Professional Documents
Culture Documents
The necessity for an exact and complete the location of the foramen, its size and
knowledge o f the topographic and micro the thickness o f the cementum, is com
scopic anatomy of the dental apex has pletely erroneous. Blayney, Grove and
been recognized. That these studies have many other authors share this same opin
not been made has been acknowledged ion. The extreme assertions about the
by Orban,1"4 Blayney,5'8 Skillen,9' 10
Grove,1116 O n o17 and others.
Presented at the e xtra o rd in a ry session o f the M e x i
Anatomy, of course, is the foundation can S o cie ty o f E n d o d o n tia .
Professor o f p o stg ra d u ate s, N a tio n a l U nive rsity of
of the art and science of healing. The M e xico .
terminal part of the root canal and the 1. O rb a n , Balint. W h y root ca na ls sh ou ld b e filled to
the dentinoce m e ntal junction. J . A .D .A . 17:1086 June
tissues which surround it are the center 1930.
of the most activity and the greatest con 2. O rb a n , Balint. P ro b le m o f root canal treatment.
J .A .D .A . 19:1384 A u g . 1932.
cern in the treatment and filling of 3. O rb a n , Balint. O r a l h isto lo g y an d e m b ry o lo gy ,
ed. 3. St. Louis, C . V. M o s b y C o., 1953.
the root canal. The works of Preis- 4. O rb a n , Balint. Personal com m un icatio n.
werk,18 Fischer,19,20 Hess,21 Barrett22 and 5. Blayney, J. R. B io lo g ic a sp e ct o f root-cana! ther
apy. D. Item s Interest 49:681 Sept. 1927.
Davis23,24 and others which date from 6. Blayney, J. R. Present con ce p tio n o f vita l reactions
the end of the last century and from the which occu r w ithin a p ic a l tissues after p u lp rem oval.
J A .D .A . 16:851 M a y 1929.
beginning of the present one, had as 7. Blayney, J. R. Proble m o f the pulpless tooth. J. D.
Res. 10:425 A u g . 1930.
their almost exclusive center of interest 8. Blayney, J. R. Progre ss o f p u lp ca na l therapy.
the number of root canals and their Proc. D. C entenary, 1940, p. 646.
9. Skillen, W . G . R e p o rt on form a tio n of dentin and
divisions. cem entum relative to structure o f root end. J . N .D .A . 8:3
Jan. 192!.
U p to the present time the endodontist 10. Skillen, W . G . " W h y root ca n a ls sho uld be filled
has worked with extremely poor data. to the dentinoce m e ntal ju n ctio n ." J .A .D .A . 17:2082
N o v . 1930.
The roentgenogram of the apex seldom 11. G rove , C . J. B io lo g y o f m ulti-can aliculate d roots.
D. C o sm o s 58:728 Ju ly 1916.
offers a clear view of the terminal part
12. G ro v e , C . J. N a tu re 's m ethod o f m a k in g perfect
of the canal; therefore, one is obliged to root fillin g s fo llo w in g p u lp rem oval, with a brief co n
sid e ra tio n o f the d e v e lo p m e n t o f se con d a ry cem entum .
use information not scientifically proved. D. C o sm o s 63:968 O c t. 1921.
Much of the information available was 13. G ro v e , C . J. Faulty technic in in ve stiga tio ns of
ap ic e s o f p u lple ss teelh. J .A .D .A . 13:746 Ju ne 1926.
obtained from a limited number of 14. G rove , C . J. A sim ple sta n d a rd ize d technic for
fillin g root ca n a ls to de n to -ce m e nta l junction with p e r
studies, mostly macroscopic, of apexes fect fitting im p e rm e a b le m aterials. J . A .D .A . 16:1594
Sept. 1929.
principally in transverse sections of the 15. G ro v e , C . J. W h y root ca n a ls sh o u ld be filled
root. to d e n tino-cem ental unction. J . A .D .A . 17:293 Feb.;
1529 A u g . 1930; 18:314 Feb. 1931.
The prevailing idea of the topographic 16. G ro v e , C . J. V a lu e o f dentino ce m e n tal junction
in p u lp canal surgery. J. D. Res. 11:466 Ju n e 1931.
and microscopic anatomy of the apex,
17. O n o, T oran osuke. O n the a na tom y o f root canals
that is, the direction, form, diameter and with spe cial references to its transition a c c o rd in g to
years o f a g e . Tr., Int. D. C o n g . {8th) Tr. Supp l., 1931,
so forth o f the terminal part of the canal, Sec. I, 82.
544
KUTTLER . . . V O L U M E 50, M A Y 1955 545
Table 1 S u m m a ry o f d a ta c o n c e r n in g d e n ta l a p e x
18 to 2 5 y e a r g r o u p 5 5 y e a r a n d o ld e r g r o u p
VL MD T o ta l VL MD T o ta l
No. % %
No. No. No. No. No.
C e n t e r o f fo ra m e n in
a p ic a l v e r t e x o r c e n te r 111 29 34 63 32 24 15 39 20
C e n t e r o f fo ra m e n o u t sid e
a p ic a l v e r te x o r c e n te r (2) 62 69 131 68 58 88 146 80
U n io n C D C c le a r w ith m a g
n ific a tio n o f 21 d ia m e te r s (14) 103 130 233 57 145 148 293 74
U n io n C D C c le a r o n ly w ith
m a g n ific a t io n o f 5 6 d ia m e te rs 73 54 127 31 41 48 89 21
1151
U n io n C D C n o t c le a r (16) 15 9 24 6 1 3 4 1
U n io n C D C n o n e x iste n t 117) 10 14 24 6 5 8 13 4
T e e th o b t a in e d 142 126
R o o t s s e p a r a t e d from
c ro w n s 197 186
A p e x e s p re p a re d 208 194
This research was carried out to help group), the center of the principal fora
improve the treatment of root canals; men was localized in the apical vertex
therefore, the main canal, the most cen or center (Fig. 3, above) and generally
tral and vertical one, or the one of the followed the axis o f the canal (Fig. 2, be
greatest caliber, that is, the one that the low left, # 1 and Table 1, # 1 ) . In the
endodontic instrument would follow, teeth of the second series (the 55 years
seemed most interesting. The lateral, and older group) the coincidence of the
secondary and accessory small canals, al center of the foramen and the vertex or
though sketched and noted, were not center o f the apex was found in 20 per
studied because in most instances they cent (Fig. 2, below right, # 1 and Table
do not present a clinical problem. In the 1). The remaining 68 per cent of the
bifurcations and deltas the canals which roots in the first series had the center of
most approached the principal axis were the foramen somewhat outside or toward
studied, that is, the ones which offered some side of the center or vertex of the
the greatest possibilities for the endodon apex (Fig. 2, below left, # 2 ) , whereas
tic instrument to enter so that the prin in the second series (Fig. 2, below right,
cipal foramen could be reached. # 2 ) , 80 per cent were located outside
The foramen in this study is under the center or vertex of the apex (Table
stood to be the circumferential line of 1, # 2 ).
the canal that forms an angle above the The average distance between the ver
surface of the root, or, in other words, tex or apical center and the center of the
the lineal circumference of the end of foramen was 495 microns in the first series
the canal (Fig. 2, below, # 4 ) . (Fig. 2, below left, # 3 ) and 607 microns
in the second series (Fig. 2, below right,
R ESU LT S # 3 and Table 2 ).
The average diameter of the foramen
In 32 per cent of the roots of the teeth in the first series (Fig. 2, below left, # 4 )
in the first series (the 18 to 25 year was 502 microns and that o f the second
KUTTLER . . . V O L U M E 50, M A Y 1955 547
series (Fig. 2, below right, # 4 ) was 681 in the second series (Fig. 2, below right,
microns (Table 2, # 4 ) . # 5 ) was 425 microns (Table 2, # 5 ) .
The diameter of the foramen is seldom As a result of the separation of the two
found to be perpendicular to the axis of diameters, a base of a triangle is formed
the apical canal; nevertheless, instances (Fig. 2, below, # 6 ) . This base measured
of this situation of the diameter were 255 microns in the first series and 287
noted. A diameter was measured whose microns in the second series (Table 2,
line departed from the en d . of the fora # 6).
men closest to the axis of the canal, M uch fruitless polemic between Grove
crossed the axis of the canal perpendicu and his opponents could have been
larly and ended at the other end inside avoided had they com e to an agreement
the canal; therefore, the perpendicular on terminology. Nobody can doubt the
diameter was smaller than the diameter existence of a uniting line between the
o f the foramen. The average diameter cementum and the dentin (Fig. 3, C D ) .
of the foramens perpendicular to the axis This union (with very few exceptions,
of the apical canal in the first series (Fig. such as that shown in Fig 3, above) ar
2, below left, # 5 ) was 375 microns and rives at the canal, a point that shall be
Tab le 2 M e a s u r e m e n t s in d e n ta l a p e x
18 to 2 5 y e a r g r o u p 5 5 y e a r a n d o ld e r g r o u p
VL MD T o ta l VL MD T o ta l
I
% %
*
*
<
<
A v.*| M o. A v .*| N o . A v.*| N o . Mo. A v .* No. No.
>
> !
D ist a n c e from c e n te r o f fo ra m e n
t o a p ic a l ce n te r (3) 510 487 495 510 661 607
D ia m e te r o f fo ra m e n p e r p e n
d ic u la r to a x is o f c a n a l (5) 491 318 375 451 403 425
D ia m e te r o f c a n a l a t h e ig h t
o f t w o e v e n C D C (7) 3 46 43 270 39 306 82 53 282 55 274 54 274 109 60
D ia m e t e r o f c a n a l at
a p ic a l u n io n C D C 18) 3 10 28 280 39 298 67 280 29 287 39 268 68 1
D ia m e te r o f c a n a l at
c e r v ic a l u n io n C D C (9)
M in o r d ia m e te r o f c a n a l
3 49 35 3 02 43 327 78
!W 315 33 247 42 285
1 40
M i n o r d ia m e te r o f c a n a l
in de ntin (11) 331 30 239 30 299 60 42 299 21 218 29 254 50 29.5
M i n o r c a n a l d ia m e te r at
u n io n C D C 112) 250 22 216 25 2 44 47 32 207 32 217 38 210 70 41
D ist a n c e from fo ra m e n to
m in o r c a n a l d ia m e te r (13) 566 454 524 600 696 6 59
T h ic k n e s s o f ce m e ntu m o n
righ t s id e c a n a l (18) 4 67 522 508 875 734 802
T h ic k n e ss o f ce m entu m o n
left sid e c a n a l (19) 5 14 496 505 882 672 767
T h ic k n e ss o f ce m entu m o u tsid e
c a n a l (1. sid e ) (21) 289 340 326 6 37 464 551
* ln m icrons.
548 T H E J O U R N A L O F T H E A M E R IC A N D EN T A L A S S O C IA T IO N
Fig. 1 D ental apexes. A b ov e left: L ow er lateral incisors, older age group. V estibulo
lingual sections ex cep t mesiodistal section at far right. A b ov e right: U pp er third molars, older
group. From left to right lingual root, distal root, mesial root, mesiodistal section s; far
right, distal root, vestibulolingual section. Below left: L ow er second molars, younger group.
T w o at left, mesial roots, mesiodistal section s; at right, distal roots, vestibulolingual and
mesiodistal sections respectively. Below right: L ow er second bicuspids, younger group. T w o
at left, mesiodistal section s; at right, vestibulolingual sections
KUTTLER . . . V O L U M E 50, M A Y 1955 549
T a b le 3 A v e r a g e a g e s at w h ic h p e rm a n e n t teeth a r r iv e a t o c c lu s io n
D e n ta l c la ssific a tio n
i 1 2 3 4 1 5 6 1 7
U p p e r arch 8 -1 0 -9 * 9 -8 -2 7 1 2 -4 -2 6 1 0 -1 0 -1 3 1 1 -7 -1 9 7 -3 -4 1 3 -2 -2 8
same level. The average diameter was of the canal the thickness of the
244 microns in the first series and 210 cementum in the first series was an aver
microns in the second series (Table 2, age of 508 microns and 802 microns in
# 1 2 ). the second series (Fig. 2, below, # 1 8 and
The distance between the center of the Table 2, # 1 8 ) . The thickness of the
foramen and the narrowest part of the cementum on the left side of the canal
apical canal was an average of 524 was an average of 505 microns in the first
microns in the first series and 659 microns series and 767 microns for the second
in the second series (Fig. 2, below, # 13 series (Fig. 2, below, # 1 9 and Table 2,
and Table 2, # 1 3 ) . #19).
The union or point CDC is not always It was attempted to determine whether
found; therefore, it was studied from there exists any relationship between the
histological sections. In 57 per cent of teeth that have been in occlusion the
the sections of the first 'series and in 74 longest and the thickness of the
per cent of the second series, this union cementum. The order of eruption is
was precise and was distinctly visible known to be that expressed in Table 4.25
with a magnification of 21 diameters The order of the teeth in the first series
(Fig. 2, below left, # 1 4 and below right with the thickest cementum on the right
# 1 4 a and b and Fig. 3,. below, C D C ). side of the cementum canal is given in
In 31 per cent of the first series and 21 Table 5. A comparison of the tables indi
per cent of the second series, a greater cated that there was no relationship. The
magnification was necessary and 56 thickness of the cementum probably de
diameters was used. In 6 per cent of the pends on the strength of mastication
first series and 1 per cent of the second rather than on the length of time the
series, the point CDC was so confusing teeth have been in occlusion.
that its location could not be determined The thickness of the cementum was
with any magnification (Table 1, # 1 6 ) . measured somewhat outside the canal
In 6 per cent of the first series and 4 where it often thins quickly. The average
per cent of the second series, the point thickness of the cementum on the right
CDC did not exist, either because the side of the canal in the first series was 343
line of union between the cementum and microns and for the second series 619
dentin did not reach the canal or because microns (Fig. 2, below, # 2 0 and Table
the cementum was nonexistent (Fig. 3, 2, # 2 0 ) . The measurement on the left
above and Table 1, # 1 7 ) . side of the canal was 326 microns for the
It is widely known that the thickness first series and 551 microns for the sec
of the cementum diminishes from the ond series (Fig. 2, below, # 21 and Table
apex to the dental cervix and that the 2 , # 2 1 ).
cementum thickens with age. The thick It was believed that the canal is more
ness of the cementum on each side of the or less conical, following in its apical
canal was measured, and the following third the same direction as the middle
results were obtained: On the right side and cervical third and ending in the ex-
550 THE J O U R N A L O F THE A M E R IC A N D EN T A L A S S O C IA T IO N
Fig. 2 " A bove left: Erroneous con cept of apex. A b ov e cen ter: A p ex of younger group from
averages obtained. A bove right: A p ex of older group according to averages obtained. Below :
A pexes of younger group (le ft) and older group (r ig h t) 1, vertex or apical c en ter; 2,
cen ter of foram en ; 3, distance betw een vertex or apical center and center of foram en ; 4,
diameter of foram en ; 5, diameter of foram en-canal perpendicular to axis of canal; 6, un
evenness o f two diam eters; 7, diameter of canal at height of two even C D C union p oin ts; 8,
diameter of canal at height of apical C D C union poin ts; 9, diameter of canal at height of
cervical C D C union p oin t; 11, place of minor diameter of canal (42 per c e n t ) ; 13, distance
betw een center of foram en and minor diam eter of canal; 14, union points of cem entum ,
dentin and canal, 14a (a p ica l), 14b (c e r v ic a l); 18, cem entum of right side of canal (n o te
th ickn ess); 19, cem entum of left side of canal (n o te th ickn ess); 20, cem entum o f right side
at point at which it thins rapidly; 21, cem entum of left side at point at which it thins rapidly
KUTTLER . . . V O L U M E 50, M A Y 1955 551
SU M M ARY
D angers of A ctive Ignorance T h e appearance of science as a major social force has creatcd
many problems. W e are justly proud of our Am erican civilization. But h ow much scientific cul
ture does M r. Average Am erican have? O ur educational system has failed miserably in raising
the culture of our people to an appreciation o f the need o f basic science. There is even less of
what James B. Conant has called an Understanding o f Science.
M r. Average Am erican has not been taught to think critically or to w eigh evidence. In the
current controversy over the incorporation o f fluorides in drinking water the pu blic uses per
sonal testimonials on the same basis as scientific evidence. Should our amusement not be tempered
with sadness when w e read I found that drinking one bottle o f H adacol cured my rheum atism?
W ith even m ore sadness, we find some scientifically trained people thinking in the same
fashion. . . .
In very few areas of our educational system have the basic facts and methods o f science
been properly incorporated and taught. T h e result is that the m ajority o f our people are
scientifically illiterate. This creates an extremely dangerous situation, anticipated by Goethe
when he said, There is nothing more frightful than an active ignorance. W ard Pigman,
W anted: M o re Iv ory T o w e r s T h e Scientific M on thly 80 :25 2 April 1955.