DENTIN

- Dr Zadeno kithan
 CONTENTS

● Introduction • clinical considerations & Significance

● History • Dentin Hypersensitivity
● Physical properties of dentin • Dentin permeability
● Mechanical properties of dentin • Dentinal caries
● • Developmental Anomalies of Dentin
Chemical composition of dentin
• Effect of systemic Diseases on Dentin
● Dentinogenesis • Adhesion of Dental materials to Dentin
● Life cycle of the Odontoblast • Dentin Bonding agents
● Classification of dentin • Conclusion
● Histology of dentin • References
● Age related and functional changes
● Structure of dentin
 Introduction

Dentin is the mineralised tissue that forms the bulk and general form of the tooth.

-In the crown in it is covered my enamel, in the root by

Cementum.

-It is Rigid but elastic tissue consisting of large numbers

Of small, Parallel tubules in a mineralised collagen

Matrix.

-It determines the shape of the crown, including the

Cusps and ridges, and the number and size of the roots.

Oral anatomy, histology and embryology: B.k.B Berkovitz,5th edition.

 HISTORY
● 1771: John hunter- Hard tissue
● 1873: Purkinje and Retzius explained about dentinal tubules
● 1867: Neuman gave the term “ neumans sheath”
● 1891: Von ebner gave the term- Ebners growth lines or
imbrication lines
● 1906: Von korrfs gave the term korffs fibers
 PHYSICAL PROPERTIES OF DENTIN

COLOUR : Pale yellow in deciduous teeth,yellow in permanent teeth.

Thicker enamel does not permit light to pass through readily and hence appears whiter.

Thickness :Range : 3-10 mm

Ratio of thickness in primary and permanent teeth is 1:2

HARDNESS :Harder than bone and cementum but considerably softer than enamel

-⅕ th that of enamel and 3 times harder in DEj than near the pulp

-Varies slightly between tooth types and between crown and root dentin.

Ten cates Oral histology: Development, structure and function: Antonio Nanci,8th edition.
 MECHANICAL PROPERTIES OF DENTIN

Compressive strength 217-300 Mpa

Modulus of elasticity 1.67 x 10 6 Psi

Tensile strength 40 Mpa(½ that of enamel )

Specific gravity 2.14

Stiffness ( Young’s modulus ) 17.6-22.9. Gpa

Phillips science of Dental materials.: Anusavice; 10th edition.

CHEMICAL COMPOSITION OF DENTIN

BY WEIGHT BY VOLUME

70% Inorganic 50% Inorganic

20 % Organic 30% Organic

10 % Water 20% Water

Oral histology and embryology : Orbans 14th edition

 INORGANIC CONSTITUTES
In the form of calcium hydroxyapatite crystals.

The crystallites are calcium- Poor and Carbonate-rich in comparison to pure hydroxyapatite

Formula : Ca10(PO4)6(OH)2

- 0.35nm x 10nm.

Oral Anatomy, histology and embryology : B.k.B Berkovitz;5th edition.

 ORGANIC CONSTITUENTS

•90% of the organic matrix comprises of Collagen.

-Type I collagen( Principal collagen fibril).

-Traces of type III and type V collagen.

Most of the collagen fibrils run parallel to pulpal surface

In mineralised dentin the collagen fibrils are of larger diameter( 100nm)

•8% Non collagenous proteins

•2% Lipids

Oral anatomy, histology and embryology: B.k.B Berkovitz,5th edition

 Non collagenous Proteins

8% of the organic matrix

1)Dentin phosphoproteins- main non collagenous protein .High CA ion binding properties

2)Proteoglycans

Biglycan and decorin.

Role in collagen fibril assembly and their cell mediated effects such as adhesion, migration, proliferation and
differentiation.

3)Glycoproteins/ Sialoproteins.

Osteonectin, Osteopontin, Dentin sialoprotein.

Osteopontin identified in predentine.

4)Gamma- Carboxyglutamate- containing proteins( Gla- proteins)

Bind strongly,but reversibly to Hydroxyapatite crystallites.

5)Growth factors
- Insulin growth factor (IGF)-II, Bone morphogenic protein (BMP)-2,
- Transforming growth factor (TGF)- beta.

6)Metalloproteinases
-MMP-1 and MMP-20( enamelysin)

7) Serum- derived proteins

Albumin

Oral anatomy,histology and embryology : B.k.B Berkovitz,5th edition

 DENTINOGENESIS

Dentin is formed by cells called Odontoblasts that differentiate from

ectomesenchymal cells of the dental papilla following an organising
influence that emanates from inner enamel epithelium.
Dentin formation begins when the tooth germ has reached the bell stage of
development.

12-14 weeks IU
 3 stages

1.CYTODIFFERENTIATION

Odontoblasts differentiate from undifferentiated mesenchymal cells

- The Dental papilla cells are small and undifferentiated and exhibit central nucleus and
few organelles. They are separated from inner enamel epithelium by an acellular
zone.
⬇️
- They change from ovoid to columnar Shape as they grow and nuclei becomes basally
oriented.These cells are called as Preodontoblasts.
⬇️
- The Golgi apparatus becomes pronounced and RER in nucleus moves away from the
basement membrane called as Reversal of polarity.
- These cells are now called as Odontoblasts which secrete predentin.
 ⬇️
- Once the formation of Predentin at cuspal or incisal edges begins,
the differentiating new Odontoblasts takes place further apically in
dental papilla.

● Initially daily increments of 4um/Per day are formed.Once crown

completion completes, it slows down to 1um/ day.

The dentin forming the initial shape of

the tooth is called primary dentin and
is usually completed 3 years after
tooth eruption (for permanent teeth).

Oral anatomy, Histology and embryology: B.k.B Berkovitz,5th edition.

 2. Organic matrix Formation

Differentiated Odontoblasts will have features of secretory cells ie abundance of RER,well developed Golgi
apparatus,mitochondria and secretory granules

⬇️

Pro collagen synthesised in RER is transferred to Golgi apparatus and finally appears in secretory granules.

The matrix mainly contains type1 collagen,Proteoglycans and glycoproteins.

⬇️

As matrix formation continues, the Odontoblasts leave the extensions called as Tomes fibre

⬇️

A layer of organic matrix called as predentin is always found between Odontoblasts

Oral anatomy, histology and embryology : B.k.B Berkovitz, 5th edition.

 3. Matrix maturation
Influx of ground substance , obscuring the fibrillar element

⬇️

Matrix vesicles bud off from base of cell, being released into matrix.

In bell stage, membranes disappear and apatite crystals appear, function as mineralization sites.

⬇️

Matrix calcification - Buds produced by Odontoblasts,exhibit spicule shaped Crystallite,which

appears centrally, spreads peripherally.

Oral anatomy,histology and embryology: B.k.B Berkovitz, 5th edition.

 Patterns of mineralization

1)GLOBULAR/CALCOSPHERIC CALCIFICATION :Involves deposition of crystals

in several discrete areas of matrix by heterogeneous capture in collagen.

With combined crystal growth, globular masses are formed that continue to
enlarge and eventually fuse to form a single calcified mass.

-Seen in mantle dentin.

Ten cates oral histology: Development, structure and function: 8th edition.
2)LINEAR CALCIFICATION

When the rate of formation progresses slowly, the mineralization front

appears more uniform. This is called linear calcification.

eg, in Circumpulpal dentin the mineralization can occur in both linear and
globular pattern.

Ten cates oral histology : Development, structure and function;8th edition.

 LIFE CYCLE OF ODONTOBLASTS
4 Periods:

1) Prepolarising stage
2) Polarising stage
3) Secretory stage
4) Resting Stage

Oral histology, inheritance and

Development: Vincent provenza;

2nd edition.
1.Prepolarizing stage
● The cells bordering the basement membrane are pleomorphic.
● Protoplasmic processes extend from the cell mass.
● Central mass is dominated by the nucleus.
● Of the organelles,the endoplasmic reticulum is most abundant.
● Free ribosomes,mitochondria and golgi components are present in reduced
amount.
 2.Polarizing stage
● The cells at the crest of the papilla are the first to become oriented so
that their cell bodies are positioned side by side and in close
proximity,thus reducing the intercellular space.
● The rounded cell bodies become cuboidal and later columnar.
● Polar positioning of the nucleus.
● A single major process extends from the distal segment of the
odontoblast.
● Few microtubules,microfilaments,vacuoles of various sizes,secretoty
vesicles and mitochondria are seen.
 3.Secretory stage
● Cells continue to lengthen and the organelles hypertrophy,preparatory to production and secretion of
collagen.
● Seven cytoplasmic zones are seen:
1.The process
2.Terminal web
3.Distal RER
4.Golgi apparatus
5.Supranuclear ER
6. Nuclear &
7.Infranuclear zone.
● Prosecretory granules containing dense mass are seen.
● They get further condensed becoming secretory granules and migrate to the odontoblast surface to be
released into the intercellular space eventually to form collagen.
4.Resting stage

● Subsequent to the deposition and calcification of developmental and primary

dentin,dentinogenic cells undergo changes resulting in “resting condition” of the
odontoblast.
● The activities associated with the matrix formation and calcification are suspended.
● Shortening of the odontoblasts to low columnar/cuboidal, reduction in organelle
populations and disappearance of their stratification.
● These structural and morphologic changes are retained until functional demands are
imposed on them for matrix synthesis required in the formation of secondary dentin.
 CLASSIFICATION OF DENTIN

ACCORDING TO DEVELOPMENT PATTERN ACCORDING TO PATTERN OF

MINERALIZATION
•Primary dentin
•Interglobular dentin
•Secondary Dentin
•Tomes granular layer
•Tertiary dentin
•Sclerotic dentin
ACCORDING TO LOCATION

•Interglobular dentin

•Intratubular/ peritubular dentin

•Intertubular dentin

•Mantle dentin

•Circumpulpal dentin Oral histology and embryology: Orbans; 14 th edition

 HISTOLOGY OF DENTIN

PRIMARY DENTIN-Dentin which is formed before root completion.

2 types : 1) Mantle dentin 2)Circumpulpal dentin

MANTLE DENTIN

- It is the first formed dentin in the crown underlying the DE junction. It is soft and

Provides cushioning effect to the tooth. It is the most peripheral part of the primary dentin and is
about 20-150um thick.

-Collagen Fibres are largely oriented perpendicular to the DE junction.

-larger collagen fibres than Circumpulpal dentin - 0.1-0.2 um, argyrophilic and are known as Von
Korffs fibers.

-Mainly type III collagen.

 CIRCUMPULPAL DENTIN
Outlines the pulp chamber,forms the remaining primary dentin or bulk of the tooth

-Collagen Fibrils -0.05 um

- Collagen fibrils are closely packed

together than mantle dentin

-More minerals than mantle dentin

Oral histology and embryology: Orbans

14th edition.
 SECONDARY DENTIN
Aka regular secondary dentin.

-The dentin formed after root completion. It is Narrow band of dentin bordering the pulp

- Contains fewer tubules than primary dentin.

-Greater amounts on the roof and floor of the coronal pulp chamber and protects the pulp from
exposure in older teeth.

- Pronounced contour line of Owen- due to change in direction of the dentinal tubules with coincidence
of secondary curvatures .

Oral histology and embryology:

Orbans 14th edition

 TERTIARY DENTIN
Localised formation of dentin on the pulp dentin border, produced in reaction to various stimuli,such as
attrition,Caries or a restorative dental procedure.Subclassified as

1) Reactionary

- Deposited by preexisting odontoblasts

2)Reparative

- Deposited by newly differentiated odontoblast- like cells

Wide range of presentations:

-May resemble secondary dentin in having a regular tubular structure

-May have few and or irregularly arranged tubules

-May be relatively atubular.

Oral histology and embryology : Orbans,14th edition

 Interglobular Dentin
Areas of unmineralized or hypomineralized dentin where globular zones of mineralization
(calcospherites) have failed to fuse into a homogeneous mass within mature dentin
- Especially prevalent in human teeth in which the person has had a

deficiency in vitamin D or exposure to high levels of fluoride at

the time of dentin formation.

- Most frequently seen in the
Circumpulpal dentin
- Dentinal tubules pass without
deviation through interglobular areas
-Dark In transmitted light

Oral histology and embryology: Orbans

14th edition
 Intratubular / Peritubular Dentin
The dentin that is deposited on the walls of the dentinal tubule,narrowing the lumen, and it’s
formation gradually leads to obliteration of the tubule.
- mineralised type I collagen.
- Increased radiographic and electron density
than intertubular dentin.
- 5-12% more mineralised than intertubular dentin .
- Occupies two-thirds of the cross sectional area
in outer dentin and approximately 3% near the
predentin.

Oral histology and embryology: Orbans;

14th edition
 Intertubular Dentin
Dentin located between the dentinal tubules.
- Represents the primary formative product of the odontoblast.
- Consists of tightly interwoven network of type I collagen fibrils.
- 50-200nm in diameter
- Fibrils arranged randomly in a plane at roughly right angles to the
dentinal tubules.

Oral histology and embryology: Orbans; 14 th edition

 Tomes granular layer

When dry ground sections of the root dentin are visualized in transmitted
light, a zone adjacent to the cementum appears granular, known as Tomes
granular layer.
- Increases slightly in amount from CE junction to the root apex and is
believed to be caused by coalescing and looping of the terminal
portions of the dentinal tubules.
- Among hypomineralized areas, tomes granular layer showed highest
concentrations of calcium and phosphorus.
 HYALINE LAYER.
- A clear hyaline layer present outside the granular layer
- Narrow band ( upto 20um)
- Non tubular, relatively structureless.
- May serve to bond cementum to dentin

Ground longitudinal section of a root showing the

granular (A) and Hyaline( C) layers beneath a layer
of acellular cementum Oral histology and embryology:
Orbans;14th edition.
 Sclerotic Dentin
Sclerotic Dentin describes dentinal tubules that have become occluded with calcified material.
- Forms as a response to an external stimulus such as under slowly advancing caries or beneath
areas of severe attrition.
- structurless and transparent.
- Platelike crystals of Octacalcium phosphate.
- most common in apical third of the root, and
in the crown midway between the DE junction
and the surface of the pulp.

Oral histology and embryology: Orbans;14th edition

 Age related and Functional changes
The gradual deposition of secondary dentin and deposition of apatite crystals in the
dentinal tubules causing sclerosis or transparent dentin are the important age changes.

DEAD TRACTS: Degenerated dentinal tubules, occur in dental caries or due to exposure
of dentinal tubules. Dead tracts appear black or dark in transmitted light due to air
entrapment in the empty dentinal tubules in the ground section. It appears bright or
white in reflected light.

Oral histology and embryology:

Orbans,14th edition.
 STRUCTURE OF DENTIN

ODONTOBLAST

Bodies of odontoblasts are arranged in a layer on the pulpal surface

of the dentin and only their cytoplasmic processes are included in
the tubules in the mineralised matrix.

Each gives rise to one process which traverses the predentin and
calcified dentin within one tubule & terminates in a branching
network at the junction with enamel or cementum

pathways of the pulp: Cohen;9th edition

 DENTINAL TUBULES

Odontoblast processes run in canaliculi that traverse the dentin layer

and are referred to as Dentinal tubules.The tubules follow a gentle curve
in the crown, less so in the root, where it resembles a gentle S(sigmoid
course ) in shape. These curvatures are called primary curvatures.
- starting at right angles from the pulpal surface,the first convexity of
this doubly curved course is directed towards the apex of the tooth.
- S shaped curvature least pronounced beneath the Incisal edges and
cusps ( almost straight course).

Oral histology and embryology : Orbans 14th edition

 - Over their entire lengths, the tubules exhibit minute, relatively
regular secondary curvatures that are sinusoidal in shape.
- lateral branches throughout Dentin known as Canaliculi or
microtubules.

Ground section showing DT cut

longitudinally & Ground section of dentin near the DEJ( arrow)
Demonstrating the sinusoidal primary showing branching of DT
curvature
 DIAMETER
- Near the pulp :2.5um
- Mid portion of Dentin: 1.2 um
- Near the DEJ :900 nm
- No of tubules per unit area on the pulpal and outer surfaces of the Dentin- 4:1
- Near the pulpal surface, no per square mm of dentinal tubules : 50,000-90,000.
- Near the enamel : 30,000.

Oral histology and embryology: Orbans:14th edition.

 CONTENTS OF DENTINAL TUBULES
- The Processes of the Odontoblasts that are responsible for their formation.
- Afferent nerve terminals: limited mainly to the dentin of the crown beneath the cusps in
over 40% of tubules
and 4-8 % in cervical part of the crown
- Microtubules and Intermediate filaments run longitudinally throughout the odontoblast
process, and made up of Proteins like Actin, tubulin and vimentin.
- Mitochondria are sometimes present in the process in the predentin.
- Strands of rough endoplamsic reticulum.
- Presence of Periodontoblastic space within the DT filled with Extracellular dentinal fluid,
having higher concentration of Potassium ions and relatively lower Concn of Sodium ions.
- Thin organic lining or membrane high in GAG called Lamina Limitans. It is important for
Regulation and inhibition of calcification of DT.

Oral histology and embryology: Orbans;14th edition

Tem of DT in inner calcified dentin in cross- Tem of DT from the middle region of coronal
section. Three of the tubules contain naked circumpula dentin.Some tubules appears to
nerve endings as well as Odontoblast contain cell processes,some contain noncellular
process. material and some are empty
 Dentino-enamel junction

The junction between enamel and dentin is seen as a scalloped

profile in cross section. The junction is a series of ridges,this
arrangement increases the adherence between dentin and
enamel. The ridging is most pronounced in coronal dentin, where
occlusal stresses are the greatest.

Clinical signifance:
The shape and nature of the junction prevent shearing of the
enamel during function

Tencates oral histology 8th edition

 CLINICAL CONSIDERATIONS & SIGNIFICANCE
When 1mm Square of dentin is exposed, about 30,000 living cells are damaged. It is Advisable to seal
the exposed dentin surface with a non irritating, insulating substance.

•DENTINAL TUBULES - It provides a passage for invading

bacteria and their products through either a thin or

thick dentinal layer.

•DENTINAL FLUID- It may serve as a sink from which injurious agents can diffuse into pulp producing
inflammatory response.

Conversely, it may serve as a vehicle for egress of bacteria from necrotic pulp into periradicular tissue.
Ten cates oral histology: Development, structure and function:8th edition
• SECONDARY DENTIN

It is important in determining form of cavity preparation for certain dental restorative procedures

Also tubules of secondary dentin sclerose more readily than those of primary dentin. This process tends to
reduce the overall Permeability of the dentin thereby protecting the pulp.

Secondary dentin deposition decreases the size of pulp chamber and canal dimensions and causes difficulties
in locating the canal orifices during endodontic therapy.

•DEAD TRACTS & SCLEROTIC DENTIN

They reduce the sensitivity and the permeability of the dentin, and thus prolongs pulp vitality.

Sclerotic dentin prevents caries progression and it is also a cause for breakage of roots in apical third during
extraction of teeth in elderly patients.

Ten cates oral histology : Development, structure and function;8th edition

•REPARATIVE DENTIN

It forms as a reaction to save the underlying pulp from injurious elements like bacteria and
their products and harmful substances from restorative materials.

•ROOT DENTIN

In premature loss of root sheath cells,there is no formation of Odontoblasts and hence no

dentin formation. But accessory canals are formed which plays a role in spread of infection
either from pulp to PDL or vice versa.

Ten cates oral histology : Development, structure and function;8th edition.

 Clinical consideration during restorative procedures

● Deep dentin is very porous and susceptible to desiccation.

● Therefore efforts to cover deep dentin, to limit dentinal tubular Fluid
flow, and to create a protective thermal/physical barrier are warranted.

-Generally, it is desirable to have approximately a 2-mm dimension of bulk

between the pulp and a metallic restorative material. This bulk may include
remaining dentin, liner, or base.
-If the removal of soft dentin does not extend deeper than 1 to 2 mm from
the initially prepared pulpal or axial wall, usually no liner is indicated.
- If the excavation extends to within 0.5 mm of the pulp, a liner usually is
selected to cover the deepest area of the dentin.
 DENTIN HYPERSENSITIVITY
Dentin hypersensitivity is characterized by short, sharp pain arising from exposed dentin in
response to stimuli typically thermal, evaporative, tactile, Osmotic or chemical and which cannot
be ascribed to any other form of dental defect or pathology.

- Holland et al.

ETIOLOGICAL AND PREDISPOSING FACTORS:

•Loss of enamel •Gingival recession

Attrition, abrasion, abfraction. •Erosion (intrinsic & extrinsic ).

•Tooth malposition. Denudation of cementum

Periodontal disease and it’s treatment •Periodontal surgery

•patient habits

Art and science of operative dentistry : Sturdevant;5th edition

 Three theories of Dentin hypersensitivity:
1)DIRECT INNERVATION THEORY:

This theory postulates that direct mechanical stimulation of exposed nerve endings at the DEJ is responsible for dentinal
hypersensitivity.

Limitations: Insufficient evidence to prove that the outer dentin that is most prone to be sensitive is well innervated.

2) ODONTOBLAST RECEPTOR THEORY/TRANSDUCTION THEORY:

It Proposes that Odontoblasts themselves act as neural receptors and relay the signal to the nerve terminal.

It was argued that because the Odontoblast is of neural crest origin, it retains an ability to transduce and propagate an impulse.

Limitations: No evidence to demonstrate synapses between Odontoblasts and nerve terminals.

 3) HYDRODYNAMIC THEORY

•Most accepted theory. • Proposed by Brannstrom.

•Suggests that DH is due to the hydrodynamic fluid movements occurring across exposed dentin with
open tubules which in turn mechanically activates the nerves present in the inner ends of the dentin
tubules or in the outer layers of the pulp.

MECHANISM: -Dentin tubules which are open and wide contain fluid. Various stimuli ( thermal,
tactile,Chemical, osmotic changes ) displaces this fluid in the tubules in either inward or outward
direction.

- The movement of this fluid stimulates the Odontoblastic processes, and the subsequent mechanical
disturbances stimulates baroreceptors( a nerve receptor sensitive to pressure ) that leads to neural
discharges( depolarisation)

- This neural pulpal activation is perceived as pain by the patient.

Art and science of operative dentistry: Sturdevant;5th edition

 DENTIN PERMEABILITY
The tubular structure of dentin allows for the possibility of substances applied to its outer surface
to reach and affect the dental pulp.

•Dentin permeability increases rapidly as the pulp chamber is approached because the no and
diameter of the tubules are more per unit area towards pulp than towards periphery ( total tubular
surface near DEJ is 1% of the total surface area of dentin , and close to the pulp it may be nearly
45%)

•Dentin beneath deep cavity preparation is much more permeable than under a shallow cavity.

•Radicular dentin less permeable than coronal dentin due to decrease in density of dentinal
tubules from approximately 42,000/mm 2 in cervical dentin to about 8,000/mm 2 In radicular dentin.

•Dentinal sclerosis reduces permeability.

Art and science of operative dentistry: Sturdevant;5th edition

 Smear layer and Dentin permeability
•Subsequent to instrumentation of the tooth, a natural deposits composed of microcrystalline cutting debris
embedded within the denatured collagen is formed on the cut surface. This is known as smear layer.

•It is upto 1-2um thick

•2 phases: solid phase made up of cutting debris ie denatured collagen and mineral,

Liquid phase made up of tortuous fluid filled channels around the cutting debris.

•It may also consists of blood, saliva ,bacteria, enamel,and dentin particles.

•Some of the cutting debris may also be pushed into the tubules by almost 1-5 um forming smear plugs.

•The smear layer + Smear plug serve as a functional unit to reduce the permeability and to protect the pulp.

•Smear layer reduces dentin permeability by 86%.

Art and science of operative dentistry : Sturtevant;5th edition

 DENTINAL CARIES:Clinical and histopathological
Characteristics and Reparative responses.
Progression of caries in dentin is different from the overlying enamel .

Dentin contains less mineral and the tubular structure provides a pathway for the ingress of acids and
egress of minerals. The DEJ has the least resistance to caries attack and allows rapid lateral spreading
when caries has penetrated enamel. Because of these characteristics,dentinal caries is V shaped with a
wide base at the DEJ and the apex directed pulpally. Thus a cavity of considerable size may actually form
with only slight clinically evident changes.

3 levels of dentinal reaction to caries can be recognised:

1- Reaction to long term, low level acid demineralisation associated with a slowly advancing lesion

- Sclerotic dentin formation,Crystallite precipitates form in the lumen of the dentinal tubules,
tubules becomes occluded and appears clear when a section of tooth is evaluated (transparent
dentin )
2-Reaction to a Moderate intensity attack

-The infected dentin contains a wide variety of Pathogenic materials or irritants, including high acid levels,
hydrolytic enzymes,bacteria and bacterial cellular debris. These materials can cause degeneration and death of the
Odontoblasts and their processes below the lesion. These group of empty tubules are dead tracts.

-The pulp may be sufficiently irritated from high acid levels or bacterial enzyme production to cause formation of
replacement Odontoblasts. These cells produce reparative dentin on the affected portion.

3- Reaction to severe,rapidly advancing caries characterised by very high acid levels

Acute rapidly advancing caries with high acid levels over powers dentinal defences and results In infection,
abscess and death of pulp.

Art and science of operative dentistry: Sturdevant;5th edition

 ZONES OF DENTINAL CARIES

ZONE 1: NORMAL DENTIN

- Deepest area which has tubules with Odontoblastic processes

- No crystals in the lumen

-Normal collagen and apatite

-No bacteria in the tubules

-Stimulation of dentin produces sharp pain

ZONE 2: SUB TRANSPARENT DENTIN

- Zone of demineralization of intertubular dentin

- Initial formation of fine crystals in tubule lumen
- Damage to Odontoblastic process
- No bacteria in the zone
- Stimulation of dentin produces pain
- Dentin is capable of remineralisation.
ZONE 3:TRANSPARENT DENTIN

- softer than normal enamel and shows further loss of mineral

- Many large crystals in the tubules
- Stimulation of region produces pain
- No bacteria found
- Despite organic acid attack, collagen cross linking is intact.
- Region capable of repair.

ZONE 4: TURBID DENTIN

-Zone of bacterial invasion

- Widening and distortion of tubules

-little mineral present

-collagen is irreversible denatured

-Dentin does not self repair

- Must be removed before restoration.

ZONE 5:INFECTED DENTIN

-Outermost Zone

-Non recognizable Zone

-Collagen and mineral seem to be absent

-Great no of bacteria are dispersed in this

granular material

-Removal is essential

Art and science of operative dentistry: Sturdevant;

5th edition.
AFFECTED DENTIN INFECTED DENTIN

•Aka Inner carious dentin. •Aka outer carious dentin

•Zone of demineralization of ( outermost carious lesion )
intertubular dentin and of initial •marked by widening and
formation of fine crystals in the distortion of the dentinal
tubule lumen at the advancing tubules, which are filled with
front. Bacteria.
•Softer than normal dentin •Softer than affected dentin.
•Stimulation produces pain •Collagen irreversibly
•Collagen cross-linking intact damaged.
•Zones 2,3,4 •Zone 5
•Capable of self repair, •Cannot be remineralized,and
provided that the pulp remains it’s removal is essential to
vital. sound, successful restorative
procedures and for the
prevention of spreading the
infection.

Art and science of operative dentistry: Sturdevant;5th edition

 Adhesion of Dental materials to Dentin

The classic concepts of Operative dentistry were challenged by the introduction of new adhesive techniques, first for
enamel and dentin.

Nevertheless, adhesion to dentin remains difficult.

Challenges in Dentin Bonding substrate.

•Dentin contains a substantial portion of water (20 vol %) and organic material (30 Vol %). It’s high fluid content Places
stringent requirements on materials that can be effective coupling agents between dentin and a restorative material.

•The tubular architecture of Dentin provides a variable area through which dentinal fluid may flow to the surface to
adversely affect adhesion.

•The formation of Smear layer interferes with resin tag formation. The removal of Smear layer and smear plugs with acidic
solutions results in an increase of the fluid flow onto the exposed dentin surface interfering with adhesion

•Remaining Dentin thickness affects adhesion: Bond strengths are generally less in deep dentin than in superficial dentin.

•Other factors : Radius and length of the tubules,Viscosity of dentin fluid, molecular size of the substances dissolved in the
tubular fluid, etc.
 Concept of Dentin hybridization.
The Formation of hybridized dentin is the major mechanism of bonding
with current generation bonding systems.It is sandwiched between Dentin
and cured resin.
HYBRID LAYER Is the structure formed in dental hard tissues( enamel,
dentin, cementum) by demineralization of the surface and subsurface
followed by infiltration of monomers and subsequent Polymerisation.
(Nakabayashi, 1982)
•The resulting structure is neither resin nor tooth but a hybrid of the two.
•HYBRIDIZED DENTIN is formed by diffusion of monomers from the
adhesive interface into the demineralized dentin

• Depending on the chemistry of the bonding system,the hybrid layer

may vary from 0.1-5um thick.Following formation of hybridized dentin
and coupling with resin to the dentinal surface there is no space for
microleakage

•High quality hybridized dentin resists both acid and Proteolytic

challenge and should resist the development of recurrent caries, a very
important clinical goal..

Hybridization of dental hard tissues: Nakabayashi,1998 by

quintessence publishing.
Bonding of resin to dentin using an etch-and-rinse technique.
 DENTIN BONDING AGENTS
● THE BEGINNING: During the 1950s, it was reported that a resin containing
glycerophosphoric acid dimethacrylate (GPDM) could bond to a hydrochloric
acid etched dentin surface.

GENERATIONS OF DENTIN ADHESIVES

FIRST GENERATION
. The development of the surface-active comonomer NPG –GMA was the basis for
Cervident
MOA: Theoretically, this comonomer could chelate with calcium on the tooth surface
to generate water-resistant chemical bonds of resin to dentinal calcium.

sturdevants 4th edition

 Second Generation
● In 1978, the Clearfil Bond System F was introduced in japan
● A phosphate-ester material (phenyl-P and HEMA in ethanol).
● MOA: Based on the polar interaction between negatively charged phosphate
groups in the resin and the positively charged calcium in the smear layer .

THIRD GENERATION
● In 1979,the concept of phosphoric acid-etching of dentin before application of a
phosphate ester-type bonding agent was introduced by Fusayama and others
● MOA: Most third-generation materials were designed not to remove the entire smear
layer, bur rather to modify it and allow penetration of acidic monomers such as Phenyl-P
or PENTA.
● later on the removal of the smear layer with chelating agents, such as EDTA, was
recommended before the application of a solution of 5% glutaraldehyde
and 35% HEMA in water.
Fourth Generation (3 step)

● Introduced for use on acid-etched dentin.

● MOA: When primer and bonding resins are applied to etched dentin, they penetrate the intertubular
dentin, forming a resin-dentin interdiffusion zone, or "hybrid layer." They also penetrate and polymerize
in the open dentinal tubules, forming resin tags.
● Eg All-Bond 2 , OptiBond and Scotchbond MultiPurpose

Fifth Generation (2 step)

● simplification of the bonding procedure
● Eg One-Step ,Prime & Bond.
● MOA:Phosphoric acid treatment exposes a collagen network that is nearly devoid of hydroxyapatite.
Bonding occurs by diffusion and infiltration of the resin within the collagen mesh, forming a hybrid layer.

sturdevants 4th edition

phillips science of dental materials 12th edition
Sixth Generation (2 step)

● An acidic monomer which is not rinsed, is used to condition and prime the tooth at the same time
● 2 TYPES: Mild self-etch adhesives (pH = 2): only partially dissolve the dentin surface, so a substantial
amount of hydroxyapatite remains available within the hybrid layer.
Strong self-etch adhesives have low pH (<1) : Strong bonding mechanism that resembles the etch-
and-rinse adhesives.

Seventh Generation (1 step)

● Reduced and less complex number of clinical steps required compared with multistep etch-and-rinse
adhesives.
● Delivered by a bottle, vial, or single-unit dose applicator, which are formulated as a single
component.

Phillips science of dental materials 12th edition

 Developmental Anomalies of Dentin.
•DENTINOGENESIS IMPERFECTA( Hereditary opalescent Dentin)

-Caused by mutation in DSPP gene.

- Mesodermal portion of the odontogenic apparatus is disturbed.

- Colour of the teeth varies from a grey to brownish violet or yellowish brown

Shields classification

Type 1- DI that always occurs in families with osteogenesis imperfecta

Type 2- DI that never occurs in association with osteogenesis imperfecta

Type 3- Brandywine Types- shows clinical appearance of type 1 and type 2 and multiple Pulp exposure

in deciduous teeth.
R/F -Precocious obliteration of pulp chambers and root canals by
continued formation of dentin.Roots may be short and blunted.

Type 3 shows Shell teeth: Normal enamel,extremely thin

dentin,enormous pulp chambers due to insufficient dentin formation.

Textbook of oral pathology: Shafers,9th edition

 Dentin dysplasia

Rare disturbance of dentin formation characterised by

normal enamel,atypical dentin with abnormal pulpal morphology.

Witkop classification

•Type 1: Radicular Dentin dysplasia

-Normal morphologic appearance and

occasionally slight amber translucency.

-Delayed eruption

-Extreme mobility and premature exfoliation.

R/F: Periapical radiolucencies are common

H/F Lava flowing around boulders / Cascades of dentin.

Type 2: Coronal Dentin dysplasia

Deciduous teeth show yellow, bluish and grey opalescent appearance

Permanent teeth shows normal clinical appearance.

R/F- Thistle tube in permanent teeth

Amorphous and atubular dentin

in deciduous teeth.

Textbook of oral pathology: Shafers; 9th edition.

 Regional odontodysplasia/ Ghost teeth
•Unusual dentin anomaly in which one or several teeth in a localised area are affected in an
unusual manner.

•Maxillary teeth more frequently affected than mandibular teeth.

•Delay or total failure in eruption.

•Shape is markedly altered with evidence of defective mineralization.

•Marked reduction in amount of dentin,widening of predentin layer

,large areas of interglobular dentin & irregular tubular pattern.

R/F : Due to Marked reduction in radiodensity , the teeth assume a

“ Ghost appearance ’’

Textbook of oral pathology: Shafers,9th edition

 Effects of systemic Diseases on dentin

BONE AND JOINT DISEASES

OSTEOGENESIS IMPERFECTA
-Heterogenous group of genetic diseases with a predominantly autosomal dominant pattern of
inheritance.
-Basic defect lies in the organic matrix with failure of fetal collagen to be transformed into mature
collagen.

Effect on Dentin: Type 1 collagen being the primary collagen constituting dentin,OI causes abnormal
dentin formation affecting both the dentitions,in the form of opalascent Dentin.

Textbook of oral pathology:shafers;9th edition

 Hematological Disease
ERYTHROBLASTOSIS FETALIS

A congenital haemolytic anemia due to Rh incompatibility

results from the destruction of
foetal blood brought about by a reaction
between maternal and foetal blood factors

Effect on dentin: Deposition of blood pigments

in the enamel and dentin of the developing
teeth giving them a green,brown or blue hue.
The stain is intrinsic.

Textbook of oral pathology:shafers,9th edition.

 Diseases of the skin
Ectodermal Dysplasia

-Ectodermal dysplasia syndrome (EDS) is a large heterogenous group of inherited

disorders, the manifestations of which could be seen in more than one ectodermal
derivative.

-It results from aberrant development of ectodermal derivatives in early embryonic life.

Effect on Dentin: Frequent malformation of teeth,both deciduous and permanent

dentition, with truncated or cone shaped.

Textbook of oral pathology:shafers,9th edition.

 EHLERS -DANLOS SYNDROME

-EDS is the name given to a group of more than 10 different inherited

disorders,all involving a genetic defect in collagen and connective tissue
synthesis and structure.
-characterized by hypermobility,cutaneous fragility and hypextensibility.

Effect on Dentin:
Alterations in structure of teeth with lack of normal scalloping of the DE junction,
the passage of many dentinal tubules into the enamel, the formation of much
irregular dentin and increased density to form pulp stones.

Textbook of oral pathology:shafers,9th edition

 Metabolic Diseases
VITAMIN A

In vitamin A deficiency, ameloblasts fail to differentiate properly,their organising influence on

the adjacent mesenchymal cells is disturbed, and atypical dentin known as OSTEODENTIN is
formed.

In Root dentin: Premature loss of root sheath cells-no formation of odontoblasts hence no
formation of dentin.
Accessory canals formed;clinically significant in spread of infection either from
pulp to pdl or vice versa.

Textbook of oral pathology: Shafers;9th edition

 Vitamin D- Deficient Rickets

Characterized by hypomineralized bone matrix, ie

failure of endochondral calcification.

Effect on Dentin : Abnormally wide predentin zone

and much interglobular Dentin

Textbook of oral pathology: Shafers;9th edition.

 Vitamin C

In general, the action of vitamin C appears to be, to further the normal

development of intercellular ground substances in bone, dentin and other
connective tissues.

Effect on Dentin of scorbutic Guinea pig is the atrophy and disorganisation of

the Odontoblasts, resulting early in the deficiency state in the production of
irregularly laid down dentin with few, irregularly arranged tubules.
Eventually dentin formation ceases and the predentin becomes hypercalcified,
producing a heavy, basophilic staining line between dentin and pulp

Textbook of oral pathology: Shafers,9th edition.

PROGERIA

-A very rare disease originally described by Hutchinson in 1886.

-A protein called Progeria makes the nucleus unstable and this
cellular instability leads to premature ageing resulting in progeria
- Characterized by dwarfism and premature senility.

Effect on Dentin: Accelerated formation of Irregular secondary

dentin, apparently a manifestation of the premature aging process
and delayed eruption of teeth.

Textbook of oral pathology: Shafers, 9th edition.

 CONCLUSION
Dentin is a dynamic substance. A biologic approach to restorative
dentistry requires knowledge of the normal structure and physiology
of dentin, including age related changes.The vitality of Dentin- pulp
complex plays an important role in maintenance of a functional
dentition.Developing an understanding of the physiologic
dentinogenesis holds the key for a new biological era in restorative
dentistry.
REFERENCES
•Art and science of operative dentistry : Sturdevant,5th edition; mosby Inc.

•Oral anatomy, histology and embryology: B.K.B Berkovitz; 5th edition.

•Oral histology and embryology : Orbans; 14th edition.

•Ten cates Oral histology: Development,Structure and function: Antonio Nanci, 8th edition.

•Philips science of dental materials : Anusavice: 10th edition, Saunders.

•Pathways of the pulp: Cohen, 9th edition; mosby Inc

•A textbook of oral pathology : Shafers; 9th edition

•Oral histology, inheritance and development : Vincent Provenza; 2nd edition.

•Hybridization of dental hard tissues : Nakabayashi; 1998 by quintessence publishing.

THANK YOU