This document provides an overview of the blood supply of the head and neck region. It begins with an introduction to circulation and the functional parts including arteries, arterioles, capillaries, and veins. It then details the major arteries supplying the head and neck, including the common carotid artery, external carotid artery, and its branches like the lingual artery and facial artery. It also discusses the internal carotid artery and its branches. Finally, it briefly mentions the venous drainage and pulp vasculature before concluding.

1. BLOOD SUPPLY OF
HEAD AND NECK
Presented by,
Swapnika.G.
(1 MDS)
Conservative Dentistry and Endodontics
5/19/2020 1

2. CONTENTS
INTRODUCTION
FUNCTIONAL
PARTS OF
CIRCULATION
ARTERIAL SUPPLY
OF HEAD AND
NECK
VENOUS
DRAINAGE OF
HEAD AND NECK
PULPAL
MICROVASCULATURE
CONCLUSION
REFERENCES
5/19/2020 2

3. INTRODUCTION
The function of the circulation is to serve the needs of the tissues :
• To transport nutrients to the tissues,
• To transport metabolic waste products away from the tissues,
• To conduct hormones from one part of the body to another.
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4. FUNCTIONAL PARTS OF CIRCULATION
• The function of the Arteries is to transport blood under high pressure to the
tissues.
• Arterioles are small branches of arterial system, act as control channel through
which blood is released into capillaries.
• The function of the capillaries is to exchange fluid, nutrients, electrolytes,
hormones between blood and interstitial fluid.
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5. • Hence the capillary walls are very thin with numerous minute capillary pores
permeable to water and other substances.
• The venules collect blood from the capillaries, gradually coalesce into
progressively larger veins.
• The veins function as channel for transport of blood from the tissues back to the
heart. They serve as reservoir of blood.
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6. VASCULAR SYSTEM
• ARTERIAL SYSTEM
• CAPILLARY NETWORK
• VENOUS DRAINAGE
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7. ARTERIAL SUPPLY OF HEAD AND NECK
• AORTA
• COMMON CAROTID ARTERY
• EXRERNAL CAROTID ARTERY
• INTERNAL CAROTID ARTERY
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8. ARCH OF
AORTA
Right
Brachiocephalic
trunk
Right Common
Carotid
External
Carotid Artery
Internal Carotid
Artery
Right
Subclavian
Left Common
Carotid
Left Subclavian
5/19/2020 8
BD Chaurasia. Human Anatomy regional and applied Dissection and clinical head & neck. 7th
ed Vol:3, CBS publishers and Distributors; New Delhi:2016.

9. COMMON CAROTID ARTERY
5/19/2020 9

10. • In the neck, each CCA extends
upwards & laterally with in the
carotid sheath to the level of
upper border of lamina of thyroid
cartilage.
• The bifurcation takes place in
carotid triangle opposite the disc
between C3 & C4 vertebra.
5/19/2020 10
BD Chaurasia. Human Anatomy regional and applied Dissection and clinical head & neck. 7th
ed Vol:3, CBS publishers and Distributors; New Delhi:2016.

11. • One of the terminal branches of the common carotid artery.
• It lies anterior to the internal carotid artery.
• The chief artery of supply to structures in front of the neck and the face.
• It begins in the carotid triangle at the level of the upper border of the thyroid
cartilage opposite the disc between the third and fourth cervical vertebrae.
• Anteromedial to the internal carotid artery in its lower part and anterolateral in
its upper part.
5/19/2020 11
BD Chaurasia. Human Anatomy regional and applied Dissection and clinical head & neck. 7th
ed Vol:3, CBS publishers and Distributors; New Delhi:2016.
EXTERNAL CAROTID ARTERY

12. EXTERNAL
CAROTID ARTERY
ANTERIOR
Superior
Thyroid
Lingual
Facial
POSTERIOR
Occipital
Posterior
Auricular
MEDIAL
Ascending
Pharyngeal
TERMINAL
Maxillary
Superficial
Temporal
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13. SUPERIOR THYROID ARTERY
• Arises from the external carotid artery just below
the level of the greater cornua of the hyoid bone.
• Runs downwards and forwards parallel and just
superficial to the external laryngeal nerve.
• The external laryngeal nerve and the superior
thyroid artery are close to each other, but diverge
slightly near the thyroid gland.
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14. • Runs along the lower border of the hyoid
bone deep to thyrohyoid.
INFRAHYOID ARTERY
• Descends laterally across the carotid sheath.
STERNOCLEDOMASTOID
ARTERY
• Pierces the thyrohyoid membrane in company
with the internal laryngeal nerve.
SUPERIOR LARYNGEAL
ARTERY
• Anastomoses with the artery of the opposite
side in front of the cricovocal membrane.
CRICOTHYROID ARTERY
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15. LINGUAL ARTERY
• It arises from the ECA opposite to the tip of the greater cornua of the hyoid
bone.
• It is tortuous in its course.
• Its course is divided into 3 parts by the hyoglossus muscle.
• The horizontal part of the artery is accompanied by the lingual nerve.
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16. • Lies in the carotid triangle.
• It forms a characteristic upward loop which is crossed by the hypoglossal nerve.
• This loop permits free movements of the hyoid bone.
1st PART
• Lies Deep to the hyoglossus along the upper border of hyoid bone.
• Superficial to middle constrictor.
2nd PART
• Anterior profunda linguae/ deep lingual artery
3rd PART
• Upward along the anterior border of hyoglossus, and then horizontally forwards on
the undersurface of the tongue.
4th PART
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17. 5/19/2020 17
BD Chaurasia. Human Anatomy regional and applied Dissection and clinical head & neck. 7th
ed Vol:3, CBS publishers and Distributors; New Delhi:2016.

18. • small, runs along upper border of hyoid bone to
anastomose contralateral part.SUPRAHYOID
• medial to hyoglossus muscle.
• Supplies mucous membrane of tongue,
palatoglossal arch, tonsil, soft palate &
epiglottis.
DORSAL
LINGUAL
• Supplies sublingual gland, mylohyoid muscle,
buccal and gingival mucous membrane.SUBLINGUAL
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19. UNUSUAL BRANCH OF THE LINGUAL ARTERY SUPPLIES THE
INFRAHYOID MUSCLES
Rodella. LF, Rezzani.R, Buffoli.B, Verzelletti.V
• Infrahyoid muscles are usually supplied by muscular
arteries, originating from the superior and inferior thyroid
artery and the internal thoracic artery.
• A unilateral anatomical variation of the branching pattern of
the lingual artery, was observed.
• An accessory branch arising from the root of the lingual
artery that run down medially and supplied the infrahyoid
muscles.
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20. FACIAL ARTERY
• The facial artery arises from the ECA just above the tip of the greater cornua of
the hyoid bone.
• It runs upwards in the neck as cervical part ,then on the face as facial part.
• The tortuosity of the artery in the neck allows free movements of the pharynx
during deglutition.
• On the face it allows free movements of the mandible , the lips and the cheek
during mastication and various facial expressions.
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21. • The Cervical part of the facial artery runs upwards on the superior constrictor of
pharynx deep to the posterior belly of the digastric, with the stylohyoid and to
the ramus of the mandible.
• It grooves the posterior border of the submandibular salivary gland.
• It makes an S-bend first winding down over the submandibular gland, and then
up over the base of the mandible.
• The facial part enters the face at the anteroinferior angle of the masseter muscle,
runs upwards close to angle of mouth, side of the nose till the medial angle of the
eye.
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22. 5/19/2020 22

23. Ascending
palatine
Tonsillar
Submental
glandular
CERVICAL
PART
Inferior labial
Superior labial
Lateral nasal
Angular artery
FACIAL
PART
Tonsil
Root of tongue
tonsil
Large artery
Submental triangle
Sublingual salivary gland
Submandibular salivary gland
Lymph nodes
inferior labial glands
mucus membrane
muscles of lower lip
Nasalis muscle
Terminal branch
Upper lip
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24. VARIANT SUPRAHYOID ARTERY FROM FACIAL ARTERY
: A CASE REPORT
Sethi. M, Kumar. D
5/19/2020 24
 The aim of this report is to describe a rare origin of
variant suprahyoid artery from facial artery with its
clinical and embryological perspective.
The suprahyoid artery also known as hyoid artery is a
branch of the lingual artery in the neck. The suprahyoid
artery gives small vascular collateral branches to
omohyoid, sternothyroid, and thyrohyoid muscles.

25. OCCIPITAL ARTERY
• Arises from the posterior aspect of the external carotid
artery, opposite the origin of the facial artery.
• It is crossed at its orign by the hypoglossal nerve.
Carotid triangle Sternocledomastoid
branches
Accompanies the
accessory nerve
Arises near the orign
of occipital nerve
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26. POSTERIOR AURICULAR ARTERY
• Arises from the posterior aspect of the external carotid artery just above the
posterior belly of digastric.
• Runs upwards and backwards deep to the parotid gland but superficial to the
styloid process.
• Crosses the base of the mastoid process and ascends behind the auricle.
• Supplies part of parotid gland, external ear, back of auricle, bulk of scalp & middle,
inner ear structures. ( Fig: 1)
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27. STYLOMASTOID ARTERY
Tympanic
membrane
Mastoid antrum
Mastoid air cells
AURICULAR BRANCHES
supplies the scalp &
both surfaces of the
auricle.
OCCIPITAL BRANCHES
supplies the occipital
belly of the
occipitofrontalis
5/19/2020 27Gray Henry. Anatomy of Human Body. 39th ed,Lea and Febiger; Philadelphia:1918.

28. 5/19/2020 28
Fig: 1- Posterior Auricular Artery Fig: 2- Ascending Pharyngeal Artery

29. ASCENDING PHARYNGEAL ARTERY
• Arises from lower end of the medial aspect of the external carotid artery.
• It runs vertically upwards between the side wall of the middle ear and the
auditory tube. (Fig:2)
• Ascends to base of skull between wall of pharynx & Internal Carotid artery.
PHARYNGEAL • wall of pharynx, tonsil, auditory tube, soft
palate
TYMPANIC • medial wall of tympanic cavity
MENINGEAL
BRANCHES
• supplies duramater
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30. SUPERFICIAL TEMPORAL ARTERY
• It is the smallest terminal branch.
• It begins, behind the neck of the mandible under cover of the parotid gland.
• About 5cm above the zygoma, it divides into anterior and posterior branches
which supply the temple and scalp.
• The anterior branch anastomoses with the supraorbital and supratrochlear
branches of the ophthalmic artery.
• It also gives branches like transverse facial artery and a middle temporal artery.
5/19/2020 30

31.  Superficial branch:
Zygomatico-orbital Artery
Zygomatico-temporal artery
 Deep branch:
Middle temporal Artery
 Terminal branch:
Divide above zygomatic arch
1. Parietal branch
2. Frontal branch
5/19/2020 31Gray Henry. Anatomy of Human Body. 39th ed,Lea and Febiger; Philadelphia:1918.

32. MAXILLARY ARTERY
• A larger terminal branch of the external carotid
artery.
• Begins behind the neck of the mandible under
cover of the parotid gland.
• It runs forwards deep to the neck of the mandible
below the auriculotemporal nerve and enters the
infratemporal fossa.
5/19/2020 32Gray Henry. Anatomy of Human Body. 39th ed, Lea and Febiger; Philadelphia:1918.

33. It has a wide territory of distribution and supplies :
5/19/2020 33
Muscles of temporal and infratemporal regions
Duramater
External and middle ears and the auditory tube
Palate and root of the pharynx
Nose and paranasal air sinuses
Upper and lower jaws

34. MANDIBULARPART • Deep Auricular
• Anterior
Tympanic
• Middle
Menengial
• Accessory
Menengial
• Inferior Aveolar
PTERYGOIDPART
• Deep Temporal
• Pterygoid
branches
• Massetric
Artery
• Buccal Artery
PTERYGOPALATINEPART
• Posterior
Superior
Alveolar
• Infraorbital
• Greater
Palatine
• Pharyngeal
• Artery to
Pterygoid Canal
• Sphenopalatine
Artery
5/19/2020 34
G.J. Romanes. Cunningham’s Manual of Practical Anatomy head and neck & brain. 15th ed
vol 3, Oxford Medical Publications; 2002.

35. 5/19/2020 35

36. BRANCHES FORAMINA TRANSMITTING DISTRIBUTION
Deep auricular Foramen in the floor of
external acoustic meatus
• Skin of external acoustic
meatus
• Tympanic membrane
• Temporomandibular joint
Anterior tympanic Petrotympanic fissure Medial surface of tympanic
membrane
Middle meningeal Foramen spinosum • Meninges
• 5th and 7th cranial nerves
• Middle ear
• Tensor tympani
Accessory meningeal Foramen ovale Extracranial to pterygoids
Inferior alveolar Mandibular foramen • Lower teeth
• Mylohyoid muscle
5/19/2020 36
MANDIBULAR PART-BRANCHES AND DISTRIBUTION

37. BRANCHES FORAMINA
TRANSMITTING
DISTRIBUTION
Posterior superior
alveolar
Alveolar canals in body
of maxilla
• Upper molar and
premolar teeth and
gums
• Maxillary sinus
Infraorbital Inferior orbital fissure • Lower orbital Muscles
• Lacrimal sac
• Maxillary sinus
• Upper incisor and
canine teeth
• Nose
Greater palatine Greater palatine canal • Soft palate, tonsil
• Palatine glands and
mucosa
• Upper gums
5/19/2020 37
PRERYGOPALATINE PART – BRANCHES AND DISTRIBUTION

38. 5/19/2020 38
BRANCHES FORAMINA
TRANSMITTING
DISTRIBUTION
Pharyngeal Pharyngeal or
palatovaginal canal
• Roof of nose and
pharynx
• Auditory tube
• Sphenoidal sinus
Artery of pterygoid canal Pterygoid canal • Auditory tube,
• Upper pharynx
• Middle ear
Sphenopalatine Sphenopalatine foramen • Lateral and medial
walls of nose
• Paranasal air sinuses

39. INTERNAL
CAROTID ARTERY
CERVICAL PART PETROUS PART
CAVERNOUS
PART
Cavernous
Hypophyseal
Menengial
CEREBRAL PART
Opthalmic
Anterior
Cerebral
Middle Cerebral
Posterior
Communicating
Anterior
Choroidal
5/19/2020 39

40. 5/19/2020 40
Fig: A- Carotid Siphon of Angiograms
Fig: B- Circle of Willis

41. VEINS OF FACE AND NECK
Facial Vein
Superficial Temporal Vein
Maxillary Vein
Retromandibular Vein
External Jugular Vein
Internal Jugular Vein
Subclavian Vein
5/19/2020 41

42. MAXILLARY VEIN
• The maxillary vein is a short trunk which accompanies the first part of the
maxillary artery.
• Formed by the confluence of veins from the pterygoid plexus. (Fig: 3)
• Passes between the sphenomandibular ligament and the neck of the mandible ,
to enter the parotid gland.
• It unites within the substance of the gland with the superficial temporal vein to
form the retromandibular vein.
5/19/2020 42

43. 5/19/2020 43
Fig: 3- Maxillary Vein Fig: 4- Facial Vein

44. FACIAL VEIN
• The main vein of the face.
• After receiving the supratrochlear and supraorbital veins, the facial vein travels
downwards by the side of the nose. (Fig:4)
• It then passes under zygomaticus major, risorius and platysma and then over
surface of masseter.
• It crosses the body of the mandible, runs down in the neck to drain into the
internal jugular vein.
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45. ANGULAR VEIN
• The uppermost segment of the facial vein ,
above its junction with the superior labial vein is
called as the angular vein.
SIGNIFICANCE :
• Any infection of the mouth or face can spread via
the angular veins to the cavernous sinuses
resulting in thrombosis.
5/19/2020 45

46. 5/19/2020 46
Fig: D- Retromandibular VeinFig: C

47. 5/19/2020 47

48. ABSENCE OF RETROMANDIBULAR VEIN ASSOCIATED WITH
ATYPICAL FORMATION OF EJV IN THE PAROTID REGION
Jyotsna Patil, Kumar.N, Satheesha B. Nayak
5/19/2020 48

49. PULPAL MICROVASCULATURE
(arteriole-capillary-venule system)
5/19/2020 49
• The arterioles are resistance vessels, measuring
approximately 50 μm in diameter.
• Metarterioles give off capillaries, which are about 8 μm in
diameter.
• The wall of a capillary is about 0.5 μm thick and serves as a
semipermeable membrane. It restricts egress of proteins
and cells from the vascular compartment under normal
conditions, and it is this filtering property that generates a
colloidal osmotic pressure within the vascular system.
Kenneth M. Hargreaves, Harold E. Gooddis, Franklin R. Tay (eds). Seltzer and Bender’s Dental
Pulp. 2nd ed. Quintessence Publishing Co, Inc; China: 2012.

50. 5/19/2020 50
The branch points of terminal arterioles and capillaries are
characterized by the presence of clumps of smooth muscle that
serve as precapillary sphincters. These sphincters are under
neuronal and local cellular control (via soluble factors) and act to
regulate local blood flow through a capillary bed. These functional
units permit localized changes in blood flow and capillary filtration
so that adjacent regions of the pulp have substantially different
circulatory conditions. Thus, pulpal inflammation can elicit a
localized circulatory response restricted to the area of
inflammation and does not necessarily produce pulpwide
circulatory changes.

51. ARTERIOVENOUS ANASTOMOSIS AND “U”
TURN LOOPS
• Before the arterioles break up into capillary beds , the
ARTERIOVENOUS ANASTOMOSIS (AVA) often arise to connect
the arteriole directly to a venule.
• The AVA’s are relatively small vessels , having a diameter of
approximately 10 micrometers.
• More frequently present in the radicular area of the pulp.
• AVA’s play a key role in the regulation of blood flow.
• “U” TURN LOOPS are frequently found in the pulp vascular
network.
5/19/2020 51
Michel Goldberg(ed). The Dental Pulp Biology, Pathology and Regenerative therapies.
Springer,Verlag Berlin Heidelberg: 2014.

52. 5/19/2020 52
• Pulpal blood flow has been measured in animals with a variety of methods: tracer
disappearance (eg, potassium [42K], lead [86Pb], iodine [131I], hydrogen [2H], or xenon
[133Xe]), electrical impedance, plethysmography, and other techniques.
• Several general methods have been used to clinically evaluate pulpal circulation, including LDF,
pulse oximetry, and transmitted-light photoplethysmography.
• Determination of PI in conditions of homeostasis and inflammation is critical for understanding
vascular responses to pulpal injury. Methods to determine PI include photoelectric methods,
pressure transducer systems, tonometric measurements, and micropuncture techniques.
• In cases of large injuries to the pulp, PI values of about 16 to 60 mm Hg were recorded.
• PI values of about 5 to 6 mm Hg under controlled conditions.
• Studies have demonstrated that PI increases in response to inflammation.

53. CIRCULATORY RESPONSES TO DRUGS, DENTAL
PROCEDURES, AND INFLAMMATION
• Both infiltration and intraligamentary routes of injection of local
anesthetic with vasoconstrictor produce a profound reduction in pulpal
blood flow. This effect is the result of arteriolar vasoconstriction,
primarily by increasing vascular resistance.
• Following localized orthodontic tooth movement, vasodilation and a
steady and significant increase in blood flow can be observed not only
in the periodontal tissues but also in the pulp.
5/19/2020 53
Kenneth M. Hargreaves, Harold E. Gooddis, Franklin R. Tay (eds). Seltzer and Bender’s Dental
Pulp. 2nd ed. Quintessence Publishing Co, Inc; China: 2012.

54. • Dental procedures alter pulpal microcirculation via two major routes:
(1) thermal stimulation when handpieces or certain techniques are used.
(2) the effects of dental treatment, including restorative materials.
• Drilling of outer dentin produces vasodilation in intact but not in
chronically denervated teeth. The study indicates that water spray plays a
critical role in reducing pulpal inflammatory responses to dental
preparation procedures and that the absence of water spray induces a
circulatory response that is mediated primarily by activation of trigeminal
sensory nerves in tooth pulp.
5/19/2020 54

55. • If the pulp is partially extirpated during endodontic therapy, profuse hemorrhage may
result because of the rupture of wide-diameter vessels in the central part of the pulp.
There would be less hemorrhage if the pulp were extirpated closer to the apex of the
tooth.
• A number of inflammatory mediators that are released after pulpal injury may have direct
effects, or indirect effects via modulation of trigeminal sensory nerve fibers, on pulpal
vasculature.
• The two major actions of mediators of acute inflammation are alterations in pulpal blood
flow and increases in capillary permeability, leading to plasma extravasation.
5/19/2020 55
Kenneth M. Hargreaves, Harold E. Gooddis, Franklin R. Tay (eds). Seltzer and Bender’s Dental
Pulp. 2nd ed. Quintessence Publishing Co, Inc; China: 2012.

56. CONCLUSION
• Before doing any dental procedure on a patient, thorough knowledge about the
anatomy and blood supply of the head and neck are important.
• With knowledge of anatomy of the area to be anaesthetised and proper
technique of aspiration, overdose as a result of inadvertent intravascular injection
is minimized.
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57. REFERENCES
• Gray Henry. Anatomy of Human Body. 39th ed, Lea and Febiger; Philadelphia:
1918.
• G.J. Romanes. Cunningham’s Manual of Practical Anatomy head and neck & brain.
15th ed vol 3, Oxford Medical Publications; 2002.
• BD Chaurasia. Human Anatomy regional and applied Dissection and clinical head
& neck. 7th ed Vol:3, CBS publishers and Distributors; New Delhi:2016.
• Stanley F. Malamed. Handbook of Local Anesthesia. 6ed, Mosby an Imprint of
Elesevier Inc; St. Louis Missouri: 2014.
• Inderbir Singh. Textbook of Human Anatomy. 6th ed vol 3, Jaypee Publications;
New Delhi, 2016.
5/19/2020 57

58. • John I. Ingle, Leif K. Bakland, J. Craig Baumgartner. Ingle’s Endodontics. 6th ed, BC
Decker Inc; Hamilton: 2008.
• Kenneth M. Hargreaves, Louis H. Berman. Cohen’s Pathways of the Pulp. 11th ed,
Elesevier Inc; St. Louis, Missouri: 2016.
• Sethi M, Kumar D. Variant suprahyoid artery from facial artery: A case report. OA
Anatomy 2014 Jun 10;2(2):12.
• Jyotsna Patil, Kumar N, Sateesha B Nayak. Absence of Retromandibular vein
associated with atypical formation of external jugular vein in the parotid region.
Anatomy and Cell Biology 2014. [http://dx.doi.org/10.5115/acb.2014.47.2.135]
• Buffoli B, Verzeletti V, Rezzani R, Rodella LF. Unusual branch of Lingual artery
supplies the infrahyoid muscles. Anat Sci Int 2019 Aug 23.
[https://doi.org/10.1007/s12565-019-00501-6]
5/19/2020 58

59. • G S Kumar. Orban’s Oral Histology and Embryology, 13th ed, Elesevier Inc; New
Delhi: 2012.
• Kishi Y, Takahashi K. Change of vascular architecture of dental pulp with growth.
In: Inoki R, Kudo T, Olgart L (eds). Dynamic Aspects of Dental Pulp. London:
Chapman and Hall, 1990:97–129.
• Kenneth M. Hargreaves, Harold E. Gooddis, Franklin R. Tay (eds). Seltzer and
Bender’s Dental Pulp. 2nd ed. Quintessence Publishing Co, Inc; China: 2012.
• Michel Goldberg(ed). The Dental Pulp Biology, Pathology and Regenerative
therapies. Springer,Verlag Berlin Heidelberg: 2014.
5/19/2020 59

60. 5/19/2020 60