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Tertiary dentin is only formed by an odontoblast directly affected by a stimulus; therefore, the architecture and structure depend on the intensity and duration of the stimulus, e.g., if the stimulus is a carious lesion, there is extensive destruction of dentin and damage to the pulp, due to the differentiation of bacterial metabolites and toxins.
Reactionary dentin is formed by odontoblasts when the injury does not damage the odontoblast layer. Reparative dentin is formed by replacement odontoblasts when the injury is so severe that it damages a part of the primary odontoblast layer. Thus a type of tertiary dentin forms in reaction to stimuli, such as attrition or dental caries.
Dentin formation, known as dentinogenesis, is the first identifiable feature in the crown stage of tooth development. The formation of dentin must always occur before the formation of enamel. The different stages of dentin formation result in different types of dentin: mantle dentin, primary dentin, secondary dentin, and tertiary dentin. [31]
Tertiary dentin on the surface of a gorilla tooth. The darker area indicated by the white arrow is tertiary dentin and has formed as a response to tooth wear. Wear on the surface of a tooth can lead to the exposure of the underlying dentin. When wear is severe tertiary dentin may form to help protect the pulp chamber. [4]
Reactionary dentin is secreted at varying speeds, dependent on the speed of progression of caries in the outer dentin surface. Histologically, it is easily distinguishable by its disordered tube structure, the location of the secretion (it protrudes into the pulpal cavity) and its slightly lower degree of mineralization than normal.
There are three types of dentin, primary, secondary and tertiary. [19] Secondary dentin is a layer of dentin produced after root formation and continues to form with age. Tertiary dentin is created in response to stimulus, such as cavities and tooth wear. [20]
The structure of dentin is an arrangement of microscopic channels, called dentinal tubules, which radiate outward from the pulp chamber to the exterior cementum or enamel border. [81] The diameter of the dentinal tubules is largest near the pulp (about 2.5 μm) and smallest (about 900 nm) at the junction of dentin and enamel. [ 82 ]
The overall pulp cavity may become smaller by the addition of secondary or tertiary dentin and cause pulp recession. The lack of sensitivity associated with older teeth is due to receded pulp horns, pulp fibrosis, the addition of dentin, or all these changes. Restorative treatment can be performed without local anaesthesia on older dentitions. [2]