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 ENDODONTICS 7
Ingle’s

Partial_FM.indd 1 19/02/19 9:24 AM

 ▼         About the Editors
Ilan Rotstein
Dr. Ilan Rotstein is Professor and
Associate Dean, and Chair of
Endodontics, Orthodontics and
General Practice Residency at
the Herman Ostrow School of
Dentistry, University of Southern
California, Los Angeles, Cali-
fornia.
He has served in leader-
ship roles for various dental
organizations, including chair
of the Research Committee of the International Federation
of Endodontic Associations, member on committees of the
American Association of Endodontists and the European
Society of Endodontology, and as scientific reviewer for
international endodontic and dental journals. He has also
served as president of the Southern California Academy of
Endodontists, president of the International Association
for Dental Research–Israel Division, president of the Israel
Endodontic Society, and chair of the Israel National Board
of Diplomates in Endodontics.
Dr. Rotstein has published over 150 scientific articles and
research abstracts in the dental literature as well as chap-
ters in international endodontic textbooks including Ingle’s
Endodontics, Pathways of the Pulp, Endodontics: Principles
and Practice, Seltzer and Bender’s Dental Pulp, Endodontia:
Biologia e Técnica, and Harty’s Endodontics in Clinical Practice.
He has lectured extensively in more than twenty-five coun-
tries throughout five continents.
Partial_FM.indd 2
John I. Ingle
Dr. John I. Ingle, is best known
as author of ENDODONTICS,
a leading text in the field,
first published in 1965. He
is also the author of PDQ
ENDODONTICS, a compila-
tion of information from the
larger text.
Dr. Ingle obtained his den-
tal degree from Northwestern
University in 1942. He received
his graduate degree in periodontics and endodontics from the
University of Michigan in 1948. Among his many contribu-
tions to endodontics, in 1957 Dr. Ingle standardized the size
and shape of endodontic instruments, an international stand-
ard that remains today. In 1965, he was granted the Alumni
Merit Award from Northwestern University. In 1987, he
received the Ralph E. Sommer Research Award from the
American Association of Endodontists, and in 1999 the
Edgar D. Coolidge Leadership Award. He has also received
the International Louis I. Grossman Award from the French
Society of Endodontics.
Dr. Ingle is a Fellow of the American and International
Colleges of Dentists and is listed in Who’s Who in America.
He has published over 80 scientific articles in the dental lit-
erature and has lectured extensively throughout the world.
21/02/19 9:08 PM
 ENDODONTICS 7
Ingle’s

ILAN ROTSTEIN, DDS

Professor and Associate Dean
Chair, Division of Endodontics, Orthodontics and
General Practice Residency
Herman Ostrow School of Dentistry of USC
University of Southern California
Los Angeles, California

JOHN I. INGLE, DDS

Loma Linda University
School of Dentistry
Loma Linda, California

Partial_FM.indd 3 19/02/19 9:24 AM

 PMPH USA, Ltd.

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19 20 21 22/KING/9 8 7 6 5 4 3 2 1
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Front cover image courtesy of Dr. Clifford J. Ruddle, Santa Barbara, California.
Library of Congress Cataloging-in-Publication Data
Names: Rotstein, Ilan, editor. | Ingle, John Ide, 1919-2017, editor.
Title: Ingle’s endodontics 7 / [edited by] Ilan Rotstein, John I. Ingle.
Other titles: Ingle’s endodontics seven | Endodontics 7
Description: Raleigh, North Carolina : PMPH USA, [2019] | Preceded by Ingle’s
endodontics 6 / [edited by] John I. Ingle, Leif K. Bakland, J. Craig
Baumgartner. | Includes bibliographical references and index.
Identifiers: LCCN 2019002258| ISBN 9781607951926 | ISBN 1607951924 | ISBN
9781607959356 (eISBN)
Subjects: | MESH: Dental Pulp Diseases
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Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and
drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly
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not be employed as, a substitute for individual diagnosis and treatment.

Partial_FM.indd 4 19/02/19 9:24 AM

 ▼ In Memoriam:
John I. Ingle, DDS, MSD, 1919–2017
A beloved endodontic leader,
Dr. John I. Ingle, passed
away on September 25, 2017
in San Diego at the age of
98. He was predeceased by
his wife, Joyce Ledgerwood
Ingle, who passed away on
March 8, 2014. They leave
three children, five grandchil-
dren, and two great grand-
children. John and Joyce
Ingle knew each other all
their lives: their families were
close friends when they were
FIGURE 1
born seven months apart in
June 1918 and January 1919,
and they attended school
together from elementary
school through college. Joyce
became an accomplished
jazz pianist and even learned
Braille in order to translate
books for blind children.
FIGURE 2 They married on July 11,
1940 (Figure 1), and were
married for nearly 74 years
(Figure 2).
Dr. John Ingle was born
in 1919 in Colville, Wash-
ington. His career in dentis‑
try and endodontics spanned
more than six decades, begin-
ning with dental school at
Northwestern University in
Chicago, which he completed
in 1942.
After serving the country
in the military for four years
FIGURE 3 as a dental officer (Figure 3),
Dr. Ingle began a long and
distinguished career in den-
tal education. He accepted an offer to teach periodontics at
the University of Washington in Seattle. However, Dr. Ingle
had an interest in both periodontics and the new emerging
field of root canal therapy—endodontics. Because of that
interest, he was sent to the University of Michigan, where he
v
Partial_FM.indd 5
earned a graduate degree in both periodontics and endodon-
tics in 1948, returning to Seattle to teach both disciplines.
He subsequently earned certification from both the
American Board of Periodontics (ABP) and the American
Board of Endodontics (ABE).
Establishing the first endodontic specialty program on
the West Coast in 1959, Dr. Ingle was involved in the educa-
tion of many endodontists who followed in his path of endo-
dontic education. He took great pride in inspiring others to
become engaged in teaching endodontics. After 16 years of
teaching at the University of Washington, Dr. Ingle moved
to Los Angeles, California to assume the position of Dean
of the School of Dentistry at the University of Southern
California, which allowed him to become involved in the
expanding endodontic community in Southern California.
Dr. Ingle’s interest in endodontics covered all aspects of
the discipline, including the instruments used for root canal
­treatment, the outcomes of treatment, the dissemination of
information, and the participation in activities of the s­ pecialty.
Frustrated with the lack of standardization of root canal
instruments, Dr. Ingle tried to interest dental companies in
developing a worldwide standard for the size and shape of
endodontic files and reamers. In the United States, nonmetric
measurements were used while in the rest of the world the
metric system was universal. In addition, each manufacturer
had its own standards for sizes and shapes of instruments. In
an attempt to generate an interest in the problem, Dr. Ingle
published a paper pointing out the need for standardization
of instruments, and following intensive research he developed
the standardization system in 1957—the 0.2 taper and metric
measurements—that is still in use today.
The precision in design and manufacturing of endodontic
instruments that Dr. Ingle’s innovation created so early in
the history of endodontics is taken for granted today. It illus-
trates, however, how he would identify a problem and work
hard to find a solution. His constant search for solutions
to treatment problems made him open to accepting many
innovations in techniques and instruments, and he ensured
that they were described in his textbooks. While root canal
therapy probably originated in the mid-1800s, the treatment
of teeth with root canal infections was set back when in the
early 1900s the focal infection theory put a roadblock in the
path of such treatments. It took the efforts of pioneers such
as Dr. Ingle to change the attitudes of many in the dental and
medical professions. Even in the 1950s, endodontics was not
widely accepted, and questions were raised about both the
success and the safety of such treatments.
19/02/19 9:24 AM
 vi In Memoriam: John I. Ingle, DDS, MSD, 1919–2017

Along with ­ pioneers was unique for medical texts at that time. In addition to the
such as Dr. Larz Strindberg superb illustrations, it contained full-size plates of access
in Sweden, Dr. Ingle preparations. It soon became a textbook that inspired many
conducted research in
­ dentists to pursue endodontics as a specialty and has been a
endo­dontic outcome that model for other textbooks to follow.
enabled us to describe In recognition for his many contributions to our specialty,
important clinical and radi- Dr. Ingle received the American Association of Endodontists’s
ographic factors associated (AAE) Ralph F. Sommer Award in 1987 and the Edgar D.
with the success and fail- Coolidge Award, the AAE’s highest honor, in 1999. The
ure of root canal treatment. Sommer Award had a special meaning for Dr. Ingle in that
It soon became known as Dr. Sommer had been one of his teachers at the University
the “Washington Study.” of Michigan. In 2015, the AAE General Assembly, at the
Its importance was that it Annual Session, honored Dr. Ingle with a special recognition
FIGURE 4 demonstrated a high rate of for his contributions to endodontics. He was also honored by
success in root canal treatment, as well as identifying the main many other international organizations.
causes of failures: poorly performed treatment procedures. Dr. Ingle’s interests spanned many areas. After com-
The conclusion was that root canal therapy could be success- pleting six years as Dean of the School of Dentistry at the
ful if done properly. Thus, the classic “Washington Study” has University of Southern California, he was honored by being
taken its place in the history of important contributions to appointed Senior Staff Officer to the Institute of Medicine
endodontics. in the National Academy of Sciences in 1972.
One of Dr. Ingle’s passions in life was to disseminate The words “icon,” “legend,” and “giant” are so overused
­information on all aspects of endodontics. That led to the that John Ingle would not have wished to be described in
publication of a milestone in endodontic textbooks—Ingle’s such terms. He would likely have been pleased to be remem-
Endodontics—the first edition of which was published in bered as a mentor, a teacher, and a friend to numerous col-
1965 (Figure 4). It was followed by six additional editions leagues in the United States and abroad, and one who has
spanning over half a century. Ingle’s Endodontics gained had a lasting impact on the lives and careers of dental profes-
notice as soon as it was published. The bright yellow-colored sionals and endodontists worldwide.
book [a color suggested by his wife, Joyce] was an innova- —Leif Bakland
tive textbook for its day, and its nine by eleven-inch size —Ilan Rotstein

Partial_FM.indd 6 19/02/19 9:24 AM

 ▼D
 edication
To my wife Lucille and our daughters Meirav, Netta and Tamar, and in loving memory of Sara and Samuel (Milu) Rotstein.

With gratitude to those special people who influenced my professional path:

Miriam Rotstein
Miriam Yacobovich
Eduardo Llamosas
Harold C. Slavkin
John I. Ingle

vii

Partial_FM.indd 7 19/02/19 9:24 AM

Partial_FM.indd 8 19/02/19 9:24 AM
 ▼         Contents
Contributors ���������������������������������������������������������������������������������������������������������������������������������������������������������������� xiii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Preface to the 7th Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi
Preface to the 6th Edition������������������������������������������������������������������������������������������������������������������������������������������� xxiii

▼         THE SCIENCE OF ENDODONTICS

Chapter 1 Anatomy and Morphology of Teeth and Their Root Canal Systems���������������������������������������������������� 1
Blaine M. Cleghorn, William H. Christie

Chapter 2 Structure and Function of the Pulp–Dentin Complex ������������������������������������������������������������������������ 59

Sivakami R. Haug, Syngcuk Kim, Karin J. Heyeraas

Chapter 3 Microbial and Nonmicrobial Etiologies of Endodontic Diseases������������������������������������������������������ 85

José F. Siqueira, Jr., Isabela N. Rôças, Domenico Ricucci

Chapter 4 Inflammation and Immunological Responses������������������������������������������������������������������������������������111

Ashraf F. Fouad, George T.-J. Huang

Chapter 5 Pulpal Pathosis ����������������������������������������������������������������������������������������������������������������������������������������143

Graham R. Holland, Tatiana M. Botero, Stephen B. Davis

Chapter 6 Periradicular Disease������������������������������������������������������������������������������������������������������������������������������167

Domenico Ricucci, Isabela N. Rôças, José F. Siqueira, Jr.

Chapter 7 Dental Innervations and Pain of Pulpal Origin����������������������������������������������������������������������������������201

Nikita B. Ruparel, Asma A. Khan

▼        THE PRACTICE OF ENDODONTICS

Diagnosis

Chapter 8 Examination and Diagnosis of Pulp, Root Canal, and Periapical/Periradicular Conditions ������� 215
Paul V. Abbott

Chapter 9 Imaging Devices and Techniques

A Analog Radiography �����������������������������������������������������������������������������������������������������������������������������������������������268
Richard E. Walton, Manuel R. Gomez

B Digital Radiography �������������������������������������������������������������������������������������������������������������������������������������������283

Allan G. Farman, Martin D. Levin, Ramya Ramamurthy, Lars G. Hollender

ix

Partial_FM.indd 9 22/02/19 5:20 PM

 x Contents

C Cone Beam Computed Tomography�����������������������������������������������������������������������������������������������������������������295

Martin D. Levin, Allan G. Farman

D Magnetic Resonance Imaging ���������������������������������������������������������������������������������������������������������������������������317

Hatice Dogan-Buzoglu

E Ultrasound �����������������������������������������������������������������������������������������������������������������������������������������������������������325
Elisabetta Cotti

Chapter 10 Imaging Interpretation ��������������������������������������������������������������������������������������������������������������������������337

Parish P. Sedghizadeh, Rafael A. Roges, Jose-Maria Malfaz

Clinical Decision-Making
Chapter 11 Treatment Planning and Case Selection����������������������������������������������������������������������������������������������359
Paul A. Rosenberg, Matthew Malek, Katsushi Okazaki

Chapter 12 Endodontic Considerations in Dental Trauma ����������������������������������������������������������������������������������373

Martin Trope

Chapter 13 Crown-Originating Dental Fractures ��������������������������������������������������������������������������������������������������391

Leif K. Bakland

Chapter 14 Vertical Root Fractures ��������������������������������������������������������������������������������������������������������������������������405

Aviad Tamse, Louis H. Berman

Chapter 15 Pathologic Tooth Resorption ����������������������������������������������������������������������������������������������������������������421

Jens O. Andreasen, Geoffrey S. Heithersay, Leif K. Bakland

Chapter 16 Rhinosinusitis and Endodontic Disease����������������������������������������������������������������������������������������������439

Roderick W. Tataryn

Chapter 17 Non-Odontogenic Toothache and Chronic Head and Neck Pain����������������������������������������������������451

Bernadette Jaeger

Management
Chapter 18 Management of Pain, Fear, and Anxiety in the Endodontic Patient������������������������������������������������491
Stanley F. Malamed

Chapter 19 Preparation for Treatment����������������������������������������������������������������������������������������������������������������������509

C. John Munce, Terrell F. Pannkuk, Adham A. Azim, Rajiv G. Patel, Ziv Simon

Chapter 20 Preparation of the Coronal and Radicular Spaces������������������������������������������������������������������������������557

Michael Hülsmann, Edgar Schäfer

Chapter 21 Irrigants and Intracanal Medicaments ������������������������������������������������������������������������������������������������635

Markus Haapasalo, Ya Shen, James S. Lin, Ellen Park, Wei Qian, Zhejun Wang

Chapter 22 Obturation of the Radicular Spaces������������������������������������������������������������������������������������������������������669

Arnaldo Castellucci

Partial_FM.indd 10 19/02/19 9:24 AM

 Contents xi

Chapter 23 Endodontic Orthograde Retreatment and Management of Mishaps����������������������������������������������729

Pierre Machtou, Clifford J. Ruddle

Chapter 24 Surgical Endodontics������������������������������������������������������������������������������������������������������������������������������797

Mahmoud Torabinejad, Mohammad Sabeti, Gerald N. Glickman

Chapter 25 Intentional Replantation of Endodontically Treated Teeth��������������������������������������������������������������835

Stephen P. Niemczyk

Chapter 26 Endodontic Therapy in Teeth with Anatomical Variations ��������������������������������������������������������������861

Ilan Rotstein, Eduardo Llamosas, Kyung-Soo Choi

Chapter 27 Vital Pulp Therapy ����������������������������������������������������������������������������������������������������������������������������������885

George Bogen, Nicholas P. Chandler

Chapter 28 Management of Teeth with Immature Apices��������������������������������������������������������������������������������������911

Shahrokh Shabahang

Chapter 29 Regenerative Endodontics����������������������������������������������������������������������������������������������������������������������935

Anibal R. Diogenes, Anthony J. Smith

Chapter 30 Treatment of Endodontic Abscesses/Cellulitis, Cysts, and Flare-ups����������������������������������������������963

J. Craig Baumgartner, Paul A. Rosenberg

Chapter 31 Management Considerations for the Medically Complex Endodontic Patient������������������������������981

Bradford R. Johnson, Joel B. Epstein

Chapter 32 Drug Interactions and Laboratory Tests��������������������������������������������������������������������������������������������1007

S. Craig Rhodes, Paul D. Eleazer

Prognosis

Chapter 33 Outcomes of Endodontic Therapy������������������������������������������������������������������������������������������������������1019

Kishor Gulabivala, Yuan-Ling Ng

Chapter 34 Achieving Long-Term Success with Endodontic Therapy ��������������������������������������������������������������1067

Fernando Goldberg

▼ INTERDISCIPLINARY ENDODONTICS
Chapter 35 Contemporary Restoration of Endodontically Treated Teeth��������������������������������������������������������1079
Nadim Z. Baba, Charles J. Goodacre

Chapter 36 Endodontic–Periodontal Interrelationships��������������������������������������������������������������������������������������1111

Ilan Rotstein, Borja Zabalegui, Khalid Al-Hezaimi

Chapter 37 Endodontic Therapy in the Elderly Patient����������������������������������������������������������������������������������������1131

Thomas A. Levy, Jaydeep S. Talim, Ilan Rotstein

Partial_FM.indd 11 19/02/19 9:24 AM

 xii Contents

Chapter 38 Endodontic Therapy in the Pediatric Patient������������������������������������������������������������������������������������1147

Enrique Bimstein, Yaara Y. Berdan

Chapter 39 Interrelationships of Endodontics and Orthodontics in Treatment Planning

and Patient Treatment��������������������������������������������������������������������������������������������������������������������������1181
James L. Gutmann, Vivian Manjarrés

Chapter 40 Tooth Discoloration and Bleaching of Non-Vital Teeth������������������������������������������������������������������1203

Ilan Rotstein

Index��������������������������������������������������������������������������������������������������������������������������������������������������� 1215

Partial_FM.indd 12 19/02/19 9:24 AM

 ▼ C ontributors
Paul V. Abbott, BDSc, MDS [7] Yaara Y. Berdan, DDS [38]
Winthrop Professor of Clinical Dentistry Assistant Professor of Clinical Dentistry
School of Dentistry/Oral Health Center of Herman Ostrow School of Dentistry of USC
Western Australia University of Southern California
University of Western Australia Los Angeles, California
Crawley, WA, Australia Private Practice
Tarzana, California
Khalid Al-Hezaimi, BDS, MSc [36]
Research Chair for Growth Factors and
Bone Regeneration, 3D Imaging and Louis H. Berman, DDS [14]
Clinical Associate Professor of
Biomechanical Laboratory
Endodontics
College of Applied Medical Sciences
University of Maryland School of
King Saud University
Dentistry
Riyadh, Saudi Arabia
Baltimore, Maryland
Private Practice
Jens O. Andreasen, DDS, Odont Dr [15] Annapolis, Maryland
Department of Oral and Maxillofacial Surgery
University Hospital (Rigshospitalet)
Copenhagen, Denmark Enrique Bimstein, DDS [38]
Professor Emeritus of Pediatric Dentistry
Adham A. Azim, BDS [19] University of Kentucky College of Dentistry
Director, Advanced Program in Endodontics Lexington, Kentucky
School of Dental Medicine
University at Buffalo
Buffalo, New York George Bogen, DDS [27]
Senior Lecturer
School of Dentistry
Nadim Z. Baba, DMD, MSD [35]
Faculty of Health and Behavioural
Professor and Director
Sciences
Hugh Love Center for Research and
The University of Queensland
Education in Technology
Brisbane, Australia
Loma Linda University School of Dentistry
Loma Linda, California
Tatiana M. Botero, DDS, MS [5]
Leif K. Bakland, DDS [13, 15] Clinical Associate Professor
Professor Emeritus of Endodontics Department of Cariology, Restorative
Loma Linda University School of Dentistry Sciences, and Endodontics
Loma Linda, California School of Dentistry
University of Michigan
J. Craig Baumgartner, DDS, MS, PhD [30] Ann Arbor, Michigan
Professor Emeritus of Endodontology
Oregon Health & Science University
Portland, Oregon

xiii

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 xiv Contributors
Arnaldo Castellucci, MD, DDS
Assistant Professor of Endodontics
Master in Endodontics
University of Cagliari
Cagliari, Italy
Assistant Professor, Micro Surgical Endodontics
Department of Oral Surgery
University Federico II
Naples, Italy
Private Practice in Endodontics
Florence, Italy
Nicolas P. Chandler, BDS, MSc, PhD [27]
Associate Professor of Endodontics
University of Otago
Dunedin, New Zealand
Kyung-Soo Choi, MS, DDS, PhD
Private Practice
Chicago, Illinois
William H. Christie, DMD, MS
Professor of Dentistry, Retired
Department of Restorative Dentistry
College of Dentistry
Faculty of Health Science
University of Manitoba
Winnipeg, Manitoba, Canada
Blaine M. Cleghorn, DMD, MS [1]
Professor and Assistant Dean, Clinics
Faculty of Dentistry
Dalhousie University
Halifax, Nova Scotia, Canada
Elisabetta Cotti, DDS, MS
Professor and Chair
Department of Conservative Dentistry
and Endodontics
University of Cagliari
Cagliari, Italy
Stephen B. Davis, DDS [5]
Former Director, Endodontic Residency
Program
Tibor Rubin VA Medical Center
Long Beach, California
Anibal R. Diogenes, DDS, MS, PhD [29]
Associate Professor of Endodontics
University of Texas Health Science Center
at San Antonio
San Antonio, Texas
Partial_FM.indd 14
[22] Hatice Dogan-Buzoglu, DDS, PhD [9D]
Professor, Department of Endodontics
Faculty of Dentistry
Hacettepe University
Ankara, Turkey
Paul D. Eleazer, DDS, MS [32]
Professor and Chair, Retired
Department of Endodontics
University of Alabama
Birmingham School of Dentistry
Birmingham, Alabama
Joel B. Epstein, DMD, MSD [31]
Professor
Cedars-Sinai Health Systems
Los Angeles, California
[26] Consulting Staff
City of Hope National Medical Center
Duarte, California
[1] Allan G. Farman, BDS, PhD, EdS, MBA,
DSc [9B, 9C]
Professor Emeritus of Radiology and
Imaging Science
University of Louisville
Louisville, Kentucky
Independent Consultant on Maxillofacial
Imaging Science
Chicago, Illinois
Ashraf F. Fouad, BDS, DDS, MS [4]
Freedland Distinguished Professor and Chair
Department of Endodontics
School of Dentistry
[9E] University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Gerald N. Glickman, DDS, MS, MBA, JD [24]
Professor and Chair
Department of Endodontics
Director of Graduate Endodontics
Texas A&M University
Baylor College of Dentistry
Dallas, Texas
Fernando Goldberg, DDS, PhD [34]
Professor Emeritus of Endodontics
Dental School of the University of El
Salvador
Asociación Odontológica Argentina
Buenos Aires, Argentina
19/02/19 9:24 AM

Manuel R. Gomez, DDS [9A]
Clinical Associate Professor
Department of Endodontics
University of Iowa
College of Dentistry and Dental Clinics
Iowa City, Iowa
Charles J. Goodacre, DDS, MSD [35]
Distinguished Professor
Department of Restorative Dentistry
School of Dentistry
Loma Linda University
Loma Linda, California
Kishor Gulabivala, BDS, MSc, FDS,
RCS, PhD [33]
Professor of Endodontology
Consultant in Restorative Dentistry
Head of Department of Restorative
Dentistry and Endodontology
UCL Eastman Dental Institute
London, United Kingdom
James L. Gutmann, DDS, PhD
Professor Emeritus, Restorative Sciences/
Endodontics
Texas A&M University
Baylor College of Dentistry
Dallas, Texas
Markus Haapasalo, DDS, Dr Odont (PhD) [21]
Professor and Chair, Division of Endodontics
Head, Department of Oral Biological and
Medical Sciences
University of British Columbia
Vancouver, British Columbia, Canada
Sivakami R. Haug, DDS, Dr Odont [2]
Associate Professor and Head
Section for Endodontics
Department of Clinical Dentistry
Faculty of Medicine and Dentistry
University of Bergen
Bergen, Norway
Geoffrey S. Heithersay, AO, BDS, MDS,
DDSc [15]
Clinical Professor
School of Dentistry
The University of Adelaide
Adelaide, Australia
Partial_FM.indd 15
Contributors xv
Karin J. Heyeraas, CMD, Dr Odont [2]
Professor Emeritus
Faculty of Medicine and Dentistry
Department of Biomedicine
University of Bergen
Bergen, Norway
Graham R. Holland, DDS, PhD [5]
Professor of Dentistry
Department of Cariology, Restorative
Sciences, and Endodontics
School of Dentistry
Professor of Cell and Developmental
Biology
School of Medicine
University of Michigan
Ann Arbor, Michigan
Lars G. Hollender, DDS, PhD [9B]
Professor Emeritus of Oral Radiology
University of Washington
School of Dentistry
Seattle, Washington
[39]
George T.-J. Huang, DDS, MSD, DSc [4]
Director for Stem Cells and Regenerative
Therapies
Professor of Bioscience Research
University of Tennessee Health Science
Center
Memphis, Tennessee
Michael Hülsmann, DDS [20]
Professor of Conservative and Preventive
Dentistry and Periodontology
University of Göttingen
Göttingen, Germany
John I. Ingle, DDS [Editor]
Loma Linda University School of Dentistry
Loma Linda, California
Bernadette Jaeger, DDS [17]
Associate Professor, Department of
Anesthesiology
School of Medicine
Section of Oral Medicine and Orofacial Pain
School of Dentistry
University of California, Los Angeles
Los Angeles, California
19/02/19 9:24 AM
 xvi Contributors

Bradford R. Johnson, DDS, MHPE [31] Pierre Machtou, DDS, MS, PhD [23]
Department Head and Director of Professor Emeritus
Postdoctoral Endodontics Co-Director of the Specialty Program in
University of Illinois at Chicago Endodontics
College of Dentistry Paris, France
Chicago, Illinois Visiting Professor, University of Geneva
Geneva, Switzerland
Asma A. Khan, BDS, PhD [7]
Associate Professor of Endodontics Stanley F. Malamed, DDS [18]
UNC School of Dentistry Professor Emeritus of Dentistry
The University of North Carolina at Chapel Hill Herman Ostrow School of Dentistry
Chapel Hill, North Carolina of USC
University of Southern California
Los Angeles, California
Syngcuk Kim, DDS, PhD, MD (Hon) [2]
Louis I. Grossman Professor of Endodontics Matthew Malek, DDS [11]
Associate Dean for Global Affairs and Advanced Education Program Director
Continuing Education Clinical Assistant Professor
University of Pennsylvania Ignatius N. and Sally Quarararo Department
School of Dental Medicine of Endodontics
Philadelphia, Pennsylvania New York University
College of Dentistry
Martin D. Levin, DMD [9B, 9C] New York, New York
Chair, Dean’s Council
University of Pennsylvania School of Dental Jose-Maria Malfaz, DDS, MD, PhD [10]
Medicine Lecturer
Philadelphia, Pennsylvania Private Practice Limited to Endodontics,
Private Practice in Endodontics Endodontic Microurgery, and Dental
Chevy Chase, Maryland Traumatology
Valladolid, Spain
Thomas A. Levy, DDS, MS [37]
Former Associate Professor of Clinical Dentistry Vivian Manjarrés, DDS [39]
Herman Ostrow School of Dentistry of USC Dental Medicine Faculty
University of Southern California Assistant Professor, Endodontics
Los Angeles, California Miami Lakes Periodontal Associates
Fort Lauderdale, Florida
James S. Lin, DDS, MSc [21]
Clinical Associate Professor and Director C. John Munce, DDS [19]
Undergraduate Endodontic Program Assistant Professor
Department of Oral Biology and Medical Department of Endodontics
Sciences Loma Linda University School of Dentistry
University of British Columbia Loma Linda, California
Vancouver, British Columbia, Canada
Yuan-Ling Ng, BDS, MSc,
Eduardo Llamosas, DDS [26] MRD RCS, PhD [33]
Founding Professor of Endo-Perio Program Director of Masters Programmes in
Coordinator of the Dental Specialties Endodontology
Facultad de Estudios Superiores Iztacala Senior Clinical Lecturer in Endodontology
Universitad Nacional Autónoma de México UCL Eastman Dental Institute
Mexico City, México London, United Kingdom

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Stephen P. Niemczyk, DMD
Director, Endodontic Microsurgery
Albert Einstein Medical Center, Dental
Division
Philadelphia, Pennsylvania
Director, Endodontic Microsurgery
Harvard University School of Dentistry
Boston, Massachusetts
Private Practice, Limited to Endodontics
Drexel Hill, Pennsylvania
Katsushi Okazaki, DDS, PhD
Clinical Assistant Professor
Ignatius N. and Sally Quarararo Department
of Endodontics
New York University College of Dentistry
New York, New York
Terrell F. Pannkuk, DDS, MScD
Private Practice
Santa Barbara Endodontics
Santa Barbara, California
Ellen Park, DDS, MSc, Dip Endo
Clinical Instructor in Endodontics
Graduate Endodontic Division
University of British Columbia
Vancouver General Hospital
Vancouver, British Columbia, Canada
Rajiv G. Patel, BDS, DDS [19]
Private Practice in Endodontics
Endodontic Excellence
Flower Mound, Texas
Wei Qian, DMD, MSc, PhD [21]
Private Practice
Vancouver, British Columbia, Canada
Ramya Ramamurthy, DDS, MS
Private Practice
Greenroot Endodontics and Microsurgery
San Jose, California
S. Craig Rhodes, DMD [32]
Associate Professor and Pre-Doctoral
Director
Department of Endodontics
School of Dentistry
University of Alabama, Birmingham
Birmingham, Alabama
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Contributors xvii
[25] Domenico Ricucci, MD, DDS [3, 6]
Private Practice
Cetraro, Italy
Isabela N. Rôças, DDS, MSc,
PhD [3, 6]
Professor of Endodontics
Head, Molecular Microbiology Laboratory
Estácio de Sá University
Rio de Janeiro, Brazil
[11] Rafael A. Roges, DDS [10]
Director, Advanced Endodontics Program
The Wayne G. and Margaret L. Bemis
Endowed Professor in Endodontics
Herman Ostrow School of Dentistry
of USC
University of Southern California
[19] Los Angeles, California
Paul A. Rosenberg, DDS [11, 30]
Professor of Endodontics
Ignatius N. and Sally Quartararo
[21] Department of Endodontics
New York University College of Dentistry
New York, New York
Ilan Rotstein, DDS [26, 36, 37, 40]
Professor and Associate Dean
Chair, Endodontics, Orthodontics and
General Practice Residency
Herman Ostrow School of Dentistry
of USC
University of Southern California
Los Angeles, California
Clifford J. Ruddle, DDS [23]
Assistant Professor of Graduate
Endodontics
[9B] Loma Linda University
Loma Linda, California
Assistant Professor of Graduate
Endodontics
University of California, Los Angeles
Los Angeles, California
Nikita B. Ruparel, MS, DDS, PhD [7]
Assistant Professor
Department of Endodontics
University of Texas Health Science
Center at San Antonio
San Antonio, Texas
19/02/19 9:24 AM
 xviii Contributors

Mohammad Sabeti, DDS, MA [24] Jaydeep Shashikumar Talim, BDS, MSc [37]
Health Science Clinical Associate Professor Assistant Clinical Professor
Director, Advanced Speciality Education Department of Endodontics
Program in Endodontics Herman Ostrow School of Dentistry
UCSF School of Dentistry of USC
San Francisco, California University of Southern California
Los Angeles, California
Edgar Schäfer, Prof Dr [20]
Head of Interdisciplinary Ambulance Aviad Tamse, DMD [14]
School of Dentistry Professor Emeritus
University of Münster Department of Endodontology
Münster, Germany Tel Aviv School of Dental Medicine
Tel Aviv, Israel
Parish P. Sedghizadeh, DDS, MS [10]
Associate Professor of Clinical Dentistry Roderick W. Tataryn, DDS, MS [16]
Section Chair of Diagnostic Sciences Lecturer, Endodontics
Director, USC Center for Biofilms Loma Linda University
Herman Ostrow School of Dentistry Loma Linda, California
University of Southern California Private Practice, Tataryn Endodontics
Los Angeles, California Spokane, Washington

Shahrokh Shabahang, DDS, MS, PhD [28] Mahmoud Torabinejad, DMD, MSD,
Associate Professor of Endodontics
PhD [24]
Loma Linda University School of Dentistry
Director of the Torabinejad Institute of
Loma Linda, California
Surgical Education and Research Venues
Irvine, California
Ya Shen, DDS, PhD [21]
Assistant Professor Martin Trope, BDS, DMD [12]
Department of Oral Biological and Medical Clinical Professor of Endodontics
Sciences University of Pennsylvania
Division of Endodontics Philadelphia, Pennsylvania
University of British Columbia
Vancouver, British Columbia, Canada
Richard E. Walton, DMD, MS [9A]
Professor Emeritus of Endodontics
Ziv Simon, DMD, MSc [19] University of Iowa College of Dentistry
Instructor
Iowa City, Iowa
Herman Ostrow School of Dentistry
University of Southern California
Los Angeles, California Zhejun Wang, DDS, PhD [21]
Private Practice Limited to Periodontics Division of Endodontics
Beverly Hills, California Department of Oral Biological and Medical
Sciences
University of British Columbia
José F. Siqueira Jr., DDS, MSc, PhD [3, 6] Vancouver, British Columbia, Canada
Chair and Director, Postgraduate Program
in Endodontics
Faculty of Dentistry Borja Zabalegui, MD, DDS, PhD [36]
Estácio de Sá University Professor of Endodontics
Rio de Janeiro, Brazil University of the Basque Country/EHU
Leioa, Bizkaia, Spain
Private Practice Limited to Endodontics
Anthony J. Smith, PhD [29] Bilbao, Spain
Professor Emeritus
School of Dentistry
University of Birmingham
Birmingham, United Kingdom

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 ▼ F oreword
Fifty-three years ago, the year I graduated from the University of Southern California School of Dentistry with John Ingle
as our dean he published, unknown to me at the time, his first edition of ENDODONTICS — now celebrating its 50th
Anniversary Edition. This is remarkable on several different levels.

First, John hired me in 1968 as an Assistant Professor of Biochemistry and Nutrition in the USC School of Dentistry to start
my 46-year tenure on the full-time faculty of the University of Southern California.

Second, I have been able to join with others over the years to celebrate John’s birthdays. We celebrated John’s 98th birthday in
January 2017 while he continued to savor the pleasures of authorship, editing, friendship, and staying connected to his passion
for endodontics.

Finally, this is a very special occasion to also celebrate my colleague and dear friend Ilan Rotstein who has joined with John
to produce the 7th edition of Ingle’s ENDODONTICS. Together, John and Ilan have organized an excellent and authoritative
edition that includes 40 chapters contributed by internationally recognized experts in the field. Collectively, these contribu-
tions reflect the most comprehensive textbook in modern endodontics worldwide. Further, they emphasize the science of
endodontics, the practice of endodontics, and the interdisciplinary nature of endodontics.

I celebrate their accomplishment with this 7th edition of Ingle’s ENDODONTICS and encourage the reader to learn and enjoy
this fascinating field. Cheers!

—Harold C. Slavkin, DDS

Professor and Dean Emeritus
6th Director of the NIDCR, National Institutes of Health

xix

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Partial_FM.indd 20 19/02/19 9:24 AM
 ▼ P reface to the 7th Edition
Endodontic treatment is an important therapeutic modality that allows retention of the natural dentition in the oral cavity
and its return to health and function.

The specialty of endodontics has gone through many groundbreaking changes over the past several years. Recent advances in
concepts, technology, materials, and equipment have changed the way endodontics is being practiced today. These advances
have made it possible to efficiently perform successful endodontic treatment with improved precision and predictability and
with greater patient acceptance and comfort.

The seventh edition of Ingle’s ENDODONTICS is the most recent revision of the text that has been known as one of the
most authoritative in the field for half a century. This 50th anniversary edition includes 40 chapters written by internationally
renowned authors from six continents, contributing new, cutting-edge knowledge and updates on topics that have formed the
core of the specialty. The evidence-­based information provided in this edition continues to influence what is thought, what is
taught, and what is practiced in modern endodontics worldwide. It is the standard against which all other endodontic texts
will be measured.

The three main themes of this edition are The Science of Endodontics, The Practice of Endodontics, and Interdisciplinary
Endodontics. Endodontic treatment is an art requiring clinical skills that build upon a robust foundation of scientific evidence.
In tandem, the endodontic professional must play a significant role as part of a team of specialists in order to attain the correct
diagnosis, proper treatment decision-­making, and a predictable outcome.

I wish to thank the authors for their most valued contribution, especially under a very intensive and ambitious timeline. Their
efforts and dedication have made this edition the most comprehensive textbook in endodontics today.

I owe a special debt of gratitude to Dr. John Ingle, a pioneer, leader, mentor, and educator for entrusting me with one
of his most precious treasures: Ingle’s ENDODONTICS. I was surprised and humbled when Dr. Ingle asked me to be the
Editor-­In-­Chief of this textbook. Thank you, John, for the mentorship, trust and support. For me, it made this project an
extraordinarily enriching learning experience and a labor of love.

A hearty thank you to Dr. Leif K. Bakland and Dr. J. Craig Baumgartner for their advice, guidance, and unconditional help.

I hope you, the reader, enjoy this book and that it will become a well-­used reference in your practice.

—Ilan Rotstein

xxi

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Partial_FM.indd 22 19/02/19 9:24 AM
 ▼  reface to the 6th Edition
P
“Pull and be Damned Road”
Revisited

Over 40 years ago, the preface to the first edition of Endodontics ­featured
“Pull & Be Damned Road.” Nothing from the first edition left such a
lasting impression as that saying. Even today, “old timers” come up to
me at meetings to reminisce about this preface. They may not remem-
ber the details of endodontic cavity preparation or the chapter on pain
first expressed in that edition. Those features have become an integral
part of any endodontic practice. But they do remember “Pull and Be
Damned Road.” And for good reason.

Forty years ago it was more prevalent to extract teeth than to save
them by root canal therapy. A plea was made in this preface to trust
endodontic treatment and to reverse this trend toward “oral amputa-
The original sign for Pull and be Damned Road has been
tion.” Gradually this became a fact, as endodontics spurred ahead and
pilfered so many times the authorities have had to place
full dentures declined.
a new sign over 20 feet above the ground. (Courtesy of
Dr. James Stephens.)
And this brings to mind an incident I long have savored. I was a speaker
at the Hinman Dental Meeting in Atlanta. Joining me as a headliner
was Dr. Will Menninger, head of the famous Menninger Psychiatric Clinic, then based in Topeka, Kansas. Dr. Menninger and
his brother Karl were unquestionably the world’s most famous psychiatrists. Dr. Will had been a brigadier general in World
War II, head of all the army’s psychiatrists. In 1948 he was the first psychiatrist on the cover of TIME magazine. It was an
honor for me to be on the same program with him, and I eagerly attended his first lecture that preceded mine.

When I began my lecture, there was Dr. Menninger seated in the front row. I considered it professional courtesy on his part,
but I did notice him taking notes.

The Hinman had a format wherein each lecturer would repeat his same lecture the next day. I didn’t attend Dr. Menninger’s
second lecture but he attended mine. There he was again, seated in the front row. I was flattered beyond measure. At the end
of the lecture I asked him why his sudden interest in endodontics. His reply was startling.

“Dr. Ingle,” he said, “I was so impressed with your lecture, but I was also terribly embarrassed. On behalf of my profession
I must apologize to you for my past behavior. When I think of how many patients I have recommended that they have their
teeth extracted, I am appalled at the destruction I have caused. I had no idea. Now I find these teeth could have been saved
and their abscesses healed. You have no idea how thankful I am to you, for directing me from my past behavior.” Spoken like
a psychiatrist!

We’ve come a long way since those days, a time of wholesale extractions. But we face a new challenge today; not wholesale
extractions but selective extractions; for the sole purpose of placing an implant. Once again, dentists are urging patients to have
teeth extracted, ignoring the fact that a healthy root is far preferable to a mechanical implant; less costly, less painful, less time
consuming, and above all, more biological.

Now I’m not saying implants are unhealthy or less successful. What I am expressing is my concern that many salvable teeth
are being sacrificed on the altar of insatiability. Back to pull and be damned. I’m not against implants! As a matter of fact,
implant therapy is now being taught in a number of endodontic post doctoral programs. The thesis being, however, that teeth

xxiii

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 xxiv Preface to the 6th Edition “Pull and be Damned Road” Revisited

that cannot or should not be saved by endodontics may well be extracted and replaced by an implant rather than a bridge. And
who better to place that implant than a well-trained endodontist who has just made that judgment?

The 6th edition of Endodontics is replete with new innovations and knowledge. Now, more than ever, it remains the “Bible of
Endodontics” a name long applied by others to the previous editions.

I feel most comfortable as I “pass the torch” to the new editors, Leif Bakland and Craig Baumgartner. And I have a feeling the
profession will come to its senses; veering off “Pull and Be Damned Road” and onto the “Road Best Traveled.”

John I. Ingle
December 2007

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 The Science of Endodontics
Chapter 1

Anatomy and Morphology of Teeth and Their

Root Canal Systems
Blaine M. Cleghorn, William H. Christie

Successful root canal therapy requires a thorough knowledge
of tooth anatomy and root canal morphology,1–3 which may
be quite variable within the norm. Anomalies or deviations
in the usual shape and root number in the adult human den-
tition outside the norm may also occur. When an anomalous
form of tooth or root anatomy occurs fairly frequently in a
given population or ethnic group, it should be considered a
variant form and recognized.
Root canal treatment may fail if the root canal system
is not fully identified and treated. Lack of knowledge of
the variability of human root morphology, misadventure,
and weakening of root structure may result in a search
for a nonexistent canal. Therefore, a thorough knowledge
of both normal and abnormal morphologic variations is
required.
For each tooth in the permanent dentition, there is a wide
range of variations reported in the literature. It specifically
focuses on the frequency of occurrence of number and shape
of root canals with each root, number of roots,2,4–17 and
incidence of molar root fusion.18–24 A range of variations in
the length of roots, overall size, and curvatures within root
morphology are also treatment considerations but should be
addressed outside this chapter.
A number of factors contribute to the variations in mor-
phology, which are discussed in a few studies (Table 1-1).
Root canal morphology of teeth is often extremely complex
and highly variable,2,4,6,13,15–17 as illustrated in the three-
dimensional (3-D) models of the maxillary first molar in
Figure 1-1.6 Variations may also result from ethnic factors,
age, and gender of the population studied.

A B C

Figure 1-1 Root canal systems of a maxillary first molar. A & B. Mesiobuccal views (MB root canal system is centered).
C. Mesial view (MB root canal system is far right). (Reprinted with permission from Brown P, Herbranson E. Dental Anatomy
and 3-D Tooth Atlas Version 3.0. Illinois: Quintessence, 2005: Maxillary First Molar- 3-D Models 1-3.)

CH01.indd 1 13/02/19 4:52 PM

 2 The Science of Endodontics

Table 1-1 Factors Contributing to Variations in Reported Root and Root Canal Morphology
Factors Further Information and References

Definition of a canal: Negotiated and obturated to within 4 mm of the apex25

Separate orifice found on floor of pulp chamber26
Two instruments placed into two MB canals of a maxillary first molar
to a minimum of 16 mm from a cusp of an intact tooth27
One that can be instrumented to a depth of 3–4 mm12
A treatable canal28
Age: 8,29–31
Ethnicity: 32–61
Gender: 11,21,28
Source of teeth (specialty endodontic practice vs. general practice): 62
Study design (in vivo versus in vitro): 27,63,64
In vitro methods

Clinical examination: 65–67

Radiographic examination: 29,31,56,68–72
Radiography and instrumentation: 73–75
Clearing: Clinical and Radiographic examination76
Chinese Ink60,77
Chinese Ink and Hyperbaric oxygen78
India Ink and radiography54,55,79
India Ink and Stereomicroscopy80
India Ink11,81–111
Hematoxylin dye35,70,112–115
Hematoxylin dye and stereomicroscope116
Oil-based dye117
Stereomicroscope118,119
Methylene Blue dye120
Waterproof Black Ink121
Sectioning: 52,122–127
& Radiography128–130
Stereomicroscopy131
Radiography and instrumentation58,132
Instrumentation133
Injection of stained plastic resin (plastic casts): 19,134–136
Metal castings: 8
Visual examination: 137,138
Scanning electron microscopy: 139,140
Grinding: 5
Radiopaque elastomer and radiography: 136
CBCT: 141,142
CBCT and Histology Comparison: 143
Spiral CT: 144,145
Helical CT: 146
Micro CT: 147–56
Dental loupes and modified access opening: 157
Surgical operating microscope (SOM) and ultrasonics: 158
In vivo methods

Clinical and radiographic examination: 159–162,127

Review of FMS and/or Panoramic radiographs: 22,40,163,164,36
Review of post-RCT teeth: 30,57,165–172
CBCT: 47,61,173–194
Spiral CT: 195,196
SOM: 25
Dental loupes, headlamp and modified access opening: 28
Dental loupes and SOM: 197
Comparison of Radiology, CBCT, SOM and Start X ultrasonics: 198

CH01.indd 2 13/02/19 4:52 PM

 Chapter 1 Anatomy and Morphology of Teeth and Their Root Canal Systems 3
Data generated from a series of teeth that were presented
for endodontic treatment in a specialty endodontic practice
may not represent the overall frequency of incidence in a
general population, as more complex cases are more likely to
be referred to a specialist,62 thus skewing the sample reported
in some clinical studies. Differences in reported results may
also be due to the study design (clinical radiographs ver-
sus laboratory, gross morphology or microscopic)63 or even
unintentional bias in the selection of teeth to study and pub-
lication bias.
The “gold standard” for assessing canal morphology in
laboratory studies is the clearing method, where extracted
teeth are rendered transparent and a dye is injected into the
canal systems. A 3-D shape of the entire length of the canals
may be viewed under magnification and assessed according
to the criteria predetermined by independent observers.
Results from early clinical studies generally reported fewer
canals than in vitro bench studies. In recent years, however,
data from clinical studies are becoming more comparable to
laboratory studies. The use of dental loupes, headlights, sur-
gical operating microscopes (SOMs), and ultrasonic meth-
ods has greatly improved the clinical detection of canals
(Table 1-1).
The increased use of computed tomography (cone beam
computed tomography [CBCT], spiral CT, helical CT,
and micro-CT) has improved the accuracy of identifica-
tion of canals and dramatically changed the reported results.
Although there are some limitations with CBCT, both
I II
V VI
Figure 1-2 Vertucci’s classification of root canal systems (Types I–VIII).
CH01.indd 3
practically and economically, it has been shown to provide
comparable results to those laboratory studies that used
clearing methods.199–207
Another source of variations in the reported number of
canals in clinical studies may be due to the authors’ defini-
tion of what constitutes a canal. In some studies, a separate
canal is defined as a separate orifice found on the floor of the
pulp chamber,26 two instruments placed simultaneously into
two mesiobuccal canals of a maxillary first molar, to a mini-
mum depth of 16 mm from the cusp of an intact tooth,27 of
which one can be instrumented to a depth of 3 to 4 mm,12 or
an analysis of treatable canals in retrospective clinical stud-
ies.28 Other studies failed to provide a clear definition of a
separate canal and may only look at radiographic outcomes.
CLINICAL ENLIGHTENMENT
From the Three-Canal Molar Tooth to the Four
or More Canal Molars
In 1969, Weine et al.122 provided the first clinical classifi-
cation of more than one canal system in a single root and
used the mesiobuccal root of the maxillary first molar as
the sample specimen. Pineda and Kuttler31 and Vertucci14
further developed a system for canal anatomy classification
for any tooth having a broad buccolingual diameter and is
more applicable for use in laboratory studies (Figure 1-2).
All canal types reported in this chapter are based on the
III IV
VII VIII
13/02/19 4:52 PM
 4 The Science of Endodontics

Vertucci’s classification. Additional canal types not included
in Vertucci’s original classification system have been reported
by Sert and Bayirli (Figure 1-3)11 and Gulabivala et al.91 Sert
and Bayirli11 reported an additional 14 new canal types that
had not yet been classified.
Vertucci14,208 found the proximity of the canal orifices to
each other as indicative of whether they joined or remained
as separate canals. If the separation of the orifices was >3 mm,
the canals tended to remain separate through their entire
length. In contrast, canals were usually joined together if the

IX X XI XII

XIII XIV XIX XV

XVI XVII XVIII XX

XXI XXII XXIII

Figure 1-3 Sert and Bayirli’s additional canal types to Vertucci’s classification of root canal systems (Types IX–XXIII).

CH01.indd 4 13/02/19 4:52 PM

Another random document with
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The Project Gutenberg eBook of Rockabye,
Grady
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
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Title: Rockabye, Grady

Author: David Mason

Illustrator: Temple

Release date: September 7, 2023 [eBook #71584]

Language: English

Original publication: New York, NY: Royal Publications, Inc, 1957

Credits: Greg Weeks, Mary Meehan and the Online Distributed

Proofreading Team at http://www.pgdp.net

*** START OF THE PROJECT GUTENBERG EBOOK ROCKABYE,

GRADY ***
 Rockabye, Grady

by DAVID MASON

Illustrated by TEMPLE

When on Pru'ut, you must do as the natives

do—and that includes dying as they do!

[Transcriber's Note: This etext was produced from

Infinity July 1957.
Extensive research did not uncover any evidence that
the U.S. copyright on this publication was renewed.]
On the charts, it's P-1345-AZ, and a thin blue line marked with
cryptic letters indicates that a Mallor Lines cargo ship stops three
times in each local year. The Guide will tell you a little more; that it's
a small hot planet, covered with fern forests and swamps, and
inhabited by one of the innumerable primate-human species of the
universe. It was also inhabited, for a while, by one Terran, James
Grady.
The natives call it Pru'ut, which, freely translated, means "the world."
They refer to themselves as Kya, which means "people." James
Grady, being a realist, called it the Mudhole, and added a descriptive
adjective or two; but he did not find it nearly as unpleasant a place
as a few others in which he had been in the course of forty years of
wandering.
Pru'ut has no inclination, and only one season, which is rather like a
rainy August on Earth. When Grady arrived, he stepped from the
landing stage of the Mallor Lines' Berenice into six inches of gluey
mud; the sun was seldom out long enough to harden the surface of
Pru'ut.
"It's not an easy place," the departing agent, Jansen, told Grady.
"Rain, and heat, and getting along with the locals."
"Anything the matter with 'em?" Grady asked. He was watching the
tall, yellow-pale shapes of natives loading bales into the Berenice's
cargo slings.
"Nothing much," Jansen said. "Sane as any primitives. All kinds of
complicated rules and taboos, and naturally they'll get as mad as hell
at you if you scratch a single rule. Most of the data on that is in the
agent's notebooks. You add anything to the record that seems to be
worth putting down, the way the rest of us have."
"And if they get mad at you, they stop packing plants," the Berenice's
mate put in. "Which will make the Mallor Company mad at you, too.
This place is a regular bargain basement for drug materials. At least
eight different drug plants, all of them worth as much as uranium.
More, in some ways."
"Mm." The ex-agent picked up a handful of brown leaves from a
table. "This, for instance. It's a distant relation of coca. The natives
chew it for fun, but it's the source of a first class anesthetic. And this.
If your kidneys ever break down, the doctors use this stuff to keep
you alive. Kerosin, it's called. Anyway, you'll find price lists and
descriptive material in the files. You've worked for Mallor before,
haven't you?"
"Yes," Grady said. "I put in three years on Tengo, in Port City. Then I
quit for a while. Had something else to do."
"Oh? What?"
Grady's face cracked into a slight grin. "Little bit of an argument. The
Mutiny. I joined the local army, if you could call it that. I had my own
gun, so they made me a major on the spot."
"The Mutiny?" The Berenice's mate had heard of that brief and
savage war, in which a handful of settlers and local militia had
beaten off the troops of a powerful state, and had actually won. The
mate hastily readjusted his opinion of Grady upward. A trader's
agent was one thing; a man who had fought through the Mutiny was
something more than that. The mate opened his mouth to ask more
of the story; but the Berenice's air-horn cut him off with a long wail.
"Take-off in twenty minutes," the mate said, as the noise subsided.
"You ready, Jansen?"
The ex-agent nodded, and shook hands with Grady. "Good luck," he
said, and started for the ship, the mate following.
"Yeah," Grady said, closing the door of the agency. He had
completely put the Berenice out of his mind by the time the roar of
her departure split the wet air of Pru'ut. He was, in fact, well on his
way to settling down as a permanent resident by that time.
A year later, the Berenice had called twice, and her captain and mate
were calling Grady by his first name. He had also acquired a native
woman, who, in accordance with one of the innumerable customs,
could not call him by name at all. She referred to him as Kotasa,
which is a sort of title. He, also in accordance with customs, called
her Shallra, which was not her name, but that of her mother. Grady
was also extremely careful not to speak to her mother at all, because
of another custom.
Grady—Kotasa to his wife, and Shassa to the rest of the village—
fitted in well, better than any Terran had until his coming. Grady had
spent most of his life living in odd places and with strange people;
and had come to the conclusion that it was always a good idea to be
a conservative by local standards. He could recall, quite clearly, the
day he had found what was left of Steynert, who had tried to change
the dietary habits of the inhabitants of Kree.
By comparison with the Kree, the Kya were an easy people to get
along with. Their lives were not hard, since Pru'ut was a fertile world,
and full of food sources. The Kya farmed their garden patches,
fished, and hunted, and spent the remaining time gathering plants for
Grady and reciting endless and complex genealogies. Grady paid for
the plants with goods from the trade warehouse, and listened gravely
to the genealogies, making mental notes whenever anything was
mentioned that might be of practical use. He did not consider himself
as a collector of scientific information; he was a practical man, and
he selected information for practical ends.
Shallra was the best wife he had ever had, and Grady had lived on
several worlds. She spoke little, and when she did, it was direct and
to the point. She was affectionate, but, like most Kya,
undemonstrative. She had been brought up to consider that males
were equals, but that certain male privileges, such as the lodge
magics and the use of horn pipes, were inviolable. Grady had lived
on one world where men were considered very much superior to
women, and had found that the attitudes which result are not as
pleasant as they might seem. And lastly, Shallra was probably the
best cook on Pru'ut, if not the best on several worlds.
The Kya generally liked and trusted Grady, and, after two years, he
was almost one of them. Standing on the agency porch, in the weak
sunlight, he seemed to have acquired the same yellowish skin and
lean face, and he was dressed in the same loose kilt. Shallra came
out to stand beside him, and they looked like any other Kya.
"The sun," she said gravely. "There will be a dance tonight."
Grady nodded. "Like to see it," he said. "The dance, I mean."
"It is for men," Shallra said. "Koor," she pointed at the sun, "is a god
belonging to men. The women dance when the sky clears in the
night."
"Men's dance, eh?" Grady said, sucking on his pipe. "You're
probably right about it being all right for me to go. But I'd better
check with the Chief anyway."
He started down the log-paved walk, toward the Chief's house on the
other side of the village. He could see it clearly at the far end of the
long, muddy street, but it was necessary to walk along a twisting
detour, rather than directly toward it. There was an acre of ground in
the center of the village, filled with crumbling, empty huts, and no
Kya walked through this ground. It belonged to Sa'ahah, whose
ghost walked in a wide circle around the hut where a jealous rival
had speared him in his sleep.
The house was the usual Kya affair, on tall stilts, with painted signs
on its facade, but much more elaborate as befitted the Chief's
position. He was Anla-Who-Speaks-for-the-Ancestors. There were
several other kinds of chief, but it was Anla whom Grady consulted
before trying anything in the least unusual. Anla sat on his porch
now, regarding the sun through slitted eyes.
Grady greeted him in proper form, and Anla returned the greeting,
rising and bowing.
"Is there any reason why this person may not attend the dance of
Koor with his brothers on this night?" Grady asked.
Anla thoughtfully pulled his lower lip; then, nodding, he said, "No,
there is no reason not to."
Then Grady made the mistake. He made it in full view of Anla's
mother-in-law, who sat peering balefully out from her special room in
the corner of the Chief's house; and of Anla's wife, and of his wife's
innumerable relations, who were clustered on the porch. When
Grady saw their silent staring, he looked down at his feet, and he
saw what it was that he had done. Anla saw it too, and the two men
looked up again, and at each other, very gravely.

Grady did not say he was sorry. It would have been of no use
whatever. Nor did he point out that the sun came out so infrequently
that his mistake was one which could be excused. Among the Kya
there are very few mistakes which can be excused, and stepping on
the shadow of a chief is not one of them.
Neither did Anla make any reference to the long friendship between
them, because there would have been no point in doing so. Anla's
eyes grew darker, and the wrinkles at their corners deepened, but
his words were calm, the correct words for such a time.
"Your name was Shassa," Anla said. "You have broken the ghost-
cloak of the Chief, and your name cannot be Shassa. From this
place and this time I take back your name, Shassa, and you have no
name."
Grady did not say anything, because a Kya cannot hear the words of
a man without a name; besides, there was nothing to say, though a
great deal to think about. The Berenice was due in four days. Four
days during which a man without a name would have to avoid the
custom which decreed that such a man must be killed. Killed as soon
as possible, because each day he continued to live was a day which
must be removed from the calendar, a day on which no man's birth
date might be celebrated, or any animal killed for food, or any root
taken from a garden.
Grady turned, and walked slowly, with a stiff back, down the path
away from the Chief's house. To run, or to show fear, would be fatal;
the Kya were themselves in a state of shock at the thing which had
happened, and it would be an hour or more before they began to
prepare for what they had to do. Therefore, Grady held his spine
straight, feeling a cold spot between his shoulderblades where the
first iron-headed arrow might strike in.
Ahead of him, through the village, the silent children ran on light feet,
darting into the houses and out again—the children, who were the
bearers of news. He saw three of them dash toward the agency, and
enter it; and in a moment, as he came up the path, Shallra came out
on the porch, carrying a clay pot in her hands.
"You who were Kotasa," she said, "take this, and drink it to free me
of your name."
It was the standard form of divorce among the Kya, and if the eyes of
Shallra had not been bright with tears, Grady might have slipped. He
took the clay pot, but he did not drink, because he could smell the
faint and bitter odor about it, which was not the odor of the fruit wine
that it should have held.
"Why?" he asked her, quietly.
"Because it is an easier death than the knife and the arrow," she
said, and added, "When you were Kotasa, you were—a good man
for me. Drink the wine." She said it pleadingly. He shook his head.
"I am sorry," Shallra said, and there is nothing harder for a Kya to
say. But she added something even harder for a Kya woman to say;
his name, his proper name, which she had always known but could
never use. Then she walked away, and out of Grady's life, because
he was now a man without a name.
He set the pot down carefully on the agency's steps and went inside.
As he closed the door, there was a high, whistling noise, and a sharp
thud against the door planks. He did not need to look to know that an
arrow stood in its wooden panels.
Grady closed the heavy wooden shutters carefully, not even jumping
when a second arrow whickered through the last shutter as it swung.
He lit a table lamp and took the heavy, seldom-used rifle from the
wall. He did not need to check it; he had oiled and cleaned it once a
week for two years. Instead, he laid it on the table and took a book
down from a shelf.
"General Code of the Federation Authority," Grady read the words on
the spine, and opened it. "Extent of responsibilities of individuals on
mandated planets...."
Under the circumstances, Grady discovered, he could kill any
number of Kya if he were so inclined. The Authority would require a
full report, in quadruplicate, of the circumstances—and as another
arrow struck the door, Grady wondered wryly who would make out
that report.
Also, Grady was not in the least inclined to kill any Kya. If doing so
would have saved his life, he would have shot any number of them
without any particular qualms. But there were no reasons at all to
think that killing any of them would do Grady any good. And Grady
thoroughly understood why it was that they had to kill him. He was
no more angry with the Kya than he had been with the Imperial
Guards, five years before, when they had come up Kanno Hill with
their band playing and their bayonets gleaming. He could remember
how military and colorful they had looked, in comparison to the
overalled, grimy rabble who stood beside him; and how they had
come up that hill again and again, fewer of them each time, and the
band losing a bit of verve on the last. Grady's anger then had been
at the damned fool, whoever he was, who ordered those useless
charges; and his anger now was with himself, because it had been
his own mistake.
There was a growing murmur outside the agency. The villagers were
gathering in the street, and in the yards behind the building. There
was no way out now, and nowhere to go if there had been a way out.
Grady got up, and walked to the door. He opened the sliding panel a
crack and peered out.
The rain had begun again, and through its thin gray curtain he could
see the ranks of villagers, silent, standing around the house, along
the railings, and watching. The men stood in front, each holding his
weapons, his bow bent in his hands. There was Lahrsha, who had
been brother in the Lodge to Grady, and whose blood had been
mixed with his to seal the tribal bond. There was Ahl, whose small
son Grady had nursed through a bad week. There were Grady's
friends and neighbors and brothers, each with an arrow on the nock
for Grady.
"It's a queer thing to happen," Grady said to himself, aloud. The
sound of his own voice startled him; he had become so much a Kya
that to him a man without a name should not have a voice.
The arrows struck oftener now. Grady saw a small group of men
move away, and then return, carrying a short log.
The door, Grady thought. They'll break it down, and come in, with
their grave faces and their polite ways, and they'll cut my throat. And
it won't matter if I kill one or two or ten of them; they'll do it anyway.
They won't hear an argument, because they can't hear me at all,
without a name; they won't even hear any noise I make when they
finish me off.
The log had begun to beat against the door, with a steady thunder.
Grady opened a cabinet, and took out a jar of brown liquid. Quickly
he drank it and sat down, his face graying. His head fell forward on
his arms, and the book of regulations fell to the floor, atop the unfired
rifle.
The Berenice swung outward, riding home to port with an empty
hold. The Mallor Company would not be pleased, but there were
other jobs. And the mate, sitting across the messroom table from
James Grady, put the matter in its simplest terms.
"Just one of those things," the mate said. "You can't be blamed.
They'll take another agent without any fuss, I imagine."
"No doubt of it," Grady said. "Can't say I'm glad to leave, though. It
was a good place."
"I still don't get it," the mate said. "We came in and found you in the
agency, out cold with coca. The door was down, and arrows all over
the place. Why didn't they come in and dig a knife into you?"
"Customs and taboos," Grady said. "I took a chance on it, but I was
pretty sure I was right. Common sense—by their standards. Man's
asleep—his ghost is walking around. If you kill him in his sleep, you
free his ghost, which is very bad, very strong magic. So you have to
wake him up to kill him. And they couldn't wake me up; I was full of
that coca leaf, enough for a week."
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GRADY ***

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