WORKING LENGTH

DETERMINATION
Where to end your root canal preparation?

“ The proper point to which root canals should be

filled is the junction of the dentin and the
cementum and that the pulp should be severed at
the point of its union with the periodontal
membrane”

Groove C., JADA 1930

Methods of Working Length Determination

• Predetermined normal tooth length

• Radiographs
• Tactile sense
• Paper points
• Patient response
• Electronic Apex Locators
working length is defined as “the distance from a coronal
reference point to a point at which canal preparation and
obturation should terminate”
• Reference point: is that site on occlusal or the incisal surface
from which measurements are made.
• A reference point is chosen which is stable and easily visualized
during preparation. Usually this is the highest point on incisal
edge of anterior teeth and buccal cusp of posterior teeth.
Reference point should not change between the appointments.
• The anatomic apex is the tip or the end of the
root determined morphologically,

The radiographic apex is the tip or end of the root

determined radiographically
The apical constriction is the apical portion of the root canal
having the narrowest diameter. This position may vary but is
usually 0.5 to 1.0 mm short of the center of the apical
foramen
SIGNIFICANCE OF WORKING LENGTH
• Working length determines how far into canal, instruments can
be placed and worked.
• It affects degree of pain and discomfort which patient will
experience following appointment by virtue of over and under
instrumentation.
• If placed within correct limits, it plays an important role in
determining the success of treatment.
• Failure to accurately determine and maintain working length may result in
length being over than normal which will lead to postoperative pain,
prolonged healing time and lower success rate because of incomplete
regeneration of cementum, periodontal ligament and alveolar bone.
• When working length is made short of apical constriction it may cause
persistent discomfort because of incomplete cleaning and underfilling.
Apical leakage may occur into uncleaned and unfilled space short of apical
constriction. It may support continued existence of viable bacteria and
contributes to the periradicular lesion and thus poor success rate.
 METHODS OF DETERMINING WORKING LENGTH

• To achieve the highest degree of accuracy in working

length determination, a combination of several
methods should be used. This is most important in
canals for which working length determination is
difficult.
Determination of Working Length
by Radiographic Methods:
The following items are essential to perform this procedure:

1. Good, undistorted, preoperative radiographs showing the

total length and all roots of the involved tooth.
2. Adequate coronal access to all canals.
3. An endodontic millimeter ruler.
4. Working knowledge of the average length of all of the
teeth.
5. A definite, repeatable plane of reference to an anatomic
landmark on the tooth.
SELECT A REFERENCE POINT
It is imperative that teeth with fractured cusps or cusps severely weakened
by caries or restoration be reduced to a flattened surface, supported by
dentin.
Failure to do so may result in cusps or weak enamel
walls being fractured between appointments. Thus, the original site of
reference is lost. If this fracture goes unobserved, there is the probability of
over instrumentation and overfilling, particularly when anesthesia is used.
• Method:
1. Measure the tooth on the preoperative radiograph.
2. Subtract at least 1.0 mm “safety allowance” for
possible image distortion or magnification.
3. Set the endodontic ruler at this tentative working
length and adjust the stop on the instrument at that level
.
4. Place the instrument in the canal until the stop is at the
plane of reference unless pain is felt (if anesthesia has not
been used), in which case, the instrument is left at that
level and the rubber stop readjusted to this new point of
reference.
5. Expose, develop, and clear the radiograph.
6. On the radiograph, measure the difference between the end of
the instrument and the end of the root and add this amount to the
original measured length the instrument extended into the tooth. If,
the exploring instrument has gone beyond the apex, subtract this
difference.
7. From this adjusted length of tooth, subtract a 1.0 mm “safety
factor” to conform with the apical termination of the root canal at
the apical constriction
8. Set the endodontic ruler at this new corrected length and readjust the stop on the
exploring instrument.

9. Because of the possibility of radiographic distortion, sharply curving roots, and

operator measuring error, a confirmatory radiograph of the adjusted length is
highly desirable.

10. When the length of the tooth has been accurately confirmed, reset the
endodontic ruler at this measurement.

11. Record this final working length and the coronal point of reference on the
patient’s record.
• Advantages of radiographic methods of working length
determination
1. One can see the anatomy of the tooth
2. One can find out curvature of the root canal
3. We can see the relationship between the adjacent teeth and anatomic
structures.
• Disadvantages of radiographic methods of working length
determination
1. Varies with different observers
2. Superimposition of anatomical structures
3. Two-dimensional view of three-dimensional object
4. Cannot interpret if apical foramen has buccal or lingual exit
5. Risk of radiation exposure
6. Time consuming
7. Limited accuracy
 RADIOGRAPHIC LENGTH

• THE LENGTH OF THE TOOTH AS IT APPEARS

ON THE RADIOGRAPH.
ESTIMATED WORKING LENGTH

RADIOGRAPHIC LENGTH MINUS 1MM.

 FINAL WORKING LENGTH
IS DETERMINED TO BE -1 MM FROM THE
ANATOMICAL APEX AS MEASURED FROM THE
WORKING LENGTH (WL) RADIOGRAPH.

THIS IS THE LENGTH TO WHICH

THE CANAL WILL BE CLEANED &
SHAPED AND OBTURATED.
TAKE A PREOPERATIVE RADIOGRAPH
PREOPERATIVE RADIOGRAPH

Apex

• MEASURE THE
RADIOGRAPHIC LENGTH.

Reference pt.
MEASURE THE RADIOGRAPHIC LENGTH

EX. 22MM
COMPUTE FOR ESTIMATED LENGTH

• ESTIMATED LENGTH
IS RADIOGRAPHIC
LENGTH MINUS 1MM.

EX. 22MM - 1MM = 21MM

TREATMENT RECORD

Incisal edge 21 mm
SET #15 FILE TO ESTIMATED LENGTH

INSERT THE FILE INTO THE CANAL TO STOPPER LENGTH AND

TAKE A RADIOGRAPH AT THIS TIME.
WORKING LENGTH RADIOGRAPH

• THE BEST CASE

SCENARIO IS THAT
THERE IS NO
RADIOGRAPHIC
DISTORTION WITH THE
PREOPERATIVE
RADIOGRAPH.
• THE WORKING LENGTH
RADIOGRAPH SHOULD
SHOW THAT THE FILE
ENDS 1MM SHORT OF
THE APEX.
WORKING LENGTH RADIOGRAPH

• FILE APPEARS
TO END 1MM
SHORT OF THE
APEX.
• NO NEED TO
ADJUST THE
FINAL
WORKING
LENGTH.
WORKING LENGTH RADIOGRAPH
• IN THIS CASE,
ESTIMATED
WORKING
LENGTH IS
EQUAL TO THE
FINAL WORKING
LENGTH.
• EWL = FWL
• RECORD FWL
TREATMENT RECORD

Incisal edge 21 mm 21 mm
WORKING LENGTH RADIOGRAPH

• Sometimes, the
radiograph shows
that the file extends
more apical than the
ideal.
• This means that the
EWL is long.
• Deduct this
discrepancy from
your EWL to arrive
at the Final Working
Length.
WORKING LENGTH RADIOGRAPH
WORKING LENGTH RADIOGRAPH
• Example:
EWL=21mm
1mm

• Since radiograph
shows that file is 1mm
long then…
WORKING LENGTH RADIOGRAPH
• Example:
• EWL – 1mm = FWL
1mm

• 21mm – 1mm = 20mm

TREATMENT RECORD

Incisal edge 21 mm 20 mm
WORKING LENGTH RADIOGRAPH
• Sometimes, the
radiograph shows that
the file does not reach
the ideal length.
• This means that the
EWL is short.
• Add this discrepancy to
your EWL to arrive at
the Final Working
Length.
WORKING LENGTH RADIOGRAPH
WORKING LENGTH RADIOGRAPH
• Example:
0.5mm • EWL=21mm

• Since radiograph
shows that file is
0.5mm short
then…
WORKING LENGTH RADIOGRAPH
• EXAMPLE:
0.5mm • EWL+0.5 MM=FWL

• 21MM+0.5MM=21.5MM
TREATMENT RECORD

Incisal edge 21 mm 21.5 mm

WORKING LENGTH RADIOGRAPH

• IF THE RADIOGRAPH SHOWS THAT THE

DISCREPANCY IS MORE THAN 2MM,
THEN A NEW RADIOGRAPH SHOULD BE
TAKEN AFTER COMPUTING FOR THE
WORKING LENGTH.
UNACCEPTABLE DISCREPANCY
ELECTRONIC APEX LOCATOS (EAL)
• Electronic apex locators (EAL) are used for
determining working length as an adjunct to
radiography. They are basically used to locate the
apical constriction or cementodentinal junction or the
apical foramen, and not the radiographic apex.
Components of Electronic Apex Locators
• Lip clip
• File clip
• Electronic device
• Cord which connects above three parts.
 Advantages of EAL

1. Devices are mobile, light weight and easy to use

2. Much less time required
3. Additional radiation to the patient can be reduced
(particularly useful in cases of pregnancy)
4. 80 - 97 % accuracy observed
5. Provide objective information with high degree of accuracy.
6. Some apex locators are also available in combination with
pulp tester, or with rotary system, so can be used in
combination.
 Disadvantages

a. Can provide inaccurate readings in following cases:-

i. Presence of pulp tissue in canal
ii. Too wet or too dry canal
iii. Use of narrow file
iv. Blockage of canal
v. Incomplete circuit
vi. Low battery
b. Chances of over estimation
c. May pose problem in teeth with immature apex
Accurate Working Length Determination

The key to accurate working length

determination is clear understanding of apex
anatomy, knowledge of limitations of current
techniques, and corroboration of information
gained by different methods for working
length determination.
Thank you