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Cohen’s TWELFTH
EDITION

PATHWAYS
of
the
PULP
EDITORS
LOUIS H. BERMAN, DDS, FACD
Clinical Associate Professor
Department of Endodontics
School of Dentistry
University of Maryland
Baltimore, Maryland
Faculty
Albert Einstein Medical Center
Philadelphia, Pennsylvania
Private Practice
Annapolis Endodontics
Annapolis, Maryland
Diplomate, American Board of Endodontics

KENNETH M. HARGREAVES, DDS, PhD, FICD, FACD

Professor and Chair
Department of Endodontics
Professor
Departments of Pharmacology, Physiology (Graduate School),
and Surgery (Medical School)
President’s Council Endowed Chair in Research
University of Texas Health Science Center at San Antonio
San Antonio, Texas
Diplomate, American Board of Endodontics

Web Editor
ILAN ROTSTEIN, DDS
Associate Dean of Continuing Education and Chair
Division of Endodontics, Orthodontics, and General Practice Dentistry
Herman Ostrow School of Dentistry
University of Southern California
Los Angeles, California
ELSEVIER
3251 Riverport Lane
St. Louis, Missouri 63043

COHEN’S PATHWAYS OF THE PULP, TWELFTH EDITION ISBN: 978-0-323-67303-7

Copyright © 2021 by Elsevier Inc. All rights reserved.

Previous editions copyrighted 2016, 2011, 2006, 2002, 1998, 1994, 1991, 1987, 1984, 1980, and 1976.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to
be administered, to verify the recommended dose or formula, the method and duration of administra-
tion, and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

International Standard Book Number: 978-0-323-67303-7

Content Strategist: Joslyn Dumas

Senior Content Development Manager: Luke Held
Senior Content Development Specialist: Jennifer Wade
Publishing Services Manager: Julie Eddy
Book Production Specialist: Clay S. Broeker
Design Direction: Patrick Ferguson

Printed in Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 About the Editors

Louis H. Berman
Dr. Berman received his dental degree from the University of Maryland School of
Dentistry and his Certificate in Endodontics from the Albert Einstein Medical Center. He
is Clinical Associate Professor of Endodontics at the University of Maryland School of
Dentistry and a Clinical Instructor and Guest Lecturer at the Albert Einstein Medical
Center. He has lectured internationally in the field of endodontics and has published in
several peer-reviewed international dental journals as well as co-authoring textbook
chapters on numerous topics in various endodontic textbooks. He is past president of
the Maryland State Association of Endodontics and is a member of the Journal of End-
odontics Scientific Advisory Board. A Diplomate of the American Board of Endodontics
and Fellow of the American College of Dentistry, Dr. Berman has been in full-time
private practice in Annapolis, Maryland since 1983.

Kenneth M. Hargreaves
Dr. Hargreaves is Professor and Chair of the Department of Endodontics at the
University of Texas Health Science Center at San Antonio. He is a Diplomate of
the American Board of Endodontics and maintains a private practice limited to
endodontics. He is an active researcher, lecturer, and teacher and serves as the
Editor-in-Chief of the Journal of Endodontics. He is principal investigator on several
nationally funded grants that combine his interests in pain, pharmacology, and
regenerative endodontics. He has received several awards, including a National In-
stitutes of Health MERIT Award for pain research, the AAE Louis I. Grossman
Award for cumulative publication of research studies, and two IADR Distinguished
Scientist Awards.

Ilan Rotstein
Dr. Rotstein is Professor and Chair of Endodontics, Orthodontics, and General Practice
Residency and Associate Dean at the Herman Ostrow School of Dentistry of the Univer-
sity of Southern California in Los Angeles. He is on the Executive Leadership Team of the
School of Dentistry and an ambassador member of the University of Southern California.
He has served in leadership roles for various dental organizations, including Chair of
the International Federation of Endodontic Associations’ Research Committee; as a
committee member of the American Association of Endodontists and European Society
of Endodontology; and as a scientific reviewer for international endodontic and dental
journals. He has also served as President of the Southern California Academy of Endo-
dontists, Israel Endodontic Society, and International Association for Dental Research—
Israel Division and as Chair of the Israel National Board of Diplomates in Endodontics.
Dr. Rotstein has published more than 150 scientific papers and research abstracts in
the dental literature as well as chapters in international endodontic textbooks, includ-
ing Pathways of the Pulp, Ingle’s Endodontics, Endodontics: Principles and Practice, Seltzer
and Bender’s Dental Pulp, and Harty’s Endodontics in Clinical Practice. He has lectured
extensively in more than 25 countries throughout 5 continents.

iii
This page intentionally left blank
 Dr. John Ingle

The development of every edition of Cohen’s Pathways of the Washington Study established proof of outcome for endo­
Pulp, for all of its editors and contributors, is a journey into dontic treatment and remains a seminal work in the
both the future and the past of endodontics. What we as literature for our field.
clinicians know today and the care that knowledge enables New fields offer many new challenges to their pioneers,
us to provide to our patients are the result of the curiosity, and Dr. Ingle soon turned his attention to the development
dedication, and commitment of the teachers, researchers, of standardization of endodontic instruments. His work
and clinicians who have come before us. Dr. John Ingle, resulted in the metric measurements and the 0.2 taper of
who contributed to the science, practice, and teaching endodontics files that were established in 1957.
of endodontics for more than 7 decades, is one of those In 1965, Dr. Ingle brought together his experience
extraordinary pioneers. as both a clinician and an educator in the publication of
Dr. Ingle began his career as an educator at the Univer- his foundational textbook Ingle’s Endodontics. Now in its
sity of Washington in Seattle, where he taught periodon- sixth edition, Ingle’s Endodontics has provided an essential
tics. While teaching, he became interested in the new field evidence-based reference to students and clinicians for
of endodontics and, perhaps drawing on the example of more than 50 years.
his pioneer great-grandfather, Daniel Boone, he entered While Dr. Ingle’s many accomplishments are known and
a specialty program in endodontics at the University of admired, the attributes of his character are equally revered.
Michigan to explore this new discipline, earning graduate Dr. Ingle was modest about his many contributions to end-
degrees in endodontics and periodontics. odontics and was unfailingly generous in his support and
As an educator and clinician, Dr. Ingle knew the impor- encouragement of others. The compassion and empathy
tance of evidence in establishing the efficacy of endodontic that motivated his work were experienced by all those he
treatment as a new specialty. To meet this need, he evalu- touched throughout his long and exemplary career and life.
ated the results of endodontic treatment in 3000 patients It is with profound gratitude and appreciation that we
and presented his findings to the annual session of dedicate this twelfth edition of Cohen’s Pathways of the Pulp
the American Association of Endodontists in 1953. The to Dr. John Ingle, a scholar, a leader, and a gentleman.

v
Contributors

Anita Aminoshariae, DDS, MS Serge Bouillaguet, DMD, PhD

Professor Professor and Head of the Endodontic Unit
Endodontics Division of Cardiology and Endodontology
School of Dental Medicine School of Dental Medicine
Case Western Reserve University University of Geneva
Cleveland, Ohio Geneva, Switzerland

Abdulaziz A. Bakhsh, BDS, MClinDent, Nicholas Chandler, BDS (Lond), MSc (Manc),
MEndo (RCSed) PhD (Lond), LDSRCS (Eng), MRACDS (Endo),
Endodontist FDSRCPS (Glas), FDSRCS (Edin), FFDRCSI, FICD
Department of Restorative Dentistry Professor of Endodontics
Faculty of Dentistry Faculty of Dentistry
Umm Al-Qura University University of Otago
Makkah, Saudi Arabia Dunedin, New Zealand

Bettina Basrani, DDS, PhD Gary S.P. Cheung, PhD, BDS, MDS, MSc, FHKAM,
Program Director FCDSHK (Endo), SFHEA, FICD, FAMS, FRACDS,
MSc Endodontics MRACDS (Endo), FDSRCSEd
Department of Endodontics Clinical Professor
University of Toronto Division of Restorative Dental Sciences
Toronto, Canada Associate Dean of Undergraduate Education
Faculty of Dentistry
Ellen Berggreen, PhD University of Hong Kong
Professor Pokfulam, Hong Kong
Biomedicine
University of Bergen Till Dammaschke, Prof, Dr Med Dent
Head of Research Dentist and Assistant Medical Director
Vestland County Department of Periodontology and Operative Dentistry
Bergen, Norway Westphalian Wilhelms University
Münster, Germany
Louis H. Berman, DDS, FACD
Clinical Associate Professor Didier Dietschi, DMD, PhD, Privat-Docent
Department of Endodontics Senior Lecturer
School of Dentistry School of Dental Medicine
University of Maryland Department of Cardiology and Endodontics
Baltimore, Maryland University of Geneva
Faculty Geneva, Switzerland
Albert Einstein Medical Center Adjunct Professor
Philadelphia, Pennsylvania School of Dentistry
Private Practice Department of Comprehensive Care
Annapolis Endodontics Case Western Reserve University
Annapolis, Maryland Cleveland, Ohio
Diplomate, American Board of Endodontics
Anibal Diogenes, DDS, MS, PhD
George Bogen, BS, DDS Assistant Professor
Senior Lecturer Endodontics
Department of Endodontics University of Texas Health Science Center at San Antonio
School of Dentistry San Antonio, Texas
University of Queensland
Brisbane, Australia Melissa Drum, DDS, MS
Diplomate, American Board of Endodontics Professor and Advanced Endodontics Director
Endodontics
Ohio State University
Columbus, Ohio

vi
 CONTRIBUTORS vii

Conor Durack, BDS NUI, MFDS RCSI, James L. Gutmann, DDS, Cert Endo, PhD, FICD,
MClinDent (Endo), MEndo RCS (Lond) FACD, FIAD, FAAHD, FDSRCSEd, Dipl ABE
Specialist Endodontist and Practice Partner Professor, Chair, and Postdoctoral Program Director
Riverpoint Specialist Dental Clinic Endodontics
Limerick, Ireland College of Dental Medicine
Nova Southeastern University
Bing Fan, DDS, PhD Davie, Florida
Professor and Chair Professor Emeritus
Endodontic Center Restorative Sciences/Endodontics
School and Hospital of Stomatology College of Dentistry
Wuhan University Texas A&M University
Wuhan City, China Dallas, Texas
Adjunct Professor Honorary Professor
Department of Endodontics Stomatology
Dental College of Georgia School of Stomatology
Augusta University Wuhan University
Augusta, Georgia Wuhan, China

Mohamed I. Fayad, DDS, MS, PhD Kenneth M. Hargreaves, DDS, PhD

Director of Research and Clinical Associate Professor Professor and Chair
Department of Endodontics Department of Endodontics
College of Dentistry Professor
University of Illinois at Chicago Departments of Pharmacology, Physiology (Graduate
Chicago, Illinois School), and Surgery (Medical School)
President’s Council Endowed Chair in Research
Ashraf F. Fouad, DDS, MS University of Texas Health Science Center at San Antonio
Distinguished Professor and Vice-Chair San Antonio, Texas
Comprehensive Oral Health Diplomate, American Board of Endodontics
Adams School of Dentistry
University of North Carolina George T.-J. Huang, DDS, MSD, DSc
Chapel Hill, North Carolina Professor and Director for Stem Cells and Regenerative
Therapies
Inge Fristad, DDS, PhD Department of Bioscience Research
Department of Clinical Dentistry University of Tennessee Health Science Center
University of Bergen Memphis, Tennessee
Bergen, Norway
Vincent J. Iacono, DMD
Bradley H. Gettleman, DDS, MS Distinguished Service Professor, Chair, and Tarrson
Private Practice Professor of Periodontology
Assistant Clinical Professor Periodontology
College of Dental Medicine Stony Brook University
Midwestern University Stony Brook, New York
Glendale, Arizona
Diplomate, American Board of Endodontics Bradford R. Johnson, DDS, MHPE
Associate Professor and Director of Postdoctoral
Gerald N. Glickman, DDS, MS, MBA, JD Endodontics
Professor Department of Endodontics
Department of Endodontics University of Illinois at Chicago
Texas A&M College of Dentistry Chicago, Illinois
Dallas, Texas
Diplomate, American Board of Endodontics Scott C. Johnson, DMD
Clinical Assistant Professor
Kishor Gulabivala, BDS, MSc, FDSRCS, PhD, Endodontics
FHEA, FACD Midwestern University College of Dental Medicine,
Professor of Restorative Dentistry and Endodontology, Arizona
Consultant in Restorative Dentistry, and Head of Glendale, Arizona
Endodontology and Restorative Dental Sciences
Eastman Dental Institute William T. Johnson, DDS, MS, FICD, FACD
University College London Professor Emeritus
London, United Kingdom University of Iowa
Iowa City, Iowa
viii CONTRIBUTORS

Bill Kahler, DClinDent, PhD Matthew Malek, DDS

Honorary Associate Professor Post Graduate Program Director
School of Dentistry Endodontics
University of Queensland College of Dentistry
Brisbane, Australia New York University
New York, New York
Asma A. Khan, BDS, PhD
Associate Professor Donna Mattscheck, DMD
Endodontics Private Practice
University of Texas Health Science Center Endodontics
San Antonio, Texas Advanced Endodontics
Tigard, Oregon
James C. Kulild, DDS, MS
Professor Emeritus Madhu K. Nair, BDS, DMD, MS,
Endodontics Lic Odont (Sweden), PhD, Dipl ABOMR
School of Dentistry Professor and Director of Radiology, Assistant Dean of
University of Missouri, Kansas City Graduate Clinical Programs, and Director of the Oral
Kansas City, Missouri and Maxillofacial Radiology Residency Program and the
Imaging Center
David J. Landwehr, DDS, MS Diagnostic Sciences
Fellow College of Dentistry
American Academy of Oral and Maxillofacial Pathology Texas A&M University
Private Practice Limited to Endodontics Dallas, Texas
Capital Endodontics
Madison, Wisconsin Umadevi P. Nair, BDS, MDS, Dipl ABE
Chief Executive Officer
Alan S. Law, DDS, PhD Nair Endodontics PLLC
Adjunct Associate Professor Dallas, Texas
Restorative Sciences
University of Minnesota Yuan-Ling Ng, BDS, MSc, RCS, PhD. FHEA
Minneapolis, Minnesota Professor of Endodontology and Programme Director in
President Endodontology
The Dental Specialists Restorative Dental Sciences (Endodontics)
Minneapolis, Minnesota Eastman Dental Institute
University College London
Linda G. Levin, DDS, PhD London, United Kingdom
Adjunct Associate Professor
Department of Endodontics John M. Nusstein, DDS, MS
University of North Carolina at Chapel Hill Professor and Chair
Chapel Hill, North Carolina Division of Endodontics
Ohio State University College of Dentistry
Martin D. Levin, DMD Columbus, Ohio
Adjunct Professor
Department of Endodontics Donald R. Nixdorf, DDS, MS
University of Pennsylvania Professor
Philadelphia, Pennsylvania Diagnostic and Biological Services
Adjunct Assistant Professor
Roger P. Levin, DDS Department of Neurology
Chairman and Chief Executive Officer University of Minnesota, Twin Cities
Management Minneapolis, Minnesota
Levin Group, Inc. Research Investigator
Owings Mills, Maryland Health Partners Institute for Education and Research
Bloomington, Minnesota
Louis M. Lin, BDS, DMD, PhD
Professor Shanon Patel, BDS, MSc, MClinDent, MRD,
Department of Endodontics PhD, FDS, FHEA
New York University College of Dentistry Consultant Endodontist
New York, New York King’s College London Dental Institute and Specialist
Practice
London, United Kingdom
 CONTRIBUTORS ix

Christine I. Peters, DMD Avishai Sadan, DMD, MBA

Senior Lecturer Dean
School of Dentistry Herman Ostrow School of Dentistry
University of Queensland University of Southern California
Brisbane, Australia Los Angeles, California
Adjunct Clinical Professor
Arthur A. Dugoni School of Dentistry Frank Setzer, DMD, PHD, MS
University of the Pacific Assistant Professor, Endodontic Clinic Director, and
San Francisco, California Director of Predoctoral Endodontic Program
Department of Endodontics
Ove A. Peters, DMD, MS, PhD University of Pennsylvania
Professor Philadelphia, Pennsylvania
School of Dentistry
University of Queensland Stéphane Simon, DDS, MPhil, PhD, HDR
Brisbane, Australia Senior Lecturer
Adjunct Professor Department of Endodontics
Arthur A. Dugoni School of Dentistry Paris Diderot University
University of the Pacific Paris, France
San Francisco, California
Jose F. Siqueira, Jr., DDS, MSc, PhD
Tara F. Renton, BDS, MDSc, PhD, FDS RCS, Adjunct Professor
FRACDS (OMS), FHEA Postgraduate Program in Dentistry
Professor Faculty of Dentistry
Oral Surgery Grande Rio University
King’s College London Rio de Janeiro, Brazil
London, United Kingdom
Franklin Tay, BDSc (Hons), PhD
Domenico Ricucci, MD, DDS Department of Endodontics
Private Practice Augusta University
Endodontics Augusta, Georgia
Cetraro, Italy
Aviad Tamse, DMD
Isabela N. Rôças, DDS, MSc, PhD Professor Emeritus
Adjunct Professor Department of Endodontology
Postgraduate Program in Dentistry Goldschlager School of Dental Medicine
Faculty of Dentistry Tel Aviv, Israel
Grande Rio University
Rio de Janeiro, Brazil Fabricio B. Teixeira, DDS, MS, PhD
Chair and Professor
Robert S. Roda, DDS, MS Endodontics
Adjunct Clinical Faculty College of Dentistry and Dental Clinics
Advanced Education in General Dentistry University of Iowa
Arizona School of Dentistry and Oral Health Iowa City, Iowa
Mesa, Arizona
Yoshitsugu Terauchi, DDS, PhD
Paul A. Rosenberg, DDS CT and Microendodontic Center
Professor Endodontics
Endodontics Intellident Medical Corporation
College of Dentistry Yamato City, Japan
New York University
New York, New York Edwin J. Zinman, DDS, JD
Lecturer
Ilan Rotstein, DDS Department of Periodontology
Associate Dean of Continuing Education and Chair University of California, San Francisco
Division of Endodontics, Orthodontics, and General San Francisco, California
Practice Dentistry
Herman Ostrow School of Dentistry
University of Southern California
Los Angeles, California
New to This Edition

The radiographic interpretation of odontogenic and non­ Science Topics, and Part III: Advanced Clinical Topics. The
odontogenic lesions is exactly that: an “interpretation.” twelve chapters in Part 1 focus on the core clinical con­
This new twelfth edition boasts a completely new chapter cepts for dental students, while the chapters in Parts II and
entitled Lesions That Mimic Endodontic Pathosis that eluci­ III provide the information that advanced students and
dates and differentiates lesions that may appear as endo­ endodontic residents and clinicians need to know. In addi­
dontic origin. This is a perfect adjunct to the chapters on tion, three additional chapters are included in the online
Diagnosis and Radiographic Interpretation. version.
The chapter on Managing Iatrogenic Events has been The new organization better reflects the chronology of
completely rewritten to include an expansive section on endodontic treatment.
injury to the inferior alveolar nerve.
Damage to the inferior alveolar nerve secondary to endo­
dontic treatment is an avoidable dilemma. There is now Digital Content
specific content elaborating on the avoidance and manage­
ment of these types of injuries. New features included on the companion site include:
Root resorption and root fractures can be some of the n Three chapters found exclusively online:
most difficult defects to clinically manage. The Root Resorp­ n Chapter 26: Bleaching Procedures
tion chapter on these subjects has been completely updated n Chapter 27: Endodontic Records and Legal Responsi­
and will prove beneficial to the clinician and academician.
bilities
This edition updates all of the previous chapters to reflect n Chapter 28: Key Principles of Endodontic Practice
the changes in the literature since the last edition.
Management
n Case Studies
Review Articles
New Chapter Organization n
n Review Questions
n Videos
Chapters have been reorganized and grouped into three parts:
Part I: The Core Science of Endodontics, Part II: Advanced

x
 Introduction

The foundation of the specialty of endodontics is a gift from clinician, or with the augmented reality of digital microsur-
the generations of great endodontists and researchers be- gical devices? In the years to come, will we be able to truly
fore us. They guided us with the goals of treatment, the eliminate all of the canal microorganisms, biofilms, and
benefits of their advancements, and the frailties of their pulpal tissue? Will we be facilitating our canal cleaning with
deficiencies. From volumes of research, we have collectively less toxic and more directed irrigants? Once we are finally
built a virtual library of knowledge that leads us to the evi- able to totally clean and disinfect the canals to a microscopic
dence we need for mastering our clinical procedures and level, will we have an obturation material that finally satis-
benefiting our patients. As we look into our future, we fies ALL the material requirements that Dr. Louis Grossman
should be directed toward developing the necessary tools enumerated at the inception of our specialty? Will this obtu-
for maximizing our outcomes with consistency, longevity, rating material be newly regenerated vital pulp?
and, above all, patient well-being. Clearly, our endodontic future lies in out-of-the-box
Over the past several decades, we have gone from arsenic thinking, with the next generation of transformations
to sodium hypochlorite, from bird droppings to gutta- coming with collaborations not just from within the bio-
percha, from hand files to motor-driven files, from culturing logical sciences, but also in conjunction with physicists,
to one-visit appointments, from 2D to 3D radiography, and chemists, engineers, and a multitude of other great inno-
from pulp removal to pulpal regeneration. Yet still, the vative minds. The predictability of endodontics must be
clinical and academic controversies are pervasive. incontestable, not just with better technology to guide us
With patients living longer and with the inescapable toward greater success, but also to better elucidate exactly
comparison of endodontics to endosseous implants, the when endodontic treatment cannot be successful. Our fu-
demand for endodontic excellence has greatly increased. ture needs to focus on predictability and consistency, which
Surprisingly, we still base our diagnosis on a presumed and will only be achieved with disruptive technologies, rather
almost subjective pulpal status. Imagine a future in which than persisting with variations and modifications of our
endodontic diagnosis could be made more objective by current convictions. As a specialty, we have advanced by
noninvasively scanning the pulp tissue. Imagine algorithms leaps and bounds since our inception; but we are still in our
built into all digital radiography for interpreting and infancy with a brilliant future ahead of us. Since 1976,
extrapolating disease processes. CBCT has made a huge and now with 12 editions, Cohen’s Pathways of the Pulp has
impact on endodontic diagnosis, but can we enhance these always been about the art and science of endodontics, with
digital captures with a resolution that would approach an emphasis on evidenced-based direction rather than an-
microcomputed tomography, and with less radiation? Will ecdotal guidance. The dedicated contributing authors have
these 3D scans guide us not just with diagnostic objectivity, generously given their time to meticulously describe what
but also with direct treatment facilitation to guide us dur- is considered the state of the art of our specialty. We are
ing surgical and nonsurgical treatment? Truly, we are now hopeful that future editions will guide us toward enhanced
on the cusp of gaining the knowledge and technology endodontic outcomes, with the never-ending pursuit of
for accomplishing this. As for clinical visualization, will 3D endodontic excellence.
visualization and monitor-based observation change the
way we visualize and implement our procedures? Will our Louis H. Berman
procedures still be done with the fine motor skills of the Kenneth M. Hargreaves

xi
Contents

PART I THE CORE SCIENCE 15 Microbiology of Endodontic Infections, 585

JOSÉ F. SIQUEIRA, JR. and ISABELA N. RÔÇAS
OF ENDODONTICS
16 Pathobiology of Apical Periodontitis, 619
1 Diagnosis, 2 LOUIS M. LIN and GEORGE T.-J. HUANG
LOUIS H. BERMAN and ILAN ROTSTEIN

2 Radiographic Interpretation, 34 PART III ADVANCED CLINICAL

MADHU K. NAIR, MARTIN D. LEVIN, and UMADEVI P. NAIR
TOPICS
3 Lesions That Mimic Endodontic Pathosis, 78 17 Evaluation of Outcomes, 652
DAVID J. LANDWEHR
YUAN-LING NG and KISHOR GULABIVALA
4 Diagnosis of the Nonodontogenic 18 Root Resorption, 711
Toothache, 115 SHANON PATEL, CONOR DURACK, DOMENICO RICUCCI,
ALAN S. LAW, DONALD R. NIXDORF, and DONNA MATTSCHECK and ABDULAZIZ A. BAKHSH

5 Case Assessment and Treatment Planning, 139 19 Management of Endodontic Emergencies, 737
PAUL A. ROSENBERG and MATTHEW MALEK FABRICIO B. TEIXEIRA and GARY S.P. CHEUNG

6 Pain Control, 162 20 Managing Iatrogenic Events, 756

JOHN M. NUSSTEIN, MELISSA DRUM, and ASMA A. KHAN YOSHITSUGU TERAUCHI and TARA F. RENTON

7 Tooth Morphology and Pulpal Access 21 The Role of Endodontics After Dental Traumatic
Cavities, 192 Injuries, 808
JAMES L. GUTMANN and BING FAN BILL KAHLER

8 Cleaning and Shaping of the Root Canal 22 Chronic Cracks and Fractures, 848
System, 236 LOUIS H. BERMAN and AVIAD TAMSE
OVE A. PETERS, CHRISTINE I. PETERS, and BETTINA BASRANI
23 Restoration of the Endodontically
9 Obturation of the Cleaned and Shaped Root Canal Treated Tooth, 870
System, 304 DIDIER DIETSCHI, SERGE BOUILLAGUET, AVISHAI SADAN,
ANITA AMINOSHARIAE, WILLIAM T. JOHNSON, JAMES C. KULILD, and KENNETH M. HARGREAVES
and FRANKLIN TAY
24 Vital Pulp Therapy, 902
10 Nonsurgical Retreatment, 343 GEORGE BOGEN, TILL DAMMASCHKE, and NICHOLAS CHANDLER
ROBERT S. RODA, BRADLEY H. GETTLEMAN, and SCOTT C. JOHNSON
25 Endo-Perio, 939
11 Periradicular Surgery, 411 GERALD N. GLICKMAN and VINCENT J. IACONO
BRADFORD R. JOHNSON, MOHAMED I. FAYAD,
and LOUIS H. BERMAN

12 Regenerative Endodontics, 475

ANIBAL DIOGENES, STÉPHANE SIMON, and ALAN S. LAW

PART II ADVANCED SCIENCE TOPICS

13 Structure and Functions of the Dentin-Pulp
Complex, 512
INGE FRISTAD and ELLEN BERGGREEN

14 Pulp Reactions to Caries and Dental

Procedures, 557
ASHRAF F. FOUAD and LINDA G. LEVIN

xii
PART I

THE CORE SCIENCE

OF ENDODONTICS
PART OUTLINE 1. Diagnosis, 2 8. Cleaning and Shaping of the Root Canal
System, 236
2. Radiographic Interpretation, 34
9. Obturation of the Cleaned and Shaped
3. Lesions That Mimic Endodontic Pathosis, 78
Root Canal System, 304
4. Diagnosis of the Nonodontogenic
10. Nonsurgical Retreatment, 343
Toothache, 115
11. Periradicular Surgery, 411
5. Case Assessment and Treatment Planning, 139
12. Regenerative Endodontics, 475
6. Pain Control, 162
7. Tooth Morphology and Pulpal Access
Cavities, 192
 1 Diagnosis
LOUIS H. BERMAN and ILAN ROTSTEIN

CHAPTER OUTLINE Art and Science of Diagnosis Digital Radiography

Chief Complaint Cone-Beam Computerized Tomography
Medical History Magnetic Resonance Imaging
Dental History Cracks and Fractures
History of Present Dental Problem Crack Types
Dental History Interview Vertical Root Fractures
Examination and Testing Perforations
Extraoral Examination Clinical Classification of Pulpal and
Intraoral Examination Periapical Diseases
Soft-Tissue Examination Pulpal Disease
Intraoral Swelling Normal Pulp
Intraoral Sinus Tracts Pulpitis
Palpation Reversible Pulpitis
Percussion Irreversible Pulpitis
Mobility Previously Treated
Periodontal Examination Previously Initiated Therapy
Pulp Tests Apical (Periapical) Disease
Thermal Normal Apical Tissues
Electric Periodontitis
Laser Doppler Flowmetry Symptomatic Apical Periodontitis
Pulse Oximetry Asymptomatic Apical Periodontitis
Special Tests Acute Apical Abscess
Bite Test Chronic Apical Abscess
Test Cavity Referred Pain
Staining and Transillumination Summary
Selective Anesthesia
Radiographic Examination and Interpretation
Intraoral Radiographs

Art and Science of Diagnosis and carefully interpreting the answers. In essence, the pro-
cess of determining the existence of an oral pathosis is the
Diagnosis is the art and science of detecting and distin- culmination of the art and science of making an accurate
guishing deviations from health and the cause and nature diagnosis.
thereof.6 The purpose of a diagnosis is to determine what The process of making a diagnosis can be divided into five
problem the patient is having and why the patient is having stages:
that problem. Ultimately, this will directly relate to what
1. The patient tells the clinician the reasons for seeking
treatment, if any, will be necessary. No appropriate treat-
advice.
ment recommendation can be made until all of the whys
2. The clinician questions the patient about the symptoms
are answered. Therefore, careful data gathering as well as
and history that led to the visit.
a planned, methodical, and systematic approach to this
3. The clinician performs objective clinical tests.
investigatory process is crucial.
4. The clinician correlates the objective findings with the
Gathering objective data and obtaining subjective find-
subjective details and creates a tentative list of differential
ings are not enough to formulate an accurate clinical
diagnoses.
diagnosis. The data must be interpreted and processed to
5. The clinician formulates a definitive diagnosis.
determine what information is significant, and what infor-
mation might be questionable. The facts need to be col- This information is accumulated by means of an orga-
lected with an active dialogue between the clinician and nized and systematic approach that requires considerable
the patient, with the clinician asking the right questions clinical judgment. The clinician must be able to approach
2
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 Physics - Concept Map
Spring 2025 - Program

Prepared by: Researcher Davis

Date: July 28, 2025

Methodology 1: Interdisciplinary approaches

Learning Objective 1: Key terms and definitions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Case studies and real-world applications
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 3: Best practices and recommendations
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Comparative analysis and synthesis
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Assessment criteria and rubrics
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Statistical analysis and interpretation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 7: Diagram/Chart/Graph]
Key Concept: Best practices and recommendations
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Best practices and recommendations
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Interdisciplinary approaches
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 10: Diagram/Chart/Graph]
Unit 2: Statistical analysis and interpretation
Key Concept: Fundamental concepts and principles
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Current trends and future directions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Study tips and learning strategies
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Problem-solving strategies and techniques
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 15: Current trends and future directions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 16: Learning outcomes and objectives
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Practical applications and examples
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Problem-solving strategies and techniques
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 20: Diagram/Chart/Graph]
Section 3: Critical analysis and evaluation
Remember: Assessment criteria and rubrics
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Case studies and real-world applications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 22: Literature review and discussion
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 25: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Statistical analysis and interpretation
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Fundamental concepts and principles
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 28: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 29: Diagram/Chart/Graph]
Remember: Study tips and learning strategies
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 30: Diagram/Chart/Graph]
Topic 4: Case studies and real-world applications
Remember: Assessment criteria and rubrics
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Practical applications and examples
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 36: Key terms and definitions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Key terms and definitions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Problem-solving strategies and techniques
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Unit 5: Study tips and learning strategies
Note: Learning outcomes and objectives
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 41: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 43: Research findings and conclusions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 45: Diagram/Chart/Graph]
Important: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 46: Diagram/Chart/Graph]
Important: Ethical considerations and implications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Study tips and learning strategies
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 49: Problem-solving strategies and techniques
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Section 6: Historical development and evolution
Note: Fundamental concepts and principles
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 51: Critical analysis and evaluation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 52: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Current trends and future directions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Research findings and conclusions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Historical development and evolution
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Comparative analysis and synthesis
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 57: Diagram/Chart/Graph]
Definition: Statistical analysis and interpretation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 59: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Appendix 7: Statistical analysis and interpretation
Key Concept: Problem-solving strategies and techniques
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 61: Theoretical framework and methodology
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Research findings and conclusions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Ethical considerations and implications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Literature review and discussion
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 65: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 66: Problem-solving strategies and techniques
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 67: Case studies and real-world applications
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 68: Diagram/Chart/Graph]
Important: Comparative analysis and synthesis
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 69: Ethical considerations and implications
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Discussion 8: Learning outcomes and objectives
Note: Statistical analysis and interpretation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Practical applications and examples
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Experimental procedures and results
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 73: Assessment criteria and rubrics
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Current trends and future directions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 75: Diagram/Chart/Graph]
Key Concept: Critical analysis and evaluation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 76: Diagram/Chart/Graph]
Practice Problem 76: Key terms and definitions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 77: Diagram/Chart/Graph]
Example 77: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Literature review and discussion
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Introduction 9: Interdisciplinary approaches
Practice Problem 80: Practical applications and examples
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Historical development and evolution
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Case studies and real-world applications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Historical development and evolution
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Fundamental concepts and principles
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Comparative analysis and synthesis
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Practical applications and examples
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 88: Diagram/Chart/Graph]
Example 88: Practical applications and examples
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Section 10: Comparative analysis and synthesis
Remember: Experimental procedures and results
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 91: Diagram/Chart/Graph]
Practice Problem 91: Problem-solving strategies and techniques
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Current trends and future directions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Experimental procedures and results
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 94: Diagram/Chart/Graph]
Key Concept: Case studies and real-world applications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Practical applications and examples
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Key Concept: Practical applications and examples
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 99: Current trends and future directions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Discussion 11: Statistical analysis and interpretation
Example 100: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Ethical considerations and implications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 102: Historical development and evolution
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 103: Diagram/Chart/Graph]
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