Transcribed by Chris Bedoya Craniofacial Biology Lectures 29 Dentin II by Dr.

Wishe

April 28, 2014

Slide 1 Fig 4-3 Tubules Branching Good morning. Today were going to finish our discussion of dentin, then there will be a CCP on enamel defects, by Dr. Page Caulfield. Hes into various aspects of dentistry, a little histology, some microbiology, some biochemistry, etc. This was almost the last picture we looked at, then I had to advance the slides to get to my animal picture in the middle of the lecture. Slide 2 Fig 8-31 Dentin Incremental Lines and Tetracycline Staining Today were going to start off the discussion with incremental lines. And incremental means to add on, and that occurs with both enamel, and dentin, and cementum. Youre always adding on more tissue. Incremental lines are more or less a general term, and some folks just use that term but I dont think thats specific enough. Since we are in dentin, were going to start off our discussion with the Contour Lines of Owen, the neonatal lines, and the lines of von Ebner. And the counterparts of enamel, we have Lines of Retzius, in dentin we have Contour Lines of Owen. In enamel daily incremental lines, and in dentin Lines of von Ebner. And both tissues have a neonatal line. And theyre all caused by disturbances in terms of growth and mineralization, during the development of the individual. As you look at these pictures, you can see these lines in your dentin. Much more dramatic as you look at an actual tooth. And if you try to follow this line (draws a horizontal line in dentin) it follows essentially the contour of the tooth. And its shown much better in this diagrammatic version. Again its the same philosophy why they happen; something causes a disturbance in the growth and mineralization, as a result you dont get the right amount of mineralizations, and these lines are actually hypomineralized structures. Slide 3 Fig 4-13 Lines of Owen Another section of a different tooth. And this one is quite, vary dramatic here. And here youre going around the pulp horns and everything. While we have this picture, you can see part of the enamel has been eaten away here, and the surface seems a little too flat. That means part of the enamel also has disappeared from the occlusal surface. This is actually your pulp chamber, and you see in this particular region a pulp horn. One on the other side seems to be much smaller in nature. Slide 4 Fig 8-11 Contour Lines of Owen High power of your Contour Lines of Owen. A little different type of lighting scenario makes these lines really stand out quite well. Again, just keep in mind that theyre hypomineralized lines. Slide 5 Fig 4-14 Neonatal Line Now heres our neonatal line in terms of dentin. The neonatal line whether were talking enamel or dentin, is really an exaggerated Line of Retzius, or Contour Line of Owen. This is the difference between the environments, the feeding pattern, before 1

Transcribed by Chris Bedoya

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birth vs. after birth. So as we look at this picture this represents your pulp, your odontoblast would be located over here (on right side at border of pulp and postnatal dentin). The enamel is not really shown, should be in this neck of the woods (far left). Looks like a space, so its probably the enamel space. And this is the region where you have your DEJ. So the dentin thats closest to the DEJ is actually the oldest dentin, and the dentin closest to the odontoblast represents the newest dentin. Young, old. And this is the neonatal line, not very impressive in this picture, but is essentially just a thickened Contour Line of Owen, which separates pre- vs. postnatal dentin formation. Slide 6 Fig 9-15 Von Ebner This is kind of neat. What youre actually seeing in a horizontal position happens to be the dental tubules. Then youll see these lines perpendicular to the dental tubules, let me draw that separately (draws horizontal ladder in margin), this sort of looks like a ladder. And thats how I illustrated the enamel rods also, in terms of the rods vs. your daily incremental lines. Just in enamel I had the ladder extending in this direction (vertical ladder). So theres a certain amount of dentin that forms on a daily basis, and that gives you the slight interruptions in growth and mineralizations And then you have larger areas of dentin, just as in enamel, where you have a larger amount of growth, and then theres something that goes wrong or stops the process of mineralization. Slide 7 Angry Puppy (that exists?) This was our last picture from last week. Slide 8 Fig 4-17 Interglobular Dentin Interglobular dentin, essentially exists in the crown, but you can find some of it in limited amount in the root. And the way this tissue mineralizes could be one or two patterns: linear, and thats what Im essentially drawing here the deposition of HAP crystals (horizontal dashed line), the other one is globular (draws some asterisks near one another, with a wavy border on one side of them). Not too well drawn, but here are two globules. So that means the HAP crystals are laid down, giving you a crystalline structure that resembles a globule, a scalloped area. So this tissue would actually be fully calcified, but the area in between would not be. And the area in between is what is known as interglobular dentin. Some people like to call these globules as globular dentin. And as we look at this picture, whatever you see in dark really represents the interglobular dentin. And its hypomineralized. So everything in between, like all of this material, is a fully mineralized tissue. This represents your DEJ. And theres the enamel. Slide 9 Fig 8-2 Enamel/Mantle, Dentin/Interglobular Dentin Another picture showing you the same thing. This is the DEJ, thats the enamel. And you seem to have this area as separated from this area (mantle vs interglobular), and the picture doesnt give us whats underneath it. So in reality, this is your mantle dentin, which we spoke about last time, and all the way at the bottom should be your circumpulpal dentin. And mantle and circumpulpal together equals primary 2

Transcribed by Chris Bedoya

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dentin. Then between the two you find this patchy-like material, which represents your interglobular dentin. If youll recall I mentioned mantle dentin is quite a bit les mineralized than circumpulpal dentin. Then the odontoblasts get a bit confused, so as they go into producing circumpulpal dentin theres a certain region here where the formation of the dentin and the mineralization takes place in a peculiar way, so as a result youll get regions that are not fully mineralized or calcified. Slide 10 Fig 8-30 Interglobular Dentin This is just another picture again showing you different types of microscopy showing you the interglobular dentin. So all these areas are hypomineralized (highlights light stained globules in B). In B and C, you can see the tubules extending through the dentin pretty good. You can see it in picture A as well, but its not as obvious. Slide 11 Fig 4-15 Tomes Granular Layer Now here were looking at a longitudinal section through a tooth. We dont see much of the tooth, so Im going to assume this is some sort of incisor. This is the outside cruel world (far right). This represents your cementum, theres your enamel. In this case it looks like a knife-edged junction point where the cementum and enamel meet. It could also be enamel overlaps the cementum, or cemtum overlaps the enamel, or you can actually have a gap. Enamel, cementum. If you have a gap-type situation, then all you have protecting your dentin is your soft CT, so bacteria will attack that region first because it is hypomineralized, and theres no real hard protective later. Hard to see, but nevertheless you find these dark patchy areas in the crown. That represents the interglobular dentin. Heres the mantle, circumpulpal would be over here (close to words dentin on top right, darker area). So almost youd be good to say that the interglobular dentin separates mantle from circumpulplal. As you look in the root there are little patchy areas over here (interglobular dentin on image), that could also be considered interglobular dentin. But most of the interglobublar dentin really exists in the crown. Then as we look as the cemento-dental junction, which is some place over here, as you look in the dentin you see this dark granular layer, thats known as Tomes granular layer. In essence it is an example of interglobular dentin, but how it comes about to be formed is completely different. When we go back to crown formation, we had a dental papilla full of mesenchyme, the inner enamel epithelium released bone morphogenic proteins which acted on msx1 and 2 genes in mesenchyme cells, this induction effect stimulated the mesenchyme cells to become odontoblasts. With further release of BMP, the odontoblasts are then stimulated to produce enamel. First the odontoblast has to form an odontoblastic process, then you get your tubule formation. Lets make believe this is the mesenchyme of your dental papilla, and this is your DEJ. Were just making believe. So we have this mesenchyme cell over here, it gets larger, it forms a tubule, but this cell now has to come to lie up against the DEJ. And as its doing that, its moving, its getting larger, its producing dentin, you wind up with a situation that looks like this. I didnt do that so good, lets try this again. Thats a little bit better (looks sort of like the letter C). The dental tubule coils up on itself, and when you have this event happening, less mineral can deposit in 3

Transcribed by Chris Bedoya

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this region, so you have more organic material. So this is up right against the DEJ before I really should have said the cementum-dental junction. And so these tubules are coily, and since theres less mineral here, youre gonna get these dark patchy areas, and theyre referred to as Tomes granular layer. It essences its interglobular dentin, but its just how its formed. In terms of this region in the crown, its just a matter of not enough mineral being deposited. Theres no coiling or tubules or anything. Whereas when you come to the root, you do have the coiling of the tubules thereby preventing the proper amount of calcium from mineralizing that part of the tissue. Slide 12 Fig 8-32 Tomes Granular Layer Heres a cross section through the root. Theres your dentin, your cementum, and here we have Tomes granular layer. Its right by the CDJ. Slide 13 Fig 9-9 Tomes Granular Layer Another picture showing you the same thing, dentin, Tomes granular layer. And theyre showing you fairly good representation of acellular cementum. You see nothing in the cementum. However as you look at diagram B, you can see these dark little areas, those represent cells and lacuna. So this would be an example of cellular cementum. Dr. Craig will go into this material thoroughly. Slide 14 Fig 4-11 Secondary Dentin Now there are different types of dentin. Weve already spoken about primary dentin, which is really mantle plus circumpulpal. Well now go into our discussion of secondary, tertiary, and sclerotic dentin. As I mentioned previously, once the tooth has erupted into the oral cavity and is functional, that terminates the formation of primary dentin. And then throughout the life of the tooth you can have secondary dentin forming. At one time we used to refer to this as secondary regular dentin. Here you can get the impression that youve got a sort of S-shaped tubule, then all of a sudden the tubules straighten out, and the tubules appear to be more of less right angles to long axis of the tooth. As you look at this entire region, you almost get the impression that theres a line here, a line of demarcation between primary and secondary dentin (draws vertical line between the horizontal lines and oblique lines, through the lighter colored area). As we look at the tubules over here, the tubules of the primary dentin do become continuous with the tubules of the secondary dentin. However, there are fewer tubules in the secondary dentin. Why? Some of the odontoblasts just die off, so you have fewer processes and fewer tubules. Also, as you look at the tubules here (horizontal tubules), theyre sort of wavy, whereas the tubules in the primary dentin have a straighter appearance. Secondary regular dentin will form around the whole pulp chamber, the pulp canal, but not to the same amount. If you look at a pulp horn from a multi-cusp tooth, as you get older youll find the pulp horns becomes filled with secondary regular dentin. So if you have a young patient vs. an older patient, with the young patient you have to be more careful because you can drill through the dentin right into the pulp. When you take someone like me, my pulp horns are all filled, doesnt mean you shouldnt be careful but you have more of a leeway. And then the roof of the pulp chamber and floor of 4

Transcribed by Chris Bedoya

April 28, 2014

the pulp chamber has quite a bit of secondary regular dentin forming. As you go down into the pulp canal, the pulp canal also becomes smaller because of the formation of the secondary dentin, but the pulp canal never gets obliterated, theres always a canal thats present. Slide 15 Fig 8-2 Secondary Regular Dentin A little bit hard for you to see, but look where the arrowheads are, this is really sort of pointing to a line of demarcation which is supposed to represent the distinction between primary and secondary dentin. Slide 16 Fig 8-65 Young and Old Tooth Were looking at essentially at the same type of tooth, young vs. old. And technically the young tooth should have a larger amount of your pulp, in terms of your chamber and canal. Whereas the older one should have much less. Not the greatest picture at all. Doesnt show exactly what its meant to show Slide 17 Fig 4-23 Tertiary Dentin Then we have 2 types of response dentin forming. One called tertiary dentin, and the other sclerotic dentin. You could consider this almost as part of aging, pathologicaltype scenarios leading to the formation of this type of dentin. Dentin is a living tissue, and you want to keep it as alive as possible, you want to protect the underlying pulp. Dentin is not normally exposed to the oral cavity, but there are situations where it is. Number 1, if you dont have hte tooth covered by enamel or cementum, and I referred to that before, all you have CT which is not really very protective. You can have this type of situation (signaling top section of tooth in picture on left), were just going to assume that the enamel has worn away, so youll havea loss of your vertical height, and once the enamel wears away, eventually youre going to hit the dentin area. So all these tubules will be opened up, air rushes in, and once the air rushes in you wind up with these dead tracts. Not only does air rush in, but so do bacteria. As you look in this area (left picture, bottom left portion of lighter stained tissue bordering darker stained tissue), you can actually see the Sshape, and heres where you have your secondary regular dentin. But right now, were going to be interested in this region (reparative dentin). Thats tertiary dentin, and at one time tertiary dentin used to be referred to as secondary irregular dentin, but then that became confusing, regular vs. irregular, so now we just use the terms secondary regular dentin and tertiary dentin. Makes it a little bit clearer to understand. So the odontoblasts in this area react and try to play dentist, and fill this region (left image, bottom part of the dead tract bordering reparative dentin) where you have all the dead tracts, air, bacteria rushing in. Its like taking a piece of chewing gum and sticking it under the desktop, or its like plugging up a hole in the wall with Plaster of Paris. Tertiary dentin generally forms rather rapidly. Another cause by the way of the formation of tertiary dentin could be trauma, caries, anything of that nature. So as I mentioned, its going to form fairly rapidly. It all depends on the extent of damage from the trauma or lesion. If the damage is really bad and you have a fast moving system where air and bacteria are really migrating very quickly, then the tertiary dentin will be formed quite rapidly. And because its 5

Transcribed by Chris Bedoya

April 28, 2014

formed so rapidly, youre going to get a type of dentin that sort of has irregular characteristics. You may have tubules, you may not. The tubules that could be present could be very irregular in shape. And because this type of dentin forms so rapidly, you could get parts of the odontoblast and the odontoblastic process literally trapped in this tertiary dentin. Youll notice the word over here, reparative dentin (right image). There are 2 types of tertiary dentin: reparative and reactive. Both are tertiary dentin, but its a matter of how its formed. If I go over to one of you and push you, the natural response is to push me back. Thats your reaction, so in reactive dentin the pre-existing odontoblasts will form this tertiary dentin. But in reparative dentin, the mesenchyme cells in the pulp, which are always there, will give rise to new odontoblasts, and its these new odontoblasts which will form the tertiary dentin. So its just a difference of which odontoblast are going to form the tertiary dentin. As I said it seals off the area of injury. The number of tubules, besides being irregular, are tremendously reduced, or you may not have any tubules there at all. Now when this type of dentin forms slowly, and it can because the lesion is not moving quickly, then youre gonna find more tubules present, a little bit more regularity. So the dentin may somewhat resemble a little better what dentin should look like. Thats when the term osteodentin is used, osteo referring to bone. I had mentioned that dentin does look like bone to some extent. Chemically it is 70% mineral, bone is 65% mineral. Odontobalsts form dentin, osteoblasts form bone. Osteoblasts have cytoplasmic processes, which will be located in the bone tissue, remember the osteoblast becomes an osteocyte trapped in a lacuna. In this case, the odontoblast has its own process, odontoblastic processes. And its not that the whole cell is necessarily trapped in the dentin, but definitely the odontoblastic process. And when you get this tertiary dentin it is possible to get the entire cell trapped in the dentinal matrix. Slide 18 Fig 8-67 Dead Tracts, Mantle Dentin Here we have a different type of tooth. Here you can see your S-shaped tubules, and the S-shape is generally confined to the crown. In the root the tubules are more or less at right angles to the long axis of the tooth. Here we have a bending effect, so thats going to be your secondary regular dentin. Then youll notice all these tubules are dark. Once you see dark tubules you know somehow air has entered the tubules, therefore theres been some sort of trauma or lesion effect. You dont see that effect here (top right part of image), but things arent perfectly straight. So the lesion could be someplace out here, and it has this effect on the tubules. And by the way, if this is the point of origin of the lesion (top right), notice this is the region where you would find your tertiary dentin (left-most region of the dark S-shaped tubules). Thats because of the S-shaped nature of the tubule. But if the tubules were straight like this, then you would find the tertiary dentin really adjacent to the dentinal tubules. Slide 19 Fig 4-24 Dead Tracts In this picture we can see a number of different things. The enamel is not that clearly illustrated, but the dentin really is. You can see 2 cusps. And associated with each cusp youre gonna see an area of dead tracts. That means that somewhere here and here (tops of each cusp), you may have started off with an enamel lamella, which 6

Transcribed by Chris Bedoya

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became a crack, and where theres a lamella or a crack its hypomineralized, and as a result bacterial acid eats its way through a hypomineralized way much faster than one that is properly mineralized. This would be one pulp horn, heres another pulp horn. And if you look carefully it looks like something is happening over here. And the tooth is responding to the dead tracts by trying to seal up the area between those tubules and the pulp itself. We can see that very nicely over here (bottom left). So here youve had a certain amount of erosion, a good part of the dentin has been eaten away, and the enamel has been chewed up over here and eventually disappears. So that means thats only covered by soft tissue. So all these tubules have been punctured open, and air and bacteria have come in. And then here is your little piece of chewing gum which as formed (region where dark band meets pulp horn on bottom left of pulp), it could be tertiary dentin. Theyre calling it reparative, and theres no way for us to tell if its reparative or reactive, unless if youve really done a whole series of sections which may give you the idea that it came from old odontoblasts or new, but looking at this picture you cant tell. Slide 20 Fig 8-4 Tertiary Dentin High power. This is labeled as carious dentin, but looking at it you cant tell that either. I dont see dead tracts or anything like that. But underneath, theres this piece of additional dentin, and it is separated from the rest of the dentin. So tertiary dentin forms as a local phenomenon. It does not form all around the pulp chamber and pulp canals. And this is just trying to show us that parts of the cell, and the cell are becoming trapped in the formation of the tertiary dentin. Slide 21 Fig 8-19 Tooth Restoration Heres a nice picture of a tooth thats been restored. And heres your amalgam filling. So the lesion that occurred went through he whole enamel, and into part of the dentin. Now this whole region should show you dead tracts, it doesnt. It shows you dead tracts over here in the corner, but his is where we see the tertiary dentin (site labeled as reparative dentin). So itd make sense to me if these were filled with air (lines underneath the amalgam), those would be dead tracts, and this little piece of chewing gum represents the tertiary dentin. Slide 22 Fig 8-28 Sclerotic Dentin The other type of response dentin is sclerotic/transparent dentin. Heres your background, and as you look through the dentin of the tooth, what do you see? The background. The only way to see the background is if you truly have a highly mineralized tissue. So sclerotic dentin is not new dentin forming, but rather old dentin, pre-existing dentin, which becomes much more mineralized, even to the extent of enamel. Remember enamel is translucent, and doesnt have its own color, youre seeing the color of the dentin below. Here the same event is happening. Generally speaking sclerotic dentin forms in the roots of older people, but it can form in the crown, and it can form in young individuals as well. So there are 2 types of responses to help protect the pulp: formation of tertiary dentin, and one is the formation of sclerotic, alias transparent dentin.

Transcribed by Chris Bedoya

April 28, 2014

Slide 23 Fig 9-4 Canals This just showing us the pulp canals, the root canals. Normally youd have an apical foramen down here some place, but in many cases the apical foramen isnt necessarily in the center of the tooth, it could be off to one side. What were actually seeing over here are additional, or accessory canals that have formed (both arrows pointing). Again this will be discussed in the periodontal lectures. Clinically speaking, its not good to have exposed dental tubules. Cause the bacteria will penetrate, destroy the odontoblastic processes, eventually get towards the pulp, infect the pulp, and then youll have different versions of pulpitis. Then youll have a bigger job to help correct that situation. At one time early on, even like the early 1900s, we did not have high-speed instruments. They moved very slowly. When you have slow drills and youre trying to drill into a tooth, thats painful. The instruments generated a lot of heat, now theyre water-cooled, or cooled by some other device. If you think of the pulp, very important to keep the pulp loaded with the right amount of fluid, otherwise youll have dehydration, which will lead to other poblems. So the formation of your tertiary dentin can be considered as a form of indirect pulp capping. In addition to the pulp, dentin is living. So you must somehow avoid dehydration. Slide 24 DVD - Dentin Now this is a nice picture where it shows you a number of things. We saw this in connection wit enamel. Theres a number of lesions occurring. These two are almost down to the DEJ. This one the lesion has eaten its way through the enamel, through the DEJ, and into the dentin. You can see a little hole here. How did the bacteria get in? Could be right where the arrow is pointing (2 arrow heads coming from same stem), could be in back or in front, or something of that nature. Of course, here the tubules are dark, theyre really your dead tracts. This is also showing us another area of dead tracts (top right), so the lesion probably came in in this area. And notice right at the bottom of the dead tract, theres something there. It looks completely blank. Its actually sclerotic dentin, which has formed in response to the carious lesion. So here we have an example of sclerotic dentin in the crown. Osteogenic proteins, bone morphogenic proteins, theres a whole list of them. And these BMPs, induce/stimulate, bone, cartilage, and dentin formation. And the bone morphogenic proteins were first used in stimulating the repair of say like the femur, and the other parts of the leg bones. So it just speeds it up. But when you have BMPs present in dentin, you have very interesting reaction. What you can do is take a matrix, put the BMPs in, drill out the region, and lets say this is where I put the matrix with the BMPs (center of tooth, right at the base of the arrow pointing straight up). The BMPs now stimulate underlying odontoblasts to produce dentin and fill in the region. So this production of new dentin isnt really at the expense of the pulp, its just filling in bad dentin located somewhere within the dentin itself. It was a popular idea, sounded good, but I havent seen any literature recently to indicate this is a good working system. But it has possibilities. Slide 25 Fig 6-17 Dentinogenesis Imperfecta

Transcribed by Chris Bedoya

April 28, 2014

Dentinogenesis imperfecta. As you look at these teeth, you know they dont look right. Somethings wrong with them. First thing that catches your eyes, look at the jagged edges. So parts of the enamel has fractured. Here you have a decent amount of the tooth thats gone. The key to having enamel work properly in protecting the tooth is to have your underlying dentin really acting as a good support base. In dentinogenesis imperfect that doesnt exist, the dentin isnt fully mineralized, and it becomes a softer tissue which isnt a good strong supporting base. As a result this enamel up here will fracture much more easily. Not only is the enamel exposed, but right in the center you have dentin exposed as well. Then as you look at the more posterior teeth they look a little more on the greyish side, whether thats the effect of the D.I., Im not sure, but it does seem to resemble a little bit like tetracycline stain. So there may be more than 1 effect occurring there. Slide 26 Animal Pic Finally, sometimes you just have the urge and you have to scratch. So Dr. Caulfield should be here in a couple of minutesso you have a little break.