The morphology of the reparative dentine bridge

Pink Spot - Literature Review and Case Report

BACKGROUND

Pink spots in teeth were first described by Mummery in 1920, and were related to resorption. Resorption is a pathologic process that often eludes the clinician with its varied etiologic factors and diverse clinical presentations. Resorption can be generally classified as internal and external resorption. Internal resorption has been described as a rare occurrence as compared to external resorption.

CASE REPORT

This article describes a pink spot that was diagnosed as a progressing resorption process. Early diagnosis enabled a successful management of the lesion.

CONCLUSION

Early diagnosis and treatment of an internal resorption, clinically seen as a pink spot, in a primary central incisor may prevent its fast progress and subsequent loss.

A light and transmission microscopic study of mechanically exposed monkey pulps: dynamics of fiber elements during early dentin bridge formation

OBJECTIVE

The aim of this investigation was to assess the role of the von Korff-like fibers (VKF) during the process of dentin bridging.

STUDY DESIGN

The monkey pulps, exposed to a hard-set calcium hydroxide, were evaluated at 3, 7, 14, 21, 30, 90, and 180 days.

RESULTS

At 21 days, longitudinal and transverse collagen fibrils were organized as lamellar structures in close proximity to and subjacent to the newly formed predentin. VKF bundles were present between newly formed odontoblastoid cells. The VKF were bundles of thin collagen fibrils inserted into the predentin, which consisted of thick collagen fibrils. At 30 days, the exposure site was completely occluded with a new predentin matrix; lamellar structures and VKF were no longer present.

CONCLUSIONS

The VKF may play a role in the connective tissue attachment to the dentin bridge, early in its formation.

Pulp remains viable following vital amputation of the mesio-buccal root of the maxillary fourth premolar in dogs

Vital amputation of the mesio-buccal root of the maxillary fourth premolar (P4) was performed bilaterally in 8 dogs. Histopathologic evaluation of the tooth structure revealed normal pulp in the remaining mesio-buccal, mesio-palatal, and distal roots and crown during a mean follow-up period of 3.5 +/- 1.9 months. Amputation site healing was characterized by a reparative dentin bridge produced by odontoid cells. Tunnel defects were observed in 13 of 16 (81%) dentin bridges. It is concluded that the pulp of a tri-rooted, periodontal disease-free tooth remains viable during a 6-month period following vital root amputation. These results point to the intriguing possibility that this may also occur in humans, however, this needs to be directly tested in man.

Dynamics of the pulpo-dentin complex

Dentin has a relatively high water content due to its tubular structure. Once dentin is exposed, this intratubular water is free to move in response to thermal, osmotic, evaporative, or tactile stimuli. Fluid shifts across dentin are thought to cause sufficient shear forces on odontoblasts, nerve endings, nearby fibroblasts, and blood vessels to cause significant mechanical irritation, disruption, or damage, depending on the magnitude of the fluid shift. Even in the absence of fluid shifts, the water-filled tubules provide diffusion channels for noxious (i.e., bacterial products) substances which diffuse inward toward the pulp, where they can activate the immune system, provide chemotactic stimuli, cytokine production, and produce pain and pulpal inflammation. Viewed from this perspective, dentin is a poor barrier to external irritants. However, pulpal tissues react to these challenges by increasing the activity of nerves, blood vessels, the immune system, and interstitial fluid turnover, to make the exposed dentin less permeable either physiologically, via increased outward fluid flow, or microscopically, by lining tubules with proteins, mineral deposits, or tertiary dentin, thereby enhancing the barrier properties of dentin, and providing additional protection to pulpal tissues. These reactions involve dentin and pulp, both in the initiation of the processes and in their resolution. These responses of the dental pulp to irritation of dentin demonstrate the dynamic nature of the pulpo-dentin complex.

Effect of calcium hydroxide in powder or in paste form on pulp-capping procedures: histopathologic and radiographic analysis in dog's pulp

The pulps of seventy dog teeth were evaluated histopathologically and radiographically following intentional exposure and treatment with either a calcium hydroxide powder or a calcium hydroxide paste prepared with distilled water. The results were recorded after periods of 2, 30, 70, and 120 days. No differences were detected in the pulpal responses to direct pulp capping achieved with a calcium hydroxide paste and with a calcium hydroxide powder.