Med Bio Eng Comput (2006) 44:695–701
DOI 10.1007/s11517-006-0076-7
O R I G I N A L A RT I C L E
Electronic root canal length measurement before
and after experimentally induced pulpitis and apical
periodontitis in dogs
Maja Kovacevic Æ Tomislav Tamarut Æ
Snježana Glavičić Æ Nives Jonjic Æ Sanja Zoričić-Cvek Æ
Dragica Bobinac
Received: 15 December 2005 / Accepted: 25 May 2006 / Published online: 13 July 2006

International Federation for Medical and Biological Engineering 2006
Abstract The aim of the study was to examine the
influence of the state of the pulp and apical peri-
odontium on the results of electronic root canal length
measurement (ERCLM) with a resistance measuring
device in dogs. Pulpitis and apical periodontitis were
induced by pulp exposure and contamination by the
oral flora in the premolar teeth of six mongrel dogs,
comprising four experimental groups (36 root canals).
In a control group, measured lengths of teeth with
uninfected pulps were performed on the first experi-
mental day (44 root canals). In all animals the ERC-
LMs were performed on teeth with healthy pulps, and
at the end of the experimental period (20, 35, 50 and
65 days) following pulp exposure. The point of mea-
suring canal lengths was the anatomical obstacle above
the apical delta. Electronically measured lengths
(EML) were compared between each other and with
the root canal length established by tactile-sense
measurement verified radiographically. The EMLs
were less accurate in teeth with healthy pulps and teeth
with pulpitis in the third experimental group
(dif = 2.27 · 2.65 mm2; t test, p < 0.05), while they
were most precise after 65 days in teeth with com-
M. Kovacevic (&) Æ T. Tamarut Æ S. Glavičić
Department of Dental Pathology, Medical Faculty,
Brace Branchetta 20, Rijeka 51000, Croatia
e-mail: kmaja@medri.hr
N. Jonjic
Department of Pathology, Medical Faculty,
Brace Branchetta 20, Rijeka 51000, Croatia
S. Zoričić-Cvek Æ D. Bobinac
Department of Anatomy, Medical Faculty,
Brace Branchetta 20, Rijeka 51000, Croatia
pletely necrotic pulp and established chronic apical
periodontitis (dif = 0.54 · 1.36 mm2; t test, p > 0.05).
These results suggest that the state of the pulp and
periapical tissue may have an influence on the ERC-
LM.
Keywords Electronic root canal length measurement
Æ Transitional ion concentration zone Æ Pulpitis Æ
Apical periodontitis Æ Dog
1 Introduction
Electronic methods have become routine for root canal
length measurement in endodontic practice [6].
Numerous factors can influence the accuracy of these
devices including the diameter of the apical foramen
[7, 13, 19], the presence of conductive irrigant [8], the
presence of blood, pus or exudate [9], the relation of
the diameter of the measuring probe to the diameter of
the root canal [1], the distance between the measuring
probe and the inactive electrode [14], the thickness of
the remaining dental wall [11], and the presence of
accessory canals or fractured roots [1]. The thickness
and type of measuring probe is not clinically significant
[21].
During clinical work we noticed that the accuracy of
electronic root canal length measurement varies with
the pulp and periapical condition [16–18, 20]. One
explanation for this phenomenon is the different con-
ductivity of the pulpal tissue in different pathological
states, because the quantity of electrically conductive
particles [17, 18]. The effect of the concentration of
cations on the accuracy of ERCLM was demonstrated
in an ex vivo experiment [7].
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If the pathologically altered pulpal tissue has an al-
tered concentration of cations in relation to the healthy
tissue, it can be assumed that similar changes may also
occur in the periapical tissue. From electrophysiology
it is known that on the border of two mediums of dif-
ferent concentrations of ions (the so-called transitional
ion concentration zone) diffusive potentials appear [2].
We simulated this phenomenon in another ex vivo
experiment in which the appearance of a transitional
ion concentration zone was demonstrated in groups
with different concentrations of ions inside and outside
the root canal. This affected the results of ERCLM. In
the control group in which the concentration of ions
was the same inside and outside the root canal the
results of ERCLM showed great variability in teeth
with a wide apical foramen and we were unable to
locate the constriction with an electroconductive
medium in the root canal [19].
The purpose of this study was to test the hypothesis
of the existence of an apical transitional ion concen-
tration zone in an experimental dog model. This was
tested by repeated measurements in undergoing pulp
breakdown, where the transition of healthy and dis-
eased tissue continued to change.
Since the influence of these factors on ERCLM
measurements is reduced in latest generations of de-
vices [8], we choose to test the effect of this occurrence
on the most sensitive apparatus, i.e. a first generation
resistance-type electronic apex locator.
2 Materials and methods
The Croatian veterinary chamber (approval no. 111/
97) approved this experimental protocol. Eight mon-
grel dogs aged 1–4.5 years served as experimental
models. One day prior to the operation, the animals
were premedicated with 0.2–0.5 mL of 0.5% atropine
(Belupo, Koprivnica, Croatia). The dogs were anaes-
thetised with Ketanest (ketamine hydrochloride,
35 mg Kg–1; Goedecke/Parke-Davis, Berlin, Germany)
and Rompun (xylazine, 10 mg Kg–1; Bayer AG, Le-
verkusen, Germany). Access to the pulp chambers of
the upper and lower premolars was performed for all
animals (each experimental group with at least eight
root canals), giving a total of 80 root canals. The ani-
mals were divided into four experimental (36 root ca-
nals) and one control group (44 root canals) with
healthy pulps. The control group consisted of two
animals, as did the first and fourth experimental
groups. The second and the third experimental groups
were both in one animal.
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Med Bio Eng Comput (2006) 44:695–701
That teeth were isolated with rubber dam, and a
conventional, resistance type device EED 11 (Struja,
Zagreb, Croatia) was used. The inactive electrode was
placed on the oral mucous membrane in the buccal
angle area and the active electrode was inserted into
the root canal. For all experimental groups and the
control group, K-files, size 10, were used as the active
electrode (Maillefer, Ballaigues, Switzerland). Root
canal lengths were measured using the test values on
the measuring scale which was determined by mea-
suring electrical conduction of the periosteum at the
point between the free and attached gingiva, using the
active electrode. The test value was the value which
was referent for electronic root canal length measure-
ment. Readings were taken using a vernier caliper.
The endodontic space in dogs is distinguished from
that in man by its specific morphology. Instead of an
apical foramen, there is an apical delta, so that the
active electrode cannot penetrate further. Whenever
the active electrode reached the apical delta and the
test value failed to appear on the measuring scale, the
following procedure was followed: addition of 1 mm to
the length that was one degree shorter than the test
value, 2 mm to a length two degrees shorter, and so on.
All measurements were compared to tactile sense
measurements to the apical delta which was also con-
firmed radiographically.
In both the experimental and control animals,
measurements took place immediately after pulp
chamber access and preflaring, when the pulp was
healthy, and at the end of the experimental period
during which it had been exposed to the action of
microorganisms in the oral cavity by open pulp cham-
bers. In the first experimental group the induction
period lasted 20 days, in the second 35 days, in the
third 50 days, and in the fourth group 65 days. The
animals showed no signs of distress due to the fact that
drainage was maintained, and thus no analgesics were
administered.
The canal lengths determined electronically in all
groups on the zero day and on the last day of the
experiment were compared. The results within the
groups were analysed by means of t test for dependent
samples and those between the groups by analysis of
variance and LSD test at the significance level of
p = 0.05. Electronically measured lengths (EML) were
compared with tactile-sense measurements to the api-
cal delta (root canal length, RCL) and were analysed
by means of t test for dependent samples at the sig-
nificance level of p = 0.05.
At the end of the experimental period the animals
were euthanized with an intracardial injection of T 61
(Hoechst Veterinär GmbH, München, Germany).
Med Bio Eng Comput (2006) 44:695–701 697

Four roots with their surrounding jawbone from
each group were randomly selected and analysed his-
tologically to assess the histopathological status of the
pulp and periapical tissues. Tissue blocks were sec-
tioned longitudinally in a bucco-lingual direction
through the central parts of the teeth. Sections 5–7 lm
thick were stained with Toluidine blue (TB) and
examined using a light microscope. Five sections of
each tooth that included the region of the apical delta
were used for histological evaluation of the pulp and
periapex. The histopathological analysis was done by
an independent pathologist as a descriptive finding.
(0.54 ± 1.36 mm) differed significantly from the dif-
ference between electronically and tactile measured
lengths in the control (2.16 ± 3.23 mm) and third
experimental groups (2.27 ± 2.65 mm) (ANOVA,
LSD-test; p < 0.05; Fig. 1).
3.2 Histological analyses
Typical histological appearance of the specimens of
pulp and periapex are presented in Figs. 2, 3 and 4, and
all findings are summarised in Table 2.

3 Results 4 Discussion

3.1 Electronic root canal length measurement
Results of electronic root canal length measurement
are presented in Table 1.
Differences between electronically and tactile sense
measured length in the first (–0.87 ± 0.35 mm), second
(–0.63 ± 0.62 mm) and fourth experimental group
In this investigation, the results of electronic root canal
length measurement in the dog’s teeth with healthy
pulps proved to be much less accurate than in teeth
with necrotic pulps. Apart from the fact that mea-
surements were much shorter, reliability of the mea-
surements also showed great standard deviation
ðControl group x dif ¼ 2:16
3:23 mmÞ:

Table 1 Results of electronic measurement length (EML)

Tactile sense measurement (mm) EML 0th day (mm) EML last day (mm)

Control group 12.25 ± 5.75 10.08 ± 4.18* –

First experimental group 23.70 ± 3.15 17.20 ± 0.71* 24.58 ± 3.17**
Second experimental group 9.89 ± 1.15 8.70 ± 1.87 10.52 ± 1.37**
Third experimental group 10.42 ± 1.46 10.04 ± 1.61 8.14 ± 2.52**
Fourth experimental group 9.19 ± 1.39 4.46 ± 1.28 8.65 ± 1.84**
*Difference between tactile sense measurement and electronic root canal length measurement on the zero day is statistically significant
(t test, p < 0.05)
**Difference between electronic root canal length measurement on the zero day and electronic root canal length measurement on the
last experimental day is statistically significant (t test, p < 0.05)

Fig. 1 Difference between

root canal length (RCL) and
electronically measured
lengths (EML) on the last
experimental day represents
the position of the tip of the
active probe in the root canal.
* difference is statistically
significant (t test, p < 0.05)

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Fig. 2 Tooth with pulpitis. a Pulp, disrupted typical zones of stain purple (arrowhead). Apart from mast cells, macrophages,
cells in the pulp. Numerous inflammatory cells in the tissue lymphocytes and plasma cells predominate. Active osteoclasts
(original magnification 20·; Toluidine blue). b Periapex, mast are visible on the surface of the bone (arrow) (original
cells predominate in the serous exudate which metachromatically magnification 20·; Toluidine blue)

A characteristic of dog’s teeth is an apical pulp
delta. The electric circuit is established through the
tiny openings of the apical delta, because otherwise it
would be impossible to carry out electrical measure-
ments, and the occurrence of a barrier to progress
deeper of instruments on the apical delta allows
reproducible tactile and radiographically confirmed
measurements of canal length.
Differences in measured lengths between the groups
were due to the loss of coronal tooth tissue during
access to the root canals and due to the size of the teeth
in different animals. They were mutually statistically
analysed and differences compared between the first
and second measurement, and not absolute values, and
consequently the differences in absolute values did not
influence the accuracy of the results. On the last
experimental day electronically measured lengths in
the fourth experimental group, when all pulps were
necrotic, amounted to x dif ¼ 0:54
1:36 mm: Even
Sunada claimed that measurements in pulpless teeth

Fig. 3 Tooth with partially

necrotic pulp. a Central part
of the pulp. Layer of
odontoblasts almost entirely
destroyed (a), dilated blood
vessels (b) leukocytes
(primarily
polymorphonuclear)
commenced migration and
permeate almost the whole of
the ground substance (c).
Beside them in the tissue pulp
profuse bleeding (d). Area of
necrosis (e) (original
magnification 20·; Toluidine
blue). b Periapex. Periodontal
connective layer preserved on
the surface of the root (a).
Exudate with a relatively
small number of cells (b) and
initial resorption of alveolar
bone (c). Root apex (d)
(original magnification 10·;
Toluidine blue)

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Fig. 4 Tooth with completely necrotic pulp. a Root surface (a).
Periapical lesion in which accumulated polymorphonuclear
leukocytes are diffusely intermingled (b) and granulation tissue
(c). Polymorphonuclear accumulations in the openings of the
apical delta (arrow) (original magnification 10·; Toluidine blue).
b Periapical lesion from a with greater magnification. Polycentric
accumulations of lymphocytes and polymorphonuclear cells
(arrow) can be seen intermingled with granulation tissue
(arrowhead) (original magnification 20·; Toluidine blue)
were more accurate than in teeth with vital pulps, and
his observations have been confirmed by other authors
[10, 13, 15, 22].
Various investigations yield different accuracy levels
for even the most recent devices, such as the Root ZX
(Morita, Japan). The study by Dunlap et al. [3] calcu-
lated the accuracy level to be of 82.3%, while in the
study by Shabahang et al. [12] it was accurate in 96.2 %
of cases. Many factors can influence their accuracy. In
his investigation, Huang [4] proved that physical phe-
nomena, such as the caliber of the apical foramen, the
moisture content of the root canal and the length of a
nonconducting tubule, affect the accuracy of electronic
root canal measurement.
Lee et al. [8] showed that the Root ZX showed
longer readings in those root canals containing highly
electro-conductive media, while lower electro-conduc-
tive media caused shorter readings. Similarly, pulp
699
tissue can act as a high electro-conductive medium or
low electro-conductive media, as was confirmed by
Tamarut et al. [17, 18].
First generation of resistance type-devices do not
have in-built compensatory mechanisms, aimed at
minimizing the influence of electroconductive media,
which makes them most suitable for studies of their
influence. In the present investigation, the object was
to test the hypothesis, established in an in vitro
experiment, that transitional concentration zones are
formed at the borderline between two different con-
centrations of electrical conductive particles inside and
outside the canal in the periapex. These differences in
the concentration are the result of phasally different
decomposition of the pulp tissue and later of the
periapical tissues. Between these different phases of
decomposition, differences occur in the concentration
of ions inside and outside the canal. Both concentra-
tions are formed as a result of the concentrational
gradient of diffusive electrical potentials which change
typical electroconductive pulp. The formed layer of
transitional concentrations is a zone of highest resis-
tance, which in the ERCLM method of measurement is
read as resistance at the foramen. This transitional
concentration of ions can also form in the region above
the foramen. Thus we can explain the occurrence of
long measurements which become short when they are
read for the second time [19].
The least precise measurements, with highest stan-
dard deviations, were noticed in the control group.
This result can be explained by the fact that a transi-
tional concentration zone did not form in healthy teeth.
In cases of pulpitis, which prevailed in the third
group, the cation quantity was decreased, and the
quantum of serous fluid increased, leading to greater
conductivity compared to healthy pulp (17, 18]. In such
a case, electronic measurement will read even shorter
lengths than in cases with healthy pulp, as corroborated
by our results, although the difference in comparison
with healthy pulp was not statistically significant.
In the first and second experimental group, elec-
tronic measurements after microbial induction of
pathological lesions were longer in comparison with
measurements performed in teeth with healthy pulp,
i.e. electronic measurement would lead to overinstru-
mentation. Histologic analysis showed that diagnoses
of partial pulp necrosis with subacute apical peri-
odontitis and pulp necrosis with chronic apical peri-
odontitis were present in similar proportions. In such
cases, it appears that transitional concentration zones
began to form in the periapical region, outside the root
canal [19].
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Table 2 Histological analyses of pulp and periapical tissue in experimental groups
Pulp/periapical diagnosis Pulpitis + Partial pulp
acute pulpitis necrosis + subacute
apical periodontitis
First experimental group – 2
Second experimental group – 1
Third experimental group 3 –
Fourth experimental group – –
Other authors have also shown that electronic
measurements of root canal length in teeth with ne-
crotic pulps generally lead to overinstrumentation,
regardless of whether the measuring instruments are
conventional or most up-to-date (3, 13]. It is ques-
tionable whether such teeth with necrotic pulps had
formed stable chronic apical periodontitis with
inflammatory cell infiltrate, such as in our fourth group
with preserved drainage tracts through 65 days, or the
periapical diagnosis was somewhat different. In the
fourth group all teeth had a diagnosis of complete pulp
necrosis with dense chronic cell infiltration with
resorption of periapical bone and no exudate in the
area around the apices of the teeth and, with main-
tained drainage, a transitional concentration zone
formed in the area of the apical delta [19]. In spite of
opinions that resorption of the apical tip influences
measuring in such conditions, we did not observe sig-
nificant resorption of root apices in our histological
specimens. In this group, electronic root canal length
measurements were most accurate and were not sta-
tistically significantly different from tactile-sense mea-
surements verified radiographically.
This is the first study in which we have attempted, in
an in vivo experiment, to test the transitional concen-
tration zone hypothesis [19]. In our clinical work, we
are often faced with problems of shorter or longer root
canal length measurements with even the most up-to-
date devices, such as the Root ZX, in cases where the
clinical diagnosis is pulpitis. It can be said that current
application of «crown down» [5] root canal preparation
techniques as standard, has diminished the influence of
pulp tissue on electronic measurement. However, we
must be aware that in clinical practice, it is impossible
to extirpate the whole of the pulp tissue in one act, and
that parts of the tissue always remain on the walls, or in
the apical third. There are also conditions in which the
application of «crown down» technique is not indi-
cated, and clinicians are faced with the problem of
measuring the length of the root canal through its
content. The way in which our hypothesis is established
can explain such occurrences, although additional tests
are necessary to finally confirm the hypothesis.
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Med Bio Eng Comput (2006) 44:695–701
Pulp necrosis + Pulp necrosis +
apical abscess chronic apical
periodontitis
– 2
– 3
1 –
– 4
5 Conclusion
Summarising the results of this experiment, we can
conclude that in teeth with healthy pulps electrical
measurement of the canal length were least satisfac-
tory. With the progress of pulp decomposition caused
by the microbial infection, inflammatory changes begin
in the periodontium, accompanied by resorption of
alveolar bone (teeth with pulpitis and acute serous
apical periodontitis). With the establishment of a typ-
ical periapical lesion above the narrowest part of the
canal (apical delta), a transitional concentrational zone
of arranged cations and anions forms. They form dif-
fusive potential in a layer which has high resistance,
which occasionally corresponds with the resistance of
the apical constriction. This transitional concentra-
tional layer of ions can form within the canal, in the
foramen or above it. Thus we can explain the different
accuracy in investigations on the results of electrical
methods of measuring canal length. The condition of
the pulp and periapical tissue has an influence on the
accuracy of electrical determination of the length of
the root canal.
Acknowledgments The authors are grateful to Mrs. Snježana
Šimac and Mrs. Marija Mršić, Department of Anatomy, Medical
Faculty, University of Rijeka, for their assistance during the
laboratory procedures of the experiment. We also wish to thank
Prof. Ratko Zelenika, PhD, Head of Department of General
Economic theory, Faculty of Economics, University of Rijeka,
for his assistance in the preparation of the manuscript.
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