Anatomy of the Pulp and Periapex 2009

Objectives and Goals

  • be able to develop a rationale for where to terminate a root canal fill.
  • be able to develop a rationale for where to resect a root end.
  • be familiar with the "normal" apical anatomy.
  • be familiar with some of the changes in apical anatomy that occur with age and pathology.
  • be familiar with the basic embryology of the pulp.

Coolidge,  Edgar. Anatomy of the root apex in relation to treatment problems. JADA 1929;16:1456-1465.

Grove, Carl J. Why root canals should be filled to the dentinocementaljunction. JADA 1930;17:293-296.

Kuttler Y. Microscopic investigation of root apexes. JADA 1955;50:544.

Green D. A stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg 1956;9:1224.

Green D. Stereomicroscopic study of 700 root apices of maxillary and mandibular posterior teeth. Oral Surg 1960;13:728.

Seltzer S, Soltanoff W, Bender IB, Ziontz M. Biologic aspects of endodontics. 

I. histologic observations of the anatomy and morphology of root apices and surrounding structures. Oral Surg 1966;22:375.

Chapman CE. A microscopic study of the apical region of human anterior teeth. Brit Endod Soc 1969;3(4):52-58.

Burch JG, Hulen S. The relationship of the apical foramen to the anatomic apex of the tooth root. Oral Surg 1972;34:262.

Gutmann JL. Prevalence, location, and patency of accessory canals in the furcation region of permanent molars. J Periodontol 1978;49(1):23-26.

Takahashi K, Kishi Y, Kim K.  A scanning electron microscope study of the blood vessels of dog pulp using corrosion resin casts. J Endodon 1982;8(3):131-135.

Dummer PMH, McGinn JH, Rees DG. The position and topography of the apical canal constriction and apical foramen. Int Endod J 1984; 4(October):192 -198.

Johnsen DC.  Innervation of teeth: Qualitative, quantitative, and developmental assessment. J Dent Res 1985;64:555-563.

Auyeung L, Bouwsma OJ, Polson AM. Periodontal fiber attachment and apical root resorption. Endod Dent Traumatol 1988;4(5):219 - 225.

Stein TJ, Corcoran JF. Anatomy of the root apex and it histologic changes with age. Oral Surg 1990;69(2):238-242.

Blaskovic-Subat V, Maricic B, Sutalo J. Asymmetry of the root canal foramen. Int Endod J 1992;25(3):158-164.

Harrison JW, Roda RS.  Intermediate cementum. Oral Surg 1995;79(5):624-633.

Ponce E, Fernandez J.  The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy.  J Endodon 2003;(3):214-219

Mannocci M, Peru M, Sherriff M, Cook R, Pitt Ford T.  The isthmuses of the mesial root of mandibular molars: a micro-computed tomographic study.  Int Endod J 2005;38:558-563

Degerness R, Bowles W.  Anatomic determination of the mesiobuccal root resection level in maxillary molars.  JEndodon 2008;34(10):1182-1186

Olson D, Roberts S, Joyce A, Collins D, McPherson J.  Unevenness of the apical constriction in human maxillary central incisors.  JEndodon 2008;34(2):157-159

Pathways of the Pulp. 9th edition pp 148-165 (no abstract)


Green D. A stereo-binocular microscopic study of the root apices and surrounding areas of 100 mandibular molars.  Oral Surg 1955;8:1298

Mizutani T, Ohno N, Nakamura H. Anatomical study of the root apex in the maxillary anterior teeth. J  Endodon 1992;18(7):344-347.

Morfis A, Sylras S, Georgopoulou M, Kernani M, Prountzos F.  Study of the apices of human permanent teeth with the use of a scanning electron microscope.  JOralSurg 1994;77(2):172-176