in a re$entl erupte" toot! #e$ome $al$ifie" an" "isappear earl in life "ue to $onstant masti$ator stimulus, Man"i#ular lateral in$isor is parallel to $entral in$isor #ut onl lar+er in "imension, T!e man"i#ular $uspi" resem#les t!e maxillar $uspi" *it! smaller "imensions, Onl one pulp !orn is present in t!e a"ult toot!, 9 roots *it! usuall 9 $anals situate" in3

an" palatal, T!e mesio#u$$al $anal is t!e

narro*est of t!e t!ree, T!e palatal root $anal is t!e lar+est !a'in+ t!e lar+est

Man"i#ular first premolar !as a pulp $!am#er t!at is narro* mesio"istall #ut *i"er #u$$olin+uall , It !as a prominent #u$$al pulp !orn3 an" a small lin+ual pulp !orn t!at ma "isappear *it! a+e, Man"i#ular se$on" premolar is similar to t!e first premolar ex$ept t!at t!e lin+ual pulp !orn is more prominent, T!e roof t!e man"i#ular first molar pulp $!am#er is often re$tan+ular in s!ape *it! > pulp !orns ; mesio#u$$al3 "isto#u$$al3 mesiolin+ual an" "istolin+ual an" t!e floor is r!om#oi"al in s!ape, T!ree root $anals are usuall present #ut at times a se$on" "istal $anal ma also #e present, Man"i#ular se$on" molar !as a pulp $!am#er t!at is smaller t!an t!e first molar an" t!e roots are $loser to+et!er, T!ree root $anals are usuall present, Pr"$ar% Pulp Organs &un$tion for a s!orter perio" of time t!an "o permanent pulps, A'era+e len+t! of time a primar pulp fun$tions is a#out C,9 ears, T!is amount of time $an #e "i'i"e" into 9 time perio"s =: Pulp or+an +ro*t! 8: Pulp maturation 9: Pulp re+ression =, 8, 9, .!en $ro*n an" roots are "e'elopin+, = ear Root is $omplete" till root resorption, 9 rs E mont!s &rom root resorption till exfoliation, 9 ears3 @ mont!s

Per$anent Pulp Organs : Durin+ $ro*n formation t!e pulps of primar an" perm teet! are morp!olo+i$all i"enti$al, It ta)es ? ears in permanent teet!, Durin+ t!is time t!e or+ans are !i+!l $ellular3 ex!i#itin+ a !i+! mitoti$ rate spe$iall in

$er'i$al re+ion primar teet! also ne'er attain t!e same extent of neural "e'elopment seen in permanent or+an,

STRUCTURAL ELEMENTS
Dental pulp is a loose $onne$ti'e tissue an" ma"e up of a $om#ination of $ells em#e""e" in an extra $ellular matrix of fi#ers in a semiflui" +el, It $ontains A?D # *t of *ater an" 8?D or+ani$ material,

MORP)OLOGIC *ONES O+ PULP :

,- Od!nt!(last la%er : T!e outermost stratum of $ells of !ealt! pulp is t!e o"onto#last la er, T!is la er is lo$ate" imme"iatel su#a"4a$ent to t!e pre"entin3 t!e o"onto#last pro$esses3 !o*e'er3 pass on t!rou+! t!e pre"entin3 into t!e "entin, Conse6uentl 3 t!e o"onto#last la er is a$tuall $ompose" of t!e $ell #o"ies of o"onto#lasts, A""itionall 3 $apillaries3 ner'e fi#ers an" "en"riti$ $ells ma #e foun" amon+ t!e o"onto#lasts, T!is la er is t!e -E&&ECTOR %Y%TEM< of t!e pulpF all t!e ot!er elements are eit!er supporti'e or prote$ti'e of t!e $ells formin+ "entin or pro+ramme" to repla$e t!em, In t!e $oronal portion of a oun+ pulp3 t!e o"onto#lasts assume a tall $olumnar form3 t!e ti+!t pa$)in+ to+et!er of t!ese $ells ; tall an" slen"er pro"u$es t!e appearan$e of a palisa"e, T!e o"onto#alsts 'ar in !ei+!tF $onse6uentl 3 t!eir nu$lei are not all at t!e same le'el an" are ali+ne" in a sta++ere" arra , T!is often pro"u$es t!e appearan$e of a la er 95? $ells in t!i$)ness, 0et*een o"onto#lasts3 t!ere are small inter$ellular spa$es3 approximatel 9BB5>BB AB in *i"t!, T!e o"onto#last la er in t!e $oronal pulp $ontains more $ells unit area t!an in t!e ra"i$ular pulp, 0e$ause t!ere are fe*er "entinal tu#ules per unit area in t!e root t!an in t!e $ro*n of t!e toot!3 t!e o"onto#last $ell #o"ies are less $ro*"e" an" are a#le to sprea" out laterall , 0et*een a"4a$ent o"onto#lasts3 t!ere are a series of spe$iali2e" $ell5to5$ell 4un$tions, Cell p!!r .!ne : Imme"iatel su#4a$ent to t!e o"onto#last la er in t!e $oronal pulp3 t!ere is often a narro* 2one approximatel >Bmm in *i"t! t!at is relati'el free of $ells, It is tra'erse" # $apillaries3 unm elinate" ner'e fi#ers an" t!e slen"er $ toplasmi$ pro$esses of fi#ro#lasts, T!e presen$e or a#sen$e of t!e

$ell poor 2one "epen"s on t!e fun$tional status of t!e pulp, It ma not #e apparent in oun+ pulps3 *!ere "entin forms rapi"l 3 or in ol"er pulps3 *!ere reparati'e "entin is #ein+ pro"u$e", Cell/r"#' .!ne : Usuall $onspi$uous in t!e su#o"onto#lasti$ area is a stratum

$onsistin+ a relati'el !i+! proportion of fi#ro#lasts3 $ompare" *it! a more $entral re+ion of t!e pulp, It is mu$! more prominent in t!e $oronal pulp t!an in t!e ra"i$ular pulp, 0esi"es fi#ro#lasts3 t!e $ell5ri$! 2one ma in$lu"e a num#er of

ma$rop!a+es3 "en"riti$ $ells an" l mp!o$ tes, On t!e #asis of e'i"en$e o#taine" in rats molar teet!3 it !as #een su++este" t!at t!e $ell5ri$! 2one forms as a result of perip!eral mi+ration of $ells populatin+ t!e $entral re+ions of t!e pulp $ommen$in+ at a#out t!e time of toot! eruption, Alt!ou+! $ell "i'ision *it!in t!e $ell5ri$! 2one is a rare o$$urren$e in normal pulps3 "eat! of o"onto#lasts $auses a +reat in$rease in t!e rate of mitosis, 0e$ause irre'ersi#l in4ure" o"onto#lasts are repla$e" # $ells t!at mi+rate from t!e $ell5ri$! 2one3 onto t!e inner surfa$e of "entin3 t!is mitoti$ a$ti'it is pro#a#l t!e =st step in formation of a ne* o"onto#last la er, Pulp pr!per : T!is is t!e $entral mass of t!e pulp, It $ontains t!e lar+er #loo" 'essels an" ner'es, T!e $onne$ti'e tissue $ells in t!is 2one $onsist of fi#ro#lasts or pulpal $ells,

Supra!d!nt!(last reg"!n : 0e+innin+ from t!e outsi"e3 t!e potential spa$e #et*een t!e o"onto#alst la er an" t!e pre"entin $oul" #e "es$ri#e" as t!e suprao"onto#last la er, 8 stru$tures are lo$ate" in t!is re+ion, =, Unsheathed axons: &oun" almost ex$lusi'el in t!e $ro*n, T!ese !a'e #een "es$ri#e" as t!e pre"entinal plexus of 0RADLA., T!e are not a true plexus 7net*or): #ut an area *!ere a num#er of axons $on+re+ate, It is not $lear *!et!er man axons en" in t!is plexus, 0ut3 t!ese axons are in an i"eal position to sense $!an+es in flui" mo'ement t!en t!e "entinal tu#ules as *ell as $!an+es in t!e extra$ellular flui" $omposition3 *!i$!3 #e$ause of t!e #arrier properties of t!e o"onto#last la er3 *ill #e "ela e" in rea$!in+ t!e $ore of t!e pulp, 8, Dendritic antigen presenting cellsG T!e are at least ?Bm lon+ an" !a'e 9 or more main "en"riti$ pro$esses *!i$! #ran$!, T!e "en"riti$ $ells a$t at least primaril 3 as anti+en presentin+ $ells3 stimulatin+ t!e "i'ision an" a$ti'it of T5l mp!o$ tes, T!e initiate primar immune response, T!e re+ion3 t!us3 "eser'es some spe$ial mention as 7after t!e o"onto#lasti$ pro$esses: t!is is t!e first area at *!i$! external stimuli $an #e "ete$te" in t!e pulp,

CELLS +"(r!(lasts : T!e pulp or+an is sai" to $onsist of spe$iali2e" $onne$ti'e tissue #e$ause it la$)s elasti$ fi#ers, T!e fi#ro#lasts are t!e #asi$ $ells of t!e pulp an" also t!e most numerous $ell t pe, As t!eir name implies3 t!e fun$tion in $olla+en fi#er formation t!rou+!out t!e pulp "urin+ t!e life of t!e toot!, T!e are a$ti'e in $olla+en s nt!esis, T!e $ells s nt!esi2e t pe I an" III $olla+en as *ell as proteo+ $ans an" +l $osamino+l $ans, &i#ro#lasts of t!e pulp are sai" to #e li)e -Peter Pan< #e$ause t!e ne'er reall -+ro* up<, T!ese $ells "o seem to remain in a relati'el *!en $ompare" *it! fi#ro#lasts of ot!er un"ifferentiate" mo"alit

$onne$ti'e tissue of t!e #o" , T!e !a'e t pi$al stellate s!ape an" extensi'e pro$esses t!at $onta$t an" are 4oine" # inter$ellular 4un$tions to t!e pro$esses of ot!er fi#ro#lasts, In oun+ pulp3 t!e $ells "i'i"e an" are a$ti'e in protein s nt!esis3 #ut in t!e ol"er pulp3 t!e fi#ro$ tes, In t!e $ourse of "e'elopment3 t!e relati'e num#er of $ellular elements in t!e "ental pulp "e$reases *!ereas t!e fi#re population in$reases, T!e fi#ro#lasts of t!e pulp3 in a""ition to formin+ t!e pulp matrix3 also !a'e t!e $apa#ilit of in+estin+ an" "e+ra"in+ t!is same matrix, T!ese $ells t!us !a'e a "ual fun$tion *it! pat!*a s for #ot! s nt!esis an" "e+ra"ation in t!e same $ell, Due to t!is t!e are responsi#le for t!e $olla+en turno'er in t!e pulp, appear roun"e" or spin"le s!ape" *it! s!ort pro$esses an" ex!i#it fe*er intra$ellular or+anelles, T!e are t!en terme"

Od!nt!(lasts : O"onto#lasts are t!e se$on" most prominent $ell in t!e pulp, T!e resi"e a"4a$ent to t!e pre"entin *it! $ell #o"ies in t!e pulp3 an" $ell pro$esses in t!e "entinal tu#ules, T!e are approx, ?5A m in "iameter an" 8?5>B m in len+t!, Morp!olo+i$ 'ariations o$$ur in o"onto#lasts3 ran+in+ from tall $olumnar $ells in t!e $ro*n to a lo* $olumnar t pe in t!e mi""le of t!e root, &rom an %EM stu" 3 &ren$! s$ientists !a'e "emonstrate" t!at t!e o"onto#last $ell #o"ies appear ti+!tl $ro*n to t!e apex, pa$)e" in t!e pulp !orn an" su$$essi'el pear s!ape"3 spin"le s!ape"3 $lu# s!ape" for +lo#ular from

A &ULLY DI&&ERENTIATED ODONTO0LA%T

T!e o"onto#last is a !i+!l

"ifferentiate" $ell in t!e pulp, 0ot!

fi#ro#lasts an" o"onto#lasts are "eri'e" from t!e mesen$! me #ut o"onto#lasts are more !i+!l "ifferentiate" $ells t!an t!e fi#ro#lasts, T!e main fun$tion of t!e o"onto#laasts is t!e pro"u$tion of "entin, T!e $ell #o" manufa$turers t!e matrix material t!e material is transporte" to an" se$rete" from t!e o"onto#lasti$ pro$esses, Un"er %EM o"onto#lasts appear as lar+e3 $losel ali+ne"3

multila ere" s*eet potato s!ape" $ells, T!e a'era+e 95> m in *i"t! to C5 =B m in len+t!, T!e ultrastru$tural features of t!e o"onto#last !a'e #een su#4e$t to numerous in'esti+ations, T!e $ell #o" of t!e a$ti'e o"onto#last !as a lar+e3 nu$leus t!at ma $ontain up to > nu$leoli, Nu$leus is situate" at t!e #asal en" of t!e $ell an" is $ontaine" *it!in a nu$lear en'elope, A *ell "e'elope" +ol+i $omplex3 $entrall lo$ate" in supran$ulear $ toplasm $onsists of an assem#l of smoot! *alle" 'esi$les an" $isternae, Numerous mito$!on"ria are e'enl "istri#ute" t!rou+!out t!e $ell #o" , Rou+! en"oplasmi$ reti$ulum is parti$ularl prominent3 $onsistin+ of $losel sta$)e" $isternae, Od!nt!(last"# pr!#ess : Ea$! pro$ess tra'erses t!e pre"entin an" t!en o$$upies a $anali$ulus in t!e "entin3 pre"ominantl fillin+ t!e lamina of t!e "entinal tu#ules, T!e o"onto#lasti$ pro$ess $alle" "entinal fi#ers or tomes fi#ers are $ toplasmi$ tu#ular pro4e$tions3 usuall "e'oi" of ma4or $ toplasmi$ or+an $ells, Pro$esses are lar+er at pulpal en" t!an at t!e perip!er 7>G=:, Mi$rotu#ules an" mi$rofilaments are t!e prin$ipal $omponents of o"onto#lasti$ pro$esses, Mi$rotu#ules exten" from t!e $ell #o" out into t!e pro$ess, T!ese strai+!t stru$tures impart t!e impression of ri+i"it ,

T!e plasma mem#rane of t!e o"onto#lasti$ pro$ess $losel approximates t!e *all of t!e "entinal tu#ules, T!e extent to *!i$! t!e pro$ess exten"s into "entin !as #een a $ontro'ers , It !as #een lon+ t!ou+!t t!at t!e pro$ess exten"s to t!e full len+t! of "entin 7859mm:, 0ut ultra stru$tural stu"ies usin+ TEM !a'e "es$ri#e" t!e pro$ess as #ein+ limite" to t!e inner t!ir" of t!e "entin *it! t!e outer 8H9 r" $omprise" of extra$ellular flui", 0ut ot!er stu"ies emplo in+ %EM3 !a'e "es$ri#e" t!e pro$esses exten"in+ furt!er into t!e tu#ule3 often as for as t!e DEI, More re$entl 3 $onfo$al mi$ros$op usin+ rat molars3 $on$lu"e" t!at t!e pro$esses "oe not exten" upto t!e DEI3 ex$ept "urin+ t!e earl sta+es of toot! "e'elopment, 0ut ot!er stu"ies are *arrante", After t!e initial "entin formation3 t!e o"onto#lasts3 'ia t!e pro$esses $an still mo"if "entin stru$ture # pro"u$in+ peritu#ular "entin, T!is is a ! perminerali2e" $uff *it! little or+ani$ matrix in t!e tu#ule3 "e$reasin+ t!e "iameter of t!e tu#ule, T!e o"onto#lasti$ pro$esses are #at!e" # inter$ellular flui" from t!e "ental pulp, Inter#ellular 0un#t"!ns : %mall re+ions of t!e plasma mem#ranes #et*een $ells 7inter$ellular 4un$tions: are 'isi#le onl # ele$tron mi$ros$op , T!ere are 9 t pes of inter$ellular 4un$tions, =: Impermea#le 7ti+!t 4un$tion: 8: A"!erin+ 72onula a"!eren$e: 9: Communi$atin+ 7nexuses: =, I$per$ea(le 0un#t"!ns !elp t!e $ell maintain a "istin$t internal en'ironment, In t!ese 4un$tions3 t!e plasma mem#ranes of

a"4a$ent $ells appear to fuse an" affor" a ti+!t seal #et*een t!ese $ells, &oun" mainl in t!e api$al part of o"onto#lasts in oun+ teet!, 8, A"!erin+ 4un$tions are maintaine" # "esomsomes3 *!i$! are inter$ellular #ri"+es seen in li+!t mi$ros$op , T!ere are 9 t pes of "esomsomes 5 5 5 0elt %pot (emi"esmosomes

%pot "esmosomes are lo$ate" in t!e api$al part of t!e o"onto#lasti$ $ell #o"ies me$!ani$all 4oin o"onto#lasts to+et!er, T!e promote a"!esion #et*een $ells, 9, Communi$atin+ 4un$tions also $alle" +ap 4un$tions3 are stru$tures t!at me"iate "ire$t transfer of $!emi$al messa+es #et*een $ells, T!e ena#le $ells to ex$!an+e nutrients an" si+nal mole$ules for $o5or"ination of fun$tion, Numerous +ap 4un$tions pro'i"e lo*5 resistan$e pat!*a s t!rou+! *!i$! ele$tri$al ex$itation $an pass #et*een $ells, T!ese 4un$tions are most numerous "urin+ t!e formation of primar "entin +ap 4un$tions $rust spe$ial proteins $alle" $onne$tions in t!eir plasma mem#rane *!i$! $ontain pores =?AB in *i"t! +ap 4un$tions an" "esmosomes !a'e also #een o#ser'e" 4oinin+ o"onto#lasts to t!e pro$esses of fi#ro#lasts in t!e su#o"onto#lasti$ area, Od!nt!(last"# #!$$un"#at"!ns : T!e o"onto#lasti$ pro$esses are in $onta$t *it! a"4a$ent pro$esses t!rou+! an extensi'e lateral #ran$! s stem, T!e o"onto#lasts also $onta$t $ells more $entrall lo$ate" in t!e pulp t!rou+! fine protoplasmi$ pro$esses3

possi#l o*in+ to t!e presen$e of fi#rone$tin3 a me"itator of $ell5to5$ell a"!esion, T!us3 t!e o"onto#lasts ma #e re+ar"e" as part of a mesen$! mal s n$tium, T!is $ellular $onta$t is si+nifi$ant #e$ause of an o"onto#last is in4ure"3 ot!er o"onto#alsts are affe$te", T!e $ells on eit!er si"e are affe$te" # t!e #rea)"o*n pro"u$ts of t!e in4ure" o"onto#lasts *!en t!e "entin is in4ure" t!rou+! operati'e pro$e"uresF t!e normal palisa"e arran+ement of t!e o"onto#alsts is altere" resultin+ in "isruption of t!e $ontinuit of t!ese $ells, T!us3 in4ur to t!e "entin of t!e toot! $reates a rea$tion *it!in t!e pulp, DE+ENCE AND OT)ER CELLS : %ome of t!e $ells in t!e pulp are "efen$e $ells, (istio$ tes or restin+ *an"erin+ $ells are usuall foun" near t!e #loo" 'essels, T!e !a'e lon+ slen"er #ran$!in+ pro$esses an" are a#le to *it!"ra* t!ese pro$esses an" $!an+e 6ui$)l into ma$rop!a+es *!en t!e nee" arises, Un"ifferentiate" mesen$! mal $ells are present in t!e pulp3 as t!e are in all $onne$ti'e tissue, T!e are $apa#le of #e$omin+ ma$rop!a+es "urin+ in4ur , T!e also ma #e$ome fi#ro#lasts3 o"onto#lasts or osteo$lasts, Un"ifferentiate" mesen$! mal $ells $onstitute a reser'oir of $ells upon *!i$! a #o" $an $ell to assume fun$tions t!at are not or"inaril nee"e", In t!e pulp3 t!e are usuall foun" outsi"e t!e 'essel *alls, 0efore in4ur 3 t!e appear elon+ate" an" follo*in+ in4ur t!e "ifferentiate" into ma$rop!a+es an" as su$! $an in+est forei+n material, C!ara$teristi$all 3 a ma$rop!a+e !as numerous 'esi$les3 'a$uoles an" mem#rane #oun" #o"ies )no*n as l sosomes, T!e l sosomes $ontain 'arious ! "rol ti$ en2 mes t!at air in #rea)"o*n of t!e in+este" material, Ot!er transitional $ell forms in t!e pulp in$lu"e ame#oi" $ells of 'arious t pes an" l mp!oi" *on"erin+ $ells,

+IBRES Colla+en is t!e pre"ominant extra$ellular matrix $omprisin+ 8?598D of "r *t an" 9,?D of *et *t of pulp, Colla+en fi#res are s nt!esi2e" # t!e pulpal fi#ro#lasts, A sin+le $olla+en mole$ule referre" to as tropo$olla+en3 $onsists of 9 pol pepti"e $!ains3 "esi+nate" as eit!er a = or a 8 "epen"in+ on t!eir amino a$i" $omposition an" se6uen$e, T!e "ifferent $om#inations an" lin)a+es of $!ains ma)in+ up t!e tropo$olla+en mole$ule !a'e allo*e" $olla+en fi#res an" fi#rils to #e $lassifie" into a num#er of t pes, T pe I ; &oun" in s)in3 ten"on3 #one3 "entin an" pulp ?@D T pe II ; &oun" in $artila+e T pe III ; &oun" in most unminerali2e" $onne$ti'e tissue T pe IV an" VIII $olla+en ; $omponents of #asement mem#ranes T pe V ; Constituent of interstitial tissues T pe III $olla+en $onstitutes 8?D5>?D of pulp *!ile t pe I $onstitutes aroun" ?BD, 0ot! t pe III an" t pe I !a'e a similar @Anm #on"in+ #ut t pe I $olla+en $ontinues #ot! a= an" a8 mole$ules $!ains3 t pe III $ontains onl a= $!ains, .it! maturit 3 $olla+en fi#ers of approx A?BAB "iameter "e'elop, In oun+ pulp3 small $olla+en fi#ers stains #la$) *it! sil'er

impre+nation stains, T!us3 t!e are referre" to as ar+ rop!ili$ fi#ers, &ine ar+ rop!ili$ fi#ers arisin+ in t!e pulp3 form spirall t*iste" #un"les t!at

pass #et*een t!e o"onto#lasts an" fan out into t!e unminerali2e" "entin or pre"entin in a "eli$ate mes!*or), T!ese fi#ers $alle" VAN /RO&&% fi#ers form t!e fi#rillar net*or) of t!e "entin, T!ere are 8 prominent patterns of $olla+en "eposition in "ental pulp, 5 Diffuse 7in *!i$! $olla+enous fi#ers la$) "efinite orientation:, 5 0un"le t pe 7in *!i$! lar+e3 $oarse #un"les run parallel to ner'es or in"epen"entl :, Coronal pulp tissue !as more #un"le $olla+en "iffuse $olla+en, As t!e pulp +ets ol"er3 t!ere is an in$rease in fi#er extent ; mainl t pe III $olla+en, Re+ar"less of a+e3 t!e api$al portion of t!e pulp is usuall more fi#rous t!an t!e $oronal portion, Clini$all 3 t!e api$al pulp tissue !as a *!itis! appearan$e "ue to t!e pre"ominan$e of $olla+en fi#ers, On$e mature $olla+en is forme"3 it is less prone to "ama+e, As t!e pulp $!am#er narro*s *it! a+e3 t!e $olla+ens ina#ilit to "isinte+rate to a$$ommo"ate t!e smaller lumen results in fi#rosis ; a $on+estion t!at $oul" #e $alle" -CRA0GRA%%< effe$t, Gr!und su(stan#e : It is "ense an" +el li)e in nature3 'aries in appearan$e from finel +ranular to fi#rillar *it! $lear spa$es left #et*een 'arious a++re+ates, It is $ompose" of #ot! a$i" mu$opol sa$$!ari"es an" protein pol sa$$!ari"e $ompoun"s3 i,e, +l $osamino+l $ans an" proteo+l $ans, 8BD of t!e pulpal $ar#o! "rate is in +l $osamino+l $ans, T!e follo*in+ properties !a'e #een attri#ute" to +l $osamino+l $ans, 5 .ater retention 5 Ion #in"in+ an" ele$trol te "istention "urin+ minerali2ation, 5 Influen$e on $olla+en fi#rillo+enesis,

T!e meta#olism of t!e $ells an" t!e fi#ers of t!e pulp is me"iate" t!rou+! t!e +roun" su#stan$e, It is a 'is$i" flui" an" is "es$ri#e" # En+el 7=E?C: as t!e -milieu interieur< t!rou+! *!i$! meta#olites pass from t!e $ir$ulation to t!e $ells an" t!rou+! *!i$! #rea)"o*n pro"u$ts from t!e $ells $ome #a$) to 'enous $ir$ulation, T!us3 t!e meta#oli$ role of t!e +roun" su#stan$e influen$es t!e 'italit of t!e pulp, In all3 t!e +roun" su#stan$e3 5 Influen$es t!e sprea" of infe$tion 5 Meta#oli$ $!an+es in $ells 5 %ta#ilit of $r stalloi"s 5 Effe$ts of !ormones 'itamins an" ot!er su#stan$es An $!an+es in t!e nature or 6ualit of t!e +roun" su#stan$e "ire$tl influen$es t!e sprea" of inflammation an" infe$tion, =, Van (assel !as "emonstrate" t!at lo$al in$reases in flui" presen$e are exa$tl t!at ; LOCAL5$onfine" to t!e site of in4ur or irritation # a resilient $onne$ti'e tissue, T!e 'is$osit of t!e +elate" +roun" su#stan$e reinfor$e" *it! $olla+en fi#ers "oes not permit flui"s to mo'e rea"il from one part of t!e pulp to anot!er or t!e presen$e to #e transmitte" t!rou+! t!e tissue, 8, T!e +elate" +roun" su#stan$e a$ts as a #arrier a+ainst t!e sprea" of mi$roor+anisms an" toxi$ pro"u$ts, (o*e'er3 or+anisms su$! as t!e !aemol ti$ strepto$o$$us $an ela#orate a sprea"in+ fa$tor 7t!e en2 me3 ! aluroni"ase: t!at ma "issol'e t!e #arrier an" allo* a faster in'asion, 9, Alt!ou+! t!e tur+i"it of t!e +roun" su#stan$e resists t!e sprea" of # in$rements from a

inflammation3 t!e pro$ess mo'es api$all

parti$ular site, Pressure from t!e in$rease" tissue flui" $ollapses t!e t!in

*alle" 'eins an" 'enules3 $ausin+ a 'as$ular stasis an" is$!emia resultin+ in lo$al $ellular "eat!, >, C!emi$al me"iators 7e+, proteol ti$ en2 mes3 ! aluromi"ase: e"ema3 an" !eat ma also alter t!e 6ualit of t!e +roun" su#stan$e 7! "rol ti$ a+ents:, ?, C!emota$ti$ fa$tors3 $!emi$als li#erate" from in4ure" $ells not onl alter t!e 'is$osit ma$rop!a+es, @, T!e 'is$osit $an #e furt!er "e$rease" # an ex$essi'e a$$umulation of inflammator flui" 7e"ema: an" a lo$ali2e" temperature rise3 #ot! resultin+ from inflammation, A, T!e temperature alters t!e state of +roun" su#stan$e in mu$! t!e same *a as in a re'ersi#le ! "ro$olloi"3 a sol5+el t pe of interpla , T!e !eat of an inflame" pulp # separatin+ t!e mole$ules "iminis!es t!e natural #arrier of t!e +elate" state, #ut also exert $!emota$ti$ influen$e on PMNLJs an"

METABOLISM :
T!e meta#oli$ a$ti'it !as #een stu"ie" # measurin+ t!e rate of ox +en $onsumption an" t!e pro"u$tion of CO8 or la$ti$ a$i" # pulp tissue in 'itro, 0e$ause of t!e relati'el sparse $ellular $omposition of t!e pulp3 t!e rate of ox +en $onsumption is lo* in $omparison to t!at of most ot!er tissues, Durin+ a$ti'e "entino+enesis3 meta#oli$ a$ti'it is mu$! !i+!er t!an after t!e $ompletion of $ro*n "e'elopment, T!e +reatest meta#oli$ a$ti'it is foun" in t!e re+ion of t!e o"onto#last la er, In a""ition to t!e usual +l $ol ti$ pat!*a 3 t!e pulp !as t!e a#ilit to pro"u$e ener+ t!ou+! a p!osp!o+l $onate s!unt t pe of $ar#o! "rate meta#olism3 su++estin+ t!at t!e pulp ma #e a#le to fun$tion un"er 'ar in+

"e+rees of is$!emia, T!is $oul" explain !o* t!e pulp mana+es to *it!stan" perio"s of 'aso$onstri$tion resultin+ from t!e use of infiltration anest!esia emplo in+ t!e epinep!rine ; $ontainin+ lo$al anest!eti$ a+ents,

CIRCULATION :
T!e $ir$ulation of #loo" is t!e transportation s stem # means of *!i$! t!e 'arious $ells of t!e #o" are supplie" *it! nutrients an" t!e *aste pro"u$ts from t!e $ells are remo'e" for elimination from t!e #o" , S%ste$"# #"r#ulat"!n : &rom t!e 'enae $a'ae t!e #loo" passes into t!e ri+!t atrium an" from t!ere it passes t!en t!e ri+!t 'entri$le an" into t!e lun+s # *a of t!e pulmonar arter , T!e #loo" is ox +enate" in t!e lun+s an" returns to t!e !eart # *a of pulmonar 'ein3 to t!e left atrium an" is pumpe" t!rou+! t!e left 'entri$le to t!e aorta, T!e aorta +i'es off #loo" 'essels 7arteries: t!at "i'i"e into smaller an" smaller #ran$!es5 t!e arterioles, T!e arterial suppl to t!e pulps of teet! ori+inates from t!e posterior superior al'eolar3 t!e infaor#ital an" t!e inf, al'eolar #ran$!es of t!e internal maxillar arter , A sin+le arter or se'eral smaller arteries enter t!e pulps t!eir t!e api$al foramen or foramina, In a""ition3 numerous smaller 'essels enter t!rou+! lateral an" a$$essor foramina, 0loo" is returne" to t!e !eart # t!e 'enous s stem, T!e pulpal 'eins to+et!er *it! ot!er 'enous tri#utaries form t!e pter +oi" plexus lo$ate" posterior to t!e maxillar pter +oi" plexus "rains into internal maxillar tu#erosit , T!e 'ein an" t!is into t!e

external or internal 4u+ular 'ein ; superior 'ena $a'a ; !eart,

M"#r!#"r#ulat"!n : T!e primar fun$tion of mi$ro$ir$ulation is to transport nutrients to an" to remo'e meta#oli$ *aste pro"u$ts from t!e tissues, t!e pulp or+an is extensi'el 'as$ulari2e", 0loo" from t!e "ental arter enters t!e toot! 'ia arterioles !a'in+ "iameters of =?Bm or less, T!ese 'essels pass t!rou+! t!e api$al foramen or foramina *it! ner'e #un"les, %maller 'essels ma enter t!e pulp 'ia lateral or a$$essor $anals, T!e arterioles $ourse up t!rou+! t!e $entral portion of t!e ra"i$ular pulp an" +i'e off #ran$!es t!at sprea" laterall to*ar" t!e o"onto#last la er3 #eneat! *!i$! t!e $a'it to form a $apillar plexus, As t!e arterioles pass into t!e $oronal pulp t!e fan out to*ar" t!e "entin3 "iminis! in si2e an" +i'e rise to a $apillar net*or) in t!e su#o"onto#lasti$ re+ion ran+in+ from > to Cm in "iameter, T!is net*or) pro'i"es t!e o"onto#lasts *it! a ri$! sour$e of meta#olites, T!ere is no Tuni$a me"ia an" a"'entitia in t!e $apillaries, Are ma"e up entirel of a sin+le la er flat en"ot!elial $ells t!at is $ontinuous *it! t!e en"ot!elial linin+ Lo$ate" on t!e perip!er of t!e $apillaries at ran"om are peri$ tes or Rou+et: &un$tion of t!ese $ells is $ontro'ersial3 t!ou+!t to #e $ontra$tile $ells $apa#le of re"u$in+ t!e si2e of t!e lumen, Capillar #loo" flo* in t!e $oronal portion of t!e pulp is nearl t*i$e t!at in t!e root portion, Moreo'er3 #loo" flo* in t!e re+ion of t!e pulp !orns is +reater t!an in ot!er areas of t!e pulp, In assurin+ an a"e6uate suppl oun+ teet!3 "urin+ a$ti'e "entino+enesis3 $apillaries $ommonl exten" into t!e o"onto#last la er3 t!us of nutrients for t!e meta#oli$all o"onto#lasts an" retreat more pulpall on$e "entino+enesis is $omplete", T!e su#o"onto#lasti$ $apillaries are surroun"e" # mem#rane an" o$$asionall a #asement

fenestrations 7i,e, pores: are o#ser'e" in

$apillar *alls, T!ese fenestrations are t!ou+!t to pro'i"e rapi" transport of flui" an" meta#olites from t!e $apillaries to a"4a$ent o"onto#lasts,

T)E SUBODONTOBLASTIC PLE1US

In t'e e erent 2en!us s%ste$ : 0loo" passes from t!e $apillar plexus first into t!e post $apillar 'enules an" t!en into lar+er 'enules, Venules in t!e pulp !a'e "iameter $ompara#le to t!e arterioles #ut unusuall t!in *alls *!i$! ma)e t!eir lumina lar+e *!i$! ma fa$ilitate t!e mo'ement of flui" in or out of t!e 'essels, T!e mus$ular $oat of t!ese 'enules is t!in an" "is$ontinuous, T!e $olle$tin+ 'enules #e$ome pro+ressi'el lar+er as t!e $ourse to t!e $entral re+ion of t!e pulp, T!e lar+est 'enules !a'e a "iameter of t!at ma rea$! a

maximum of 8BBmm3 t!us t!e are $onsi"era#l lar+er t!an t!e anterioles of t!e pulp, Arterio'enous anastomoses 7AVA: ma #e present in #ot! $oronal an" ra"i$ular pulp, %u$! 'essels pro'i"e a "ire$t $ommuni$ation #et*een arterioles an" 'enules3 t!us # passin+ t!e $apillar #e", T!e AVAJs are relati'el small 'enules *it! a "iameter of approximatel =Bmm, Amon+ t!e oral tissues3 t!e oun+ an" normal pulp !as t!e !i+!est 'olume of #loo" flo* #ut it is su#stantiall lo*er t!an #loo" flo* in t!e ma4or 'is$eral or+ans, Regulat"!n ! pulpal (l!!d l!3 : Pulpal #loo" flo* !as #een estimate" to #e 8B5@Bml Hmin per =BB+ of tissue, Chemical regulation : Ner'es !elp to re+ulate t!e #loo" suppl to t!e "ental pulp, 5 % mpat!eti$ 7a"ernre+i$: ner'e fi#ers li#erate norepinep!rine *!i$! $onstri$ts t!e 'essels, 5 Paras mpat!eti$ 7$!oliner+i$: ner'es li#erate a$et l$!oline *!i$! "ilates t!e 'essels, T!e $ate$!olamines su$! as epinep!rine or norepinep!rine exert t!ere p! siolo+i$ effe$ts on re$eptors in t!e #loo" 'essels3 $alle" -a"renore$eptors<, T!ere are 8 t pes of a"renore$eptors, 5 Alp!a 7: 5 0eta 7: T!e #loo" 'essels of pulp $ontain #ot! an" a"renore$eptors, re$eptors are responsi#le for $ontra$tion an" pro"u$e 'aso$onstri$tion,

%timulation of re$eptors $auses a relaxation of t!e 'as$ular mus$ulature, T!e pulpal #loo" 'essels $ontain a"renore$eptors #ut are poorl e6uippe" *it! t!em, 0loo" $ir$ulation in an inflame" pulp in'ol'es 'er pat!op! siolo+i$ rea$tions, A uni6ue feature of t!e pulp is t!at it is ri+i"l en$ase" *it!in "entin, T!is pla$es it is a low-COMPLIANCE en'ironment3 mu$! li)e t!e #rain3 nail5#e" an" #one5marro*, T!us3 pulp tissue !as limite" a#ilit to expan" so 'aso"ilatation an" in$rease" 'as$ular permea#ilit e'o)e" "urin+ an inflammator results in an in$rease in pulpal ! "rostati$ pressure, rea$tion $omplex

INNERVATION :
T!e neuron is t!e #asi$ $ell of t!e ner'ous s stem, Li)e ot!er $ells3 ea$! neuron !as a nu$leus an" surroun"in+ $ toplasm, T!e neuron !as one relati'el lon+ #ran$! ; t!e axon an" numerous fi'e #ran$! 7"en"rites:, T!e axon transmits #rief ele$tri$al *a'es $alle" impulses3 t!e "en"rites re$ei'e ner'e impulses from ot!er $ells, T!e pulp is !ea'il inner'ate", &or e+ G appox, 8?BB axons enter t!e api$al foramen of a mature premolar, Pulp t"ssue "s "nner2ated # t!e fi#ers of sensor "i'ision of t!e tri+eminal +an+lions an" t!ose of autonomi$ #ran$!es of superior $er'i$al +an+lion, T!e prin$ipal fun$tion of sensor ner'es is to "ete$t stimuli an" to $on"u$t to t!e C,N,%, T!e fun$tion of autonomi$ s stem is to )eep t!e internal state of t!e or+anism $onstant an" maintain !omeostasis,

T!e sensor s stem seems to #e *ell suite" for si+nalin+ potential "ama+e to t!e toot!, T!e toot! is inner'ate" # unm elinate" ner'e fi#ers, Me%l"nated ; t!ese !a'e a s!eat! of m elin3 a su#stan$e $ompose" lar+el of fatt su#stan$es as lipi"s, M elin s!eat! fun$tions as an insulator ; "eposite" # s$!*ann $ells, Un$%el"nated 4 usuall foun" in autonomi$ ner'ous s stem3 t!e a lar+e num#ero f m elinate" an"

a$$ompan #loo" 'essels, Approximatel CBD of ner'es are unm elinate", Re+ar"less of t!e nature of sensor stimulus3 almost all afferent

impulses from t!e pulp result in t!e sensation of pain, T!e ner'e fi#ers are seen $entrall in t!e pulp of t!e root in $lose asso$iation *it! t!e #loo" 'essels, A fe* fi#ers lea'e t!e $entral #un"les in t!e root an" tra'el to t!e perip!er , Most $ontinue to t!e $oronal pulp *!ere t!e sprea" apart an" #ran$! profusel , Most of t!e #ran$!es are in t!e o"onto#lasti$ or su#o"onto#lasti$ re+ions, On$e t!e rea$! t!e $oronal pulp3 t!e fan out #eneat! t!e $ell5ri$! 2one3 #ran$! into smaller #un"les an" finall ramif into a plexus of sin+le ner'e axons )no*n as PLE1US O+ RASC)5O6, &ull "e'elopment of t!is plexus "oes not ta)e pla$e until final sta+es of toot! "e'elopment, 0ran$!es from t!is plexus pass into t!e o"onto#lasti$ la er an" t!e pre"entin to form t!e MARGINAL PLE1US3 ot!ers $ontinue into "entin to a$$ompan o"onto#lasti$ pro$ess into t!e "entinal tu#ules,

O$!i an" Matsumoto foun" t!e approximation of t!e ner'e fi#ers an" "entino#lasti$ pro$esses to #e a#out 8Bnm *it! no +ap 4un$tions or s napses present,

PLE1US O+ RASC)5O6

Ner'e en"in+s "o not exist in e'er tu#ule, Intratu#ular ner'es appear in =BD58BD of t!e tu#ules in t!e $oronal pulp !orn re+ion3 $ompare" *it! less t!an =D at t!e le'el of t!e CE 4un$tion an" onl o$$asionall ner'es are foun" in ra"i$ular "entin, Most of t!ese intratu#ular fi#ers exten" into t!e "entinal tu#ules for onl a fe* mm3 #ut a fe* ma penetrate as for as =BBmm,

Ner2e "(re t%pes : T!e spee" *it! *!i$! a ner'e impulse passes alon+ a neuron 'aries "ire$tl *it! t!e "iameter of t!e axon t!e lar+er t!e "iameter3 t!e faster t!e $on"u$tion, &i#ers !a'in+ t!e lar+est "iameter are $lassifie" as A fi#ers3 interme"iate si2e5 0 fi#ers an" smallest "iameter ; C fi#ers, T!e A fi#ers are m elinate" an" su#"i'i"e" into t!e lar+er "iameter ; A an" A5 Interme"iate 5 A %maller ; A0 Of $onsi"era#le $lini$al interest is t!e e'i"en$e t!at ner'e fi#ers of t!e pulp are relati'el resistant to ne$rosis, T!is apparentl #e$ause ner'e #un"les3 in +eneral3 are more resistant to autol sis t!an ot!er tissue elements, e'en in "e+eneratin+ pulps3 C fi#ers mi+!t still #e a#le to respon" to stimulate", Also3 C fi#ers are a#le to fun$tion in ! poxia3 e'en after #loo" flo* !as #een $ompromise", T!is ma offer an explanation as to *! instrumentation of non5'ital teet! some times $auses pain, Also3 it !as #een o#ser'e" t!at remo'al of pulp # extra$tion of t!e toot! or # pulpe$tom an" presuma#l 3 pulpotom results in t!e su$$essi'e "e+eneration of t!e $ell #o"ies lo$ate" in t!e spinal nu$leus of t!e tri+eminal ner'e3 t!e main sensor lea"in+ to t!e toot! in t!e so$)et, Bern"#7 : o#ser'e" t!e effe$ts of $aries an" restorations on un"erl in+ ner'es in t!e pulp, (e foun" a "e+eneration of su#o"onto#lasti$ plexus of ner'es asso$iate" *it! t!e pro"u$tion of "entin, (e $on$lu"e" t!at t!e terminal ner'es in t!e in4ure" pulp are sensiti'e to t!e noxious pro"u$ts of +an+lion an" t!e perip!eral ner'e

$aries an" t!e restorati'e pro$e"ures, T!e la$) of sensiti'it "e+eneration of un"erl in+ ner'es, V"tal"t% test"ng:

t!at

a$$ompanies t!e $aries pro$ess ma #e attri#uta#le3 at least partiall 3 to

ELECTRIC PULP TE%TER "eli'ers a $urrent suffi$ient to o'er$ome t!e resistan$e of enamel an" "entin an" stimulate t!e sensor A fi#ers at t!e pulp5"entin #or"er 2one, C fi#ers of t!e pulp "o not respon" to t!e $on'entional pulp tester #e$ause si+nifi$antl more $urrent is nee"e" to stimulate t!em, 0en"er et al foun" t!at in anterior teet!3 t!e optimal pla$ement site of t!e ele$tro"e is t!e in$isal e"+e of anterior teet!3 as t!e response t!res!ol" is t!e lo*est at t!at lo$ation an" in$reases as t!e ele$tro"e is mo'e" to*ar" t!e $er'i$al re+ion of t!e toot!, Col" tests usin+ CO8 sno* or li6ui" refri+erants an" !eat tests emplo in+ !eate" +utta per$!a or !ot *ater a$ti'ate ! "ro" nami$ for$es *it!in t!e "entinal tu#ules *!i$! in turn ex$ite t!e inter"ental A fi#ers, C fi#ers are not a$ti'ate" # t!ese tests unless t!e pro"u$e in4ur to t!e pulp, It !as #een s!o*n t!at $ol" tests "o not in4ure t!e pulp, (eat tests !a'e a +reater potential to pro"u$e in4ur 3 #ut if t!e tests are use" properl 3 in4ur is not li)el , Neuropeptides : Of immense $urrent interest is t!e presen$e of neuropepti"es in sensor ner'es, Pulpal ner'e fi#ers $ontain neuropepti"es su$! as $al$itonia +ene5relate" pepti"e 7CGRP:3 su#stan$e P 7%P:3 neuropepti"e Y3 neuro)inin A an" 'asoa$ti'e intestinal pol pepti"e 7VIP:, Release of t!ese pepti"es $an #e tri++ere" # su$! t!in+s as tissue in4ur 3 $omplement a$ti'ation3 anti+en anti#o" rea$tions ner'e,

On$e release" 'asoa$ti'e pepti"es pro"u$e 'as$ular $!an+es t!at are similar to t!ose e'o)e" # !istamine an" #ra" )inin 7i,e, 'aso"ilatation:, In a""ition to t!eir neuro'as$ular properties3 %P an" CGRP $ontri#ute to ! peral+esia an" promote *oun" !ealin+,

LYMP)ATICS :
T!e existen$e of l mp!ati$s in t!e pulp !as #een a matter of "e#ate #e$ause it is not eas to "istin+uis! #et*een 'enules an" l mp!ati$s in or"inar li+!t mi$rope te$!ni6ues, (o*e'er3 te$!ni6ues usin+ li+!t an" ele$tron mi$ros$op !a'e "es$ri#e" l mp!ati$ $apillaries in !uman pulp, T!eir fine en"ot!elial stru$ture ma)es t!em "iffi$ult to see, Main fun$tion of t!ese l mp!ati$ 'essels is G 5 Remo'al of interstitial flui" an" meta#oli$ *aste pro"u$ts, 5 To maintain t!e intrapulpal tissue pressure at a normal le'el 7=Bmm of (+:, T!ese l mp!ati$ 'essels follo* t!e $ourse of 'enules to*ar" api$al foramen, L mp! 'essels $onsist of en"ot!elial line" $!annels *it! "is$ontinuities in t!eir *alls an" #asement mem#rane, T!e $!ara$teri2e" # are t!e a#sen$e of R0CJs an" presen$e of l mp!o$ tes,

L mp! 'essels "rainin+ pulp an" perio"ontal tissues !a'e a $ommon outlet, T!e "rain into su#mental3 su#man"i#ular3 an" "eep $er'i$al l mp! no"es an" finall ; 4un$tion of su#$la'ian an" Internal 4u+ular 'eins,

REGRESSIVE AND AGE C)ANGES :

Regress"2e : T!e term re+ressi'e is "efine" as a $on"ition of "e$rease" fun$tional $apa#ilit or of returnin+ to a more primiti'e state, Ol"er pulps !a'e #een "es$ri#e" as re+ressi'e an" as !a'in+ a "e$rease" a#ilit to $om#at an" re$o'er from in4ur , T!is is #e$ause ol"er pulps !a'e fe*er $ells3 a less extensi'e 'as$ulature an" in$rease" fi#rous elements, Cell #'anges : In a""ition to t!e appearan$e of fe*er $ells in a+in+ pulp3 t!e $ells are $!ara$teri2e" # a "e$rease in si2e an" num#er of $ toplasmi$ or+anelles, T!e fi#ro#last of an a+in+ pulp ex!i#its less perinu$lear $ toplasm an" passes lon+3 t!in $ toplasmi$ pro$esses, T!e intra$ellular or+anelles are also re"u$e" in si2e an" num#er3 t!e mito$!on"ria an" en"oplasmi$ reti$ulum #ein+ +oo" examples of t!is, +"(r!s"s : T!e in$rease in fi#ers in t!e pulp or+an is +ra"ual an" +enerali2e" t!rou+!out t!e or+an, An external trauma su$! as "ental $aries or "eep restorations usuall $auses a lo$ali2e" fi#rosis or s$arrin+ effe$t, T!e in$rease in $olla+en fi#ers ma #e more apparent t!an a$tual3 "ue to t!e "e$rease in si2e of t!e pulp, .!i$! ma)es t!e fi#ers o$$up less spa$e3 an" !en$e ma #e$ome more $on$entrate" *it!out in$rease in total 'olume, Vas#ular #'anges : O$$ur in t!e a+in+ pulp as t!e "o in an or+an, Art!ros$leroti$ pla6ues ma appear in pulpal 'essels, In ot!er $ases3 t!e outer "iameter of

'essel *alls #e$omes +reater as $olla+en fi#ers in$rease in t!e me"ial an" a"'entitial la ers, CALCI+ICATIONS : Cal$ifi$ations are also foun" $ommonl surroun"in+ #loo" 'essels, 0asi$all 3 t!ere are 8 "istin$t t pes of $al$ifi$ations, =: &orme" stru$tures ; $ommonl $alle" as pulp stones or "enti$les, 8: Tin $r stalline masses +enerall terme" "iffuse $al$ifi$ations,

Pulpstones are foun" pre"ominantl in t!e $oronal portion *!ereas $al$ifi$ations are foun" in ra"i$ular pulp seems to #e of "iffuse 'ariet , Pulp st!nes : Pulpstones or "enti$les are "iffuse3 or no"ular3 $al$ifie" masses appearin+ in eit!er or #ot! t!e $oronal an" root portions of t!e pulp or+an, T!e usuall are as mptomati$ unless t!e impin+e on ner'e an" #loo" 'essels, T!e !a'e #een seen in fun$tional as *ell as erupte" teet!, Pulp stones ran+e in si2e from small3 mi$ros$opi$ parti$les to a$$retions t!at o$$up almost t!e entire $!am#er, I, A$$or"in+ to t!eir stru$ture3 t!e !a'e #een $lassifie" as 5 True "enti$les 5 &alse "enti$les II, A$$or"in+ to t!e lo$ation 5 &ree 5 Atta$!e" 5 Em#e""e"

True dent"#les : T!e are similar in stru$ture to "entin3 in t!at t!e !a'e "entinal tu#ules an" $ontain t!e pro$esses of o"onto#lasts t!at forme" an" t!at exist on t!eir surfa$e, True "enti$les are $omparati'el rare an" are usuall lo$ate" $lose to t!e api$al foramen, A t!eor !as #een a"'an$e" t!at t!e "e'elopment of t!e true "enti$le is $ause" # in$lusion of remnants of t!e epit!elial root s!eat! *it!in t!e pulp, T!e epit!elial remnants in"u$e t!e $ells of t!e pulp to "ifferentiate into o"onto#lasts3 *!i$! t!en form t!e "entin masses $alle" t!e pulp stones,

T!e "o not ex!i#it "entinal tu#ules #ut appear instea" as $on$entri$ la ers of $al$ifie" tissue, In some $ases3 t!ese $al$ifi$ation sites appear *it!in a #un"le of $olla+en fi#ers, Ot!er times3 t!e appear in a lo$ation in t!e pulp free of $olla+en a$$umulations, %ome false pulp stones un"ou#te"l arise aroun" 'essels, In t!e $enter of t!ese $on$entri$ la ers of $al$ifie" tissue3 t!ere ma #e remnants of $al$ifie" an" ne$roti$ $ells, $al$ifi$ation of t!rom#i in #loo" 'essels3 $alle" -P(LE0OLIT(%< ma also

ser'e as 'ili for false "enti$les, All "enti$les #e+in as small no"ules #ut in$rease in si2e # in$remental +ro*t! on t!eir surfa$es, T!e surroun"in+ pulp tissue ma appear 6uite normal, Pulp stones ma e'entuall fill su#stantial parts of t!e pulp $!am#er, &REE %TONE% are islan"s entirel surroun"e" # pulp tissue, ATTAC(ED DENTICLE% are partl fuse" *it! t!e "entin, EM0EDDED DENTICLE% are entirel surroun"e" # "entin, All are #elie'e" to #e forme" free in t!e pulp an" later to #e$ome atta$!e" or em#e""e" as "entin forma, Pro+resses pulp stones ma appear $lose to #loo" 'essels an" ner'e trun)s, Onl a relati'el small mem#er of pulp stones are suffi$ientl lar+e enou+! to #e "ete$te" in ra"io+rap!s, T!e in$i"en$e3 as *ell as t!e si2e of pulp stones in$reases *it! a+e, A$$or"in+ to one estimate G @@D 5 =B59B rs CBD 5 9B5?B rs EBD 5 o'er ?B rs )ISTOLOGICALLY : 8 t pes of stones are re$o+ni2e" =: T!ose t!at are roun" or o'oi"3 *it! smoot! surfa$es an" $on$entri$ lamellations, 8: T!ose t!at assume no parti$ular s!ape3 la$) laminations an" !a'e rou+! surfa$es, Laminate" stones appear to +ro* # t!e a""ition of $olla+en fi#rils to t!eir surfa$es3 *!ereas unlaminate" stones "e'elop 'ia t!e minerali2ation of preforme" $olla+en fi#er #un"les,

+UNCTIONS O+ PULP :
Indu#t"2e : T!e primar role of t!e pulp is to intera$t *it! t!e oral epit!elium $ells3 *!i$! lea"s to "ifferentiation of t!e "ental lamina an" enamel or+an formation, T!e pulp also intera$ts *it! t!e "e'elopin+ enamel or+an as it "etermines a parti$ular t pe of toot!, +!r$at"2e : T!e pulp or+an $ells pro"u$e t!e "entin t!at surroun"s an" prote$ts t!e pulp, T!e pulpal o"onto#lasts "e'elop t!e or+ani$ matrix an" fun$tion in its $al$ifi$ation, T!rou+! t!e "e'elopment of t!e o"onto#last pro$esses3 "entin is forme" alon+ t!e tu#ule *all as *ell as at t!e pulp5"entin front an" t!is pro$ess $ontinues t!rou+!out t!e life of t!e toot!, Nutr"t"2e : T!e pulp nouris!es t!e "entin t!rou+! t!e o"onto#lasts an" t!eir pro$esses an" # means of t!e #loo" 'as$ular s stem of t!e pulp, Pr!te#t"2e : T!e sensor ner'es in t!e toot! respon" *it! pain to all stimuli su$! as !eat3 $ol"3 pressure3 operati'e $uttin+ pro$e"ures an" $!emi$al a+ents, T!e ner'es also initiate reflexes t!at $ontrol $ir$ulation in t!e pulp, T!is s mpat!eti$ fun$tion is a reflex3 pro'i"in+ stimulation to 'is$eral motor fi#ers terminatin+ on t!e mus$les of t!e #loo" 'essels, De ens"2e !r reparat"2e : T!e pulp is an or+an *it! remar)a#le reparati'e a#ilities, It respon"s to irritation3 *!et!er me$!ani$al3 t!ermal3 $!emi$al or #a$terial # pro"u$in+ reparati'e "entin an" minerali2in+ an affe$te" "entinal tu#ules, 0ot! t!e reparati'e "entin $reate" in t!e pulp an" t!e $al$ifi$ation of t!e

tu#ules 7s$lerosis: are attempts to *all off t!e pulp from t!e sour$e of irritation, Also3 t!e pulp ma #e$ome inflame" "ue to #a$terial infe$tion or # $uttin+ a$tion an" pla$ement of an irritatin+ restorati'e material, T!e pulp !as ma$rop!a+es3 l mp!o$ tes3 neutrop!ils3 mono$ tes an" plasma an" mast $ells3 all of *!i$! ai" in t!e repair of t!e pulp,

PULPAL PAT)OLOGY: As I mentione" #efore3 t!e pulp is a $onne$ti'e tissue3 as foun" else*!ere in t!e #o" , (o*e'er3 se'eral fa$tors ma)e it uni6ue an" t!us alter its a#ilit to respon" to irritation G =: T!e pulp is almost totall surroun"e" # a !ar" tissue 7"entin:3 *!i$! limits t!e area for expansion an" restri$ts t!e pulpJs a#ilit to $ope *it! #a$teria3 ne$roti$ tissue an" inflammation, 8: T!e pulp possesses a uni6ue $ell3 t!e o"onto#last3 as *ell as $ells t!at $an "ifferentiate into !ar" tissue5se$retin+ $ells t!at form more "entin an" H or irritation "entin in an attempt to prote$t t!e pulp from in4ur , 9: T!e pulp !as almost a total la$) of $ollateral $ir$ulation *!i$! se'erel limits its a#ilit to $ope *it! #a$teria3 ne$roti$ tissue an" inflammation, In spite of t!ese $ir$umstan$es3 stu"ies !a'e in"i$ate" t!at an in4ure" pulp !as some $apa$it to re$o'er3 #ut t!e "e+ree is un$ertain,

CLINICAL CONSIDERATIONS :
T!e $auses of pulp inflammation3 ne$rosis an" " strop! 3 #e+innin+ *it! t!e most fre6uent irritant3 mi$ro5or+anisms areG Iatral causes : Ca2"t% preparat"!n : T!e !eat +enerate" # +rin"in+ pro$e"ures of toot! stru$ture !as

often #een $ite" as t!e +reatest sin+le $ause of pulp "ama+e "urin+ $a'it preparation, %*er"lo* an" %tanle pointe" out t!e #asi$ fa$tors in rotar pointe" out t!e #asi$ fa$tors in rotar instrumentation t!at $ause temperature rise in t!e pulp, In or"er of t!eir importan$e G =: &ORCE applie" # t!e operator 8: %IKE3 %(APE an" CONDITION of t!e $uttin+ tool 9: Re'olutions per minute >: DURATION% of a$tual $uttin+ time .e are #oun" to t!in) t!at t!e ultraspee" 79B3BBB rpm: instruments of to"a are more traumati$ to t!e pulp t!an t!e lo* spee" 7@3BBB rpm: instruments of t!e past, T!is is not true3 if a"e6uate air5*ater $oolant is use", It is possi#le to -#urs< t!e pulp in == se$on"s of preparation time if air alone is use" as $oolant at 8BB3BBB rpm, It s!oul" #e remem#ere" t!at t!e !i+!est intrapulpal temperatures are rea$!e" *it!in t!e first =B se$on"s of +rin"in+, %tu"ies !a'e $on$lu"e" t!at t!e "emise of t!e pulp #e+ins *it! a $!roni$ lesion turne" a$ute # t!e insult of $a'it preparation, An in$rease in interpulpal temperature of 8BB& ma result in irre'ersi#le "ama+e, Also3 $ar#i"e #urs +enerate less t!ermal $!an+e t!an "iamon" instruments an"

amon+ t!e "iamon" #urs ; $oarse "iamon"s pro"u$e a more pronoun$e" temperature in$rease t!an fine "iamon"s, Dept! of t!e preparation is also an important fa$tor, Deeper t!e penetration3 more is t!e pulp "ama+e, T!e "e+ree of pulp response is in'ersel proportional to t!e remainin+ t!i$)ness of "entin, Pulp !orn extensions are a 'er important $onsi"eration, T!e $lose proximit of t!e pulp to t!e external surfa$e of t!e toot! lea"s to exposure if t!e pulp !orn is not ta)en into $onsi"eration "urin+ $a'it $uttin+, At some points3 t!e pulp is onl =,? to 8,Bmm a*a #efore preparation is e'en #e+un, %proles in a stu" reporte" t!at @@5E@D of t!e time in t!e = st an" 8n" molar teet! t!e $er'i$al pulp !orns presents a real "an+er in $a'it preparation,

PERIODONTAL STATUS AND PULP :

T!ere is an intimate relations!ip #et*een t!e perio"ontal 'as$ular plexus an" t!e pulpal #loo" 'essels, 0esi"es 'as$ular $ommuni$ation3 $onne$ti'e tissue fi#ers run from t!e "ental pulp to t!e perio"ontal li+ament, Inflammator lesions in t!e pulp ma #e responses to toxi$ pro"u$ts entirel t!rou+! $anal openin+s t!at normall are $o'ere" *it! #one an" perio"ontal #ut no* are expose" to oral flui"s, Pulpal inflammation in perio"ontall in'ol'e" teet! $an o$$ur from extension of t!e inflame" perio"ontal $onne$ti'e tissue, Gin+i'al re$ession ma expose t!e openin+, Also "eep s$alin+ an" $urretta+e in perio"ontal treatment ma possi#l #e instrumental in $ausin+ pulp "ama+e, %ensiti'it of t!e teet! after "eep s$alin+ an" $uretta+e ma

#e "ue not onl to "enu"ation of t!e roots of t!e teet! #ut also to t!e pro"u$tion of inflammator $!an+es or !aemorr!a+es in t!e pulps of t!e teet!, Durin+ $uretta+e of a perio"ontal lesion t!at exten"s entirel aroun" t!e apex of t!e root3 t!e pulp 'essels ma #e se'ere" an" t!e pulp "e'itali2e"3 of a lateral root $anal3 espe$iall in t!e fur$ation area3 $ausin+ pain an" possi#le sprea" of infe$tion into t!e pulp,

ORT)ODONTIC +ORCE AND PULP :

In t!eor 3 t!e appli$ation of li+!t sustaine" for$e to t!e $ro*n of a toot! s!oul" pro"u$e a perio"ontal rea$tion #ut s!are little3 if an 3 effe$t on t!e pulp, T!ere is pro#a#l a mo"est an" transient inflammator response *it!in t!e pulp3 at least at t!e #e+innin+ of t!e treatment, T!ere are o$$asional reports of toot! 'italit "urin+ ort!o"onti$ treatment, Poor $ontrol of ort!o"onti$ for$e $oul" #e t!e $ulprit, If a toot! is su#4e$te" to !ea' 3 $ontinuous for$e3 a se6uen$e of a#rupt mo'ement o$$urs, A lar+e enou+! a#rupt mo'ement of t!e root apex $oul" se'ere t!e #loo" 'essels as t!e enter, As proof t!at ort!o"onti$ toot! mo'ement "oes affe$t pulp 'ia#ilit , (amers) an" $ollea+ues foun" 8AD "epression in pulp tissue respiration as a result of ort!o"onti$ for$e appli$ation, Toot! preparations for $ro*ns re6uire remo'al of most of toot! enamel, Dentinal tu#ules are opene" # t!e toot! preparation an" t!e prepare" teet! are more sus$epti#le to "e! "ration, Minimal toot! "r in+ is su++este" to a'oi" pulpal "ama+e from toot! "e! "ration, It is man"ator t!at all $ro*ns an" fixe" prost!esis are $!e$)e" for o$$lusion *!ile seatin+3 t!us eliminatin+ t!e pro#lem of o$$lusal prematurities,

Preparation in 'ital "entin usuall

ma)es use of lo$al anest!esia

ne$essar , As a result3 t!e appropriate ner'e me"iate" 'as$ular responses to t!e preparation trauma *ill #e attenuate" for a *!ile, T!is is not re+ar"e" as a serious pro#lem, 0e$ause pulpal ne'er are onl #lo$)e" for a fe* minutes after in4e$tion, (o*e'er3 *!en a 'aso$onstri$tor 7epinep!rine Ha"renaline: is use"3 t!ere *ill #e a lon+ lastin+ perio" of re"u$tion in #asal #loo" flo*, Infiltration anest!esia in upper front toot! re+ion ma lo*er #loo" perfusion of t!e pulp in a"4a$ent teet! # AB5CBD for more t!an =!our, T!ese $!an+es are not as prominent *it! a man"i#ular #lo$) #ut t!e pulp is li)el to #e 'ulnera#le to t!e $lini$al pro$e"ures "ire$te" to toot! stru$ture, It is t!erefore a"'isa#le to a'i" $ate$!olamine 'aso$onstri$tor *!en preparin+ for restorations in teet! *it! 'ital pulp,

T)E +UTURE :
Pulp "eat! seems to #e on t!e in$rease3 or per!aps onl an apparent in$rease o*in+ to an a*areness of t!e 'alue of t!e treate" pulpless toot!, .it! routine examination an" earl treatment3 *it! a $autious

temperate approa$! to all restorati'e pro$e"ures an" *it! a sensi#le use of fillin+ materials3 t!e "entist $an pre'ent a +reat "eal of pulp "eat!, Pre2ent"!n ! pulp "n0ur%: T!e -"entisto+eni$< or iatro+eni$ $ause a$$ounts for an

em#arrassin+l !i+! per$enta+e of t!e pulp in4ur an" "eat! refle$te" in t!e A,D,A, report, T!e uni'ersit T!ere are man pre'ente", =: Dept! of $a'it an" $ro*n preparation, 8: .i"t! an" extension of $a'it an" $ro*n preparation, 9: (eat "ama+e an" "essi$ation "urin+ $a'it preparation, >: C!emi$al in4ur t!rou+! me"i$aments ?: Toxi$ $a'it liners an" #ases @: Toxi$ fillin+ materials A: Pre'ention of mi$rolea)a+e Re#ent ad2an#es: Pulp $ells ma !ol" t!e )e to treatment in Par)insons "isease, 5 A stu" in ma issue of European 4ournal of neuros$ien$e s!o*s "ental pulp $ells pro'i"e +reat support for ner'e $ells lost in of Conne$ti$ut reporte" t!at -pre'ious restorati'e insults lerie" a+ainst t!e pulp t!at $an #e

treatment< *as t!e ma4or etiolo+i$ fa$tor lea"in+ to root $anal t!erap , "a 5to5"a

Par)isons "isease an" $oul" #e transplante" "ire$tl into t!e affe$te" parts of t!e #rains, 5 T!is stu" *as t!e first to test t!e post5natal stem $ells from t!e more rea"il a'aila#le toot! pulp in t!e ner'ous s stem, 5 -Nos$at< !as also stu"ie" "ental pulp stem $ells as a treatment for spinal $or" in4uries, 5 (o*e'er3 man for $ure, ears are left for t!is t!erap to #e treate" in people

CONCLUSION :
It is to $orrelate $lini$al pra$ti$e *it! #asi$ s$ien$e #e$ause ultimatel 3 an un"erpinnin+ of #asi$ s$ien$es lea"s to t!e most effe$ti'e $lini$al treatment -Dentistr *it!out #asi$ s$ien$es is onl a $raft #ut *it! +oo" foun"ation in t!ese s$ien$es3 it is a learne" profession<, As !eart is to t!e #o" 3 t!e pulp is to t!e toot!3 pro'i"in+ a $onstant sour$e of nutrition to maintain t!e 'italit of a toot!, E'er pre$aution s!oul" #e ta)en to preser'e 'italit of t!e pulp,

RE+ERENCES :
5 %tep!en Co!en -Pat!*a s of pulp< Ct! e"n 5 Io!n In+le -En"o"onti$s< ?t! e"n 5 Or#ans -Oral (istolo+ < 5 %elt2er -T!e "ental pulp< 8n" e"n 5 -Re'ie* of "ental pulp ; Clini$al $onsi"erations<, Luintessen$e Int =EC8G =9?5=9A,