Proiect: Metodologia cercetării

Aspects and studies regarding pulp-dentine

reactions in dental caries and dental caries
development
 Aspects and studies regarding pulp-dentine
reactions in dental caries and dental caries
development

Aunianu .𝐌𝟏 , Andrian 𝐒 𝟐 , Iovan 𝐆𝐢𝐚𝐧𝐢𝐧𝐚𝟑 , Topoliceanu 𝐂 𝟒 , Sălceanu 𝐌𝐢𝐡𝐚𝐞𝐥𝐚𝟓 ,

Lăcătuşu 𝐒𝐭 𝟔
1 Drd. U.M..F. “GR. T. Popa”, Iași, Facultatea de Medicină Dentară, Disciplină de Cariologie
2,6 Prof. Dr. U.M..F. “GR. T. Popa”, Iași, Facultatea de Medicină Dentară, Disciplina de
Cariologie
3 Assoc. Prof. Dr. U.M..F. “GR. T. Popa”, Iași, Facultatea de Medicină Dentară, Disciplina de
Cariologie
4,5 Asist. Univ. Dr. U.M..F. “GR. T. Popa”, Iași, Facultatede Medicină Dentară, Disciplina de
Cariologie și Endodonție

Aims. The clinical aimed to assess distribution and types of pulp-dentin defensive
reactions related to localisation, progression, depth of dental caries. This article will
also point out the role playes by these progression and age factors on dental caries
activity (smoking, alcohol consumption, stress, traumas). The change of dental caries
pattern determined an increase of uncavitated caries percent requiring complementary
exams designed to diagnose caries in incipient stages.

Matherial and methods. Caries were assessed in 128 patients divided in two groups:
13-20 age and 21-35 age.

Results were processed in Microsoft Excel . The final resuts suggest that type
intensity of defensive pulp-dentinal reactions depend on cavitation stage, localisation,
depth, group.

Coclusion. Pulp-dentine complex presents a reactive potential against bacterial

factors from dental caries, expressed through remineralization processes, dentine
hipermineralization, neodentinogenesis, volume reduction of pulp room and pulpal
calcifications.

INTRODUCTION

Dental pulp and pup tissue presents common functions and pathology, that impose us
to consider them as a pulp-dentine complex (Lăcătuşu St. 1998, Iliescu A. 2001).
 Odontoblasts are the first cells which react to external agents; odontoblasts lesions
iduce defensive mechanisms of pulp-dentine complex (Bjornal 1999).

Dentine contains numerous components, active biologic molecules and growth

factors. These components that influence mineralization processes are released from
demineralized dentine as follows: sialoproteins, osteopontins, osteocalcins (Bronckers
A.1998), bone morphogenetic proteins (Ren WH.1999) and growth factors (TGF-β1).

Bacterial agents stimulate secretion of metalloproteinases which influence

neodentinogenesis processes (Tjaderhane 2001). Some therapeutic agents used in
„stepwise” technique (calcium hydroxide, zinc oxide eugenol, glassionomers) can
stimulates neodentinogenesis and remineralization processes (Leksell E.1996, Maltz
M.2002, Oliveira E. 2006).

Radiographs could be useful to render evident these subtle phenomena which

characterize both caries lesion and dental treatment.

MATERIALS AND METHODS

The clinical and radiograph study was processed on 128 patients (80 females, 48
males) divided in two age groups: 13-20 age and 21-35 age.

Dental caries were recorded in posterior dental group as follows:

Incipient cavitated occlusal caries (indices 3, 4 Espelid&Tweit);

Incipient cavitated approximal caries (indices D3, D4);
Cavitated occlusal caries (indices 3, 4 Espelid&Tweit );
Cavitated approximal caries (indices D3, D4, D5);
Acute oclusal caries;
Acute approximal caries.

Dental caries distribution in patients group:

 Incipient cavitated occlusal caries: 15,5%

 Incipient cavitated approximal caries: 20%
 Cavitated occlusal caries: 19%
 Cavitated approximal caries: 20,5%
  Acute occlusal caries: 10%
 Acute approximal caries: 16%

Ortopantomographs were digitally processed with contrast and brightness filters and
selected aria were magnified using zoom function. The pulp-dentine complex reactions
were assessed by comparison analysis of morphology and volume of pulp room
between the studied teeth and the sound teeth.

The pulp-dentine reactions were classified as follows:

 Absent reactions;
 Moderate intensity reactions;
 High intensity reactions (visible reduction of pulp room volume, dentine
hipermineralizations, endodontic calcifications).

RESULTS

The recorded data were processed using Microsoft Excel and the results are
presentebellow in graphs 1-3. The images 1-5 present the most frequent reactions of
pulp-dentin complex in the study group.

Results presented in graphs 1-3 suggest that type and distribution of pulp-dentine
reactions are extremely various accordingly to localization, cavity stage, depth and
type of progression of dental caries.

For 13-20 age group, occlusal caries with chronic progression induce high intensity
pulpdentine reactions in 60% of deep caries and 20% of medium caries.
Graph 1. Distribution of intensity levels of pulp-dentin complex reactions for 13-20
age group.

Graph 2. Distribution of intensity levels of pulp-dentin complex reactions for 21-35

age group.
Graph 3. Distribution of intensity levels of pulp-dentin complex reactions for 21-35
age group.

For 21-35 age group, high intensity pulpdentinereactions are present in 80% of deep
occlusal chronic caries.
For deep approximal caries with chronic progression in 13-20 age group, high
intensity pulp-dentine reactions are present in 36% of case and moderate intensity
reactions in 48% of cases.
For the same categories of dental caries, distribution is different in 21-35 age group,
with 40% high intensity pulp-dentine reactions and 32% moderate intensity pulp-
dentine reactions.
The frequency of pulp-dentine reactions is very low for 13-20 age group in medium
chronic approximal caries and increases to 40% for 21-35 age group. Incipient
retractions of pulp room is present in 33% of incipient cavitated occlusal
caries for 13-20 age group while same type of reactions were noticed in 85% percent
for 21-35 age group.
In case of incipient cavitated approximal caries, moderate neodentinogenesis is
observed for 23% of dental caries in 13-20 age group and 14% of dental caries in 21-
35 age group. For caries with acute progression, moderate pulp-dentine reactions were
observed in only 9% cases of occlusal caries and 25% cases of
approximal caries in 13-20 age group.
Images 1-5 present some types of pulp-dentine reactions in various dental caries
categories.

Fig 1. C.D., 26. Incipient occlusal and approximal dental caries (3.7.). Pulp-dentine
reactions expressed through neodentinogenesis associated with moderate retraction of
pulp room.

Fig. 2. C.M., 19. Arrested occlusal dental caries (3.6.). Pulp-dentine reaction
expressed through dentine hipermineralization and pulp room
reduction.

Fig. 3. B.G., 35. Chronic distal deep dental caries (1.8.). Reaction of pulp-dentine
complex through high reduction of pulp room volume associated with
neodentinogenesis and calcifications processes.
Fig. 4. a, b. M.A., 32. Chronic approximal deep dental caries (1.7., 4.6.). Pulp room
reduction after neodentinogenesis processes.
Fig. 5. a, b. S.I., 25 . 1.8., 4.8.- Deep dental caries with acute evolution. (1.8., 4.8.).
The radiograph images present extended area of affected dentine and absence of
neodentinogenesis processes.

CONCLUSION.
High intensity pulp-dentine reactions appearmostly like dentine hipermineralisation
and masive reduction of pulp room associated with neodentinogenesis processes,
especially in medium and deep occlusal caries and deep approximal caries with
chronic progression for 21-35 age patients group. Patients of 13-20 age have frequent
acute dental caries without pulp-dentine reactions or chronic incipient and cavitated
dental caries with moderate intensity pulp-dentine reactions.
Pulp-dentine complex exhibits s a reactive potential against bacterial factors from
incipient and cavitated dental caries, expressed through
processes of dentine remineralization or hipermineralization, neodentinogenesis,
moderate and high pulp room reduction and calcification
processes.
 We are now developing a better and more complete understanding of the molecular
and cellular events which occur in the dentin-pulp complex during inflammation and
repair following carious disease. While disinfection of the dental tissue is clearly
imperative for the health of the tooth, the subsequent interaction between dental tissue
defence and repair is complex and the fine-tuning of the regulation of these processes
is important for ensuring which response predominates when vital pulp tissue can be
clinically retained or regenerated.
It is clear that sustained research activity in this area combined with clinical
translational approaches may result in the development of new therapeutics which
enable host defence and repair events. Advances in our understanding of the
interactions between immune and regenerative responses may therefore influence
clinical practice and benefit dental patients in the future.

BIBLIOGRAPHY

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