my 3rd seminar - dentin

8/10/2019 My 3rd Seminar - Dentin

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DENTIN

INTRODUCTION

DEVELOPMENT

BASIC STRUCTURE OF DENTIN

PHYSICAL PROPERTIES

CHEMICAL PROPERTIES

TYPES OF DENTIN

HISTOLOGY OF DENTIN

INNERVATION OF THE DENTIN

DEVELOPMENTAL DISTURBANCES OF DENTIN

AGE AND FUNCTIONAL CHANGES

CLINICAL CONSIDERATIONS

REFERENCES

CONCLUSION

Submitted by:

Dr A!"#um$! %#$it$!

De&t '( C'!" $!d E!d'

C'))e*e '( De!t$) S+ie!+e"

D$,$!$*ere

INTRODUCTION

-


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De!ti! &r',ide" t#e bu). $!d *e!er$) ('rm '( t#e t''t# $!d i" +#$r$+teri/ed $" $

#$rd ti""ue 0it# tubu)e" t#r'u*#'ut it" t#i+.!e"" It ('rm" ")i*#t)y be('re t#e

e!$me)1 it determi!e" t#e "#$&e '( t#e +r'0!2 i!+)udi!* t#e +u"&" $!d rid*e" $!d

t#e !umber $!d "i/e '( t#e r''t" A)'!* t#e +r'0!2 t#e de!ti! i" +',ered by

e!$me)2 $)'!* t#e r''t by +eme!tum It e!+)'"e" t#e de!t$) &u)&2 0it# 0#i+# it

"#$re" $ +'mm'! 'ri*i! (r'm t#e de!t$) &$&i))$ T#e de!ti! $!d &u)& +$! be

+'!"idered $" $ "i!*)e de,e)'&me!t$) $!d (u!+ti'!$) u!it2 '(te! de"+ribed $"

&u)&' de!ti!$) +'m&)e3

DEVELOPMENT

Dentinogenesis : It i" t#e &r'+e"" '( de!ti! ('rm$ti'! T#e de!ti! ('rm$ti'!

be*i!" i! )$te4be)) "t$*e De!ti!e i" ('rmed by t#e 'd'!t'b)$"t +e))" t#$t

di((ere!ti$te (r'm e+t'4me"e!+#ym$) +e))" '( de!t$) &$&i))$ T#u" de!t$) &$&i))$

i" $ ('rm$ti,e 'r*$! '( t#e de!ti! T#e de!t$) &u)& $)"' de,e)'&" (r'm de!t$)

&$&i))$ 0#i+# i" me"'derm$) i! 'ri*i!

De!ti!'*e!e"i" '++ur" i! t#e ('))'0i!* 5 "t$*e":

A6 Cyt'4di((ere!ti$ti'!

B6 M$tri3 ('rm$ti'!

C6 Mi!er$)i/$ti'!

Cytodifferentiation : T#i" "te& de"+ribe" #'0 'd'!t'b)$"t" di((ere!ti$te (r'm

u!di((ere!ti$ted e+t'me"e!+#ym$) +e))" Duri!* e$r)y t''t# de,e)'&me!t '( +e))"

'( de!t$) &$&i))$ re"emb)e" t#e ty&i+$) u!di((ere!ti$ted +e))" At t#e Be)) "t$*e '(

t''t# de,e)'&me!t $ di((ere!ti$ti'! '( 'd'!t'b)$"t" t$.e" &)$+e2 "t$rti!* $t +u"&$)

'r i!+i"$) re*i'! T#i" di((ere!ti$ti'! i" u!der t#e +'!tr') '( i!!er e!$me)

e&it#e)ium by e3&re""i!* ,$ri'u" *r'0t# ($+t'r" T#e +e)) +#$!*e" t#eir "#$&e

(r'm "#'rt +ub'id$) t' t$)) +')um!$r T#e !umber '( +e)) 'r*$!e))e" m$r.ed)y

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i!+re$"e" T#e !u+)eu" m',e" $0$y (r'm b$"eme!t membr$!e It re,er"e" t#e

&')$rity '( +e))" T#e"e +e))" $re +$))ed true 'd'!t'b)$"t" 0#i+# "e+rete &rede!ti!

O!+e t#e ('rm$ti'! '( &rede!ti! $t +u"&$)8 i!+i"$) re*i'! be*i!" t#e

di((ere!ti$ti'! '( !e0 'd'!t'b)$"t" t$.e" &)$+e (urt#er $&i+$))y i! de!t$) &$&i))$

I!iti$))y d$i)y i!+reme!t" '( $&&r'3im$te)y 9 m8d$y '( de!ti! ('rmed O!+e

+r'0! ('rm$ti'! +'m&)ete" t#e de!ti! ('rm$ti'! ")'0" d'0! t' -m 8 d$y T#e

r''t de!ti!e ('rm$ti'! re"emb)e" t#e +yt'4di((ere!ti$ti'! '( +r'0! but it re;uire"

&r')i(er$ti'! '( e&it#e)i$) "#e$t#


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C'm&re""i,e "tre!*t# '( de!ti! @ 9>2>>> @ >2>>> PSI

M'du)e" '( re"i)ie!+e '( ,it$) de!ti! @ ->>4-9> PSI

MATERIAL DENSITY

G8CM5

THERMAL

CONDUCTIVITY

B8M%

COEFFICIENT OF THERMAL

EPANSION RELATIVE TO

ENAMEL

DENTIN 7-9 > >

GIC 7- >-4>7 >

ENAMEL 79 >5 -

COMPOSITE -479 ->4-5 -7499

* Le"" t#erm$) +'!du+ti,e "#'0"

LOBER COEFFICIENT OF THERMAL EPANSION THAN ENAMEL

C"EMIC$L PROPERTIE

> 4 I!'r*$!i+ m$teri$)

7> 4 Or*$!i+ M$teri$)"

-> 4 $ter


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T#e i!'r*$!i+ "ub"t$!+e +'!"i"t" '( #ydr'3y$&$tite +ry"t$)" $!d "m$)) $m'u!t '(

'"$te2 +$rb'!$te" $!d "u)($te"

T#e 'r*$!i+ "ub"t$!+e +'!"i"t" '( ty&e4- +'))$*e! +'!t$i!i!* 7> '( m$tri3 0it#

&r'te'*)y+$!" bet0ee! t#e (ibre" N'! +'))$*e!'u" "u+# $" P#'"'&r'tei! $!d

Pr'te'*)+$!" Ot#er" $re Gr'0t# ($+t'r" 2 )i&id" $!d $+idi+ *)y&'&r'tei!"

NOTE:4Gr'0t# ($+t'r" i! de!ti!$) m$tri3 &)$y im&'rt$!t r')e i! ti""ue re&$ir

T#PE O! DENTIN

Primary dentin

T#e de!ti! t#$t ('rm" t#e i!iti$) "#$&e '( t#e t''t# i" +$))ed &rim$ry de!ti! It i"

u"u$))y +'m&)eted t#ree ye$r" $(ter t''t# eru&ti'!

Mantle dentin

M$!t)e de!ti! i" t#e !$me '( t#e (ir"t ('rmed de!ti! i! t#e +r'0! u!der)yi!* t#e

DE u!+ti'! It i" t#u" t#e 'uter


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I! "e+'!d$ry de!ti!2 t#e tubu)e" t$.e $ di((ere!t dire+ti'!$) &$tter! i! +'!tr$"t t'

&rim$ry de!ti!

Tertiary dentin

It i" $)"' re(erred $" $ re$+ti,e2 re&$r$ti,e2 irre*u)$r "e+'!d$ry de!ti! It

&r'du+ed i! re$+ti'! t' ,$ri'u" "timu)i )i.e +$rie"2 $ttriti'!2 +$,ity &re&$r$ti'!

et+ It i" &r'du+ed by +e))" 0#i+# $re dire+t)y $((e+ted by t#e "timu)u"

Re$+ti'!$ry


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"ITOLO O! DENTIN

Dentinal t'('les:

T#e de!ti!$) m$tri3 +'!t$i!" tubu)e"2 e$+# 'r 0#i+# r$!*e" (r'm $b'ut - t' 7m

i! di$meter $t it" 'uter e!d $!d 5 t' 9m $t it" &u)&$) "ide T#e !umber '(

tubu)e" i" $b'ut -2>>> 8mm7 !e$r t#e de!ti! e!$me) ?u!+ti'! $!d it i"

2>>>mm7!e$r t#e &u)&$) "ur($+e

T#e r$ti' bet0ee! t#e 'uter $!d i!!er "ur($+e" '( de!ti! i" $b'ut :-

A++'rdi!*)y tubu)e" $re ($rt#er $&$rt i! &eriery $!d m're +)'"e)y &$+.ed !e$r

t#e &u)&


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Enamel s)indles:

Ne$r t#e DE2 t#e de!ti!$) tubu)e di,ide" i!t' "e,er$) termi!$) br$!+#e" $!d

('rm" $! i!ter+'mmu!i+$ti!* $!d $!$t'mi/i!* !et0'r. S'me de!ti!$) tubu)e"

e3te!d i!t' t#e e!$me) ('r "e,er$) mi))imeter" T#e"e $re termed $" e!$me)

"&i!d)e"

Perit'('lar dentin:

T#e de!ti! t#$t immedi$te)y "urr'u!d" t#e de!ti!$) tubu)e" i" +$))ed &eritubu)$r

de!ti! T#i" de!ti! ('rm" t#e 0$))" '( t#e tubu)e" It i" m're #i*#)y mi!er$)i/ed

t#$! t#e i!tertubu)$r de!ti! It i" +'m&)ete)y br'.e! d'0! $!d di"$&&e$r" '!

bei!* "ub?e+ted t' r'uti!e de+$)+i(i+$ti'! met#'d"

Intert'('lar dentin:

T#e m$i! b'dy '( t#e de!ti! i" +'m&'"ed '( i!tertubu)$r de!ti! It i" )'+$ted

bet0ee! t#e de!ti!$) tubu)e" 'r bet0ee! t#e /'!e" '( &eritubu)$r de!ti!

A)t#'u*# it i" #i*#)y mi!er$)i/ed2 t#i" m$tri32 )i.e b'!e $!d +eme!tum i"

ret$i!ed $(ter de+$)+i(i+$ti'! Ab'ut '!e #$)( '( it" ,')ume i" 'r*$!i+ m$tri32

e"&e+i$))y +'))$*e! (ibre" t#$t $re r$!d'm)y 'rie!ted $r'u!d t#e de!ti!$) tubu)e"

T#e (ibre" #$,e $ )$tti+e )i.e $rr$!*eme!t +'ur"i!* i! *e!t)e +ur,e" bet0ee! t#e

tubu)e" $!d t#eir &eri4tubu)$r /'!e" Hydr'3y$&$tite +ry"t$)" $re ('rmed $)'!*

t#e (ibre" Pr',ide" te!"i)e "tre!*t# t' de!ti!

Inter glo('lar dentin:

S'metime" mi!er$)i/$ti'! '( de!ti! be*i!" i! "m$)) *)'bu)$r $re$" t#$t ($i) t'(u"e i!t' $ #'m'*e!'u" m$"" T#i" re"u)t" i! /'!e '( #y&'4mi!er$)i/$ti'!

bet0ee! t#e *)'bu)e" T#e"e /'!e" $re .!'0! $" i!ter*)'bu)$r de!ti! I!ter

*)'bu)$r de!ti! ('rm" i! t#e +r'0! '( teet# i! t#e +ir+um&u)&$) de!ti! ?u"t be)'0

t#e m$!t)e de!ti!2 $!d it ('))'0" t#e i!+reme!t$) &$tter! T#e de!ti!$) tubu)e"

&$"" u!i!terru&ted)y t#r'u*# i!ter*)'bu)$r de!ti!2 t#u" dem'!"tr$ti!* de(e+t" '(

mi!er$)i/$ti'! $!d !'t '( m$tri3 ('rm$ti'!


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Pre dentin:

Prede!ti! i" )'+$ted $d?$+e!t t' t#e &u)&$) ti""ue $!d i" 7m t' m 0ide It i"

t#e (ir"t ('rmed de!ti! $!d i" !'t mi!er$)i/ed A" t#e +'))$*e! (ibre" u!der*'

mi!er$)i/$ti'! $t t#e &re4de!ti! (r'!t2 t#e &rede!ti! t#e! be+'me" de!ti! $!d $

!e0 )$yer '( &rede!ti! ('rm" +ir+um&u)&$))y NOTE:4)'"" '( &rede!ti! i" '!e '(

t#e ($+t'r" ('r i!ter!$) re"'r&ti'!

&ran'lar layer:

#e! dry *r'u!d "e+ti'! '( t#e r''t de!ti! i" ,i"u$)i/ed i! tr$!"mitted )i*#t2

t#ere i" $ /'!e $d?$+e!t t' t#e +eme!tum t#$t $&&e$r" *r$!u)$r T#i" i" .!'0! $"

t'me" *r$!u)$r )$yer 'r #y$)i!e )$yer '( H'&e0e)) "mit# T#i" /'!e i!+re$"e"

")i*#t)y i! $m'u!t (r'm t#e Ceme!t'e!$me) ?u!+ti'! t' t#e r''t $&e3 $!d i"

be)ie,ed t' be +$u"ed by $ +'$)e"+i!* $!d )''&i!* '( t#e termi!$) &'rti'!" '( t#e

de!ti!$) tubu)e"

T#e +$u"e '( de,e)'&me!t '( t#i" /'!e i" &r'b$b)y "imi)$r t' t#e br$!+#i!* $!d

be,e)i!* '( t#e tubu)e" $t t#e de!ti!'e!$me) ?u!+ti'!" It Ser,e" t' b'!d

+eme!tum t' de!ti!

In%remental Lines:

T#e i!+reme!t$) )i!e" ,'! eb!er 'r imbri*$ti'! )i!e" 'r Stri$ '( Ret/iu" $&&e$r

$" (i!e )i!e"


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Conto'r lines of o*en:

O++$"i'!$))y "'me '( t#e i!+reme!t$) )i!e" $re $++e!tu$ted be+$u"e '( t#e

di"turb$!+e" i! t#e m$tri3 $!d mi!er$)i/$ti'! &r'+e"" Su+# )i!e" $re re$di)y

dem'!"tr$ted i! *r'u!d "e+ti'!" $!d $re .!'0! $" +'!t'ur )i!e" T#e m'"t

+'!"i"te!t)y "ee! +'!t'ur )i!e" $re $t t#e ?u!+ti'! '( t#e &rim$ry $!d "e+'!d$ry

de!ti!

Neonatal lines:

I! t#e de+idu'u" teet# $!d i! t#e (ir"t &erm$!e!t m')$r"2 0#ere de!ti! i" ('rmed

&$rt)y be('re $!d &$rt)y $(ter birt#2 t#e &re!$t$) $!d &'"t!$t$) de!ti! $re

"e&$r$ted by $! $++e!tu$ted +'!t'ur )i!e T#i" i" termed $" !e'!$t$) )i!e $!d i"

"ee! i! e!$me) $!d $" 0e)) $" de!ti!

T#i" )i!e re()e+t" t#e $bru&t +#$!*e i! t#e e!,ir'!me!t t#$t '++ur" $t birt# T#e

de!ti! m$tri3 ('rmed &ri'r t' birt# i" u"u$))y '( better ;u$)ity t#$! t#$t ('rmed

$(ter birt# $!d !e'!$t$) )i!e m$y be $ /'!e '( #y&' +$)+i(i+$ti'!

Odonto(lasts:

T#e +e))"2 0#i+# $re re)$ted t' t#e de&'"iti'! '( de!ti!2 $re t#e 'd'!t'b)$"t" T#e

'd'!t'b)$"t" $re $ )$yer '( "&e+i$)i/ed +e))"2 0#i+# )ie '! t#e "ur($+e '( t#e &u)&

$*$i!"t t#e i!ter!$) "ur($+e '( t#e de!ti!

I! $ (u))y ('rmed t''t#2 t#e 'd'!t'b)$"t" $re $rr$!*ed $t $ "i!*)e )$yer '( +)'"e)y

&$+.ed +e))"2 0#i+# $re &yri('rm i! "#$&e E$+# 'd'!t'b)$"t &'""e""e" $ )'!*

&r'+e""


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INNERV$TION O! DENTIN

Intert'('lar ner+es:

De!ti!$) tubu)e" +'!t$i! !umer'u" !er,e e!di!*" i! t#e &rede!ti! $!d i!!er

de!ti! !' (urt#er t#$! ->> t' -> m (r'm t#e &u)& M'"t '( t#e"e "m$))

,e"i+u)$ted e!di!*" $re )'+$ted i! t#e tubu)e" i! t#e +'r'!$) /'!e2 "&e+i(i+$))y i!

t#e &u)& #'r!" T#e !er,e" $!d t#eir termi!$)" $re ('u!d i! +)'"e $""'+i$ti'! 0it#

t#e 'd'!t'b)$"t &r'+e"" 0it#i! t#e tubu)e It i" be)ie,ed t#$t m'"t '( t#e"e $re

termi!$) &r'+e""e" '( t#e mye)i!$ted !er,e (ibre" '( t#e de!t$) &u)&

DEVELOPMENT$L DITUR,$NCE O! DENTIN:

De!ti!'*e!e"i" im&er(e+t$

De!ti! dy"&)$"i$

Re*i'!$) 'd'!t'dy"&)$"i$

Dentinogenesis im)erfe%ta -.ereditary o)ales%ent dentin/

T#i" $!'m$)y '++ur" 0#e! me"'derm$) &'rti'! '( t#e 'd'!t'*e!i+ $&&$r$tu" i"

$((e+ted It i" +)$""i(ied by S#ie)d" $!d #i" +'0'r.er" i!t':

Type I @ It i" $)0$y" $""'+i$ted 0it# '"te'*e!e"i" im&er(e+t$ It i" $! $ut'"'m$)

d'mi!$!t tr$it2 but "'me time re+e""i,e $)"'

Type II @ It !e,er '++ur i! $""'+i$ti'! 0it# OI It i" $)"' +$))ed #eredit$ry

'&$)e"+e!t de!ti! It i" $! AD tr$it

Type III@ It i" KBr$!dy 0i!e ty&e It i" $ut'"'m$) d'mi!$!t

T#i" $!'m$)y m$i!)y $((e+t" de+idu'u" teet# t#$! t#e &erm$!e!t2 i! Ty&e I But

i! Ty&e II2 Ty&e III b't# t#e de!titi'!" $re $((e+ted

T#e +')'ur '( t#e teet# r$!*e" (r'm *r$y t' ye))'0i"# br'0! T#e"e teet# "#'0

u!u"u$) tr$!")u+e!+y 'r '&$)e"+e!t #ue T#e e!$me) (r$+ture '++ur" e$r)y due t'

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t#e $b!'rm$) DE2 0#ere !'rm$) "+$))'&i!* i" $b"e!t T#e de!ti! u!der*'e"

r$&id $ttriti'!


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Type I Radicular: T#e r''t" $re "#'rt $!d b)u!t I! de+idu'u" de!titi'! t#ere i" $

+'m&)ete 'r &$rti$) 'b)iter$ti'! '( &u)& +#$mber I! &erm$!e!t teet# +re"+e!t

"#$&ed &u)& +#$mber i" "ee!

Type II Coronal: T#e &u)& +#$mber" $re 'b)iter$ted i! de+idu'u" t''t# $" i! ty&e

I T#e &erm$!e!t teet# "#'0 $b!'rm$) )$r*e &u)& +#$mber i! +'r'!$) &'rti'!

de"+ribed $" t#i"t)e tube $&&e$r$!+e Sm$)) &u)& "t'!e" $re $)"' "ee! i! t#e

+#$mber

"istologi%al feat'res:

It "#'0" tubu)$r de!ti!2 '"te'de!ti! $!d (u"ed de!ti+)e" T#e &u)& +#$mber i"

'b)iter$ted N'rm$) de!ti! ('rm$ti'! i" b)'+.ed "' t#e de!ti! ('rm$ti'! '++ur

$r'u!d t#e 'b"t$+)e" *i,i!* +#$r$+teri"ti+ $&&e$r$!+e +$))ed K)$,$ ()'0i!*

$r'u!d b'u)der"

Regional odontodys)lasia or &.ost teet.

T#e m$3i))$ry $!teri'r" $re m're +'mm'!)y i!,'),ed #ere It $((e+t" b't#

de!titi'! T#e eti')'*y '( di"e$"e i" u!.!'0! but it i" t#'u*#t t#$t it +'u)d be

due t' $ )$te!t ,iru" i! 'd'!t'*e!i+ e&it#e)ium2 0#i+# be+'me $+ti,e i!

"ub"e;ue!t &eri'd

T#e teet# $((e+ted "#'0" de)$y 'r ($i)ure '( eru&ti'! T#e "#$&e '( teet# i"

$)tered2 0it# irre*u)$r mi!er$)i/$ti'!

R$di'*r$i+$))y teet# "#'0 m$r.ed redu+ti'! i! r$di'de!"ity *i,e" KG#'"t teet#

$&&e$r$!+e T#e e!$me) $!d de!ti! i" ,ery t#i! $!d &u)& +#$mber i" u"u$))y

)$r*e Hi"t')'*i+$))y +#$r$+teri/ed by $ m$r.ed redu+ti'! i! t#e $m'u!t '(

de!ti!2 0ide!i!* '( &rede!ti! )$yer $!d )$r*e $re$" '( i!ter*)'bu)$r de!ti! 0it#

irre*u)$r tubu)$r &$tter! Due t' &''r +'"meti+ $&&e$r$!+e e3tr$+ti'! '( teet#

$!d re"t'r$ti'! 0it# &r'"t#eti+ $&&)i$!+e" i" u"u$))y i!di+$ted

$&E $ND !UNCTION$L C"$N&E

i Vit$)ity '( de!ti!

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ii Re&$r$ti,e de!ti!

iii De$d tr$+t"

i, S+)er'ti+ 'r tr$!"&$re!t de!ti!

Vitality of dentin:

Si!+e t#e 'd'!t'b)$"t $!d it" &r'+e"" $re $! i!te*r$) &$rt '( t#e de!ti!2 t#ere i"

!' d'ubt t#$t de!ti! i" ,it$) ti""ue I( ,it$)ity i" u!der"t''d t' be t#e +$&$+ity '(

t#e ti""ue t' re$+t t' y"i')'*i+ $!d &$t#')'*i+ "timu)i2 de!ti! mu"t be

+'!"idered $ ,it$) ti""ue

De!ti! i" )$id d'0! t#r'u*#'ut )i(e2 $)t#'u*# $(ter t#e teet# #$,e eru&ted $!d

#$,e bee! (u!+ti'!i!* ('r $ "#'rt time2 de!ti!'*e!ei" ")'0" $!d (urt#er de!ti!

('rm$ti'! i" $t $ mu+# ")'0er r$te

Re)arati+e dentin:

I( by e3te!"i,e $br$"i'!2 er'"i'!2 +$rie" 'r '&er$ti,e &r'+edure"2 t#e 'd'!t'b)$"t

&r'+e"" $re e3&'"ed 'r +ut2 t#e 'd'!t'b)$"t" die 'r i( t#ey )i,e2 de&'"it re&$r$ti,e

de!ti! T#e 'd'!t'b)$"t" t#$t $re .i))ed $re re&)$+ed by t#e mi*r$ti'! '(

u!di((ere!ti$ted +e))" $ri"i!* i! dee&er re*i'!" '( t#e &u)&

Re&$r$ti,e de!ti! i" +#$r$+teri/ed $" #$,i!* (e0er $!d m're t0i"ted tubu)e" t#$!

de!ti!

Dead tra%ts:

I! dried *r'u!d "e+ti'!" '( !'rm$) de!ti! t#e 'd'!t'b)$"t &r'+e""e" di"i!te*r$te

$!d t#e em&ty tubu)e" $re (i))ed 0it# $ir T#ey $&&e$r b)$+. i! tr$!"mitted )i*#t

$!d 0#ite i! re()e+ted )i*#t T#ey e3te!d (r'm t#e DE t' t#e +'rre"&'!di!* $re$

'( de!ti! &u)& i!ter($+e I! m'"t i!"t$!+e"2 t#e de$d tr$+t" $re "e$)ed $t t#eir

&u)&$) $"&e+t by t#e ('rm$ti'! '( re&$r$ti,e de!ti! T#e"e $re$" dem'!"tr$te

de+re$"ed "e!"iti,ity $!d $&&e$r t' $ *re$ter e3te!t i! ')der teet#

%leroti% 1 trans)arent dentin:

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16/25

I! +$"e '( +$rie"2 $br$"i'!2 er'"i'!2 +$,ity &re&$r$ti'!2 "u((i+ie!t "timu)i $re

*e!er$ted t' +$u"e +'))$*e! (ibre" $!d $&&$tite +ry"t$)" t' (i)) t#e tubu)e" 0it# $

(i!e me"#0'r.2 t#u" 'b)iter$ti!* it Su+# +$)+i(ied tubu)$r "&$+e $""ume" $

di((ere!+e i! re(r$+ti,e i!de3 be+'mi!* tr$!"&$re!t 0#i+# i" 'b"er,ed i! t#e

teet# '( e)der)y &e'&)e e"&e+i$))y i! t#e r''t" It i" $)"' ('u!d u!der ")'0)y

&r'*re""i!* +$rie" redu+i!* t#e &erme$bi)ity '( de!ti! $!d m$y &r')'!* &u)&

,it$)ity

CLINIC$L CONIDER$TION

Dentinal %aries

Pr'*re""i'! '( +$rie" i! de!ti! i" di((ere!t (r'm &r'*re""i'! i! t#e ',er)yi!*

e!$me)


17/25

76 '!e 7: Subtr$!"&$re!t de!ti!

56 '!e 5: Tr$!"&ere!t de!ti!

96 '!e 9: Turbid de!ti!

6 '!e: I!(e+ted de!ti!

$ffe%ted and infe%ted dentin

A((e+ted de!ti! i" "'(te!ed2 demi!er$)i/ed de!ti! t#$t i" !'t yet i!,$ded by

b$+teri$ T#e $((e+ted de!ti! i" +$&$b)e '( re4mi!er$)i/$ti'! It m$y be )e(t i!

&)$+e duri!* '&er$ti,e &r'+edure I!(e+ted de!ti! i" b't# "'(te!ed $!d

+'!t$mi!$ted 0it# b$+teri$ It "#'u)d be +'m&u)"'ri)y rem',ed duri!* '&er$ti,e

&r'+edure

Dentine )ermea(ility

T#e "tru+ture '( de!ti!e i" tubu)$r2 $" &re,i'u")y "t$ted2 $!d it i" t#i" +#$r$+teri"ti+ t#$t

&r',ide" t#e +#$!!e)" ('r t#e &erme$ti'! '( "')ute" $!d "'),e!t" $+r'"" de!ti!e

De!ti!e &erme$bi)ity +$! be "ub di,ided i!t' t0' br'$d +$te*'rie"


18/25

Perme$bi)ity '( '++)u"$) de!ti! i" #i*#er ',er t#e &u)& #'r!" t#$! $t t#e +e!ter '( t#e

'++)u"$) "ur($+e2 &r'3im$) de!ti! i" m're &erme$b)e t#$! '++)u"$) de!ti!2 $!d t#e

+'r'!$) de!ti! i" m're &erme$b)e t#$! r''t de!ti!

Prote%ti+e f'n%tion of dentin

A .ey (u!+ti'! '( e!$me) $!d de!ti! i" t#erm$) i!"u)$ti'! '( &u)& M'"t

re"t'r$ti,e m$teri$)" $re !'t $" i!"u)$ti!* $" de!ti! $!d t#erm$) i!"u)t" m$y

'++ur duri!* i!tr$'r$) tem&er$ture +#$!*e" T#e !eed ('r t#erm$) i!"u)$ti'! i"

*re$te"t ('r met$))i+ re"t'r$ti'!" T#erm$) i!"u)$ti'! i" &r'&'rti'!$) t' t#e

t#i+.!e"" '( i!"u)$ti!* m$teri$) A&&r'3im$te)y 7mm '( de!ti! 'r $! e;ui,$)e!t

t#i+.!e"" '( m$teri$) "#'u)d e3i"t t' &r'te+t t#e &u)&

B$+teri$) t'3i!"2 "tr'!* dru*"2 u!due '&er$ti,e tr$um$2 u!!e+e""$ry t#erm$)

+#$!*e" 'r irrit$ti!* re"t'r$ti,e m$teri$)" "#'u)d !'t i!"u)t t#e +e))" '( t#e

e3&'"ed de!ti! It "#'u)d be remembered t#$t 0#e! - mm 7'( de!ti! i" e3&'"ed2

$b'ut 5>2>>> )i,i!* +e))" $re d$m$*ed It i" $d,i"$b)e t' "e$) t#e e3&'"ed de!ti!

"ur($+e 0it# $ !'!4irrit$ti!* i!"u)$ti!* "ub"t$!+e

LINERS: )i!er" $re t#i! )$yer" '( m$teri$) u"ed &rim$ri)y t' &r',ide $ b$rrier t' &r'te+t t#e de!ti!

(r'm re"idu$) re$+t$!t" di((u"i!* 'ut '( $ re"t'r$ti'! $!d 'r 'r$) ()uid"2 0#i+# m$y &e!etr$te

)e$.y t''t# re"t'r$ti'! i!ter($+e" t#ey $)"' +'!tribute i!iti$) e)e+tri+ i!"u)$ti'! $!d *e!er$te

"'me t#erm$) &r'te+ti'! t#e !eed ('r )i!er" i" *re$te"t 0it# met$))i+ re"t'r$ti'!" t#$t $re !'t 0e))

b'!ded t' t''t# "tru+ture $!d 0#i+# $re !'t i!"u)$ti!*2 "u+# $" $m$)*$m $!d +$"t *')d

BASES : t#ey re&)$+e t#e mi""i!* de!ti! $!d &r',ide t#erm$) i!"u)$ti'! t' t#e

&u)& T#ey $re &)$+ed i! $ t#i+.!e"" '( > t' 7 mm $!d t#ey #$,e "u((i+ie!t

"tre!*t# t' "u&&'rt t#e ',er)yi!* re"t'r$ti'!

P'l) 2 %a))ing

Pu)& +$&&i!* i" t#e &r'+edure by 0#i+# $ )$yer '( +$)+ium #ydr'3ide i" &)$+ed

',er $ t#i! )$yer de!ti! rem$i!i!* ',er t#e &u)&

-


19/25

Indire%t )'l) %a))ing

I( $ t#i! )$yer '( de!ti! "ti)) rem$i!" t#e! t#e &r'+edure i" +$))ed i!dire+t &u)&

+$&&i!*

Dire%t )'l) %a))ing

#e! +$)+ium #ydr'3ide i" &)$+ed dire+t)y ',er t#e e3&'"ed &u)&$) ti""ue $!d

t#e "urr'u!di!* dee&)y e3+$,$ted de!ti!$) $re$

T#e te+#!i;ue '( i!dire+t $!d dire+t &u)& +$&&i!* i" +$rried 'ut t' i!du+e

re&$r$ti,e de!ti! ('rm$ti'! by t#e ,it$) &u)& ti""ue C$)+ium #ydr'3ide tr$!"mit"

$ )'+$) "t$te '( $).$)i!ity t#$t i" !e+e""$ry ('r de!ti! ('rm$ti'! T#e +$)+ium ('r

t#e de!ti! brid*e ('rm$ti'! +'me" (r'm t#e b)''d "tre$m

Dentinal .y)ersensiti+ity

T#e de!ti! i" #i*#)y "e!"iti,e ti""ue t#$t di((er" (r'm 't#er "e!"iti,e ti""ue" i!

t#e b'dy I! de!ti!2 di((ere!t "timu)i +$u"e '!)y &$i! E3&'"ure '( #y&er"e!"iti,e

de!ti! $ri"e" (r'm eit#er t#e rem',$) '( t#e +'r'!$) e!$me) 'r $ de!ud$ti'! '(

t#e r''t "ur($+e by t#e )'"" '( +eme!tum $!d t#e ',er)yi!* &eri'd'!t$)

"tru+ture" It i" !'te0'rt#y t#$t !'t $)) e3&'"ed de!ti!$) "ur($+e e3#ibit

#y&er"e!"iti,e "ym&t'm" F$+t'r "u+# $" $*e2 r$te '( e3&'"ure2 $!d t#e e((e+t '(

!$tur$))y '++urri!* 'r e!,ir'!me!t$) de"e!"iti/i!* me+#$!i"m" $((e+t" t#e !$ture

'( t#e "e!"iti,ity

T.eories of dentin sensiti+ity:

DIRECT NEURAL STIMULATION THEORY

TRANSDUCTION THEORY

HYDRODYNAMIC THRORY

Dire+t !eur$) "timu)$ti'! t#e'ry

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20/25

It 0$" &r'&'"ed by S+'tt Ste))$ It "t$te" t#$t "timu)i i! "'me m$!!er


21/25

U"e '( t'&i+$) $*e!t" +'!t$i!i!* &'t$""ium !itr$te2 "i),er !itr$te2 CPP @ ACP2

()u'ride"2 '3$)$te" et+

P)$+eme!t '( re"t'r$ti,e m$teri$) "u+# $" *)$"" i'!'mer +eme!t

Dentin (onding

#i)e b'!di!* t' e!$me) i" &redi+t$b)e2 b'!di!* t' de!ti! i" !'t "' e$"y De!ti!

b'!di!* i" di((i+u)t due t' t#e ('))'0i!* re$"'!":

De!ti! i" $ dy!$mi+ ti""ue t#$t "#'0" +#$!*e" due t' $*i!*2 +$rie" 'r

re"t'r$ti,e &r'+edure"

It #$" +'!"ider$b)e $m'u!t '( 'r*$!i+ m$teri$) $!d 0$ter 0#e! +'m&$red t'

e!$me)

De!ti!$) tubu)e" $re (i))ed 0it# de!ti!$) ()uid

Cut de!ti! "ur($+e i" +',ered by $ "me$r )$yer t#$t b)'+." t#e de!ti!$) tubu)e"

$!d redu+e" it" &erme$bi)ity

De!ti! i" i! +)'"e &r'3imity t' t#e &u)&2 "' di((ere!t +#emi+$)" u"ed ('r

et+#i!* $!d b'!di!* m$y irrit$te t#e &u)&

R')e '( "me$r )$yer i! de!ti! b'!di!*:

T#e "me$r )$yer i" $! $m'r'u"2 re)$ti,e)y "m''t# )$yer '( mi+r'+ry"t$))i!e

debri"2 0#i+# $&&e$r" '! $)) +ut "ur($+e '( t#e de!ti! re*$rd)e"" '( t#e +utti!*

&r'+edure u"ed

It #$" 7 +'m&'!e!t":

- T#e "u&er(i+i$) "me$r )$yer

7 Sme$r &)u*" t#$t '++)ude t#e de!ti!$) tubu)e"

7-


22/25

It +$!!'t be "ee! 0it# t#e !$.ed eye #et#er 'r !'t t#e "me$r )$yer "#'u)d be

)e(t i! &)$+e i" $ m$tter '( +'!tr',er"y O!e ,ie0 i" t#$t t#e "me$r )$yer "#'u)d

be )e(t i! &)$+e be+$u"e it e((e+ti,e)y "e$)" t#e de!ti!$) tubu)e" Rem',$) '( t#e

"me$r )$yer by $+id tre$tme!t 0'u)d '&e! $!d 0ide! t#e tubu)e" $b'ut t#ree (')d

$t t#e "ur($+e T#i" 0'u)d *re$t)y i!+re$"e de!ti! &erme$bi)ity T#e 't#er ,ie0 i"

t#$t t#e "me$r )$yer +'!t$i!" mi+r''r*$!i"m2 0#i+# 0'u)d mu)ti&)y $!d &r'du+e

i!(e+ti'! i( )e(t $)'!e M're',er t#e "me$r )$yer 0'u)d &re,e!t &r'&er b'!di!*

'( re"t'r$ti,e m$teri$) t' t#e de!ti!$) 0$)) by "er,i!* $" $ b$rrier t' t#e

&e!etr$ti'! '( re"i! t' t#e u!der)yi!* de!ti! "ub"tr$te

Re+e!t *e!er$ti'!" '( de!ti! $d#e"i,e" i!,'),e" m'di(i+$ti'! '( t#e "me$r )$yer

t' im&r',e t#e b'!d "tre!*t# t' de!ti!

C'!diti'!i!* '( de!ti!:

C'!diti'!i!* '( de!ti! i" de(i!ed $" $!y $)ter$ti'! '( de!ti! d'!e $(ter t#e

+re$ti'! '( de!ti! +utti!* debri"2 termed t#e "me$r )$yer

T#e 'b?e+ti,e '( de!ti! +'!diti'!i!* i" t' +re$te $ "ur($+e +$&$b)e '( mi+r'

4me+#$!i+$) $!d &'""ib)y +#emi+$) b'!di!* t' $ de!ti!4b'!di!* $*e!t

C'!diti'!i!* '( de!ti! m$y be d'!e by "e,er$) me$!":

C#emi+$)"

4 A+id" )i.e '"'ri+ $+id2 m$)ei+ $+id2 +itri+ $+id et+

4 C$)+ium C#e)$t'r" )i.e EDTA

T#erm$) +'!diti'!i!* u"i!* )$"er"

Me+#$!i+$) +'!diti'!i!* u"i!* $br$"i,e"

77


23/25

A+id et+#i!* '( de!ti!:

E$r)ier $+id tre$tme!t 0$" em&)'yed '!)y '! e!$me) $!d !'t '! de!ti! be+$u"e '( t#e (e$r '(

&u)&$) d$m$*e A(ter Fu"$y$m$=" re"e$r+# '! t't$) et+#i!* 0it# 5 '"'ri+ $+id2 t#e

&r't'+') ('r "imu)t$!e'u" et+#i!* '! e!$me) $!d de!ti! i" bei!* 0ide)y $++e&ted

G'$)" '( $+id et+#i!* '( de!ti!:

- M'di(i+$ti'! '( t#e "me$r )$yer t' &ermit b'!di!* t' u!der)yi!* de!ti!

7 Demi!er$)i/e t#e "u&er(i+i$) de!ti! m$tri3 t' &ermit re"i! i!(i)tr$ti'! i!t'

"ur($+e

5 U!+',er b't# i!tertubu)$r $!d &eritubu)$r de!ti!

9 C)e$! t#e de!ti! "ur($+e (ree '( $!y bi'(i)m"

Hybrid )$yer :

C'!+e&t '( #ybrid )$yer 0$" &r'&'"ed by NA%ABAYASHI

T#i" i" t#e /'!e 0#ere t#e $d#e"i,e re"i! '( t#e de!ti! b'!di!* $*e!t

mi+r'me+#$!i+$))y i!ter)'+." 0it# t#e i!tertubu)$r de!ti! $!d t#e "urr'u!di!*

+'))$*e! (iber" T#e #ybrid )$yer i" ('rmed i! t#e ('))'0i!* m$!!er:

Et+#i!* rem',e" t#e "me$r )$yer $!d e3&'"e" t#e +'))$*e! (ibri)"

Primer" &e!etr$te" t#e +'))$*e! !et0'r.

Ad#e"i,e re"i!" $)'!* 0it# t#e &rimer" ('rm re"i! mi+r't$*" 0it#i! t#e

i!tertubu)$r de!ti! $!d "urr'u!d t#e +'))$*e! (iber" u&'! +uri!*

T#e #ybrid )$yer i" $)"' +$))ed $" t#e re"i! rei!('r+ed )$yer= 'r t#e re"i! de!ti!i!terdi((u"i'! /'!e=

M'i"t ," dry de!ti! "ur($+e" :

Vit$) de!ti! i" i!#ere!t)y 0et1 t#ere('re2 +'m&)ete dryi!* '( de!ti! i" di((i+u)t t'

$+#ie,e +)i!i+$))y T#e u"e '( $d#e"i,e "y"tem" '! m'i"t de!ti! i" m$de &'""ib)e

by i!+'r&'r$ti'! '( t#e 'r*$!i+ "'),e!t" $+et'!e 'r et#$!') i! t#e &rimer" 'r

$d#e"i,e" Be+$u"e t#e "'),e!t +$! di"&)$+e 0$ter (r'm b't# t#e de!ti! "ur($+e

$!d t#e m'i"t +'))$*e! !et0'r.2 it &r'm'te" t#e i!(i)tr$ti'! '( re"i! m'!'mer"

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24/25

t#r'u*#'ut t#e +'))$*e! !et0'r. T#e 0et b'!di!* te+#!i;ue #$" bee! "#'0!

re&e$ted)y t' e!#$!+e b'!d "tre!*t#" be+$u"e 0$ter &re"er,e" t#e &'r'"ity '(

+'))$*e! !et0'r. $,$i)$b)e ('r m'!'mer i!terdi((u"i'! I( t#e de!ti! "ur($+e i"

dried 0it# $ir2 t#e +'))$*e! u!der*'e" immedi$te +'))$&"e $!d &re,e!t" re"i!

m'!'mer" (r'm &e!etr$ti!* it T#u" e3+e"" 0$ter $(ter $+id et+#i!* $!d ri!"i!*

"#'u)d be rem',ed 0it# $ d$m& +'tt'! &e))et2 bu"# 'r $ ti""ue &$&er $!d $ir

dryi!* "#'u)d be $,'ided

RE!ERENCE

Orb$!": Or$) Hi"t')'*y $!d Embr')'*y

Or$) A!$t'my Hi"t')'*y $!d Embry')'*y: Ber.',it/

Or$) Hi"t')'*y: $me" % A,ery

Or$) Hi"t')'*y: Te!+$te

De!t$) Pu)&: Se)t/er $!d Be!der

O&er$ti,e De!ti"try: Sturde,$!t

O&er$ti,e de!ti"try 4 M'der! t#e'ry $!d &r$+ti+e: M$r/'u.

Te3t b''. '( '&er$ti,e de!ti"try 4 Vim$) Si.ri

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25/25

CONCLUION

T#e +'m&)e3ity '( de!ti!$) "tru+ture" m$.e" re"t'r$ti,e $!d re#$bi)it$ti,e

&r'+edure" #i*#)y +#$))e!*i!* T#u" it i" im&er$ti,e t#$t e,ery +)i!i+i$! "#'u)d

$""imi)$te $!d $&&)y t#e .!'0)ed*e '( de!ti!$) #i"t')'*y $!d m'r')'*y t'

'bt$i! "u++e""(u) +)i!i+$) re"u)t

my 3rd seminar - dentin

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