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Comparison of Working Length Determination Using Apex Locator and Manual Method Study
Comparison of Working Length Determination Using Apex Locator and Manual Method Study
Comparison of Working Length Determination Using Apex Locator and Manual Method Study
26]
O r ig in a l A r ti cl e
Comparison of working length determination
using apex locator and manual method ‑ ex vivo
study
Jhadye Alves Carneiro, Fredson Marcio Acris de Carvalho, André Augusto Franco Marques,
Emílio Carlos Sponchiado Júnior1, Lucas da Fonseca Roberti Garcia2, Leonardo Cantanhede Oliveira Gonçalves
Department of Endodontics, Superior School of Health Sciences, State University of Amazonas, 1Department of Endodontics, Federal University of
Amazonas, Manaus, AM, 2Department of Physiology and Pathology, Araraquara School of Dentistry, Univ Estadual Paulista, Araraquara, SP, Brazil
Abstract
Background: Electronic apex locators can be a useful adjunct with a high level of accuracy for determining the real root canal
length in clinical practice. Aim: The objective of this ex vivo study was to evaluate the accuracy of electronic apex locator
for real working length determination in comparison with a manual method. Materials and Methods: Forty single‑rooted
teeth were used in this study. After coronal access, manual measurement of the real working length of each root canal
was performed by placing a size 10 K‑file, using as reference the exceeding of the file in the apical foramen. The file was
retracted by 1 mm, and its extension was measured to determine the real working length. The electronic measurement of the
working length was performed in the same teeth using the Joypex 5 electronic apex locator. Results: Data were submitted to
statistical analysis (Wilcoxon–Mann–Whitney test, P > 0.05) and no significant difference was found between the electronic
and manual methods (P > 0.05). Conclusions: It may be concluded that the electronic apex locator is a reliable and accurate
method for determining the working length of root canals, optimizing the odontometric procedure in clinical practice.
INTRODUCTION the real working length of the root canal, limiting the action
of instruments during biomechanical preparation and filling,
Endodontic therapy involves several steps.[1,2] One of the avoiding damage to the periapical tissues.[1‑4]
most important is odontometry, which seeks to measure
The working length is the distance from a coronary reference
Address for correspondence: to a point where instrumentation and root canal filling
Dr. Lucas da Fonseca Roberti Garcia, Rua Siró Kaku, n° should end.[5] The distance must be well established by the
72, Apto. 73, Bairro Jardim Botânico, CEP: 14021‑614, endodontist to prevent over‑instrumentation or over‑filling
Ribeirão Preto, São Paulo, Brazil.
E‑mail: drlucas.garcia@gmail.com This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
Access this article online tweak, and build upon the work non-commercially, as long as the author is credited and
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How to cite this article: Carneiro JA, de Carvalho FM, Marques AA,
DOI: Junior EC, Garcia Ld, Goncalves LC. Comparison of working length
10.4103/2348-1471.184730 determination using apex locator and manual method - ex vivo study.
Dent Med Res 2016;4:39-43.
of the root canal, and favor the repair process of the apical the placement of the rubber stop during the measurement
and remaining tissues.[5,6] of the working length, and to standardize the reference for
the apex electronic locator.
It is believed that the foramen is located at the limit of
cementum‑dentin junction, where the periodontal ligament Each root canal was initially explored with the aid of a size
begins, and the dental pulp ends.[6] Several studies have 10 K‑type file (Dentsply/Maillefer, Ballaigues, Switzerland),
determined that the limit is 0.5 mm or 1.0 mm short of the throughout its length until beyond the apical foramen. Once
radiographic apex, but the ideal limits for instrumentation and the limit had been exceeded, the file was retracted by 1 mm
obturation of the root canal may range from 0.0 to 2.0 mm.[7‑9] and the stop was placed on the flat incisal surface. The file
However, its exact location is still a clinical challenge for the was then removed from the root canal and with the aid of
professional.[10] a digital caliper (Digimess, Shinko Precision, Gaging, China),
the extension of the file was measured from the stop to the
Several techniques are used to determine the real working active tip to determine the real working length [Figure 2].
length of the root canal; however, they have limitations.[10] The
main limitation of the digital sensitivity technique is the internal After determining the real working length using the manual
morphology of root canals, which prevents the detection method, electronic measurement of the working length of
of the apical constriction.[10] The radiographic evaluation, the root canal was performed in the same teeth using the
despite being widely used, can present distortion, overlapping, Joypex 5 electronic apex locator (Denjoy Dental Co. Ltd,
elongating, and interference of anatomical structures, making Changsha, China) [Figure 3]. The teeth were inserted on
it difficult to accurately determine the working length.[9] a base, consisting of a glass container with fresh alginate
saturated with a 0.9% sodium chloride solution to simulate
Thus, electronic devices that act as apex locators were the periapical tissues (Rio Química, São José do Rio Preto, SP,
developed with the purpose of minimizing the technical Brazil), so the entire root portion remained submerged and
limitations when determining the real working length of the stable. Joypex 5 lip clip was placed on the experimental base
root canal.[11,12] Because electronic location is based on the to complete its circuit.[13] To maintain the root canal moist
passage of alternating current impedance through dentin, it
and the pulp chamber dry before beginning the electronic
has been hypothesized that apex locators locate the apical
measurement, the canals were irrigated with 1 ml of 2.5%
foramen with more precision than other techniques.[11]
sodium hypochlorite solution (Rio Química) and aspirated,
following the apex locator manufacturer’s recommendation.
Currently, these devices have been increasingly used in
A size 10 K‑type file was connected to the device and inserted
endodontic therapy, becoming indispensable in clinical
into the root canal until the 0.0 mark appeared on the device
practice. Thus, this ex vivo study aimed to evaluate the accuracy
display, indicating that the instrument had reached the limit
of an electronic apex locator to determine the real working
of the apical foramen.
length using an extracted tooth model. The null hypothesis
tested was that there would be no difference between the
The values obtained (mm) in the two measurement
two methods in real working length measurement.
techniques were recorded. The normal distribution of data
was measured using the Shapiro–Wilks test and the values
MATERIALS AND METHODS
of a third generation electronic apex locator and reported that root canal measurement in primary teeth. J Indian Soc Pedod Prev
Dent 2005;23:124‑5.
regardless of the irrigating solution and its concentration, the
8. Morfis A, Sylaras SN, Georgopoulou M, Kernani M, Prountzos F. Study
determination of the real working length was accurate, results of the apices of human permanent teeth with the use of a scanning
which are similar to those found in the present study. electron microscope. Oral Surg Oral Med Oral Pathol 1994;77:172‑6.
9. Cimilli H, Aydemir S, Arican B, Mumcu G, Chandler N, Kartal N.
Accuracy of the Dentaport ZX apex locator for working length
Despite the limitations of this ex vivo study, the electronic determination when retreating molar root canals. Aust Endod J
device for measuring the root canal length presented 2014;40:2‑5.
acceptable readings for root canal length determination in 10. Carrotte P. Endodontic problems. Br Dent J 2005;198:127‑33.
11. Ebrahim AK, Wadachi R, Suda H. An in vitro evaluation of the
single‑rooted teeth. However, it should not be conclude that accuracy of Dentaport ZX apex locator in enlarged root canals. Aust
the electronic apex locator can replace radiographic evaluation. Dent J 2007;52:193‑7.
12. Goldberg F, Marroquín BB, Frajlich S, Dreyer C. In vitro evaluation
Financial support and sponsorship of the ability of three apex locators to determine the working length
during retreatment. J Endod 2005;31:676‑8.
Nil. 13. Tinaz AC, Alaçam T, Topuz O. A simple model to demonstrate the
electronic apex locator. Int Endod J 2002;35:940‑5.
Conflicts of interest 14. Vasconcelos BC, Bueno Mde M, Luna‑Cruz SM, Duarte MA,
There are no conflicts of interest. Fernandes CA. Accuracy of five electronic foramen locators with
different operating systems: An ex vivo study. J Appl Oral Sci
2013;21:132‑7.
15. Uzun O, Topuz O, Tinaz C, Nekoofar MH, Dummer PM. Accuracy
REFERENCES of two root canal length measurement devices integrated into rotary
endodontic motors when removing gutta‑percha from root‑filled
1. Vier‑Pelisser FV, Meng A, Benedete Netto LC, Só MV. Influence of teeth. Int Endod J 2008;41:725‑32.
the instrumentation technique and apical preparation diameter on 16. Aggarwal V, Singla M, Kabi D. An in vitro evaluation of performance
calcium hydroxide filling in simulated curved canals. Indian J Dent of two electronic root canal length measurement devices during
Res 2012;23:784‑8. retreatment of different obturating materials. J Endod 2010;36:1526‑30.
2. Dinapadu S, Pasari S, Admala SR, Marukala NR, Gurram S, Peddi R. 17. Martins JN, Marques D, Mata A, Caramês J. Clinical efficacy of
Accuracy of electronic apex locator in enlarged root canals with electronic apex locators: Systematic review. J Endod 2014;40:759‑77.
different root canal irrigants: An in vitro study. J Contemp Dent Pract 18. Wigler R, Huber R, Lin S, Kaufman AY. Accuracy and reliability
2013;14:649‑52. of working length determination by Gold Reciproc Motor in
3. El Karim I, Kennedy J, Hussey D. The antimicrobial effects of root reciprocating movement. J Endod 2014;40:694‑7.
canal irrigation and medication. Oral Surg Oral Med Oral Pathol 19. Savani GM, Sabbah W, Sedgley CM, Whitten B. Current trends in
Oral Radiol Endod 2007;103:560‑9. endodontic treatment by general dental practitioners: Report of a
4. Grover R, Mehra M, Pandit IK, Srivastava N, Gugnani N, Gupta M. United States national survey. J Endod 2014;40:618‑24.
Clinical efficacy of various root canal obturating methods in primary 20. ElAyouti A, Weiger R, Löst C. The ability of root ZX apex locator to
teeth: A comparative study. Eur J Paediatr Dent 2013;14:104‑8. reduce the frequency of overestimated radiographic working length.
5. Kishor KM. Comparison of working length determination using J Endod 2002;28:116‑9.
apex locator, conventional radiography and radiovisiography: An 21. Mandlik J, Shah N, Pawar K, Gupta P, Singh S, Shaik SA. An in vivo
in vitro study. J Contemp Dent Pract 2012;13:550‑3. evaluation of different methods of working length determination.
6. Burch JG, Hulen S. The relationship of the apical foramen to the J Contemp Dent Pract 2013;14:644‑8.
anatomic apex of the tooth root. Oral Surg Oral Med Oral Pathol 22. Meares WA, Steiman HR. The influence of sodium hypochlorite
1972;34:262‑8. irrigation on the accuracy of the Root ZX electronic apex locator.
7. Subramaniam P, Konde S, Mandanna DK. An in vitro comparison of J Endod 2002;28:595‑8.