Young vs. Old Dental Pulp Treatment: Repair vs. Regeneration

Review Article

J Dent & Oral Disord. 2017; 3(1): 1052.

Young vs. Old Dental Pulp Treatment: Repair vs. Regeneration

Goldberg M*

Department of Fundamental and Biomedical Sciences, University of Paris-Descartes, France

*Corresponding author: Michel Goldberg, Department of Fundamental and Biomedical Sciences, University of Paris-Descartes, France

Received: January 12, 2017; Accepted: February 22, 2017; Published: February 23, 2017


During aging, the volume and content of dental pulp are modified, namely the collagen cross-links, proteoglycans, and microfibrils. The development of pulp stones and/or diffuse mineralization is also linked to the aging processes. Pulp fibroblasts, blood and lymph microcirculation, and sensory nerves underwent substantial changes within the dental pulp. Root Canal Treatment (RCT) depends on the canal preparation, easier in young pulp compared to old pulp. Pulp healing and /or regeneration constitute two different facets of RCT treatment. Pulp healing is using both chemicals and mechanical preparations, or direct versus indirect pulp capping. Endodontic treatments aim for apexification after decontamination of the lumen by root canal irrigants, enlargement of the lumen and filling with a stable, biocompatible material. Regeneration of the dental pulp may be obtained by stem cells, proliferating in young teeth from the apex toward the coronal part of the tooth. Obtaining a living pulp that will further mineralize is the main objective of future valid endodontic treatments.

Keywords: Pulp size; Root canal treatment; Pulpotomy; Endodontic treatments


Decreased volume of the aging dental pulp

During tooth development the pulp size and volume is gradually reduced. Instead of a large widely open apical root, the dental pulp is closed and the pulp is diminished. There is an overall reduction of cellular components. One half alone of the original loading is present in the aged pulp. In parallel, there is an increase of type I collagen and type III collagen fibers, but also thin fibrils of type IV collagen, type V and type VI collagen may be found during the aging process. The ratio of Dihydroxylysinonorleucine (DHLNL) to Hydroxylysinonorleucine (HLNL) is increased from 0.82 at age one to 1.33 at age four. It comes out that DHLNL is the major crosslink in the pulp. The ratio of two main cross-links (DHLNL/HLNL) is 0.49 [1,2]. In addition to pulp fibrosis, glycosaminoglycans such as chondroitin sulfate, dermatan sulfate and keratan sulfate, are present. In the form of protein associated with glycosaminoglycans, they are identified in the gel-like matrix or in the intercellular ground substance as decorin, biglycan, lumican and versican, in contrast with hyaluronic acid, which is reduced in advancing age. Microfibrillar components are present in the dental pulp. Type VI collagen microfibrils with a characteristic periodicity of about 100nm appear as long thin, flexible filaments. Lateral association contributes to the formation of 10-14nm in diameter, either as fibrillar elements, or to amorphous aggregates. Microfibrils were more abundant in the formed pulp compared to the developing pulp [3].

Dystrophic mineralized masses appear firstly as small growing lamellar calcospherites, and later as diffuse mineralization invading the most of the pulp. Pulpstones are closely associated to the walls of the pulp chamber, or they start to multiply and be formed in a more central part of the pulp. Then they gradually enlarge. They appear either as true or false denticles, or as diffuse calcifications initiated at the roof (1), or on the floor (2) of the pulp. During coronal maturation, less dentin is formed on the side (lateral) walls (3) (Figure 1).