Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: A histological and histobacteriological study.

INTRODUCTION: The present study reported the histological events that occurred in the radicular pulp of human mature teeth in the presence of medium/deep untreated caries lesions, and those teeth with restorations or direct pulp capping, with particular emphasis on the morphology of the canal wall dentine and the odontoblast layer.

METHODS: Sixty-two teeth with medium/deep caries lesions, extensive restorations or after application of a direct pulp capping procedure were obtained from 57 subjects. Fourteen intact mature teeth served as controls. Stained serial sections were examined for the pulp conditions of the coronal pulp. The teeth were classified as those with pulpal inflammation, or those with healed pulps. Histological changes that occurred in the roots at the pulp-dentine junction were investigated in detail.

RESULTS: All teeth (100%) in the experimental group showed pathologic changes in the radicular pulp, with varying amounts of tertiary dentine on the canal walls and absence of odontoblasts. These changes were identified from different portions of the canal wall surface. Non-adherent calcifications in the pulp tissue were observed in more than half of the specimens. Changes that deviate from classically-perceived histological relationships of the pulp-dentine complex were also observed in the radicular pulps of 33.7% of the control teeth.

CONCLUSION: When challenged by bacteria and bacterial by-products invading dentinal tubules, odontoblasts in the radicular pulp may undergo cell death, possibly by apoptosis. This phenomenon may be caused by progressive root-ward diffusion of bacterial by-products, cytokines or reactive oxygen species through the pulp connective tissue.

CLINICAL SIGNIFICANCE: Although the vitality of the dental pulp in teeth with deep dentinal caries may be maintained with direct pulp capping or pulpotomy, the repair tissue that is formed resembles mineralised fibrous connective tissues more than true tubular dentine.