Unit 9.

WORKING LENGTH DETERMINATION

Working length determination 2. Technique for determination 3. Practical sessions
1.

Mar Jovani

1. Working length determination

The objective is to establish the length (distance from the apex) at which canal preparation and subsequent obturation are to be completed.

Root canal preparation and obturation end short of the anatomic and radiographic root apex

The apical foramen usually does not exit at the anatomic root apex but is offset approximately 0.5 mm and seldom more than 1 mm from the true apex.

Anatomic or true root apex

Apical foramen

 Anatomic apex refers to the tip or end of the root of a tooth as

determined morphologically.

Radiographic apex refers to the tip or end of the root of a

tooth as seen on a radiograph, in other words is the anatomic apex as seen on the radiograph.

Apical foramen refers to the opening of the root canal on the

external surface of the root and not necessarily coincide with the anatomic apex, depending on the apical curvature of the canal inside the root.

Apical region
Pulp Constriction (CDJ)
Apical foramen

Apex

APICAL CONSTRICTION
Radiographic end

Cementum Dentin

Apical Foramen

Apical constriction: 0,5-1mm from the radiographic apex

Proximal view anterior tooth

Cementum Dentin

0.5mm -1.0mm

Proximal view anterior tooth

X-ray with the instrument adjusted to WL (1mm short of foramen).

 Apex location varies; these variations can be approximated

but not usually determined using only a diagnostic radiograph.

REFERENCE POINT
The reference point is the site on the occlusal or incisal surface from which measurements are made. This point is used throughout canal preparation and obturation.

Usually this is:

The highest point on the incisal edge on anterior teeth A buccal cusp tip on posterior teeth. The same reference point is best used for all canals in multirooted teeth. The mesiobuccal cusp tip is preferred in molars.

Stable:
Selection reference point
A reference point that will not change during or between appointments

Easily visualized during preparation

Examples of unstable reference points are undermined cusps, marginal ridges or the floor of the chamber.

2. Technique for determination

Different techniques have been used for determining working length:

Radiographic (conventional or digital) methods

Tactile methods

Electronic methods

2.1 Radiographic method

Estimated Working Length
1.

The diagnostic film, which is made using a paralleling technique, is measured from the reference point to the apex with a millimeter endodontic ruler.

From the radiographic tooth measurement, 1 mm is subtracted for the estimated working length. 3. An instrument stop measured to the estimated working length is placed on each of a series of small files.
2.

These files are used in successively larger sizes to explore the canal until a size is reached that binds (locks) at or slightly short of the estimated working length. 5. A radiograph is then made with a file binding tight.
4.

 No. 8 or 10 files should not be used to take working length

radiographs; small file tips fade out and are usually not visible. On molar radiographs, No. 15 file tips are often obscure. In a multicanaled tooth, files are usually placed in all canals. If a root contains two canals (or may have an undiscovered canal), the cone should be positioned at a 20-to 30-degree horizontal deviation from the standard facial projection. A film is exposed with the instruments in place.

Corrected Working Length

The corrected working length is determined by measuring the discrepancy between the tip of the file and the radiographic apex. The file is then adjusted to 1 short of the radiographic apex.

Variations
Working length distance from the apex is determined when the following are seen radiographically:
A. No bone or root resorption: 1 mm from apex. B. Bone but no root resorption: 1.5 mm from apex. C. Bone and root resorption: 2 mm from apex.

2.2 Electronic Methods:

Electronic Apex locators have been designed to determine

canal length by "reading" when periodontal ligament has been reached by the file tip at the apical foramen.

The original electronic apex locators (EALs) operated on direct current, which is supplied by the unit on the upper right. One electrode is in contact with the metal shaft of the file; the other contacts soft tissue, usually by a lip clip. When the tip of the file touches tissue at the apical foramen, current begins to flow.

 A problem with these devices was that conductive fluids such

as hemorrhage, exudate, or irrigants in the canal would permit current flow and therefore a false reading.

Newer devices are impedance-based, using alternating current of two frequencies.

These measure and compare two electrical impedances that

change as the file moves apically. The benefit is that these devices are much less affected by fluid conductive media in the canal. The impedance type apex locators have been demonstrated to be 80 to 95% accurate in identifying the apical foramen.

 One electrode is attached to the patient (commonly a lip

clip) and the other electrode is clipped to the file. The patient therefore forms part of the circuit.

 When current flows, the operator is notified by one signal.

 After the length adjustment is made, a confirmatory

radiograph is made (angled when indicated) with an appropriate size file at this length.
Radiographs not only determine working lengths, but angled working

films also provide information regarding tooth and canal anatomy, curvatures, and relationships.

If once the radiograph has been taken: a variance occurs between the radiographic image which shows a short file with respect to the radiographic terminus of the canal and the apex locator which has just indicated that we have reached the foramen,

One must consider the locator reading as valid since evidently the foramen is in an area (buccal or lingual/papalatal) not radiographically identifiable.

The apex locators are most useful for:

Determining or confirming lengths on apices that are not

clearly visible radiographically

 Identifying the presence and location of a perforations.

The apex locator indicated that the instrument has reached the apex however, the radiograph shows that it has entered a perforation.

Causes of incorrect measurement by the apex locator:

1. 2. 3. 4. Incorrect use of the rubber dam Presence of hypochlorite in pulp chamber Contact between the instrument and a metallic restoration Contact between the hypochlorite of the chamber and a metallic restoration 5. Instrument diameter too thin compared to the diameter of the apical foramen (the digital scale oscillates frenetically between the zero value and beyond the apex value)

2.3 Tactile methods

A popular belief is that a dentist with well developed fingertip tactile sense can detect when the file tip has reached the apical constriction. In most instances, this is unreliable. Many apical regions do not in fact have a constriction; even those that do are at variable distances from the apical foramen.

In this case, the apical constriction corresponds to a calcification situated coronally to the cementodentinal junction.

3. Practical sessions
1.

Make the preoperative film

2.

Measure the preoperative film from the reference point to the apex with a millimeter endodontic ruler.

From the radiographic tooth measurement, substract 1 mm for the estimated working length. 4. Make a radiograph with a file binding tight.
3.