Accuracy of Paper Point Technique for Final Working Length Measurement after Canal Preparation

Objective: The aim this study was to check the accuracy of paper point technique for final working length measurement after canal preparation. Study Design: Randomized controlled trial Place and Duration: Study was performed in department of operative dentistry, Liaquat University of Medical & Health Sciences, Jamshoro for one year duration from January 2017 to December 2017. Methodology: This study was performed on 78 patients divided equally into two groups. In one group working length was established by using electronic apex locator while in second group working length was established by using electronic apex locator with paper point technique. To check the working length master apical gutta percha point (GP point) was inserted into canal and radiograph were taken by paralleling angle technique. Results: There were 34 (43.6%) males while 44 (56.4%) patients were females. Mean age of patients was 30.5±8.9 years. Mean tooth number was 28.8±11.0. Group A is concerned that was treated only with Electronic Apex Locator showed lesser number of acceptable length than group B. on the other hand, group B was treated with electronic apex locator and paper point technique showed higher acceptable length of respondents with a difference of 4 frequencies or 7% in excess. A less value of chi-square test showed relationship between observed and expected data; whereas, significance value indicated no significant difference between group A and B. Conclusion: Paper point technique is as reliable as other techniques for final working length measurement. Key Words: Electronic Apex Locator, Paper Point Technique, Endodontic Working Length

Comparison of the effect on postoperative pain between instrumentation with and without connected electronic apex locator: a randomized clinical trial

Background: The aim of the present study was to evaluate the postoperative pain between root canal instrumentation with unconnected electronic apex locator and instrumentation with connected electronic apex locator. Methods: Forty-two patients were randomly divided into two groups (n=21). Group 1 was treated using the traditional endodontic motor with unconnected electronic apex locator (EAL) and group 2 was treated using the endodontic motor with connected EAL. All teeth were treated in single-visit endodontic therapy. Postoperative pain levels at 6, 24, 48, 72 h and 1 week were recorded by patients. The data were collected and analyzed using the χ2, and Mann-Whitney U tests with significance at 0.05. Results: Postoperative pain levels were significantly reduced by half at 6 hours in both experimental groups; however, no significant differences were found in postoperative pain levels between the two groups at all considered times. The postoperative pain levels using a percussion test were reduced on day 7 in both groups, and there was no significant difference in this variable between two groups. Conclusions: Both groups have a similar effect on reduction of the postoperative pain for endodontic patients undergoing root canal.

Endodontic length measurements using 3D Endo, cone-beam computed tomography, and electronic apex locator

Background The objective of this study is to investigate the accuracy of the 3D Endo software, cone-beam computed tomography (CBCT) software, and the electronic apex locator (EAL) in endodontic length determination. Methods 302 root canals in 111 human extracted molars were chosen. Access cavity was performed, and root canal lengths were measured with a digital caliper for actual length (AL) and EAL for electronic length. Teeth were then scanned using CBCT device at voxel size of 0.10 mm. It measured root canal lengths using the CBCT (Romexis Viewer), 3D Endo for proposed length (3D-PL) and correct length (3D-CL). Mean differences between the four methods with the AL were calculated and compared. Fisher’s exact test, paired t-test, Bland-Altman plot were used to test the differences among the experimental modalities in working length determination at the significance of 0.05. Results The accuracy in the range of ± 0.5 mm of the EAL ProPex II was highest among the experimental modalities, however this method disagreed with the actual length. Conclusions The correct working length after adjustment from the semi-automatically length by the 3D Endo software and Romexis Viewer measurements agreed with the AL.

Endodontic length measurements using cone beam computed tomography with dedicated or conventional software at different voxel sizes

The aim of this study is to investigate the accuracies and the agreements of the 3D Endo software, conventional CBCT software Romexis Viewer at three voxel sizes, and the EAL ProPex Pixi in endodontic length measurements. Three hundred and twenty-nine root canals in 120 intact human extracted molars were accessed. The actual lengths (AL) and electronic lengths (EL) were measured using the ruler and electronic apex locator (EAL), respectively. Teeth were scanned using the CBCT at different voxel sizes (0.075, 0.10, and 0.15 mm). Root canal lengths were measured using 3D Endo with proposed length (3D-PL) by software, corrected length (3D-CL), Romexis Viewer. The Fisher’s exact test, paired t-test and Bland–Altman plots were calculated to detect the agreements of the four methods with AL measurements. The ProPex Pixi measurements obtained the highest accuracy in the range of ± 0.5 mm. There was agreement between the 3D-PL and the 3D-CL with AL measurements at voxel size of 0.15 mm and at voxel size of 0.10 mm, respectively. The CBCT Romexis Viewer measurements agreed with AL at three voxel sizes. The conventional CBCT measurements using Romexis Viewer and dedicated software did not reach to the 100% accuracy in the range of ± 0.5 mm.

Effect of Orthodontic Brackets on the Accuracy of Apex Locators: A Pilot Study

The purpose of this study was to evaluate the effect of metal orthodontic brackets on the accuracy of electronic apex locator (EAL). The actual canal lengths (ACL) of 40 mandibular incisor teeth were determined. Then, the teeth were randomly divided into two groups ( n = 20 ). Orthodontic metal brackets were applied in the first group, and no brackets, in the second group. The working length of each tooth was measured with an EAL under 3 test conditions according to the distance between the lip clip and sample tooth. Data were analyzed using one-way repeated measures analysis of variance and Tukey’s post hoc tests ( p = 0.05 ). In the bracketed samples, when the lip clip was located at 1 cm and 2 cm from the samples. The mean differences between the EAL measurements and ACLs were statistically higher than those when the samples were located 3 cm from the lip clip ( p < 0.05 ). There were also statistically significant differences between EAL measurements and ACLs in the bracketed samples located 1 and 2 cm from the lip clip ( p < 0.05 ). In the nonbracketed group, the differences between EAL measurements and ACLs were not statistically significant in the samples located 1, 2, and 3 cm from the lip clip ( p > 0.05 ). Use of orthodontic metal brackets can negatively influence the accuracy of the electronic apex locator when the distance between the lip clip and bracket was short. A minimum of 3 cm distance should be kept between the lip clip and tooth in order to make consistent electronic measurements.

Comparison of Working Length Determination in Mandibular Single-Rooted Teeth

OBJECTIVES: The objective of this study was to compare working length calculated with conventional radiographs and an electronic apex locator (IPEX II) during the root canal treatment of mandibular anterior teeth. METHODOLOGY: A cross-sectional study was done in the Department of Operative Dentistry, Sardar Begum Dental Hospital, Peshawar during February and March 2018. A consecutive sampling technique was used for sampling. Only 30 patients fulfilled the inclusion criteria of our study. Detailed medical and dental history was taken. Only patient fulfilling inclusion criteria were enrolled in the study. Data were analyzed using SPSS version 20. RESULTS: The mean age for patients was 45.33±5.16. 33% out of 30 patients (10) were male and 20 were females. The mean working length calculated from radiographs was 22.25±1.29 (min 20.09-max 24.10). The mean working length calculated by the electronic apex locator (IPEX II) was 22.17±1.28 (min 20.00-max 24.07). The mean difference between working length calculated by radiograph and electronic apex locator was -0.084mm, which means the working length determined by radiographs and by electronic apex locator has no difference in mandibular anterior teeth with single canals. CONCLUSION: Both the methods can be used effectively in endodontics for single-rooted mandibular teeth, but if both are used in combinations can lead to an improvement in the working length accuracy, which may significantly reduce the number of radiographs exposure, and increase the success and comfort for endodontic patients. KEYWORDS: Working Length, Apex Locator, Conventional Radiograph

Accuracy of Working Length Measured by Apex Locator and Digital Radiography

OBJECTIVE: The objective of this study was to compare the measurements of electronic and radiographic method of working lengths calculation with actual working length of root canals. Precise working length determination is the most important part for successful root canal procedure. The most commonly used methods to determine the working length in root canal treatment are radiography and electronic apex locator. METHODOLOGY: A cross sectional study was done over a period of 06 months in the Department of Operative Dentistry, Fatima Memorial Hospital, Lahore. Sixty patients who were recommended extraction of their premolar teeth with sixty canals were selected by convenience sampling. The Root ZX* apex locator was used to determine electronic working length exactly identifying the apical constriction. Reference points were identified and radiographic working length were determined 1mm short of radiographic apex. The teeth were extracted along with file cemented before extraction inside root canal. The actual length of the root canal was then calculated using the same files and reference point with 3.5X magnification. Pearson chi square test was applied to compare the apex locator and digital radiographic measurement with actual working length. RESULTS: The Root ZX® apex locator was 95% accurate to identify the apical constriction as compared 70% accuracy given by radiographs within 0.5 mm of the apex. CONCLUSION: Electronic apex locator was more accurate as compared to digital radiography in working length determination. KEYWORDS: Working length (WL), Electronic apex locators (EAL), Radiographic working length(RWL), Apical constriction (AC) HOW TO CITE: Khan GI, Khan MT, Ehsan S, Fayyaz A, Malik HA, Hussain S. Accuracy of working length measured by apex locator and digital radiography. J Pak Dent Assoc 2021;30(1):24-28.