PULP

CONTENTS INTRODUCTION DEVELOPMENT ANATOMY STRUCTURAL FEATURES FUNCTIONS PRIMARY AND PERMANENT PULP ORGANS REGRESSIVE CHANGES CLINICAL CONSIDERATIONS

INTRODUCTION
Every individual ha a hear! !udy" relia#le ye! a every l$ver %n$& " $h $ 'ra(ile) S$" !$$ d$e every !$$!h have a hear!) A*a+in(ly de,enda#le" hi(hly 'un-!i$nal and ye! a every den!i ! %n$& $h $ 'ra(ile) En-a ed in !he ri(id" unyieldin( l$$ enin( $' !$$!h ena*el" den!in and den!in" !hi 're hly *a $' -$*,le. -$nne-!ive !i ue ,re en! a uni/ue

ni-he $' ,e-iali+a!i$n) The $nly $'! ,ar! $' !he !$$!h i! l$vin( en!i!y i !he ,ul,) 0ein( in a l$& -$*,lian-e envir$n*en!" !he ,ul, ha a 'a#ul$u de'en e ar enal !$ hel, i! ,er'$r* i! 'un-!i$n in-rea in(ly) H$&ever" i! i e/ually in a ,re ure -$$%er i!ua!i$n and -an very ea ily u--e*d !$

envir$n*en!al !i*uli) I! i !hi varia#ili!y !ha! ha led !$ !he ayin( $*e ,ul, die i' y$u l$$% -r$ ly a! !he*" !hi &$n! i' y$u -h$, !han &i!h an a.e) S$ le! u l$$% a! !he 'a -ina!in( !i ue -$*,le!e &i!h an ele-!ri-al u,,ly and !he !hr$##in( hear! !$ ee &ha! *a%e i! !i-%)

First the definition: A--$rdin( !$ C$hen 1 0y de'ini!i$n" !he ,ul, i a $'! !i ue $'

*e en-hy*al $ri(in re idin( &i!hin !he ,ul, -ha*#er and r$$! anal $' !ee!h) N$&" !$ #e(in &i!h le! e.,l$re h$& !he #a#y i #$rn) DEVELOPMENT: The den!al ,ul, ha i! (ene i in a#$u! !he 2!h &ee% $' 34 li'e durin( ini!ia!i$n $' !$$!h devel$,*en!) The !$$!h ,ul, i ini!ially -alled !he den!al ,a,illa) Thi !i ue i de i(na!ed a ,ul, $nly a'!er den!in '$r* ar$und i!) The den!al ,a,illa -$n!r$l early !$$!h '$r*a!i$n) In !he earlie ! !a(e $' !$$!h devel$,*en! i! i !he area $' !he ,r$li'era!in( 'u!ure ,a,illa !ha! -au e !he $ral e,i!heliu* !$ inva(ina!e and 'r$* !he ena*el $r(an ) The e $r(an !hen enlar(e !$ en-l$ e !he den!al ,a,illa in !heir -$n!r$l ,$r!i$n ) The den!al ,a,illa al $ -$n!r$l &he!her !he '$r*in( ena*el $r(an i !$ #e an in-i $r $r a *$lar) The devel$,*en! $' !he den!al ,ul, 5a! !he in-i $r6 #e(in a! !he ei(h!h &ee% $' e*#ry$ni- li'e) The -ell den i!y $' !he den!al ,a,illa i (rea! a a

re ul! $' ,r$li'era!i$n $' !he -ell &i!hin i!) The y$un( den!al ,a,illa i hi(hly vi uali+ed and a &ell $r(ani+ed ne!&$r% $' ve el a,,ear #y !he !i*e den!in '$r*a!i$n #e(in ) Ca,illarie -r$&d a*$n( !he $d$n!$#la ! durin( !hi ,eri$d $' a-!ive den!in$(ene i ) The -ell $' !he den!al ,a,illa a,,ear a undi''eren!ia!ed *e ne-hy*al -ell ) Gradually !he e -ell di''eren!ia!e in!$ !ella!e ha,ed 'i#r$#la ! ) A'!er !he inner and $u!er ena*el $r(an -ell in!$ a*el$#la ! " !he $d$n!$#la ! !hen di''eren!ia!e 'r$* !he ,eri,heral -ell $' !he den!al ,a,illa ,r$du-!i$n #e(in ) A !hi $--ur " !he !i ue i n$ l$n(er -alled den!al ,a,illa #u! i n$& de i(na!ed !he ,ul, $r(an) Fe& lar(e *yelina!ed nerve are '$und in !he ,ul, un!il !he den!in $' !he -r$&n i &ell advan-ed) A! !ha! !i*e nerve rea-h !he $d$n!$(eni- +$ne in !he ,ul, h$rn ) The y*,a!he!i- nerve " h$&ever" '$ll$& !he #l$$d ve el in!$ !he den!al ,a,illa a !he ,ul, #e(in !$ $r(ani+e) Anatomy: General 'ea!ure 7 The den!al ,ul, $--u,ie !he -en!er $' end $' !$$!h and -$n i ! $' $'! -$nne-!ive !i ue) Every ,er $n" n$r*ally ha a !$!al $' 89 ,ul, $r(an ) :9 in ,er*anen! !ee!h and 94 in ,ri*ary !ee!h &i!h !he ha,e -$n'ir*in( !$ !ha! $' !he re ,e-!ive !$$!h) The !$!al v$lu*e $' all ,er*anen! !ee!h ,ul, $r(an i 4):; -- and !he *ean value $' a in(le adul! hu*an ,ul, i 4)49 --)

Ea-h ,ul, $r(an i -$*,$ ed $' a -$r$nal ,ul, l$-a!ed -en!rally in !he -r$&n $' !ee!h and a r$$! $r radi-ular ,ul,) Corona !" !: In y$un( individual " !he -$r$nal ,ul, re e*#le !he ha,e $' !he $u!er ur'a-e $' !he -r$&n) I! ha 2 ur'a-e 1 $--lu al" *e ial" di !al" #u--al" lin(ual and !he 'l$$r) I! ha ,ul, h$rn &hi-h are ,r$!ru i$n !ha! e.!end in!$ !he -u , $' ea-h !$$!h) The nu*#er $' h$rn hen-e" de,end $n !he -u ,al nu*#er) The -ervi-al re(i$n -$n !ri-! a d$e !he -$n!$ur $' !he -r$&n and a! !hi +$ne !he -$r$nal ,ul, <$in !he radi-ular ,ul,) RADICULAR PULP: The ,ul, e.!endin( 'r$* !he -ervi-al re(i$n $' !he -r$&n !$ !he r$$! a,e. i radi-ular ,ul,) Sin(le in an!eri$r and *ul!i,le i ,$ !eri$r " !hey are n$! al&ay !rai(h! and vary in i+e" ha,e and nu*#er) The radi-ular ,$r!i$n

are -$n!inu$u &i!h !he ,eria,i-al -$nne-!ive !i ue !hr$u(h !he a,i-al '$ra*en $r '$ra*ina) The ha,e i !u#ular and a !$$!h *a!ure " radi-ular ,ul, narr$& ) The a,i-al ,ul, -anal i *ade *aller al $ #e-au e $' a,i-al -e*en!u* de,$ i!i$n) In i! a,i-al : rd *ul!i,le a--e $ry -anal '$r* !he a,i-al del!a &hi-h *ay -$*,li-a!e end$d$n!i- !hera,y)

APICAL FORAMEN: The *all $,enin( a! !he r$$! !hr$u(h &hi-h en!er and e.i! va -ular" ly*,ha!i- and nerve ele*en! i !he a,i-al '$ra*en) I! *ay #e -$*,$ ed $' den!in ur'a-ed #y -e*en!u* $r -e*en!u* al$ne) They vary in dia*e!er" l$-a!i$n" ha,e and nu*#er) The avera(e dia*e!er '$r *andi#ular !ee!h i a#$u! 4):* and 4)=* '$r *a.illary !ee!h) They are lar(e and -en!rally l$-!ed in devel$,in( !ee!h and #e-$*e *aller and e--en!ri- in ,$ i!i$n $n *a!ura!i$n) The lar(e ! dia*e!er '$ra*en are in !he ,ala!al r$$! $' *a.illary *$lar and di !al r$$! $' *andi#ular *$lar ) F$ra*en *ay #e l$-a!ed a! !he very end $r ana!$*i- a,e. #u! are u ually l$-a!ed li(h!ly *$re $--lu ally) They -$vered &i!h ana!$*i- a,e. $nly in 3>?=2@ and are l$-a!ed a! avera(e 4)8?4)>* a&ay 'r$* !he a,e.6) There *i(h! #e a in(le '$ra*ina $r r$$! -anal #ran-hin( !$ '$r* 9 '$ra*en -han(e in !he *$r,h$l$(y" l$-a!i$n and i+e $' !he '$ra*en #y ,eria,i-al de,$ i!i$n $' -e*en!u* -an #e indu-ed #y ,hy i$l$(i- -han(e r$$! -anal !hera,y" $--lu al '$ra*ina and *e ial dri'!) ACCESSOR# CANALS: Seen any&here al$n( !he r$$!" !hr$u(h ,ar!i-ularly nu*er$u in !he a,i-al !hird" !he e lead 'r$* !he radi-ular ,ul, la!erally !hr$u(h r$$! den!in !$ !he ,eri$d$n!al !i ue) Durin( r$$! hea!h '$r*a!i$n" a #rea% devel$, in !he -$n!inui!y $' a hea!h ,r$du-in( a *all (a, and den!in$(ene i d$e n$! $--ur $,,$ i!e u-h a

!hi de'e-! re ul!in( in '$r*a!i$n $' an a--e $ry -anal) I! *ay al $ $--ur &here !he devel$,in( r$$! en-$un!er a #l$$d ve el) The '$ll$&in( OHP (ive !he (r$ de -ri,!i$n $' ha,e $' ,ul, $'

*a.illary and *andi#ular !ee!h and varia!i$n in i+e $' ,ul, $r(an $' ,er*anen! !ee!h) Maxillary: CI LI C FP SP M Mandibular CI LI C FP SP M

STRUCTURAL FEATURES $ %ISTOLO&# Ahen !he ,ul, i e.a*ined *i-r$ -$,i-ally '$ur di !in-! +$ne -an #e di !in(ui hed) 3) The $d$n!$(eni- +$ne -$*,$ ed $' $d$n!$#la ! 5a! !he ,eri,hery6) 9) The -ell 'ree +$ne $r AeilB +$ne) :) The -ell ri-h +$ne) =) The -en!ral re(i$n $r +$ne -$n!ainin( lar(e nerve and #l$$d ve el ) '( ODONTO)LASTIC *ONE: C$n i !in( $' $d$n!$#la ! " !he e-$nd *$ ! ,r$*inen! -ell in !he ,ul," !hi +$ne i ad<a-en! !$ !he ,reden!in)$d$n!$#la ! are 8)>C in dia*e!er" 94?=8C in len(!h) The -ell #$die are -$lu*nar &i!h lar(e $val *edia #a ally) I**edia!ely ad<a-en! are r$u(h ur'a-ed end$,la *i-

re!i-ulu* and G$l(i a,,ara!u ) Dun-!i$nal -$*,le.e are ,re en!) The ,r$-e $' !he -ell" !he $d$n!$#la !i- ,r$-e e.!end !$ varyin( len(!h

in!$ !he den!in) Thi i !he '$r*a!ive +$ne $' !he ,ul, and i! <un-!i$n &i!h den!in $n all 'r$n! )

+( CELL FREE *ONE: Al $ -alled +$ne $' &eil" a =4C !hi-% rela!ively 'ree $' -ell area underlyin( !he $d$n!$#la ! layer i !he -hara-!eri !i-) The area i n$! ,re en! in all !ee!h and need n$! -ir-u* -ri#e !he en!ire ,ul, and u ually $' varia#le !hi-%ne ) In ,ul, a-!ively ,r$du-in( den!in" -ell? 'ree +$ne i a# en!) The -$*,$nen! are (r$und u# !an-e &i!h 'i#re ) Al $" !he area i n$! !$!ally dev$id $' -ell ) Fi#r$#la ! *a-r$,ha(e " ,eri-y ! and *e en-hy*al -ell are ,re en!) I*,$r!an!ly" !he ,le.u $' -a,illarie and nerve ,le.u $' Ra -h$& are ,re en!) The un*yelina!ed nerve ,le.u $' Ra -h$& i inv$lved in !he neural en a!i$n $' !he ,ul,) The -a,illary ,le.u i inv$lved in !he nu!ri!i$n $' $d$n!$#la ! and -ell $' !he +$ne) The (r$und u# !an-e i inv$lved in *e!a#$lie.-han(e $' !he -ell and li*i! ,( CELL RIC% *ONE: The -ell ri-h +$ne i l$-a!ed -en!ral !$ !he -ell 'ree +$ne) I! *ain -$*,$nen! are (r$und u# !an-e" 'i#r$#la ! &i!h !heir ,r$du-! $' -$lla(en 'i#re " undi''eren!ia!ed *e en-hy*al -ell and *a-r$,ha(e ) F$und #$!h -$r$nally and in radi-ular ,ul," i! i *u-h le !he la!!er ,e-ially a,i-ally) $#vi$u in ,read $' in'e-!i$n)

-( PULP CORE or PULP PROPER: The -en!ral -$nne-!ive !i ue *a 'r$* !he -ell ri-h +$ne in&ard i

%n$&n a !he ,ul, -$re $r ,ul, ,r$,er) I! -$n!ain #l$$d ve el and nerve e*#edded in !he ,ul, *a!ri. !$(e!her &i!h 'i#r$#la ! ) In y$un( ,ul, " !he -ell ,$,ula!i$n i (rea!er &hile in $lder ,ul, 'i#re den i!y i hi(her) The neur$va -ular #undle en!er E e.i! !hi -$re !hr$u(h !he a,i-al '$ra*en and a--e $ry -hannel ) STRUCTURAL COMPONENTS: The -$n !i!uen! $' !hi en!i!y in-lude (r$und u# !an-e" 'i#re " -$nne-!ive !i ue -ell u-h a 'i#r$#la ! " *e en-hy*al -ell " ,eri-y ! " hi !i$-y!e "

'i.ed *a-r$,ha(e " ly,h$id &anderin( -ell " *a ! -ell " #l$$d and ly*,h ve el and nerve ) Fir !ly7 &ro"nd S".stan/es: The in!er-ellular a*$r,h$u (r$und u# !an-e i !he *ain -$n !i!uen! $' !he den!al ,ul, re e*#lin( !ha! $' any $!her l$$ e -$nne-!ive !i ue) I! i den e and (el li%e in na!ure varyin( in a,,earan-e 'r$* 'inely (ranular !$ 'i#rillar) I! i -$*,$ ed *ainly $'7

3) A-id *u-$,$ly a--hairde ) 9) Pr$!ein ,$ly a--haride -$*,$und ,r$!e$(ly-an ) Durin( early devel$,*en! -h$ndri!i A and 0 and hyalur$ni- a-id have #een de*$n !ra!ed) Al $ (ly-$,e,!ide and (ly-$ a*in$li,id are ,re en!) The ,r$!e$(ly-an are hyalur$ni- a-id" -h$ndr$i!in ul'a!e" der*a!i and he,arin ul'a!e) Ma<$r (ly-$,r$!ein i 'i#r$ne-!in al$n( &i!h la*inin and !ena -in) I! 'un-!i$n in-lude7 3) Lend u,,$r! !$ !he -ell $' !he ,ul,) 9) Serve a a *ean '$r !ran ,$r! $' nu!rien! 'r$* !he #l$$d ve el !$ -ell a &ell a '$r !ran ,$r! $' *e!a#$li!e 'r$* -ell !$ #l$$d ve el ) :) Serve a a #arrier a(ain ! !he ,read $' #a-!eria and li*i! in'e-!i$n #e-au e $' i! -$n i !en-y) =) Re(ula!e $ *$!i- ,re ure) A(e and di ea e *ay -han(e !he ,read $' ul'a!e i)e) (ly-$ a*in$(ly-an and

-$*,$ i!i$n and 'un-!i$n $' !he (r$und u# !an-e)

Ne.! &e -$*e !$ !he 'i#re $' !he ,ul,7 FI)RES7 Mainly -$n i !in( $' -$lla(en$u 'i#re " al $ ,re en! are

re!i-ular" $.y!alan and ela !i- 'i#re ) The e under($ -han(e !hr$u(h$u! li'e in #$!h /uan!i!y and varie!y) Prin-i,ally -$lla(en 'i#re $' !y,e I and !y,e III in an a,,r$,ria!e ra!i$ $' 88)=8 are '$und" re*ain -$n !an! !hr$u(h$u!) The -$lla(en 'i#re e.hi#i! !y,i-al 2=* -r$ !ria!i$n and ran(e in len(!h 'r$* 34 !$ 344n* $r *$re)

They are ar(yr$,hili- in y$un( ,ul, ) On r$$! -$*,le!i$n #undle $' 'i#re in-rea e and are !er*ed di''u e $r #undle -$lla(en de,end $n a,,earan-e -an #e de*$n !ra!ed #y *a $n erri-h$ne $r *all$ !ri,e -$nne-!ive !i ue !ain) Fi#re #undle have !heir (rea!e ! -$n-en!ra!i$n in !he a,i-al ,$r!i$n" a 'a-! $' -lini-al i(ni'i-an-e i !ha! durin( ,ul,e-!$*y en(a(in( !he ,ul, &i!h a #ar#ed #r$a-h in !he re(i$n $' !he a,e. en ure #e!!er in!a-! !i ue e.!ir,a!i$n) O.y!alan 'i#re are $# erved in !he devel$,in( den!al ,a,illa ela !i- 'i#re are '$und $n *a!ura!i$n" #a i-ally in-$r,$ra!ed in!$ !he &all $' a''eren! ve el ) They are !here'$re -$n'ined !$ !he &all $' ar!eri$le ) A'!er !hi le! l$$% a! !he -ellular -$*,$nen! $' !he den!al ,ul,) Fir ! -$*e !he $d$n!$#la ! &hi-h have #een di -u ed in !he $d$n!$(eni- +$ne $' !he ,ul,)

Ne.! -$*e !he 'i#r$#la ! 7 The ,ul, 'i#r$#la ! i !he ,red$*inan! and *$ ! nu*er$u -ell !y,e) Par!i-ularly nu*er$u in !he -$r$nal ,$r!i$n $' !he ,ul, e ,e-ially in !he -ell ri-h +$ne) They 'un-!i$n in -$lla(en 'i#re '$r*a!i$n !hr$u(h$u! !he li'e $' !he !$$!h ,ul," *ainly !y,e I and III -$lla(en a &ell a ,r$!e$(ly-an and GAG) Al $" a#ili!y !$ ,ha($-y!$ e and dy ! -$lla(en en!ru ! !he* &i!h !he -$lla(en #urn$ver in !he ,ul,) They have !y,i-al !ella!e ha,e and e.!en ive ,r$-e e !ha! -$n!a-! and are <$ined #y in!er-ellular <un-!i$n !$ !he ,r$-e e $' $!her 'i#r$#la ! ) In y$un( ,ul, !he -ell divide and are a-!ive in ,r$!ein yn!he i ) In $lder ,ul, !hey a,,ear r$unded $r ,indle ha,ed &i!h h$r! ,r$-e e ) They are !hen %n$&n a 'i#r$-y!e ) In !he -$ur e $' devel$,*en! !he -ellular ele*en! de-rea e &herea 'i#r$u -$*,$nen! ,red$*ina!e) In!ere !in(ly i! ha #een re*ar%ed !ha! 'i#r$#la ! $' ,ul, li%e Pe!er ,an" Fne&er (r$& u,G '$r !he e -ell een !$ re*ain i rela!ively

undi''eren!ia!ed *$dali!y -$*,ared !$ 'i#r$#la ! $' *$ ! $!her -$nne-!ive !i ue ) I*,$r!an!ly" !hey have a dual 'un-!i$n &i!h '$ll$&u, '$r #$!h yn!he i and de(rada!i$n)

UNDIFFERENTIATED MESENC%#MAL CELLS: The e re,re en! !he ,$$l 'r$* &hi-h -$nne-!ive !i ue -ell $' !he ,ul, are derived) They are !he ,ri*ary -ell $' !he very y$un( ,ul, #u! de-rea e $n r$$! -$*,le!i$n and *a!ura!i$n) A,,earin( lar(er !han 'i#r$#la !" !hey are P$lyhedral in ha,e &i!h ,eri,heral ,r$-e e and lar(e $ral !ainin( nu-lein) They are '$und in ,ul, ve el " in !he -ell ri-h +$ne and -a!!ered !hr$u(h$u! -en!ral ,ul,) They are !he !$!i,$!en! -ell &hi-h de,endin( $n !he !i*ulu !ran '$r* in!$ $d$n!$#la ! " 'i#r$#la ! $r *a-r$,ha(e ) A redu-!i$n in !heir nu*#er in $lder ,ul, redu-e !he ne(a!ive ,$!en!ial $' !he ,ul,) Ne.! are !he de'en e $r i**un$-$*,e!en! -ell 7 Fir !ly *a-r$,ha(e 1 $r hi !i$-y!e 1 *a-r$,ha(e are !he *$n$-y!e !ha! have le'! !he #l$$d !rea*" en!ered !he !i ue and di''eren!ia!ed in!$ vari$u u#,$,ula!i$n ) I! i an irre(ularly ha,ed -ell i! h$r! #lun!

,r$-e e &i!h *all r$unded" dar%y !ain nu-lei and e.hi#i! (ranular -y!$,la *) Dye li%e !ry,an #lue -an di -l$ e !heir ,re en-e e ,e-ially in in'la**a!i$n) The di !in(ui hin( 'ea!ure i a((re(a!e $' ve i-le ,ha($ $*e " !hey are a $-ia!ed &i!h *all #l$$d ve el and -a,illarie ) 0e-au e $' !heir *$#ili!y and ,ha($-y!i- a-!ivi!y" !hey a-! a re*$vin( e.!rava a!ed R0C -aven(er $r

dead -ell and '$rei(n #$die 'r$* !i ue)

In(e !ed *a!erial i de !r$yed #y !he ly $ $*al en+y*e ) In in'la**a!i$n" !hey re*$ve #a-!eria and in!era-! &i!h $!her in'la**a!$ry -ell ) Al $ !hey ,ar!i-i,a!e in i**une rea-!i$n and al $ ,r$du-e vari$u li%e in!erleu%in?3 TNF e!-) DENDRITIC CELLS: The e are !he a--e $ry -ell $' !he i**une y !e*) They are n$n? ,ha($-y!i- and ,ar!i-i,a!e in ,ul,al i**un$ urveillan-e) The e !$(e!her &i!h *a-r$,ha(e -$n!ri#u!e ;@ $' !$!al ,ul,al -ell ,$,ula!i$n and $lu#le 'a-!$r

dendri!i- -ell e.-eed *a-r$,ha(e in !he ra!i$ $' =73) Si*ilar -ell are '$und in !he e,ider*i and *u-$u *e*#rane &here !hey are -alled Lan(erhanB -ell ) Pri*arily '$und in ly*,h$id !i ue " !hey are &idely di !ri#u!ed in -$nne-!ive !i ue in-ludin( ,ul,) They are !er*ed an!i(en ,re en!in( -ell and are -hara-!eri+ed #y dendri!i- -y!$,la *i- ,r$-e e ) They en(ul' 5C$hen6 ,r$!ein an!i(en and ,lay -en!ral r$le in indu-!i$n $' T -ell de,enden! i**uni!y) Ne.!" #$!h ly*,h$-y!e and e$ in$,hil are '$und in n$r*al ,ul,

in-rea in( *ar%edly in in'la**a!i$n) T; 5 u,,re an!6 ly*,h$-y!e are ,red$*inan! 0 ly*,h$-y!e are evere in n$r*al ,ul,) Ma ! -ell are &idely di !ri#u!ed in -$nne-!ive !i ue and are een al$n( ve el in ,ul, e ,e-ially in'la*ed ,ul,) Havin( a r$und nu-leu and

-$n!ain

*any (ranule " !hey have a der*a!i- r$le in in'la**a!$ry

rea-!i$n -$n!ainin( he,arin and hi !a*ine a*$n( $!her ) La !ly are !he ,la *a -ell een durin( ,ul,al in'la**a!i$n) The -ell ha a

-ar! &heel a,,earan-e and 'un-!i$n in !he ,r$du-!i$n $' an!i#$die ) )LOOD VESSELS AND VASCULAR SUPPL#: The ,ul, $r(an i e.!en ively va -ulari+ed) The #l$$d ve el $' !he ,ul, and ,eri$d$n!iu* ari e 'r$* !he in'eri$r $r u,eri$r alve$lar ar!ery and al $ drain #y !he a*e vein in #$!h !he *andi#ular and *a.illary re(i$n ) 0$!h a,i-al and a--e $ry -anal -$nne-!i$n e.i ! &hi-h are $' -lini-al i(ni'i-an-e #e-au e $' ,$!en!ial $' ,read $' in'e-!i$n 'r$* ,ul, !$ ,eri$d$n!iu* and vi-e ver a) S*all ar!erie and ar!eri$le en!er !he a,i-al -anal and ,er ue a dire-! r$u!e !$ -$r$nal ,ul, havin( dia*e!er $' 344C $r le ) Al$n( !heir -au e !hey (ive $'' nu*er$u #ran-he i !he radi-ular ,ul, !ha! ,a ,eri,herally !$

'$r* a ,le.u in !he $d$n!$(eni- re(i$n) Pul,al #l$$d 'l$& i *$re ra,id !han in *$ ! area $' !he #$dy &hi-h *ay #e a!!ri#u!ed !$ !he ,ul,al ,re ure &hile i a*$n( !he hi(her $' #$dy !i ue ) The 'l$& $' #l$$d in ar!eri$le i 4): !$ 3*E in ve i-le a,,r$.i*a!ely 4)38*E and 4)4;*E in -a,illarie ) The ,ul,al in!ere !ial ,re ure i a#$u! 8?;** $' H() The ve el have : layer na*ely7

a6 The 'ir ! i !he Tuni-a In!i*a7 C$n i !in( $' /ua*$u $r -u#$id end$!heliu* urr$unded #y -l$ ely a $-ia!ed #a al la*ina !hi layer live !he lu*en) #6 The Tuni-a Media i !he e-$nd layer a,,r$.i*a!ely 8C !hi-%" -$n i !in( $' 3?: layer $' *$$!h *u -le ) A #a al la*ina e,ara!e !he *edia 'r$* !he in!i*a) O--a i$nally" !he end$!helial -ell &all i in -$n!a-! &i!h !he *u -le -ell '$r*in( a *y$end$!helial <un-!i$n) The :rd and $u!er layer i !he Tuni-a Adven!i!ia7 I! i *ade u, $' 'e& -$lla(en 'i#re '$r*in( a l$$ e ne! &$r% ar$und layer ar!erie and i *$re -$n ,i-u$u in $lder ,ul,) The layer ar!eri$le (ive &ay !$ ar!eri$le &i!h dia*e!er $' 94?:4C

-$**$nly een !hr$u(h$u! -$r$nal ,ul,) Ter*inal ar!eri$le $' 34?38C a,,ear ,eri,herally i ,ul,) A 'i#r$#la ! $r ,eri-y!e *ay lie $n !he ur'a-e $' !he e ve el ) Peri-y ! are -a,illary a $-ia!ed 'i#r$#la ! ) The *aller ar!eri$le are al $ -alled ,re-a,illarie ran(in( 'r$* ;?39C* i+e) The e are -$n'luen! &i!h -a,illarie ) The !rue -a,illary i a i*,le end$!helial !u#e $' ;?34C dia*e!er) The nu-lei $' !he e -ell *ay #e !a#ula!ed and have -y!$,la *i- ,r$<e-!i$n in!$ la#ial ur'a-e) The !er*inal ne!&$r% i !he -$r$nal ,ul, a,,ear ,er,endi-ular !$ !he *ain #ran-he ) The va -ular ne!&$r% ,a e a*$n(

$d$n!$#la !

and underlie

!he* a

&ell) Fene !ra!ed -a,illarie

are

#elieved !$ #e inv$lved in ra,id !ran ,$r! $' *e!a#$li!e durin( a-!ive $d$n!$#la !i- a-!ivi!y) Al $ ,re en! are *e!a ar!eri$le and ,re-a,illarie ) The -a,illary #l$$d 'l$& -$r$nally i nearly !&i-e radi-ular 'l$& and (rea!er in ,ul, h$rn ) Fr$* !he -a,illarie #l$$d 'l$& in!$ ,$ !-a,illary venule and !hen in!$ lar(er venule ) Thi #l$$d i drained #y a y !e* $' venule !ha! are -$*,ari $n venule $' ar!eri$le ) Vein and venule !ha! are lar(er !han ar!erie a,,ear in !he -en!ral re(i$n $' r$$! ,ul, *ea urin( 344?384C* in dia*e!er &i!h le re(ular &all ) They have lu*inar &all in rela!i$n !$

lu*en i+e" 'la!!er end$!helial -ell and !heir -y!$,la * d$e n$! ,r$<e-! in!$ !he lu*en) The !uni-a *edia -$n i ! $' a in(le layer $r 9 $' !hi *$$!h *u -le -ell

!ha! &ra, ar$und !he end$!helial -ell and a,,ear di -$n!inu$u $r a# en! in *all venule ) The #a e*en! *e*#rane are !hinner and !he adven!i!ia i la-%in( $r a,,ear a 'i#r$#la ! and 'i#re -$n'ir* &i!h ,ul, !i ue) An$!her i*,$r!an! 'ea!ure are !he AVA $r ar!eri$ven$u ana !$*$ e ) The e ve el dire-!ly -$nne-! ar!eri$le &i!h venule and !hu #y,a hun! $r

!he -a,illary ne!&$r%) Pre en! #$!h -$r$nally and radi-ular" *$re

,ar!i-ular in !he la!!er) The e have an i*,$r!an! r$le !$ ,lay in re(ula!i$n $' ,ul,al -ir-ula!i$n)

The *$ ! va -ulari+ed area i !he ,eri,hery a! !he $d$n!$(eni- layer) Al $ ,ul,al #l$$d 'l$& i u# !an!ially l$&er !han a *a<$r vi -eral $r(an

indi-a!in( !ha! !he re ,ira!$ry ra!e $' ,ul, -ell i rela!ively l$&) Ne.! are !he ly*,ha!i- 7 The ,re en-e $' ly*,h ve el re*ain a -$n!r$ver ial !$,i-" elu-ida!ed u,$n #y $*e and /ue !i$ned #y $!her ) Ly*,h -a,illarie are de -ri#ed a end$!heliu* !riad !u#e !ha! <$in !hin &alled ly*,h venule $r vein in !he -en!ral ,ul,) Ly*,h ve el ari e a *all" #lind" !hi &alled ve el in !he -$r$nal re(i$n $' !he ,ul, and ,a a,i-ally !hr$u(h !he *iddle and radi-ular re(i$n $' !he ,ul, !$ e.i! via 3 $r 9 lar(er ve el !hr$u(h !he a,i-al '$ra*en) Lar(er ve el have an irre(ular ha,ed lu*en -$*,$ ed $' end$!helial -ell urr$unded #y an

in-$*,le!e layer $' ,eri-y ! $r *$$!h *u -le -ell ) They are al $ -hara-!eri+ed #y !he a# en-e $' red #l$$d -ell ly*,h$-y!e ) The -y!$,la * $' !he end$!helial -ell -$n!ain WEIBEL?PALADE and ,re en-e $'

(ranule -$n!ainin( a he*$ !a!i- a(en! !he V$n Aille#rand 'a-!$r) Ly*,h ve el drain ,ul, and ,eri$d$n!al li(a*en! have a -$**$n $u!le!) F$r an!eri$r !ee!h !hey ,a !$ !he u#*en!al ly*,h n$de ,$ !eri$r !ee!h

drain in!$ !he u#*andi#ular and dee, -ervi-al ly*,h n$de )

No0 ets oo1 at the ner2e s"!! y of !" !a inner2ation: Fir ! !he nerve $' !he ,ul,7 The a#undan! nerve u,,ly '$ll$& !he di !ri#u!i$n $' !he #l$$d ve el ) The en $ry *e-hani * $' !he ,ul, i -$*,$ ed $'7 a6 Sen $ry a''eren! 1 -$ndu-! i*,ul e 'r$* ,ul, !$ #rain &hi-h are in!er,re!ed a ,ain re(ardle $' !i*ulu )

#6 Au!$n$*i- a''eren! 1 -$ndu-! i*,ul e 'r$* -en!ral y !e* !$ !he *$$!h *u -le $' !he ar!erial ve el !$ re(ula!e #l$$d 'l$&) The en $ry y !e* a,,ear !$ #e &ell ui!ed '$r i(nalin( ,$!en!ial da*a(e !$ !he !$$!h) In addi!i$n !$ en $ry nerve " y*,a!he!i- 'i#re 'r$* !he u,eri$r -ervi-al (an(li$n re(ula!e #l$$d 'l$& and are !h$u(h! !$ #e inv$lved in re(ula!i$n $' den!in$(ene i ) Nerve 'i#re al $ e.!end in!$ den!inal !u#ule !hr$u(h $nly a#$u! 34?94@ $' -$r$nal den!in -$n!ain nerve endin( ) The *a<$r (r$u, are7 A (r$u, $' *yelina!ed nerve 'i#re 1a,,r$.) 94@) C (r$u, $' 'i#re 1 a,,r$.) ;4@)

The A 'i#re in-lude #$!h A and A 5del!a6 'i#re ) The A are *$re en i!ive !han A) a,,r$. H4@ $' !he A 'i#re are A del!a) Prin/i!a /hara/teristi/: A del!a 'i#re 5A6 Myelina!ed" dia*e!er $' 9?8C" -$ndu-!i$n vel$-i!y $' 2?:4*E " lar(er dia*e!er" i*,ul e in!er,re!ed a har, ,ri-% ,ain and di !ri#u!ed in

$d$n!$#la !i- and u#$d$n!$#la !i- +$ne " a $-ia!ed &i!h den!inal ,ain) C?'i#re I Un*yelina!ed" dia*e!er $' 4):?3)9C" vel$-i!y $' 4)=?9*E di !ri#u!ed

!hr$u(h$u! ,ul, !i ue and -$ndu-! !hr$##in( and a-hin( ,ain a $-ia!ed &i!h ,ul, !i ue da*a(e) The nerve !run% i -$*,$ ed $' *yelina!ed A del!a 'i#re in ,eri,hery and un*yelina!ed C 'i#re in !he -en!er) The en $ry ,a!h&ay i 1 Nerve i*,ul e Nerve !run% Ma.) $r *and nerve !ri(e*inal nerve ,$n !hala*u -$r!e. ,er-eived $r in!er,re!ed a ,ain) E''eren! *$!$r ,a!h&ay Sy*,a!he!i- 'i#re 'r$* u,eri$r -ervi-al (an(li$n en!er via a,i-al '$ra*en in $u!er layer $' ar!eri$le 5!uni-a adven!i!ia6 and !er*ina!e in !he *u -le $' !uni-a *edia)

Then le!

ee !he $verall nerve u,,ly7

Nerve u,,ly ,arallelB va -ular u,,ly7 !he *a<$ri!y $' 'i#re are n$n? *yelina!ed" *ay la!er #e-$*e *yelina!ed) Al $ y*,a!he!i- nerve havin( !er*ina!e $n lar(er ve el re(ula!e #l$$d 'l$&) Thi-% nerve #undle en!er !he a,i-al '$ra*en and ,r$-eed !$ !he -$r$nal area &here !he 'i#re e,ara!e and radia!e ,eri,herally !$ !he $d$n!$(eni-

+$ne) The nu*#er $' 'i#re i !he #undle very 'r$* 384?3944 i+e ran(e 'r$* 8?3:C) The lar(e *yelina!ed 'i#re *edia!e !he en a!i$n $' ,ain !ha! *ay #e -au ed #y e.!ernal !i*uli) The ,eri,heral a.$n '$r* a ne!&$r% $' nerve ad<a-en! !$ !he -ell ri-h +$ne %n$&n a !he ,arie!al layer $' nerve $r ,le.u $' Ra -h%$&) I! #e-$*e ,r$*inen! &hen r$$! '$r*a!i$n i -$*,le!e) Myelina!ed 'i#re u,!$ 8C in dia*e!er a &ell a deli-a!e n$n?*yelina!ed 'i#re le !han 3244n*

-$n !i!u!e !he ,le.u ) There i ,r$'ile #ran-hin( $' !he 'i#re in !he ,le.u ,r$du-in( a !re*end$u $verla, $' re-e,!$r 'ield ) Full devel$,*en! $' !hi ,le.u d$e n$! $--ur un!il !he 'inal !a(e $' r$$! '$r*a!i$n) Fina y /ome the NERVE ENDIN&S OR TERMINALS: Nerve a.$n 'r$* !he ,arie!al +$ne ,a !hr$u(h !he -ell ri-h and -ell 'ree #e!&een !he $d$n!$#la ! !$

+$ne and ei!her !er*ina!e a*$n( $r ,a

!er*ina!e ad<a-en! !$ !he $d$n!$#la ! ,r$-e e a! !he ,ul, ,reden!in #$rder $r in !he den!inal !u#ule ) Nerve !er*inal -$n i !in( $' r$und $r $val enlar(e*en! $' !he !er*inal 'ila*en! -$n!ain *i-r$ve i-le " *all dar% (ranular #$die and

ri#$-h$ndria) The e !er*ina!e are very -l$ e !$ !he $d$n!$#la ! ,la *a *e*#rane e,ara!ed $nly #y 94C) M$ ! $' !he e endin( are #elieved !$ #e en $ry re-e,!$r &i!h $*e y*,a!he!i- endin( !$$) Nerve a.$n '$und a*$n( !he $d$n!$#la ! and in !he -ell 'ree and -ell ri-h +$ne are n$n *yelina!ed #u! are en-l$ ed in a S-h&an -ell -$verin() M$re nerve 'i#re and endin( are '$und in !he ,ul, h$rn !han in $!her ,eri,heral area $' !he -$r$nal ,ul,) = !y,e $' !er*inal -$n'i(ura!i$n are een7 3) Si*,le *ar(inal ,ul,al nerve 'i#re nerve ,le.u !$ $d$n!$#la !i- layer) 9) Si*,le ,reden!al nerve 'i#re run !rai(h! $r ,irally !hr$u(h a den!inal !u#ule) :) C$*,le. ,reden!al nerve 'i#re rea-h !he ,reden!in and under($ a !er*inal ra*i'i-a!i$n &i!h *ul!i,le #ran-he and endin( ) een 'r$* u#$d$n!$#la !i-

=) Den!inal nerve 'i#re !u#ule in!$ den!in) O' i**en e in!ere !

een &i!h$u! !ran ver e -$ur e al$n( den!inal

are

!he u-h a

,re en-e

$'

neur$,e,!ide

$r

neur$!ran *i!!er ) Su# !an-e

u# !an-e P" 8?Hydr$.y'$ra*ine"

va $a-!ive in!e !inal ,e,!ide" $*a!$ !ain" ,r$ !a(landin a &ell a a-e!yl -h$line and n$re,ine,hrine" -al-i!$n (ave rela!ed ,e,!ide" neur$,e,!ide" Y" neur$%inin A" e!-" have #een '$und !hr$u(h$u! ,ul,) Vari$u !i*uli eli-i!

!heir relea e $n-e ev$%ed !hey a''e-! va -ular !$ne and *$di'y e.-i!a#ili!y $' nerve endin( ) In addi!i$n" !hey ,r$*$!e &$und healin() An$!her uni/ue 'ea!ure i !ha! en $ry re ,$n e in !he ,ul, -ann$! di''eren!ia!e #e!&een hea!" !$u-h" ,re ure $r -he*i-al" #e-au e $' a# en-e $' ,e-i'i- re-e,!$r ) All envir$n*en!al !i*uli eli-i! ,ain a a re ,$n e) FUNCTIONS OF PULP: 3) INDUCTIVE7 The 'ir ! r$le $' !he ,ul, anla(e i !$ indu-e $ral e,i!helial di''eren!ia!i$n in!$ den!al la*ina and ena*el $r(an '$r*a!i$n) Al $ indu-e devel$,in( ena*el $r(an !$ #e-$*e a ,ar!i-ular !y,e $' !$$!h) The in!era-!i$n #e!&een !he e,i!heliu* $' !he !$$!h (er* and !he e-!$*e en-hy*e in !he den!al ,a,illa durin( !he #ud" -a, and #ell re-i,r$-ally indu-!ive) !a(e $' !$$!h (er* *a!ura!i$n are

+( FORMATIVE AND MORP%OLO&IC FUNCTIONS: The ,ul, $r(an -ell ,r$du-e !he den!in !ha! urr$und and ,r$!e-! !he ,ul,) Od$n!$#la ! devel$, !he $r(ani- *a!ri. and 'un-!i$n in i! -al-i'i-a!i$n) The -ell al $ de!er*ine !he '$r* a-/uired #y !he -$r$nal ,ul, -ha*#er a &ell a v$lu*e $' !he ,ul,) :) NUTRITIVE7 den!in #ein( ava -ular" de,end $n !he underlyin( !i ue '$r i! #l$$d u,,ly and ly*,h draina(e) The ,ul, n$uri he !he den!in !hr$u(h !he $d$n!$#la ! and !heir ,r$-e e and #y *ean $' !he #l$$d va -ular y !e* $' !he ,ul,) =) SENSOR#7 Myelina!ed and n$n*yelina!ed nerve are '$und in !he ,ul,) All !he !i*uli re-eived are in!er,re!ed a ,ain) Thu -he*i-al" ,re ure " !her*al and $!her !i*uli ev$%e ,ain) 8) PROTECTIVE7 The en $ry nerve re ,$nd &i!h ,ain !$ all

!i*uli) The e ini!ia!e re'le.e !ha! -$n!r$l -ir-ula!i$n in !he ,ul,) Thi y*,a!he!i- 'un-!i$n i a re'le." ,r$vidin( !i*ula!i$n !$

vi -eral *$!$r 'i#re !er*ina!in( $n !he *u -le $' !he #l$$d ve el ) 2) DEFENSIVE OR REPARATIVE7 The ,ul, i an $r(an &i!h re*ar%a#le re,ara!ive a#ili!ie ) I! re ,$nd !$ in ul! &he!her

*e-hani-al" !her*al" -he*i-al $r #a-!erial #y ,r$du-in( re,ara!ive den!in and !u#ular -ler$ i ) Al $ a-u!e !i*ula!i$n *ay ,r$v$%e in'la**a!$ry rea-!i$n and -ardinal y*,!$* are e! in *$!i$n in-ludin( ,ain) Vari$u -ell $' !he ,ul, aid in !he re,air ,r$-e ) The ri(id den!inal &all and !he unyield" en-l$ ure -an lead !$ ,ar!ial $r -$*,le!e va -ular -$lla, e and ne-r$ i $' !he ,ul,) H$&ever" i' !he in'la**a!i$n i n$! !$$ evere" !he ,ul, &ill heal via i! e.-ellen! re(enera!ive ,r$,er!ie ) PRIMAR# AND PERMANENT PULP OR&ANS: PRIMARY7 !hey 'un-!i$n '$r a h$r!er ,eri$d !han ,er*anen! ,ul, $r(an ) Avera(e len(!h $' 'un-!i$n i ;): year &hi-h -an #e divided in!$ : !i*e ,eri$d 7 36 Pul, $r(an (r$&!h7 Ta%e ,la-e durin( !he !i*e !he -r$&n and r$$! are devel$,in() 96 Pul, *a!ura!i$n7 The ,eri$d a'!er !he r$$! i -$*,le!ed un!il r$$! re $r,!i$n #e(in ) :6 Pul, re(re i$n7 Peri$d 'r$* #e(innin( $' r$$! re $r,!i$n un!il e.'$lia!i$n)

The : ,eri$d are n$! $' e/ual len(!h 7 T$$!h eru,!i$n !$ r$$! -$*,le!i$n i a#$u! 3 year) R$$! -$*,le!i$n !$ #e(in r$$! l$ Pul, re(re i$n i : yr " 2 *$n!h) Ma.i*u* li'e $' ,ri*ary ,ul, i a,,r$. H)2 yr ) PERMANENT PULP OR&ANS7 durin( -r$&n '$r*a!i$n" ,ul, $' ,ri*ary and ,er*anen! !ee!h are *$r,h$l$(i-ally nearly iden!i-al) In ,er*anen! !ee!h !hi ,r$-e re/uire a#$u! 8 yr ) Pri*ary !ee!h h$&ever i : yr " H *$n!h)

never a!!ain !he e.!en! $' ,er*anen! !ee!h neural devel$,*en! al!h$u(h #$!h are hi(hly va -ulari+ed) The re*ainin( ar-hi!e-!ure i The ,eri$d $' devel$,*en! '$r ,er*anen! ,ul, i*ilar)

are l$n(er -r$&n

-$*,le!i$n avera(e 8 yr " 8 *$n!h ) Cr$&n -$*,le!i$n !$ eru,!i$n i : yr " 2 *$n!h ) Eru,!i$n !$ r$$! -$*,le!i$n i : yr " 33 *$n!h ) Thu " !he ,ul, under($ devel$,*en! '$r a#$u! 39 yr " = *$n!h in -$n!ra ! !$ = yr " 9 *$n!h '$r ,ri*ary !ee!h) Al $ ,er*anen! r$$! !a%e !i*e a l$n( !$ rea-h -$*,le!e 5> yr 8 *$n!h6 a -$*,ared !$ ,ri*ary ,ul, 5: yr " : *$n!h 6)

The ,eri$d $' ,ul, a(in( i *u-h a--elera!ed in ,ri*ary !ee!h a#$u! > yr " 8 *$n!h ) A(in( $' ,er*anen! !ee!h re/uire *u-h $' !he adul! li'e ,an) Finally" '$r #$!h ,ri*ary and ,er*anen! !ee!h" !he *a.illary ar-he re/uire li(h!ly l$n(er !$ -$*,le!e ea-h ,r$-e !han *andi#ular)

A&E AND RE&RESSIVE C%AN&ES IN T%E PULP: 3) DIMENSIONAL C%AN&ES7 The *$ ! -$n ,i-u$u a(e -han(e i !he redu-!i$n in v$lu*e $' !he ,ul, due !$ -$n!in$u de,$ i!i$n $' e-$ndary den!in and re,ara!ive den!in in re ,$n e !$ !i*uli) Thi di*uni!i$n i -alled a!r$,hy) 9) CELL C%AN&ES7 Cell #e-$*e 'ever in nu*#er and al $ i+e and nu*#er $' -y!$,la *i-

-hara-!eri+ed #y de-rea e in $r(anelle )

:) FI)ROSIS7 In !he a(in( ,ul, a--u*ula!i$n $' !$$!h di''u e 'i#rillar -$*,$nene! a &ell a #undle $' -$lla(en 'i#re a,,ear) The in-rea e in 'i#er i (radual and (enerali+ed !hr$u(h$u! !he $r(an) Any e.!ernal !rau*a -au e a l$-ali+ed 'i#r$ i $r -alin( e''e-!) The in-rea e in -$lla(en 'i#re *ay #e *$re a,,aren! !han a-!ual" a!!ri#u!a#le !$ de-rea e in ,ul, i+e" *a%in( !he 'i#re $--u,y le ,a-e and l$$% *$re -$n-en!ra!ed) I! ha even #een !he$ri+ed !ha! ,ul,al 'i#r$ i d$e n$! in-rea e a a re ul! $' a(e)

=) VASCULAR AND MISCELLANEOUS 7 Pla/ue *ay a,,ear in ,ul,al ve el ) In $!her -a e " !he $u!er dia*e!er $' ve el &all #e-$*e (rea!er a -$lla(en 'i#re in-rea e) Al $ -al-i'i-a!i$n are '$und in #l$$d ve el e ,e-ially near !he a,i-al '$ra*en) Al $ !here i a l$ a.$n ) An$!her i*,$r!an! a(e -han(e are !he -al-i'i-a!i$n $' !he den!al ,ul,) S$ n$& &e -$*e !$ !he 7 PULP STONES OR DENTICLES: Pul, !$ne are n$dular" -al-i'ied *a e a,,earin( in !he -$r$nal $r r$$! ,$r!i$n $' !he ,ul,) They devel$, in !ee!h /ui!e n$r*al in $!her a ,e-! and -an #e een in 'un-!i$nal a &ell a e*#edded uneru,!ed !ee!h) Their e!i$l$(y i !ill and a de(enera!i$n $' *yelina!ed and un*yelina!ed

un-lear and have n$! #een a $-ia!ed &i!h any a#n$r*ali!ie $' !he ,ul, ye!) CLASSIFICATION: A--$rdin( !$ !heir !ru-!ure7 3) True den!i-le ) 9) Fal e den!i-le ) :) Di''u e -al-i'i-a!i$n )

TRUE DENTICLES7 !heir !ru-!ure i

i*ilar !$ den!ine) They are rare

and are u ually een -l$ e !$ !he a,i-al '$ra*en) They e.hi#i! den!al !u#uli -$n!ainin( $d$n!$#la ! ,r$-e e ) A !he$ry ,u! '$r!h !a!e !ha! !he devel$,*en! $' !rue den!i-le i -au ed #y !he in-lu i$n $' re*nan! $' !he e,i!helial r$$! hea!h &i!hin !he ,ul, &hi-h indu-e !he ,ul,al -ell !$ di''eren!ia!e in!$ $d$n!$#la ! and '$r* ,ul, !$ne ) FALSE DENTICLES7 The e d$ n$! e.hi#i! den!inal !u#ule #u! a,,ear in !ead a -$n-en!ri- layer $' -al-i'ied !i ue and -an a,,ear &i!h a #undle $' -$lla(en 'i#re $r in a ,ul, '$r-e $' -$lla(e a--u*ula!i$n ) S$*e ari e ar$und ve el " havin( re*nan! $' ne-r$!i- and -al-i'ied -ell -en!rally) Cal-i'i-a!i$n $' !hr$*#i in #l$$d ve el -alled ,hle#$li!h *ay al $ erve a *id '$r 'al e den!i-le ) All den!i-le #e(in a *all n$dule #u! in-rea e in i+e #y in-re*en!al

(r$&!h $r !heir ur'a-e) The urr$undin( ,ul, !i ue *ay a,,ear /ui!e n$r*al) Pul, !$ne *ay even!ually 'ill u# !an!ial ,ar! $' !he ,ul, -ha*#er) DIFFUSE CALCIFICATIONS: They a,,ear a irre(ular -al-i'i- de,$ i! in !he ,ul, !i ue u ually

'$ll$&in( -$lla(en$u 'i#re #undle $r #l$$d ve el ) S$*e!i*e !hey

devel$, in!$ lar(er *a e #u! u ually ,er i ! a 'ine -al-i'ied ,i-ule ) Pul, a,,ear n$r*al) They are u ually '$und in !he r$$! -anal &herea den!i-le are *$re 're/uen! in !he -$r$nal ,ul,) Pul, !$ne are al $ -la i'ied a--$rdin( !$ !heir l$-a!i$n in rela!i$n !$ !he urr$undin( den!inal &all7 3) Free den!i-le 1 En!irely urr$unded #y ,ul, !i ue) 9) A!!a-hed den!i-le 1 ,ar!ly 'u ed &i!h den!in) :) E*#edded den!i-le 1 en!irely urr$unded #y den!in) All are #elieved !$ #e '$r*ed 'ree i !he ,ul," la!er (e!!in( a!!a-hed $r e*#edded) The in-iden-e $' ,ul, !$ne i *$re ,revalen! !han r$en!(en$(ra,hi-ally vi i#le) Their in-iden-e and i+e in-rea e &i!h a(e) A,,r$.) ? ? ? 22@ $' !ee!h in ,er $n $' 34?:4 yr $' a(e) ;4@ $' !ee!h in ,er $n $' :4?84 yr $' a(e) And H4@ $' !ee!h in ,er $n -al-i'i-a!i$n $' $*e !y,e) $ver 84 yr $' a(e -$n!ain

Al $ in-luded under -al-i'i-a!i$n -au e CALCIFIC METAMORPHOSIS lu.a!i$n $' !ee!h a a re ul! $' !rau*a *ay re ul! in -al-i'i- *e!a*$r,h$ i " a -$ndi!i$n !ha! -an in *$n!h $' yr lead !$ ,ar!ial $r -$*,le!e

radi$(ra,hi- $#li!era!i$n $' !he ,ul, -ha*#er due !$ e.-e ive de,$ i!i$n $' *inerali+ed !i ue re e*#lin( -e*en!u* $r $--a i$nally #$ne) Clini-ally !he -r$&n a,,ear a yell$&i h hue and u ually $--ur in !ee!h &i!h in-$*,le!e r$$! '$r*a!i$n u#<e-!ed !$ !rau*a!i- in ul!) Last y 0e /ome to the CLINICAL CONSIDERATIONS: 3) Durin( $,era!ive ,r$-edure " !he ha,e $' !he ,ul, -ha*#er and i! e.!en i$n in!$ -u , " !he ,ul,al h$rn i i*,$r!an! !$ re*e*#er) The &ide ,ul, -ha*#er $' y$un( individual *a%e dee, -avi!y ,re,ara!i$n ha+ard$u ) In $*e devel$,*en!al di !ur#an-e " ,ul,al h$rn ,r$<e-! hi(h in!$ !he -u , and unan!i-i,a!ed e.,$ ure -an $--ur) A radi$(ra,h hel, de!er*ine !he i+e $' ,ul, -ha*#er and e.!en! $' ,ul,al h$rn ) 9) Durin( $,enin( $' ,ul, -ha*#er '$r !hera,y" !he *$r,h$l$(y and i! varia!i$n *u ! #e %e,! in *ind &i!h advan-e a(e" ,ul, -ha*#er #e-$*e -a e *aller and l$-a!i$n $' -anal i *$re di''i-ul!) In u-h l$-a!ed 'ir ! in ,$ !eri$r i)e) di !al in

lar(e ! -anal i

*andi#ular and ,ala!al in *a.illary !$ av$id ,er'$ra!i$n) In

an!eri$r ,ul, -ha*#er *ay #e 'illed &i!h e-$ndary den!in *a%in( -anal l$-a!i$n di''i-ul!) Al $ ,ul, !$ne lyin a! $,enin( $r $!her l$-a!i$n render r$$! -anal !hera,y di''i-ul! and -u*#er $*e) :) A,i-al '$ra*en" !he land *ar% '$r end$d$n!i- ,r$-edure varie in ha,e and l$-a!i$n &hen narr$&ed #y -e*en!u*" i! i *$re readily l$-a!ed" i' i! i a! !he ide $' !he a,e." *i <ud(e*en! $' -anal len(!h and 'illin( $--ur ) Al $" in y$un(er ,ul, &i!h !rau*a" in-$*,le!e devel$,*en! $' a,e. *ay ne-e i!a!e a ,ul,$!$*y $r a,e.i'i-a!i$n ,r$-edure) =) A--e $ry -anal are a very in!ere !in( and varyin( ,r$#le*) Rarely vi i#le $n radi$(ra,h and di''i-ul! $r ra!her i*,$ i#le !$ rea-h" !hey re*ain un!rea!ed) The *a<$ri!y d$ n$! a''e-! RCT u--e ) H$&ever" &hen a--e $ry -anal are l$-a!ed near -$r$nal ,ar! $' r$$! $r in #i'ur-a!i$n" a dee, ,eri$d$n!al ,$-%e! *ay -au e ,ul,al in'la**a!i$n) Thu ,eri$d$n!al di ea e -an have a ,r$'$und e''e-! $n ,ul, in!e(ri!y and vi-e ver a) 8) VITAL PULP T%ERAP#7 E.,$ ed ,ul, are n$ l$n(er l$ ! ,ul, ) Pre en! in!$ de'en e and re,ara!ive *e-hani * $' ,ul, have

rev$lu!i$ni+ed ,ul, ,re erva!i$n) N$n in'e-!ed $r *ini*ally in'e-!ed ,ul, i' -a,,ed ,r$,erly -an '$r* den!inal #rid(e and

re!ain vi!ali!y) Pri*ary !$$!h ,ul, -a,,in( i re*ar%a#ly u--e 'ul) Vari$u *a!erial li%e Ca5OH69" den!in #$ndin( a(en! and MTA are u ed) 2) All $,era!ive ,r$-edure and *a!erial -au e an ini!ial re ,$n e in !he ,ul, de,enden! $n !he everi!y $' in ul!) Even li(h! !i*ulu -au e in'la**a!$ry -ell in'il!ra!i$n) Severe rea-!i$n re ul! in li%e Ca5OH69 indu-e re,ara!ive den!in

hy,erae*ia -$*,$und

'$r*a!i$n) Al $ le er !he den!inal de,!h $r -l$ er !he re !$ra!i$n" (rea!er i !he re ,$n e) >) Dehydra!i$n" #ein( har*'ul !$ !he ,ul," h$uld #e av$ided &hile u in( ,$!en!ially har*'ul -he*i-al e*,l$yed) ;) A vi!al ,ul, i e en!ial !$ ($$d den!i!i$n) Al!h$u(h *$dern -avi!y line h$uld #e

end$d$n!i ! -an ,r$l$n( !$$!h l$n(evi!y" n$n?vi!al !ee!h #e-$*e #ri!!le and are u#<e-!e !$ 'ra-!ure ) Thu " any ,re-au!i$n h$uld #e !a%en !$ ,re erve vi!ali!y $' ,ul,) H) In!ernal re $r,!i$n" u ually ini!ia!ed due !$ !rau*a" i u ually

a y*,!$*a!i- and re-$(ni+ed $n radi$(ra,h a a re $r,!ive de'e-! and h$uld #e !rea!ed #y end$d$n!i- !hera,y #e'$re ,er'$ra!i$n)

34) Carie

-an eli-i! varied re ,$n e

'r$* !he ,ul, 'r$* *ild

in'la**a!i$n !$ ne-r$ i !$ !i*ula!i$n) Thu vari$u ,a!h$l$(ie li%e hy,eral(e ia $r rever i#le ,ul,i!i !$ irrever i#le ,ul,i!i "

,eria,i-al ,a!h$l$(ie $r hy,er,la !i- ,ul,i!i are een and *u ! #e handled a,,r$,ria!ely) 33) Vi!ali!y $' ,ul, i $ne $' !he h$!!e ! !$,i- $' in!ere ! and re ear-h) Fr$* !he !her*al ,ul, !e ! inv$lvin( hea! and -$ld !$ !he

vi!al$*e!er inv$lvin( ele-!ri-al !i*uli !$ A del!a 'i#re all re-$rd neural vi!ali!y $' ,ul, n$! va -ular &hi-h i !he !rue indi-a!$r) La!e ! !e-hni/ue li%e la er D$,,ler 'l$&*e!ry and ,ul e $.i*e!ry are l$&ly *a%in( inr$ad a *ean $' *ea urin( ,ul,al vi!ali!y and de!er*inin( !hera,eu!i- $,!i$n )

CONCLUSION:
I! i $'!en in !he ,a ! !ha! &e 'ind !he 'u!ure) Thu a !h$r$u(h and -$*,le!e a i*ila!i$n $' !he *yriad and 'an!a !i- da!a#a e $n !he dyna*i- $' !he ,ul, and a %n$&led(e $' vari$u elu-ida!i$n ,a !" ,re en! and 'u!ure &ill ($ a l$n( &ay in en urin( !ha! &e" a den!al ,hy i-ian " ,r$vide !he hi(he ! level $' !e-hni-al and -ien!i'i- a--ura-y and ar!i !i- 'lair in !he h$li !i&ell #ein( $' !he !$$!h $r(an and in !urn 'ul'ill !he a ,ira!i$n $' !h$ e individual &h$ ,la-e in u !heir un&averin( !ru ! ? $ur ,a!ien! )