Chapter 1 The Dental Pulp and Periradicular Tissues 35
y Some of these tubules close completely and C m ntum
y
form sclerotic dentin. The decrease in pulp
volume reduces cellular, vascular, and neural
content of the pulp. The odontoblasts undergo
atrophy and may disappear completely under
areas of sclerotic dentin.
y y A reduction in the fluid content of the den-
tinal tubules is also seen. These changes make
the dentin less permeable and more resistant to
external stimuli.
y y The fibroblasts are reduced in size and num-
bers, but the collagen fibers are increased
in number and in size, probably because of
the decrease in the collagen solubility and
turnover with advancing age. This change is
referred to as fibrosis. Fibrosis is more evi-
dent in the radicular portion of the pulp than
elsewhere.
y y The blood vessels decrease in number, and
arteries undergo arteriosclerotic changes.
Calcific material is deposited in the tunica
adventitia and tunica media. These changes
reduce the blood supply to the pulp.
y y The number of nerves is also reduced.
y y The ground substance undergoes metabolic
changes that predispose it to mineralization.
Changes in the blood vessels, nerves, and
ground substance predispose the pulp to dys-
trophic calcifications.
Part 3: normal P rira i ular
e d c
i u T ss es
The periradicular tissues consist of the following:
y Cementum, which covers the roots of the teeth
y of cementum also gives form to the mature api-
y Periodontal ligament, whose collagen fibers,
y cal foramen. The foramen, as it matures, becomes
embedded in the cementum of the roots and
in the alveolar processes, attach the roots to the
surrounding tissues (Fig. 1.23)
y Alveolar process, which forms the bony troughs
y
containing the roots of the teeth
In the region of periradicular tissues portals
of entry and exit between root canals and the
surrounding tissues are located, and pathologic
­
reactions to diseases of the pulp are manifested.
Ch_01_GEP.indd 35
@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬
e e
Cementum is a bone-like calcified tissue that cov-
ers the roots of the teeth. As previously discussed, it
is derived from the mesenchymal cells of the den-
tal follicle that differentiate into cementoblasts. The
cementoblasts deposit a matrix, called cementoid,
that is incrementally calcified and produces two
types of cementum: acellular and cellular (Fig. 1.11).
Chronologically, the acellular cementum is
deposited first against the dentin forming the
cementodentinal junction, and as a rule, it covers the
cervical and the middle thirds of the root. The cel-
lular cementum is usually deposited on the acellular
cementum in the apical third of the root and alter-
nates with layers of the acellular cementum. The cel-
lular cementum is deposited at a greater rate than the
acellular cementum and thereby entraps the cement-
oblasts in the matrix. These entrapped cells are called
cementocytes. The cementocytes lie in the crypts of
cementum known as lacunae (Fig. 1.11). From the
lacunae, canals, called canaliculi, which contain pro-
toplasmic extensions of the cementocytes and serve
as pathways for nutrients to the cementocytes inter-
lace with other canaliculi of other lacunae to form a
system comparable to the Haversian system of bone.
Because cementum is avascular, its nutrition comes
from the PDL. As incremental layers of cementum
are deposited (Fig. 1.24), the PDL may be further
displaced, and some cementocytes may die as a result
and may leave empty lacunae.
The thickness of cementum reflects one of its
functions. The greater thickness of cementum at
the apex is due to its continuous deposition during
the eruptive life of the tooth to preserve its height
in the occlusal plane. The continuous deposition
https://t.me/LibraryEDent
conical, with the apex of the cone, called the minor
diameter (constriction), facing the pulp and the
base, called the major diameter, facing the PDL.
Clinical Note
Cementum is about 20–50 µm thick at the cemen-
ŠŠ
toenamel junction and 20–150 µm thick in the apical
third of the root.
(continued)
08/08/14 1:58 PM
 36 Grossman’s Endodontic Practice

@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬

Alveolar bone

Dentin

Cementum

Cementum
PDL

Alveolar bone

https://t.me/LibraryEDent

2 mm

Figure 1.23 Root, apex. This is a longitudinal section of the apical part of a root. The apical supportive tissues are
also shown. You may already have noticed the thick layer of cementum covering the dentin at the apex indicating
that this tooth once belonged to an old individual. The cementum is mostly of the cellular type. Incremental lines can
be seen and illustrates the “rhythmical” deposition of cementum (stain: H + E). (Courtesy: Mathias Nordvi, University
of Oslo, Norway.)

Ch_01_GEP.indd 36 08/08/14 1:58 PM

 Chapter 1 The Dental Pulp and Periradicular Tissues 37

@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬

Dentin Cementum

Incremental PDL
lines in
cementum

Cementocytes

Blood vessel

Alveolar
bone

500 µm

(a)

Acellular
Dentin
cementum

Border between
Dentin tubules dentin and
cementum

Cellular
cementum

Cementocytes

Incremental line
https://t.me/LibraryEDent

100 µm

(b)
Figure 1.24 (a) and (b) This is a longitudinal section of the apical part of a root. Cellular and acellular cementum along
with cementocytes and incremental lines can be appreciated (stain: H + E). (Courtesy: Mathias Nordvi, University of
­

Oslo, Norway.)

Ch_01_GEP.indd 37 08/08/14 1:59 PM

 38 Grossman’s Endodontic Practice

@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬

(continued)
ŠŠThe continuous deposition of cemen-
tum increases the major diameter and
results in an average deviation of the apical
foramen of 0.2–0.5 mm from the center of the
root apex.
ŠŠ The minor diameter dictates the apical termination
of root canal instrumentation and obturation and is
located:
- An average of 0.5 mm from the cemental surface

­
in young teeth
- An average of 0.75 mm from the cemental surface
­
in mature teeth
Although the cementodentinal junction may coin-
ŠŠ
cide with the minor diameter, cementum may grow
unevenly and may alter this relationship.
The fibers of the PDL occur between the osteo-
blasts and cementoblasts and are embedded into the
bone and cementum, respectively. These embed-
ded fibers, called Sharpey’s fibers, attach the PDL to
bone and cementum.
Repair is another function of the cementum.
Root fractures and resorptions are usually repaired
by cementum. The closing of immature roots
by apexification procedures is accomplished by
deposition of cementum or cementum-like tis-
sue. Cementum also has a protective function. It is
more resistant to resorption than bone, probably
because of its avascularity. As a result, orthodontic
movement of roots can usually be performed with
a minimum of resorptive damage. Other functions
are the maintenance of the periodontal width by
the continuous deposition of cementum and the
sealing of accessory and apical foramina after root
canal therapy.
P rio ontal igam nt
e
d
L
e
The periodontal ligament is a dense, fibrous connec-
tive tissue that occupies the space between the cemen-
tum and the alveolar bone. It surrounds the necks
and the roots of the teeth and is continuous with the
pulp and gingiva (Fig. 1.25). The PDL is composed
of ground substance, interstitial tissue, blood and
lymph vessels, nerves, cells, and fiber bundles.

Enamel space

Crown

Dentin Gingiva

Pulp

Gingiva

https://t.me/LibraryEDent
Peridontal
ligament

Cementum

Alveolar bone Root

2 mm

Figure 1.25 Tooth and its supportive structures. Longitudinal section: periodontal ligament, the alveolar bone, the
pulp, and some parts of the gingiva (stain: H + E). (Courtesy: Mathias Nordvi, University of Oslo, Norway.)

Ch_01_GEP.indd 38 08/08/14 1:59 PM

 Chapter 1 The Dental Pulp and Periradicular Tissues
Variations in width occur from tooth to tooth
and in different areas of the ligament in the same
root. Teeth with heavy occlusal loads have wider
PDLs than teeth with minimal occlusal loads, in
which PDLs are thinner. With advancing age, the
width of the PDL is reduced.
Clinical Note
The width of the PDL varies from 0.15 to 0.38 mm.
nterstitial issue
I T
The interstitial tissue is the loose connective tis-
sue that surrounds the blood vessels and the lym-
phatic vessels, nerves, and fiber bundles. This tissue
contains collagen fibers independent of the fiber
bundles of the PDL. Changes in its configuration
are due to continuing changes in the fiber bundles.
The spaces in the PDL, filled with interstitial tissue,
blood vessels, lymph vessels, and nerves, are called
interstitial spaces.
C ells o the Perio ontal igament
f d L
The active cells of the PDL are the fibroblasts, osteo-
blasts, and cementoblasts.
y Fibroblasts synthesize collagen and matrix and
y
are involved in the degradation of collagen for
its remodeling. The result is a constant remod-
eling of the principal fibers and maintenance
of a healthy PDL. Because of these important
functions, the fibroblasts are the most impor-
tant cells of the PDL.
y Osteoblasts, or bone-forming cells, are found
y
in the periphery of the PDL lining the bony
socket. They are usually seen in various stages
of differentiation. The function of osteo-
blasts is the deposition of collagen and matrix,
which is deposited on the surface of the bone
and to which Sharpey’s fibers are attached.
Calcification of the osteoid anchors Sharpey’s
fibers. The constant remodeling of bone pro-
vides for the continued renewal of the attach-
ment of the PDL to bone.
y Osteoclasts, or bone-resorbing cells, are found
y collagen and oxytalan fibers. Collagen fibrils are orga-
in the bone periphery during periods of bone
remodeling. They are multinucleated cells with
a ruffle or striated border toward the area of
Ch_01_GEP.indd 39
39
@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬
bone resorption. As the osteoclasts demineral-
ize and disintegrate the matrix, scooped-out
areas in the bone, called Howship’s lacunae, are
formed. Osteoclasts are usually found in these
lacunae. This pattern of resorption gives the
border of the bone an irregular shape.
yy Cementoblasts, as previously discussed, are
aligned in the periphery of the PDL opposite
the cementum. Their function is the deposition
of a matrix consisting of collagen fibrils and
ground substance called cementoid. Cementoid
is found between calcified cementum and the
layer of cementoblasts that thickens in periods
of activity. The fibers of the PDL are found
between cementoblasts and are entrapped in
the cementoid. As the cementoid calcifies, the
fibers of the PDL become anchored in the newly
formed cementum and are called Sharpey’s
fibers, the same as PDL fibers anchored in bone.
Cementoid may protect the cementum against
erosion.
yy Cementoclasts, or cementum-resorbing cells,
are not found in the normal PDL because
cementum does not normally remodel. They
are found only in patients with certain patho-
logical conditions.
yy Other cells present in the normal PDL are the
epithelial cell rests of Malassez, undifferenti-
ated mesenchymal cells, mast cells, and macro-
phages. The epithelial cell rests of Malassez are
remnants of Hertwig’s epithelial root sheath.
These cells are located in the cementum side of
the PDL. Their function is unknown, but they
can proliferate to form cysts in the presence of
noxious stimuli.
y Undifferentiated mesenchymal cells are usually
https://t.me/LibraryEDent
y
stellate cells with large nuclei located near the
blood vessels. These cells may differentiate into
fibroblasts, odontoblasts, or cementoblasts.
Perio ontal Fi ers
d b
The periodontal fibers are the principal structural
components of the PDL. Two types are known:
­
nized into fibers, which, in turn, are organized into
bundles. The fibers that constitute the bundles are
not continuous from bone to cementum, but consist
08/08/14 1:59 PM
 40 Grossman’s Endodontic Practice

@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬

of strands that can be continually and individually distribution of the arteries. The alveolar branches
remodeled by fibroblasts without causing loss of the innervate the apical region, the interalveolar
continuity of the bundles. The terminal fibers of the branches innervate the lateral PDL, and branches of
bundles insert into cementum on one side and bone the inter-radicular nerve innervate the furcal PDL
on the other side. These terminal fibers are called of the posterior teeth.
Sharpey’s fibers regardless of cementum or bone The nerve endings of the PDL enable one to
insertion. The fibers are arranged in bundles with a perceive pain, touch, pressure, and proprioception.
definite functional arrangement. These bundles fol- Proprioception, which gives information on move-
low an undulating course that allows some move- ment and position in space, enables one to perceive
ment of the tooth in its alveolar socket. the application of forces to the teeth, movement of
The fiber bundles are arranged into principal the teeth, and the location of foreign bodies on or
fiber groups: trans-septal, alveolar crest, horizontal, between the surfaces of the teeth. This propriocep-
oblique, apical, and inter-radicular. tive sense may trigger a protective reflex mecha-
nism that opens the mandible to prevent injury to
yy
The trans-septal group is embedded into the
the teeth or PDL when one bites into a hard object.
c­ementum of adjacent teeth traversing the
Proprioception permits the localization of areas of
­alveolar crest interproximally.
inflammation in the PDL. Such inflammatory reac-
yy
The alveolar crest group is embedded into the
tions in the PDL can be identified by percussion
cementum below the cementoenamel junction,
and palpation tests.
is situated obliquely, and ends in the alveolar
crest.
yy
The horizontal group is embedded into the Alveolar Process
cementum apical to the alveolar crest group
and moves horizontally into the alveolar bone. The alveolar process is divided into the alveolar
yy
The oblique group is embedded into the cemen- bone proper and the supporting alveolar bone.
tum apically to the horizontal group and travels
obliquely in a coronal direction to be embed- Alveolar Bone Proper
ded into the alveolar bone.
The alveolar bone proper is the bone that lines the
yy
The apical group is embedded into the api-
alveolus or the bony sockets that house the roots of
cal cementum and the fundus of the alveolar
the teeth. It begins its formation by intramembra-
socket.
nous ossification at the initial stage of root forma-
yy
The inter-radicular group is embedded in ce-
tion. The osteoblasts at the periphery of the PDL
mentum and alveolar bone of the furca of mul-
deposit an organic matrix called osteoid, which
tirooted teeth.
consists of collagen fibrils and ground substance
The functions of the fibers of the PDL are to that contains glycoproteins, phosphoproteins, lip-
attach the tooth to its alveolar socket, to suspend ids, and proteoglycans. As the osteoblasts deposit

https://t.me/LibraryEDent
it in its socket, to protect the tooth and the alveolar the matrix, some are trapped in it; these cells are
socket from masticatory injuries, and to transform called osteocytes. The matrix is calcified by the
vertical masticatory stresses into tension on the deposition of hydroxyapatite crystals consisting
alveolar bone. principally of calcium and phosphates.
The osteocytes in calcified bone lie in the oval
spaces, called lacunae, which communicate with
Innervation
each other by means of canaliculi. This system of
The alveolar nerves which originate in the tri-­ canals brings nutrients into the osteocytes and
geminal nerve innervate the PDL. They are divided removes their metabolic waste products.
into ascending periodontal or dental, interalveo- The alveolar bone proper consists of bundle
lar, and inter-radicular nerves. The nerves of the bone in the periphery of the alveoli and lamellated
PDL, as in any other connective tissue, follow the bone toward the center of the alveolar process.

Ch_01_GEP.indd 40 08/08/14 1:59 PM

 Chapter 1 The Dental Pulp and Periradicular Tissues
The peripheral bone is called bundle bone because
Sharpey’s fibers of the PDL are embedded in it.
Because the peripheral Sharpey’s fibers may be
calcified, and because lamellae are almost indis-
tinct, this bone is thick and has a more radiopaque
appearance in radiographs than cancellous bone or
PDL spaces. The radiographic image of the alveolar
bone proper is called the lamina dura.
The alveolar bone proper can also be referred to
as the cribriform plate. This term refers to the many
foramina that perforate the bone. These foramina
contain vessels and nerves that supply teeth, perio-
dontal ligament, and bone.
Supporting Alveolar Bone
Adjacent to the alveolar bone proper is cancel-
lous (spongy) bone covered by two outer tables of
compact bone. One of the outer tables of compact
bone is vestibular and the other is lingual or pala-
tal. The cancellous bone consists of lamellated bone
arranged in branches called the trabeculae. Between
the trabeculae are the medullary spaces, filled with
the marrow. The marrow can be fatty or hematopoi-
etic. In adults, the marrow in the mandible and max-
illa is usually fatty, but hematopoietic tissue is found
in certain locations such as the maxillary tuberosity,
maxillary and mandibular molar periradicular areas,
and premolar periradicular areas. Hematopoietic
marrow spaces appear radiolucent in radiographs.
Also present in the cancellous bone are the
nutrient canals. These canals contain vessels and
nerves. They usually terminate in the alveolar crest
in small foramina through which vessels and nerves
enter the gingiva.
The amount of cancellous bone varies among
areas of the maxilla and mandible and depends on
the width of the alveolar process and the size and
shape of the root of the teeth.
Bibliography
1. Ash, M., and Nelson, S.: Wheeler’s Dental Anatomy,
Physiology and Occlusion, 8th ed. Philadelphia: Saun-
ders, 2003.
2. Aubin, J.E.: J. Dent. Res., 64:515, 1985.
3. Avery, J.R.: Oral Surg., 32:113, 1971.
Ch_01_GEP.indd 41
41
@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬
The cortical (compact) bone covers the cancel-
lous bone and is formed by the lamellated bone.
This lamellated bone has lacunae arranged in
concentric circles around central canals called the
Haversian system. The cortical bone comes together
with the alveolar bone proper to form the alveolar
crest around the necks of the teeth.
Bone serves as the calcium reservoir of the body.
The body, under hormonal control, regulates and
maintains calcium metabolism. Therefore, constant
physiologic remodeling of bone by osteoclastic and
osteoblastic activity occurs. This activity can be seen
more readily in the trabeculae. The trabecular pat-
tern is constantly altered in response to the occlusal
forces. In the trabeculae are resting lines, which are
characteristic of periods of osteoblastic activity, and
resorptive lines, which are characteristic of periods
of osteoclastic activity. Resting lines are character-
istically dark lines parallel to the surface, whereas
resorptive lines are scalloped and point to the areas
of resorption known as Howship’s lacunae.
Diseases of the pulp can affect the tissues of the
periradicular area. Acute inflammatory changes
in the PDL that originate in the pulp produce
extrusion of the tooth. The chronic inflamma-
tory changes of pulpal origin in the PDL can cause
resorption of the lamina dura, external root resorp-
tion, areas of bone resorption, or areas of bone con-
densation. Systemic diseases may also produce bony
changes in the periradicular area. These pathologic
changes are discussed in Chapters 4 and 5.
The reader is advised that the discussions in
the chapter on embryology, normal pulp, and nor-
mal periradicular tissues are intended as a review
of embryology, physiology, and histology as they
apply to the clinical science of endodontics. The
https://t.me/LibraryEDent
reader is referred to standard textbooks on these
subjects for more comprehensive and detailed
discussion.
4. Baume, L.J.: The Biology of Pulp and Dentin. Basel:
S. Karger, 1980.
5. Bernick, S.: J. Dent. Res., 43:406, 1964.
6. Bhaskar, S.N.: Synopsis of Oral Histology. St. Louis: C.V.
Mosby, 1962.
08/08/14 1:59 PM
 42 Grossman’s Endodontic Practice
7. Bhaskar, S.N.: Orban’s Oral Histology and Embryology,
9th ed. St. Louis: C.V. Mosby, 1980.
8. Brännstrom, M., and Garberoglio, R.: Acta Odontol.
Scand., 30:291, 1972.
9. Brown, P., and Herbranson, E.: Dental Anatomy & 3D
Tooth Atlas Version 3.0, 2nd ed. Illinois: Quintessence,
2005.
10. Byers, M.R.: J. Comp. Neurol., 191:413, 1980.
11. Carranza, F.A.: Gllckman’s Clinical Periodontology,
6th ed. Philadelphia: W.B. Saunders, 1984.
12. Cohan, B., and Kramer, I.R.H.: Scientific Foundation
of Dentistry. Chicago: Year Book Medical Publishers,
1976.
13. Cohen, S., and Burns, R.C.: Pathways of the Pulp, 3rd ed.
St. Louis: C.V. Mosby, 1984.
14. Cutright, D.E.: Oral Surg., 30:284, 1970.
15. Fearnhead, R.W.: Proc. R. Soc. Med., 54:877, 1961.
16. Finn, S.B.: Biology of the Dental Pulp Organ: A Sympo-
sium. Alabama: University of Alabama Press, 1968.
17. Garberoglio, R., and Brännström, M.: Arch. Oral Biol.,
21:355, 1976.
18. Green, D.: Morphology of the Endodontic System. New
York: David Green, 1969.
19. Heverass, K.J.: J. Dent. Res., 64:585, 1985.
20. Holland, G.R.: J. Dent. Res., 64:499, 1985.
21. Ingle, J., and Bakland, E.: Endodontics, 5th ed. ­Hamilton:
B.C. Decker, 2002.
22. Ingle, J.I., and Taintor, J.F.: Endodontics, 3rd ed.
­Philadelphia: Lea & Febiger, 1985.
23. Jernvall, J., and Thesleff, T.: Mech. Dev., 92:19–29,
2000.
24. Johnsen, D.C.: J. Dent. Res., 64:555, 1985.
25. Kim, S.: J. Dent. Res., 64:590, 1985.
26. Kuttler, Y.: J. Am. Dent. Assoc., 50:544, 1955.
27. Linde, A.: Dentin and Dentinogenesis, Vols. I and II.
Boca Raton, FL: CRC Press, 1984.
28. Linde, A.: J. Dent. Res., 64:523, 1985.
29. Lindhe, J.: Textbook of Clinical Periodontology.
­Copenhagen: Munksgaard, 1984.
30. Maniatopoulos, C., and Smith, D.C.: Arch. Oral Biol.,
28:701, 1983.
Ch_01_GEP.indd 42
@LibraryEDent ‫ﻣﻛﺗﺑﺔ طب اﻷﺳﻧﺎن‬
31. Mjör, I.A.: J. Dent. Res., 64:621, 1985.
32. Mjör, I.A.: Reaction Patterns in Human Teeth. Boca
­Raton, FL: CRC Press, 1983.
33. Mjör, I.A., and Fejerskon, A.: Histology of the Human
Tooth, 2nd ed. Copenhagen: Munksgaard, 1979.
34. Mjor, I.A., and Heyarass, K.: In D. Orstavik and T. Pitt
Ford (eds.) Essential Endodontology, 2nd ed. Oxford:
Blackwell Munksgard, 2008.
35. Nanci, A.: Ten Gate’s Oral Histology: Development,
Structure, and Function, 6th ed. St. Louis: C.V. Mosby,
3 July 2003.
36. Närhi, M.V.O.: J. Dent. Res., 64:564, 1985.
37. Nery, E.B., et al.: Arch. Oral Biol., 15:1315, 1970.
38. Olgart, L.M.: J. Dent. Res., 64:572, 1985.
39. Oor, T.: Human Tooth and Dental Arch Development.
Tokyo: Ishiyaka, 1981.
40. Osborn, J.W., and Ten Cate, A.R.: Advanced Dental
Histology, 3rd ed. Bristol, England: J. Wright and Sons,
1976.
41. Pashley, D.H.: J. Dent. Res., 64:613, 1985.
42. Provenza, D.V.: Fundamentals of Oral Histology and
Embryology. Philadelphia: J.B. Lippincott, 1972.
43. Ruch, J.V.: J. Dent. Res., 64:489, 1985.
44. Seltzer, S., and Bender, I.B.: The Dental Pulp, 3rd ed.
Philadelphia: J.B. Lippincott, 1984.
45. Siskin, M.: The Biology of the Human Dental Pulp.
St. Louis: C.V. Mosby, 1973.
46. Stanley, H.R.: Human Pulp Response to Restorative
­Dental Procedures, rev. ed. Gainesville, FL: Storter
Printing, 1981.
47. Takahashi, K.: J. Dent. Res., 64:579, 1985.
48. Takahashi, K., et al.: J. Endod., 8:131, 1982.
49. Ten Cate, A.R.: Oral Histology: Development, Structure
and Function. St. Louis: C.V. Mosby, 1980.
50. Ten Cate, A.R.: J. Dent. Res., 64:549, 1985.
51. Thomas, H.F.: J. Dent. Res., 64:607, 1985.
52. Van Hassel, H.J.: Oral Surg., 32:126, 1971.
53. Veis, A.: J. Dent. Res., 64:552, 1985.
54. Weine, F.S.: Endodontic Therapy, 3rd ed. St. Louis: C.V.
https://t.me/LibraryEDent
Mosby, 1982.
55. Yamamura, T.: J. Dent. Res., 64:530, 1985.
08/08/14 1:59 PM