h’ ~41~1,the phases 01: anatomic stltdy in the human sy~tcm 011~ of the most

complex is that of pulp cavii,y morphology. Obturation of prrlpal ~V.XLS

that have intinit;e variations is further complicated by age and functional
chi~~l~cs. However, clinical experience indicates that the pulp cavity COU-
fot~rs to a definite pattern in the great majority of cases.’
‘I’he importance of pulp cavity morphology was strcsscd strongly in for-
rn.ulatirig proccd~lrcs in c~~tlotlontics at a recent rncetirrg of the American AS-
sociation 0-f I<Gntlotlontists.2 Today, with the aitt of the roentgenogram, im-
proved instrumenta~~i~lm, precise proccdurcs, and a greater use of our rrror-
phologic knowledge, successf’ul cndodontic treatment may be achieved on
virtually any tooth in tha oral cavity that has sufr”cicnt bone support. It is
apparent that the dcntine and cementurn formation iu the wpi<;al area. co-n-
tinuc for many years after the root shape has fully develop&L I)nc to aging
pr0ccsSes,” ’ the npicoforamiaal arca becomes inarcasingly constrictotl, iLllOW-
ing only the smallest yossiblo lurwren through which the vascular and neural
system may pass. .Lt is one of Keture’s phcnomcna that a complete rlcurd,
oscular, ad lyl~rphatic system can p;tss through such it tiny :fora.men. The
age raugc during which the root morphology :I’~dly tlcvelops is ~~suully from
9 to 15 ycar~, except, of course, for the third maxillary and mandibular molars,
the age range of which is frown 18 to 25 years. It is perhaps dne to tissue r’e-
sistsnec, density of t~~.~l.)ecl,~li~r boric, or dissimilarity of growth during the
formative years that, deviations in the COIIIXC of root. ends and can& develop,
Tooth Icngths may va.ry in proport~ion to the height of man and oftcri
bear a relati.onship to the size ant1 sbapc of the head. Teeth are rrsnally
shorter in the female than in the malo.
.A study of average lcilgths in the follow.ir*, Q description of teeth should
prove to bo helpful in cndodontic procedure. .E’or practical. purposes, 20 min.
may be adopted as the arbitrary figure with which the avcragc lengths of
teeth may be eornparecl (Kg. I) as a temporary length mcasul*e udil. it mor(:
exact length of a tooth is obtained.
_I_-
*Foundt:r of the 1Cntiotlontic
Stucl~Club, ISrookIyn, .Vcw York.
743
 0 (D

00 0
 MORPHOLOGP OF 1'Ul,P CAWTY OF PERMANENIF TEETH 745

Ratios
of root lengths to crown lengths (Table I) have bcm cor~~p~l,ed
for US(I.a supplement
;LS t,o the “average lengths” mentioned previously.
Thcsc (?oilil)nta,t,ions may be nscd when tooth lengths are indeterminable, as in
such cases as gagging patients or ~~ervous, u11ru1y youngsters. In these in-
stances, difficulty of central ray angle adjustment, may cu.usc distorted film
images. It is noteworthy that the average ratio of root length to WOW~I
length is about I .5 to 1, with slight variations. Where the shortening of a
tooth is dne to abrasion or other conditions, these figures would be less
aceuratc.

TAFXX I. AVERAGE CROWN ANu ROO,P Tlk:~(;T~l~ ANU THEIR X,ESUI,TANT DIMENSIONAL RATIOS
_.-__I____-
AVERAGE LENGTH OF AVERAGE LENGTII OF RATIO OP ROOT LENGTH
TOOTH CROWN (MM.) * ~00~ (MM.)' ToTHTi: CROWNLENOTH
Mar.%:illary l’eeth
Central incisor 10.0 12.0 3.20
Lateral incisor 5.8 13.0 1.47
Cuspid 9.5 17.3 1.82
First premolar 8.2 12.4 1.51
Second premolar 7.5 14.0 I .XG
First molar 7.7 13.2 1.71
Second molar 7.2 13.0 1.80
Third molar 6.3 11.4 1.80
‘ua7ldibula,~ Terth
Central incisor 8.8 11.8 1.34
Lateral irks01 9.6 12.7 3.32
Cuspid 10.3 15.3 1.48
First premolar 7.8 14.0 1.79
Second premolar 7.9 14.4 1.83
First molar 7.7 13.2 1.72
Second molar 6.9 12.9 1 Xi
Third molar 6.7 .___. 11.8 1.76
_____
*According to G. V. Black.'

Morphologic Study
In this ptrelimina.ry a tmlysis, I have selected 160 teeth Cor a.natomic study,
choosing ten teeth of each variety. The cutting down of the teeth in vertical
cross section to the canals wa,s accomplished under the magnification of a binoc-
UIW loupe which gives about a three-power enlargement. The teeth were
ground on a continuously revolving, wet, rough stone. Great care’ was ex-
ercised when approaching the canal to avoid grinding past extremely fine,
curved, and tortuous canals. The canal areas were finally tinted with a red
dye for the purpose of improved visibility and photography.
These teeth should be analyzed not only as we see them in the illustrated
specimens, but also in comparison with the clinical and research observations
of other investigators.4-18
The maxillary and mandibular anterior teeth and premolars, with few
eseeptions, were cut in huecolingual cross section, thereby obtaining a mesial
or distal view. This sectioning reveals the greatest variation in canal ~120~
phology, the phase about which we know the least. Roentgenogmms revea.l
only a labial or buccal aspect which gives incomplete information.
In the preparation of these teet,h, the pulp canal was often difficult to
follow because in many cases the apica. podion of the root curved in varying
 I rt a SC~~~l~'i-lt~ prelirnina.Py- microscopic study of 200 apkes, each 2 mm. in
length, which included all varief.ies of teeth, 1. noted that only in a small per-
c:ctltage of the CRSCS were linultiple foramina or accessory canals present. This
information dif&rs great;ly from the findings o-f previous investigators who
h:lcl used “ CorrOsioll L)~CI)i~I’RtiOllS”” th:it hacl distorted the specimens, a pro-
nctluro that; had rcsrtlt,cd in erroneous statistical conelusions %or many yeax.
In rcferfiug to Table II, which is a. report made by Hess in 1925, my find-
ittgs WC somewhat similar to his only as far as frequency of canals is eon-
oerncd. It, is interesting t,hat, a c~ortterrtporary of Hess, namely, Hot;tcnbil?er,6
ohtsinod results by means of casts and histologic so&ions that were contrary
lo those obtained by Hess. In his study, Rol,tenbiller used 600 freshly ex-
l.txct.otl teeth from. patictnts ra raging in age from 5 t.o 60 years. All types of
t-ccth were pro~~ot~tiOrli~i,ely reprcsc~tttetl. Root canal. ramifications were found
ittfrequenlly. Rotlenhiller Htil('S: “ Mct,hocts out:lined by Hess and Fischer
Tal~i,,~:I I. I~‘Imyr:nscu OF Casn1.s”

Central incisor
I~ntcrd incisor
Cuspid.
E’irst premolar
~Secotd premolar
First molar

Rccond molar
Third n~ol~r

Central incisor
I,ateral incisor
Cuspid
Ib’irst premolar
Second premolar
First molar
8%
Recond molar Same as first molar
!l'hircl molar TWO cartals, three
80%; canals, 207~; and
occasionally, one canal
Approximately 2070 of all canals have lateral branches
Apical ramifications prcscn 1 as Collo~~s : t
tipper and lower first and second molars --____ 70%
IJnoer and. lower x,romolars _I-- - ~~~~~__~~~~ ---45%

have other disadvantages. . . . In an att;crnpt to t’entove the organic: ntwt,txt*

from t,he root canals some of the obstructions may have persisted. On the
other hand, vulcanite may have heerr forced ini;0 small fissures produced dur-
ing cstraetion, or hy drying, processing or vulcanizing. Prieswerk, I’asoli,
 MOKZ-'HOLOGY OF I'ULL CAVITY OF PERMANENT TISETH 747

Rrlotta, IIess and Fischer have not demonstrated that these lateral canals
a,nd multiple foramina leading from the main canal connect with the outer
surface of the tooth.”
In cutting down the tooth specimens, it was observed that the secondary
dentine was whiter and more opaque than the primary dentine. Tn reference
to this, Wheeler7 kates, “Tn many spccimcns . . . it is usually possible to SW
the original outline of the pulp chamber because of the tr~anslucency and color
variation between the secondary deposit of dcntinc and the primary deposit.”
2’he maxillary cenbal incisor avera.gcs 22.5 mm. in length from incisal
edge to apex, and the ratio of the root length to the crown length is 1.25 to
1. It harbors a pulp cha.mber which is continuous with the canal. The pulp
chamber is broa.d from mesial to distal and the pulp canal is broad from labial
to lingual. The broadest part of the canal is that part which corresponds to
the cervical line, where the flat mesiodistal area of the pulp chamber meets
the flat Iabiolingual area of the pulp canal. In persons up to the age of ap-
proximately 25 years, it may be found that the pulp chamber follows the gen-
eral contour of the crown, including the pulp horns which correspond to the
mamelons. From the cervical level, the pulp canal tapers gradually to the
apical third where it becomes round and relatively narrow.
The rYLaxillary lntercll incisor averages 22.0 mm. in length, and the ratio of
the root length to the crown length is 1.47 to 1. The pulp chamber and canal
have a configuration similar to that of the maxillary central incisor, except
that the crown, root, and pulp cavity, are proportionately narrower. The
apical third of the root and canal curves more inwardly t>han does the central,
due to developmentad conditions. In root surgery, this is of particular im-
portance, since the operator must follow a lingua.1 direction in order to reach
the apex. The direction of the canal axis, as in the central incisor, is from
the apex toward the incisal edge.
The mnxillary canine averages 26.6 mm. in length, and the ratio of the
root length to the crown length is ,1.82 to 1. It is the longest tooth found in
the human mouth. Some canines measure as long as 35 mm., as may be noted
in E’ig. 2, necessitating longer than average instruments to explore to the
apical region. The pulp chamber is large but narrow in proportion, as corn-
pared to the central and lateral incisors. The coronal third of the pulp Carla.1
is larger than any of the other single-rooted teeth, and is broad labiolingually~
as is the root. The canal tapers as it approaches the apical third and becomes
abruptly narrow and round. The canal may curve mesially or distally, often
causing difficulty on openin, w into and filling this area. As in the ease of the
central and lateral incisors, the .labial arcing of the crown should be studied
when one approaches the chamber and canal.
The maxillary first premolw averages 20.6 mm. in length, and the ratio of
the root length to the crown length is 1.51 to 1. It has two canals in most
cases, although occasionally one canal and, less frequently, three canals may
be found. In young persons, the pulp che.mber has pulp horns, the occlusal
surface of the chamber is generally at a level 2 mm. eoronally to the cervical
 Fig. Z.--Sotc that the labial outlines of the ~rcwns of these teeth present an arc fl‘om
the: incisal edgo to the cervix, and the labial outline of the root prcsens a continuation of this
arc, not quite as severe, to the awx. These arc more pronounced in the oral cavity when the
tooth is placed a.t, ;tn angle of 60 clcgrces in trlc alwolar arch. Lack of attention to this arc
m&y result in a perforation through the: labial portion of tho tooth. As a rule,, the central axis
or the wn:rl follows a straight line from the apex and points tow;trd the irmsnl edge.
 MOBfHOLOGY OF PUIil’ CAVITY OF I’ERMANENT TtiETII 749

a single canal is present. The canal may bifurcate ha,lfway down or further
apically, resulting in two canals. In cases where there are two canals and a
single root, the two canals may coalesce and form a single apical foramen.

Fig. Z.---Note seventh from left in top TOW. Two canals coalesce to form a single canal
which bifurcates to again form two canals ant1 also two apical foramina. Lower row reveals
many variables in single anct double canals.

The maxillary firs2 mola,-, by virtue of its hulk, possesses one ot’ the largest
crowns in the dental arch and the pulp cha.mber, in early years, conforms to
the crown shape. The average length of the tooth is 20.8 mm. from the sum-
mit of the cusp to the apex. The ratio of the root length to the crown length
is a.71 to 1. Ita thrw? -roots arc skuYly, and i.here js gcncrally a djvcrgeuce of
>II)OII~45 ~IC~IWX ~C~WCWI thy ~IICX:~I roots, \vhi<:h are ofi en in a. viri.ually vertj-
c?nl posit-ion, ant1 the lii~gnxl root. The chamber is reaclml by opcni.ng into
t-ho ccnte~ of 1 he o(!cll~Si\ I HUI~PWC anil proceeding latertilly until the ~~t:d~~al
surf;1w of I he chsrnbw is wlnovcil. ~l’ulp stones and noduIcs, vl-hich are often
fo~md. in molar c!h ambers, present comm oi.1 irregularitics,‘4 dthough these
r.onditio1ls may 2tlSO be pl’csent in the CiUIRIS.‘5 The pLrlpa1 floor area, by com-
parison, COWYS about: one-third t,o ok:-ha1 E ihc, area of the occlusal. surff:~ce.
Ti is about 3 111r11. ~~~>es>~i~rtl of thr cervical lint, while the o~clusd surface of
the pulp ehamber is about 1 mm. coronal to the cervical line. The floor oe-
cugics the anterior two-thirds of the tooih in relation to the 0cc1usn.l s~facc
and presents a somewhat, triangular a pp~arance. The lingual canal is visually
1Rrge, round, illlfl easily :~.Ci:cSsible, The distobuccal cand is sitzxted iit a
1)osition slighlly lingual t.0 Lhc position of the unt:xiobllccal card and is con-
tinuous wit,11 the wall of the pulp chanll)cr. Its course is in 8 diStil1 direction
and is fairly accessible from ;ir~ anteri.or posit,ion and, at t,hc apical third, the
root canal often curves somewhat mcsially. The mesiobuccal canal orifice
is located q\~ito mesiobuccally and should be approached from a distal posi-
tion. As the canal lcaves the charnbc~, it courses me&ally and then slightly
distally. Often present at the orifice is a thin dentinal wall with which care
should be cxcreisctl to avoid perforating. The root. hal*boring the mesiobuccal
CRnZtl is lXY):lcl l~uccoling~nally and the CalliLl is seen in the for*m of 3 slit 01
ellipsis with the length from buccal to lingual. ITpon entering t.his orifice, t,hc
entire opening should be exylorecl, since RII additional canal resultir~g in two
a.1)ica.l Poramina may be present.
7’he mazillnry second m,olar is, in many respects, similar to the first molar.
‘Ita average, over-all length is 20.2, aid the ral io of root length lo the crown
Icngth is 1.80 to 1. It is smaller in all tlimensions than t,he first molar, al-
though t.ho roots do not diverge as much and are occasionally fused. Its oc-
clusal outline is more ~~homboitlal, as may be noted by the shorter buccal sur-
&XC -following the curvature of the occlusal :lr<;11. :It is narrower in its dist,al
measurement. The otrelllsd SUI~~CC and the f100r 0-I’ the pulp chamber are
in about the same corresponding position and surface area comparison as t~hat
o-f the first molar. The floor OP the chamber is mxrkedly COI~WX, giving a
slight funnel shape to the (;ilrltll orifices. I:sually in the young adult the oc-
clusal sur~fnoe of the pulp ohand~er is at a level 1 mm. beyond t,he cervical li?te
coronally, and Cho floor ol’ the pulp chamber is about 3 mnl. apc~wa~d OC the
cervical line. Since the length measu~~nent of the tooth is approximately ‘LO
Inm. and the measurement from the occlusal su toface to the floor of the chwm-
her is about .I0 mm., tile lcrrgtl~ of the can:11 proper would be about 30 mm.
Occasionally, the ca,niils C~L‘VO (as in most mola.rs) into the chamber at an
angle of 45 dogrces to the floor, making it necessary to remove a lip of dentine
with. tt sharp instrument in order to enter the cand orifice in a more direct
line with the canal axis. The lingual canal is similar to that of the firsl- molar,
except that its angle in relation to the bnccal roots tends toward the vertical
posit,ion, The distobuccal cana,l occasionally has a tendency to course first
 2’ha mazillary third rnolnr has an average length oI’ 17 mm., and the ratio
of’ the root length to 1hc crown 1engl.h is I.80 to 1. The crown of this tooth
generally extends bucctally so that thcrc is more working room in the vcstib-
nlar area. The ocelusd surface ill the pulp chamber is at a level of .I mm.
coronal. to the cervical line; the floor is about 3 mm. apexward of the cervical
line, leaving ifrr avcragc of about 8 mm. of actual canal length. ‘I’hC tOOtt
resembles the second molar to a great extent, but has more anomdous varia-
1 ions than any 01 the upper teeth. In most casts, the roots arc closer togothor
than those of the second moln~ and they arc often Pusccl. Three canals simi-
lar to the secontl molar may bc present. One l.argo canal, apparently the
lingual canal, encompassing the two buccal canals with a single apical foramen
Or two apical foramirra, may exist. Tn rare cases, there >Lrc four poets and
POW SCpi1l%tC canals.

The mandibdar cr!ntd incisor is the smallest tooth in bulk in the dental
arch; its average length is 20.5 mm., and -the average ratio of the root length
to the crown length is 1.34 to 1. Its pulp chamber is Aat ‘in its mesiodistal
mcasnrem ent, and the pulp canal is %t in the lahiolingua.1 mci~s~~rcmcnt, simi-
lar to that of the ma,xillary central incisors, One canal is gcncralty prcscnt,
i~lthOl~~l1 occasionally there a.re two canals. The pulp horns become calcified
sooner in life that.1 those of the maxillary anterior teeth, due to greater attri-
tion and other conditions pccuii.ar to these teeth. !I’he pnlp cavity is largest
in the area that corresponds to the cervical line forming a narrow, elliptical
slit which tapers into a fine, constricted, round canal ifs it approaches the
apical third. This tooth slopes lingually from crown to apex, a.nd the apie;rl
third curves slightly distolingually. The tooth position, in the mandible at
iLrl angle of 60 degrees in addition to the buccal. arcing from incisd edge to
 Fig. F.-Xote labial arcing fmm incisal c(?ge to apex of all mandibular anterior teeth
similar to the maxillwy anterior teeth : note also the central axes of canals pointing toward
the? irksal edges. ‘l’hcro is a slightly greater incidence of double canals in lateral incisors than
in central incisors. Man(lihuler canines have large carrals: rarely, two roots and two canals
art? pN?scr1t.

c,a,nals is more frequent thaIi in the central incisor. The curvature of the
apical third is somewhat greater in a distolingual direction than that of the
central incisor. 1Vhhcn approaching the lmlp cavit,y, it. start should bc made
from the cingulum area aild worked toward the in&al to obtain dir& access
to the pulp cl~aml~or ant1 canal. \\‘hoil tli(: lr1i~ililil~nlar incisors arc in linguo-
version, it is ot’ten necessary lo ol)en into the canal frorrl Iha labia-in&i1 angle
t0 obtain ilCCCSS.
The nwmSibul~r canine avWag;cs 25.5 mm. iii lctlgth and the iLV(?l't3gC ratio
of the root length t,o the crown length is 1.48 to 1. OJW root and one CalId
:Lre usunlly present.. Occasionally, there are two roots which may OPmay not
he fuscci and can present two canals. Quite rarely Rre there three roots iLn<l
three canals present.. This tooth is similar to’ the Jrraxillary ca.ninc in many
 MORI’HOLOGY OF PULP CAVITY OF PEKIVANEN’I’ ‘l’lW’i’l-1 753

respects, but differs in that the labiolingual and mcxiodistal measnrements arc
smaller throughout a,nd the chamber and canal are also proportionately
smaller. Since superimposition in readin g a. roentgenograrn may give the ap
pearance of one canal when two are actually present, the taking of roentgeno-
grams at a T5degree difference in lateral angulation is recommended. When
approaching the central axis of the pulp cavity, the position of the tooth in
relation to verticality and its labial arcing should be considered.
The mandibular first p~nzola~ averages 21.6 mm. in length, and the aver-
age ratio of the root length to the crown length is 1.79 to 1. It is similar to
its canine neighbor in many respects, having a single occluding cusp and a
central canal axis pointing to this cusp, as in all anterior teeth. A. single canal
is usually present and only occasionally an additional canal is found. It is
necessa,ry to open the entire chamber from buccal to lingual walls to discover
this additional canal. The entrance to the cana. is generally large and ellip-
tical, with the narrow measurement mesiodistally. This becomes suddenly
narrow and round at the apical third, occasionally making it difficult to obtain
a grip for instrumentation to the apical foramen. It has a buccal arcing from
occlusal tip to apex and, since the crown is inclined somewhat lingually, the
apllroach to chamber a,nd canal should bc from a slightly lingual position.

Fig. 7.-Mandibular prerrtolsrs. The buccolingunl cross sections reveal a high percentage
of single straight-line canals. When two canals are present, they may be difBcult to explore,
as the chamber may reach as low as the middle to apical third.

7%~ mundibulur second yrxmokw uslrally is slightly longer than the first
premolar, averaging 22.3 mm. in length, and the average ratio of the root
length to the crown length is 1.83 to 1. Tt has one canal in the majority of
cases, The buceal and lingual cusps are of about, equal length. and often
present are two lingual cusps, totaling three ensps. In compajrison to the first
premolar, the root of which is round at the cervical level, the second premolar
has a greater girth and is wider bnccolingually;7 the size and shape 01 the
canal vary proportiona.tely. .When the pulp chamber is approached, the
opening is made buecolingaally from cusp tip to CUSP tip. The canal courses
in a, straight. line and tzpcrs to a. narrowi’, round canal which may 1~) eon-
xl-rict cd. Occasiona.lly, thcri: is a tcndeney for an isIw.ntl lo form in the middie
i;hirtl arca, causing two canals to f0rm which may aoalcst~r alId again form a
iinglc canal. Less freq7ml1.1~~. at the miiitlle OF the canal, a.n additional
s7ndler enna.l spurs off which is dificult to ncgotiata when it exits from the
main canal at almost n right angle, For pm tposes of periapicnl study, the
mc-ntal fommtm is found olosor to the ii pex of this root in a grcatcr percentage
of camcs than to the first premolar apex.
T&s mandibular first molar has an avcragc length OE 21 mm.; and the aver-
iigc ratio of the root ienglJ~ to Ihe crown Icngth is 1.72 to 1. ThrPc canals are
ns7dly prcsen-one cana.l in the distal root and 1wo canals in tho mcsial
twot. ‘I’ht? pulp chamber in car7y years follows the gcncral contour of the
Loath exterior, and as years ad~amx the pulp horns tlisapl)ci\r. The occlusal
surface of the pulp chamber corresponds to a level 1 mm. above the cervix,
and the floor is about 3 mm. below. The floor is rccta.ngular it1 shape, plat:cd
slightly mcsial to a9central position, and, by comparison, covers almost one-half
the a.rea that the occlnsal surface covers. Siucc the floor is about 3 mm. be-
low the cervix and the crown measurement. is approximately 8 mm. (totaling
11 mm.) from occlusal surface to the pulp floor, this would leave the actual
length of the canals from the floor of the pulp chamber to apex at about 9
mm. The orifice of the distal canal is geuerally large and slightly elliptical,
with its length from buccal to lingual, and it is easily accessible from a some-
what anterior position. IDI:. Harry Albert,,2 in thirty-two years of clinical cs-
pcriencc, finds t,hat in a great percentage of casts Ihero are two canals in the
distal root; these arc cithcr scparatcd or connected by a corridor. Due to the
lingual incline oi’ the tooth, the orificc of the carti may be found ~011. Imdcmeath
I,he buccal et~p. so that the usual app roa.ch for instxutncnt,ation to ~hc distal canal
is from a somewhat mesiolingual position. At the apical third, the root and
canal cu:rvc slightly mcsially. In the mesial root? two canals arc invariably
prcscnt--one buccal and one lingual. The orifices arc often connected by a.
@‘OOTC which helps to locate both. canals. The orifices, in most casts arc C~OSC?
t,ogether and may bc situated well unclerneath the buccal cusp. ‘I’hesc canals
a.rc continuous with the walls of the pulp chamber, but vory often they enter
the chamber at a. distal incline. Tho two canals usually diverge and then con-
vcrgc slightly and end in two apical foramina. The apical third of the root
curves slightly &&ally. A corridor may connect both canals part way or all
the way, .forming a single ribbon-shaped canal ending in a single apical Eo-
ramen. This observa.t.ion is essent.ial in expcditiag the removal of the entire
canal contents.
The mandibular second molar has an average length of .I!).8 mm., being
slightly short,er t.han the first molar, and the average ratio of the root length to
the crown 1cngt.h is 1 .X6 t.o 1. The crown is shorter and the roots longer in com-
parison to ,thc first molar. The second molar is similar to the first molar in many
respects, including the number of canals. It differs from the first tnolar in that
the toot.h is smaller in all proportions and its distal ,wall is narrower. The
chamber is ti~)[)rOilChCCl ftY.Ym the ccrltrwl point of the ceirtral fOSSa of the OCClLl-
sal ~~rfacc. .In comparison to the first molar, the chamber is smaller and all
G3lldS arc closer together. ‘I’his tooth is inclined more lir@Sually than the first
molar, and the directional approiieh should corrcspo~l to the tilt 0-f the too-th.
‘l’he distal canal is easily approached from a somewhat anterior position. DIN
t>o the lingual inolinution ,of the tooth in the arch, the distal and mcsial carnal
orif& may be located well underneath t.hc buccal cusps. 7’1~~ m&al canals ilrc
smaller, iE3 a rule, than those of the first molar, bitt the : greaksl, difficu1t.y lies ill
the need for a posterior approach, as both mesial canals CLII’VC mcsially from lhc
lmlp orifice and then arc slightly distally. ‘I!hcsc characteristics often make it
neoe~sary to cut il,wa.y a greater portion of the mesiobuccal cusp in order to
enter the mesiobaccal ea.nal. Occasionally, it is necessary to open into the
canal from t,he exterior of the tcJoth from the buccal SL&NC, above the cervix,
in orcler to enter the mesiobuccal canal in a line with the central axis o-f the
canal.

l’he mundibulw third ndlcr averages 17.5 mm. in length, and the average
ratio of the root length to the crown length is I,76 to 1.. Tts shape and size
arc variable, as well as its chambers and canals which poSSeus many anomalous
configurations. :Pcrhaps because of its late eruption and compar;~ti~e lack of
use, its chamber and c>irIiLls are quite large in contradistinction to its neigh-,
boring molars.
 Fig. 9.- -I,ine drawn horizontal to occlus;tl surface of upper first molar. Curvetl lines
have been drawn, using this line as center. Hach tooth has its own arcing. Teeth set In
sumorting boric follow gentle curves.

operator would view a mandibular left molar of a palient sitt,ing in the dental
chair from il side position to the patient’s head and above the Icvcl. of OCClu-
sion. In this cilsc, the line of sight would bo Prom a lingual and anterior posi-
tion. Ln t,ho CIISCof a mantlihular right molar, the lint of vision woulci hc
tram a brrceal ant1 antcl*ior position. In &her case, there is difficulty in oh-
t.w.ining a direct lint of vision lo the mcsial canals without cutting away mesio-
hlH?Ciiltoot11 strrlcl;l,~ro.
It is to be noted that the entire maxilln and the mandible are ma&3 up of
harmonious cu~~cs, ant1 the roots from cuspitl to molars curve distally at
approximxtoly 811S;Xcgrco angle to the occlusal surfacca.
The teeth have an atLlitiona1 inclination idat shonlil be carefully A-
SWYOC~, t,hat is, the asial inclination from a mexial aspect of t.hc tooth. ‘I’hc
rrl>Ly he an illusion ~LRto the true position of the c>rrriLl orifices. .Irr order to
obviate this illusion, it is necessary to stand directly in front of the patient
ir,nd hold the mirror so that t.he flat surface is parallel to the distal su-rfaec
of the tooth. Therefore, in approaching the pulp cavity, one should study the
cliraction of the central axis of the both and pulp cavity by studying the line
of vision in addition to the tooth inclination. One also should consider that
all these angles may vary widely from the dorcmentionecl figures which were
computed as an average.’ The angles may change according to the atliLl.)t;L-
hility ‘of the dental ,mechanism and malposilions acqnird or irrheritcd. .A
thorough study of the position ok? the tooth in the l)one is esscrtti;\l bc:fore the
operator may crltcr the pulp cirvity.

Pulp Chamber and Curved Canal Observations

I’ulp chi~~rrFor-s vary in Iic~igiit iii poslcrior tcoth (Fig. 10) I’rom 0.5 to 5 mm.,
but; the average in adults is 3 mm. Secondary dentine may form equally from
the occlusal surface or -from the floor of the pulp chaml)er, but more often
‘l‘his kx)wledgc is csscntial, since proper cuploration of the apical apea &-
gii!tt& 01% Lhc? cicg!:rcc of curvatut~ ;LII~ the t~iaini?tef cif the ~~u’nc?I~ of the c;zJml.
Also i mpfwf :inf- 2 w l;hc tcni fwr a.ritJ ga,ugr of tlrc iristr7unrnts -used.

Pulp Stones ancl Secondary Dentine

In clinical pra,eticc, it has been found that pulp stones or: secondary clen-
tine may e%lse the lUrYlCIJ. of a canal to be reduced to microscopic dimensions
0~ even cause complete oblitcratiori.l~ :r, IS, lti These conditions may be found
to a great extcn t in c,ne or both. small omds of m.olars resulting in pulls chsm-
bcr* r:i.rcralat.ion hrirlg ca r*raicil on by l.he lar*gc canal.

Summary
1. Average lengths of teeth and computed average ratios of root lengths
to t,bc crown lengths arc stat,cd for two main reasons :
a. To assist the operator in determining the depth of insertion of
guide wire into canal before taking roentgenogram for measurement
control.
b. To assist the operator in estimating the tooth length when he is
rinablc to obtain a satisfactory roentgenogram for some reason.
2. The frequency and characteristics OS the canals in all teeth arc given.
3. The common location of canal orifices is presented.
4. The suggest& endotlo.rrt,ic approach to pulp chambers, including the
floor shapes and positions, is discussed.
5. The positions of curvat.ures and ditcctions of pulp canals are presented.
6. The variability and incidence of accessory canals and. multiple fora-
mina are discussed.
‘7. The axial inclinations a.nd positions of the teeth in tbc arch. arc COW
sideTed.
Conclusion
It is known that pulp cavities vary greatly in size anil shape in different
races as well as in different persons within the same race. It is also evident
that, as growth forces continue, there is a diminution in the size of the pulp
cavity, sometimes to a point of obliteration. Teeth may have been affected by
decay processes, erosion, abrasion, restorations of varying depths, causing
pulp injury, speed grinding, loss of vitality, etc., all of which have a tendency
to change the size and shape of the pulp cavity. Nevertheless, morphologic
knowledge is indispensable, inasmuch as one is guided in detecting the lrosition
of the pulp cavity regardless of size, shape, or position of the tooth in the arch.
Pull) cavities generally conform to the outline of the t&h before the
formation of secondary dcntine, which usually begins a-fter the teens. From
this time to middle age, the l.aying down of secondary dentine is extremely
slow and frequently imperceptible. lt is (luring this period that teeth, which
otherwise might be lost, may bc salvaged with the least amount of opcrativc
difficulty and also with the minimal amount of discomfort to the lnttierrt.
 MOIWHOLOGY OF PULP CAVl'l'Y OF PEKMANENT 'l~ICE'l'I1 159

An essential. supplement to th.e knowledge of internal dental morpbdog;y

in endodontics is the stud.ied development of digitad dexterity and a definite,
recognized procedure and modus operandi.
Morphologic knowledge aids the operator in tracing a canal to its termi-
nation, thereby increasing his degree of success. The rare unsuccessful case
falls in ,the category of the frailties of the human element of the operator and
the rebellion of the patient’s eelMar elements to injury.
References
1. Skillen, W. 6.: Morphology of Root Canals, J. Am, Dent. A. 19: 719, 1932.
2. Albert, Harry: Endodontics; a Biophysica,l Approach. Essay Before the American
Association of F:ndodontrsts in Chicago, February, 1953.
3. Bodecker! Charles F.: Fundamentals of Dental Histology and Embryology Including
Climcal Applications, New York, 1944, The Macmillan Company, p. 87.
4. Black, G. V.: Descriptive Anatomy of the Human Teeth, od. 4, Philadelphia, 1902,
8. S. White Dental Manufacturing Co., p. 17.
5. Hess, Walter: Anatomy of the Root Canals of Teeth of the Permanent Dentition,
London, 1925, John Bale, Sons and Danielson, Ltd.
6. Barret, M. T.: Internal Anatomy of the Teeth With Special Reference to the Pulp
and Its Branches, Dental Cosmos 67: 581, 1925. (Includes Rottenbiller report.)
7. Wheeler, Russell, C.: Textbook of Dental Anatomy and Physiology, Philadelphia,
1916, W. B. Saunders Company.
8. Diamond, M.: Dental Anatomy, New York 1935, The Macmillan Company.
9. Dewey, Martin: Dental Anatomy, St. Louis, 1916, The C. V. Mosby Company.
10. Weeks, Thomas E.: Manual of Operative Technics, Chicago, 1894, I-I. D. Justi & Son.
11. Grossman, Louis I.: Root Canal Therapy, ed. 3, Philadelphia, 1950, Lea $ Febiger.
12. Coolidge, Edgar D.: Endodontia, Philadelphia, 1950, Lea & Febiger.
13. Davis, Clyde W.: Operative Dentistry, St. Louis, 1945, The C. V. Mosby Company.
14. Kronfeld, Rudolf: Histopathology of the Teeth and Their Surrounding Structures,
ed. 3, revised by Paul E. Boyle, Philadelphia, 1949, Lea & Febiger.
15. Willman, Warren: Calcification of the Pulp, Bur 34: 73, 1934.
16. Thomas, N. G.: J. Am. Dent. A. 8: 11, 1921.
ONE HANSON PL.