Accuracy Of Electronic Apex Locator Research Articles

The Accuracy of Different Apex Locator Systems in Detecting Root Perforations in the Presence of Different Irrigation Solutions

Objective: One of the most studied topics in electronic apex locators (EALs) is the effect of root canal condition on the accuracy of EALs. In this study, the accuracy of Root ZX Mini, Raypex 6, and Apex ID in detecting root perforation was evaluated in a dry environment and in the presence of saline, ethylenediamine tetraacetic acid (EDTA), and sodium hypochlorite (NaOCl) solutions. Methods: The mesiobuccal roots of 64 human maxillary first molars were selected for the study. These root canals were perforated from buccal root surface using a #1 Freze Beutherlock Peeso to form a 0.4 mm cavity. After perforation, the area where #40 K type file appeared was recorded as the actual length (AL) and the length measured by EAL devices both in dry canals and in the presence of solutions was recorded as the electronic measurement (EL). All electronic measurements were statistically compared with the actual length. Results: All EALs achieved AL-consistent results on EL measures. Consistency was determined using Root ZX Mini measurements in dry canals and canals irrigated with saline. The consistency of EL and AL conducted with Raypex 6 and Apex ID in canals irrigated with NaOCl, saline, and EDTA was found. There was a statistically significant difference in ELs with irrigation solutions among all EALs (p<0.05). In the dry environment, there was no statistically significant difference between the EALs (p>0.05). A consistency was discovered between ELs generated with the Root ZX Mini and ALs in both dry and saline-irrigated canals. Consistency was observed between ELs measured with Raypex 6 and Apex ID and ALs in canals irrigated with NaOCl, saline, and EDTA. Conclusion: The accuracy rates of the EALs used in this research were 97%–100% in the 1 mm range and 83%–92% in the 0.5 mm range. Despite the fact that ALs and ELs differed statistically significantly at the 0.05 level, these variations weren't thought to be clinically relevant. In the presence of conditions with different electro conductors, EALs from different generations may be used safely, and in a range of canal situations, these devices can yield measurements that are most similar to the AL.

Variations in the morphology of apical constriction affecting electronic readings: An in vitro investigation using 3D-printed tooth models.

We investigated the interference of apical constriction position and diameter on the accuracy of electronic apex locators using 3D-printed tooth models. Single-rooted tooth models with the same length, canal taper and major foramen, but variation in apical constriction position or size, were designed and 3D-printed. A mounting model was custom-made for precise measurement of both marks (0.5 and APEX/0.0) of two electronic apex locators. The electronic measurements of both devices were correlated significantly to the major foramen rather than apical constriction. The mean measurements of the group with 0.45 mm in apical constriction width were significantly shorter than those of the other groups for both marks of the two devices (p < 0.05). The variations in apical constriction position and width negatively affected the precision of the 0.5 mark of the tested devices. The 0.0 or APEX mark was consistently located the major foramen.

Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies.

The lack of a well-defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length. To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies. Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta-analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta-analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS-2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Twenty-nine studies were included in the qualitative analysis and twenty-three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta-analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within -0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome. The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice. Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth. CRD42021277414 (PROSPERO).

Accuracy of electronic apex locators using heat-treated Ni-Ti file.

This study investigated the accuracy of two electronic apex locators (DentaPort and Bingo) using heat-treated nickel-titanium files. The true root canal length of 30 single-rooted teeth was determined using K files. Next, the electronically measured length was determined using two nickel-titanium files (ProGlider and HyFlex EDM Glide Path File) with two electronic apex locators at the 'APEX' marks. The accuracy of the electronic apex locator was evaluated by comparing the true root canal length and electronically measured length for each measurement. There was no significant difference between the measurements with two nickel-titanium files, and all differences between true root canal length and electronically measured length were within ±0.5 mm regardless of the type of nickel-titanium files or electronic apex locators. Based on the results, the heat treatment of the nickel-titanium files showed no adverse effects on the working length determination using electronic apex locators.

The influence of MTAD and QMix on the accuracy of electronic apex locator in locating simulated perforations.

The aim of this study was to evaluate the accuracy of the electronic actual length in detecting artificial perforations of the root canal in the presence of saline solution (NaCl, (Eczacibasi, Istanbul, Turkey), chlorhexidine [CHX (Werax, Tunadent, Izmir, Turkey)], QMix (Dentsply Tulsa, Maillefer, Ballaigues, Switzerland), and MTAD (Dentsply, Tulsa Dental, Tulsa, OK, USA). The root canals of 25 single-rooted extracted human teeth were perforated artificially in the middle section of the root. The actual lengths up to the perforation site were measured and then, the teeth were embedded in an alginate mold. Electronic measurements of the perforations were obtained by an electronic apex locator according to the manufacturers' recommendations under dry conditions and in the presence of NaCl, CHX, MTAD, and QMix using a #20 K-file. Each canal was irrigated with distilled water and then dried with paper points between the measurements. Statistical analyses were performed using the Friedman test and Spearman Rank correlation coefficient to assess the correlations between the measurement methods. Highest correlation between the actual length and the electronic measurement was observed under dry conditions and NaCl solution (r: 0.932, r: 0.940 respectively), and the least correlation was observed with MTAD solution (r: 0.697) using statistical analysis. Moreover, the accuracy of the electronic apex locator with different irrigation solutions was statistically different from each other (P = 0.001). The most accurate electronic measurements of artificial perforation were obtained under dry conditions or with NaCl.

Influence of Apical Patency, Coronal Preflaring and Calcium Hydroxide on the Accuracy of Root ZX Apex Locator for Working Length Determination: An In Vitro Study

Aim: One of the main steps in a successful endodontic treatment is determining the correct working length (WL) of the root canal. In this regard, electronic apex locators (EAL) have been widely used for measuring the WL. The accuracy of EALs in determining the WL may be influenced by various factors. This study is aimed to evaluate the effects of apical patency, coronal preflaring, and calcium hydroxide on the accuracy of the EAL. Materials and Methods: In this in vitro study, 20 central incisor single-rooted human teeth with fully formed apex were considered. Then, samples were randomly divided into two study groups, ten samples in each group. The WL was determined and recorded at 0.5 mm distance to the apex using Root ZX apex locator before and after creating patency, coronal preflaring, and calcium hydroxide administration. All WLs were measured separately for each tooth and reviewed independently by two experienced operators with extensive experience in using EALs. Paired t test and Wilcoxon signed-rank test were applied and the significant level was at .05. Results: Statistical analysis of the obtained data showed a significant decline in the WL after apical patency and coronal preflaring ( P &lt; .05). Moreover, WL exhibited a significant enhancement after calcium hydroxide application ( P &lt; .05). Conclusion: Apical patency and coronal preflaring increased the accuracy of apex locators in determining the WL of the teeth. Besides, calcium hydroxide residues in the root canal reduced the accuracy of the apex locator.

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.

Determination of Root Canal Length Up to Perforation Area Using Different Electronic Apex Locators and CBCT Images Obtained at Different Voxel Sizes: A Comparative Ex Vivo Study.

To compare the accuracy of electronic apex locators in the presence of blood and CBCT images obtained with two different voxel sizes (0.125 mm and 0.25 mm) in determining root canal length up to the perforation area. Forty extracted, single-rooted human teeth were selected and an artificial root perforation (0.4 ± 0.1 or 1.0 ± 0.2 mm diameter) was created in the middle third of the root. The actual root canal length up to the perforation area was determined under a stereomicroscope. CBCT images were obtained with a voxel size of 0.125 mm and 0.25 mm. The root canal length up to the perforation area was measured on CBCT images and recorded as the radiographic length. The teeth were embedded in alginate and root canal length up to the perforation area was measured using two different EALs (DentaPort ZX [Morita, Tokyo, Japan] and Gold Reciproc motor [VDW, Munich, Germany]) and recorded as the electronic length. In teeth with an artificial root perforation 0.4 mm in diameter, the measurements obtained with DentaPort ZX were more accurate than with the Gold Reciproc motor (P ˂ 0.05), and on CBCT images, more accurate measurements were obtained with a voxel size of 0.125 mm compared to 0.25 mm (P ˂ 0.05). In teeth with an artificial root perforation 1.0 mm in diameter, the radiographic length was closer to actual length than the electronic length (P ˂ 0.05). In artificial root perforations with a diameter of 0.4 mm, CBCT gives more reliable results than EALs. Both EAL and CBCT measurements were closer to actual length in artificial perforations that were 1.0 mm in diameter.

The accuracy of two electronic apex locators on effect of preflaring and file size: An in vitro study.

Aim:This study was conducted to evaluate the effect of preflaring and file size on the accuracy of the Root ZX and E-PEX Pro electronic apex locators (EALs).Materials and Methods:The actual working length was set 1 mm short of the apical foramen in the forty extracted mandibular premolars. The teeth were embedded in an alginate mold, and two examiners performed the electronic measurements using #10, #15, and #20 K-files. The files were inserted into the root canals until the “0.0” or “APEX” signals were observed on the light-emitting diode or display screens for the E-PEX Pro and Root ZX, respectively, retracting to the 1.0 mark. The measurements were repeated after the preflaring using the S1 and SX Pro-Taper instruments. The mean differences between the actual length and electronic length values were analyzed by the Wilcoxon signed-ranked test with a significance level of P < 0.05. The factors evaluated were “Accuracy of EALs,” “size of file,” and “presence of preflaring.Results:No significant differences were observed in the accuracy of both EALs when compared with the actual lengths. On the size of the file, significant difference noticed with #20 K-file. The preflaring procedure significantly (P < 0.05) increased the accuracy of the measurements for the Root ZX and Epex Pro.Conclusions:The tested EALs showed acceptable accuracy, whereas the preflaring procedure revealed a more significant effect than the used file size.

Accuracy of electronic apex locator in the presence of different irrigating solutions

Accuracy of electronic apex locator in the presence of different irrigating solutions

The accuracy of electronic apex locators for determining working length: An invitro study with artificial teeth.

This study aimed to determine the accuracy of four electronic apex locators (EALs) (I-Root, Propex Pixi, Novapex and Bassi iRoot Apex), using artificial mandibular and maxillary permanent molars. The root length (RL) from 40 artificial teeth was initially determined with Kerr hand files. Then, the electronic RL were obtained for the same root canals with each EAL, and the results were compared with those obtained using hand files. The accuracy of the EALs was determined through analysis of the divergences observed in relation to the lengths obtained with files. All EALs were effective for determining the RL in the artificial teeth, showing results similar to those obtained by hand. The Bassi iRoot Apex had higher accuracy (96.7%) than the Propex Pixi (89.1%) and Novapex (85.8%) (P<0.05). Based on the results, all EALs tested had a similar performance, and artificial teeth may be used to determine the accuracy of these devices.

Accuracy and stability of electronic apex locator length measurements in root canals with wide apical foramen: an ex vivo study

The aim of the current study was to determine the accuracy of electronic apex locator (EAL) measurements when using files of different sizes in roots with wide apical foramina while considering a new parameter of stability of EAL reading. Ten teeth with straight roots were subjected to a sequential widening of the apical foramen to 0.6, 0.7, and 0.8 mm. The roots were embedded after each enlargement stage in an alginate mold and subjected to EAL readings. Measurements were done using sequential K-file sizes and the self-adjusting file (SAF). Measurement stability was introduced as a new additional parameter. As the difference between the file size used and the apical diameter of the canal decreases, the results obtained were more accurate and stable. The stability and accuracy of the measurements coincided with each other in a statistically significant manner. Within the limitations of the present ex vivo study, it may be concluded that in straight canals with wide apical foramina of 0.6–0.8 mm, both SS K-files which fit snugly to the walls of apical foramen and the SAF file may offer both accurate and stable EAL measurements.

Evaluation of the accuracy of electronic apex locators, cone-beam computed tomography, and radiovisiography in primary teeth: An in vitro study.

Electronic apex locators (EALs), cone-beam computed tomography (CBCT), and radiovisiography (RVG) claim to determine of working length (WL) in primary molar teeth. To evaluate the accuracy of WL determination by using three EALs, RVG, and CBCT imaging in extracted human primary molar teeth with/without root resorption. Twenty extracted primary molar teeth with resorption and 20 extracted primary molar teeth without resorption were used. After measuring actual lengths (AL) (Group 1), the electronic WL measurements were performed by using three different EALs [COXO C Smart-1 Pro (Group 2), iPex (Group 3), and Apex ID (Group 4)]. Two different image sets were obtained as follows: CBCT imaging (Group 5) and RVG (Group 6). AL measurements performed with an endodontic measuring ruler and compared with the EAL, CBCT, and RVG image measurements. For all groups, there were no significant differences between the teeth with resorption and without. There were no significant differences in measuring methods from AL and between the methods used (p > .05). When electronic and radiographic method were compared in different frequency ranges, there was no statistically significant difference (p > .05). This study showed that EALs, CBCT, and RVG have high accuracy in primary molar teeth both with resorption and without root resorption and can be used for determining WL.

Impact of Apical Patency on Accuracy of Electronic Apex Locators: In Vitro Study

IntroductionThis study aimed to investigate the importance of apical patency and its influence on the accuracy of 2 apex locators (Root ZX and Raypex 6). MethodsWe determined the actual working length under dental operating microscope at ×25 magnification in 43 extracted human mandibular molars with completely formed roots and patent apical foramen. Readings of the 2 apex locators were then compared with the actual microscopic working length. Thereafter, we established apical blockage at the apical foramen; files were introduced to the same previous length determined by each apex locator before blockage. Variation in the readings of apex locators after blockage was compared with original readings before blockage to determine the measurement error. ResultsFriedman's test showed no statistically significant difference between the 2 apex locators before blockage (P > .05; effect size = 0.013). Within the margin of accuracy ±1, both Root ZX and Raypex 6 revealed the same percentage of accuracy, 96.7%. After blockage, both apex locators revealed a statistically significant difference in median measurement error compared with the measurements before blockage (P < .05; effect size = 0.305). Root ZX showed a higher median measurement error (>–1 mm and 0.01–0.5 mm) than Raypex 6. ConclusionsApical foramen blockage has a negative influence on the accuracy of apex locators that was more pronounced in Root ZX than Raypex 6.

Comparative evaluation of the effect of various irrigants and dry canal on electronic apex locators in locating simulated root perforations: an in vitro study

Objective: this study aimed to evaluate the effects of irrigants and dry canal on the accuracy of electronic apex locator (EAL) in locating simulated root perforations. Material and methods: twenty singlerooted, mandibular premolars were decoronated at CEJ, and the contents were removed with a barbed broach. The canals were instrumented up to a size of 15 K-file. The roots were artificially perforated at 4 mm from the anatomic apex. The actual length (AL) up to the perforation site was determined. The electronic length (EL) of perforations was obtained by Root ZX mini and iRoot in the dry canal and in the presence of 5.2% NaOCl, SmearOff, and 0.9% sodium chloride using a size 20 K-file. The differences between the EL and AL of the perforations were calculated. Statistical analyses using Friedman and Wilcoxon signed-rank tests were used to analyse the data with the level of significance set at p &lt; 0.05. Results: there were significant differences in different canal conditions with both Root ZX mini and i Root. Measurements in dry canals were significantly longer for both apex locators (p &lt; 0.05). Measurements with NaOCl were significantly shorter for both apex locators (p &lt; 0.05). Both apex locators produced significantly accurate values for Saline and Smear OFF (p &lt; 0.05). Conclusions: in this study, both Root ZX mini and i Root were affected by different canal conditions. The most accurate measurements were seen in the presence of saline and SmearOFF.KEYWORDS Electronic apex locator; I Root; Perforation; Root ZX mini; SmearOFF; Sodium hypochlorite; Saline.Keywords: Electronic apex locator, i Root, perforation, Root ZX mini, SmearOFF, sodium hypochlorite, saline

Is there any difference in length measurement methods for pulpectomies in primary teeth?-A double-blind, controlled clinical trial.

Working length is an important step in primary teeth pulpectomy. To evaluate whether there is a significant difference in the accuracy of electronic apex locators compared to the conventional radiography in working length measurements. Sixty-four children (192 canals) between 5 and 9years of age with indication for pulpectomy of a primary molar were included after eligibility criteria. A radiographic measurement was obtained from pre-operative radiography from the cusp tip to the apex or resorption of the root. The electronic measurement was obtained from a complete measurement of the canal with an electronic device up to the apex. Data were analysed with Bland-Altman plots and Wilcoxontest. Statistical significance was set at P≤.05. Statistically, there is not any significant difference between radiographic and electronic measurements for the palatal canal or distal canal, as well as mesiobuccal canals (P>.05). Statistically, there, however, is a significant difference between the measurements for the distobuccal canal and mesiolingual canal measurements (P<.05). High internal consistency for both radiographic and electronic methods was achieved (α≅1). Electronic and radiographic methods are similar in determining the length measurement of the root canals in primary teeth pulpectomies, except in distobuccal or mesiolingual canals.

The effect ofWi-Fi signals on the measurement accuracy of electronic apex locator during root canal therapy

Background: The using of devices that emitted electromagnetic radiation has beenlimited in many healthcare centers to prevent interference with medical devices.The purpose of this in vitro study was to evaluate the effect of Wi-Fi Router(Tenda FH456) on working length determination using electronic apex locator(NSK-iPex II) in the presence of network connection with tablet (GT-N800) ornot.Materials and methods: Twenty-five intact teeth with a single root were sectioned atthe cementoenamel junction. Visually, roots were examined understereomicroscope (X20) and the working length was determined using a size 15K-file. The effect of Tenda Wi-Fi router on accuracy of electronic working lengthmeasurement of electronic apex locator (iPex II) was determined in this study inclosed room under 5 conditions (without router and tablet, with router in differentdistances 1 meter and 3 meters from electronic apex locator, with router andconnected with tablet in different distances 1 meter and 3 meters from electronicapex locator). The electronic working length was measured 3 times per canalunder each condition. The data were compared using analysis of variance.Results: The mean of working length measured under microscope was (13.30), andthe mean of working length by electronic apex locator was (13.14) while the meanvalues of working length in different conditions was fixed (13.12). Analysis ofvariance test (ANOVA) showed non-significant difference among working lengthmeasurements in different conditions (P-value ≥ 0.05).Conclusion: Within the limitations of the present study, stability and reliability ofiPex II apex locator in measurement of electronic working length where notinfluenced when placed in (1M, 3M) from Wi-Fi router and active Tablet(connected to network by Wi-Fi and streaming online videos). During root canaltherapy, active Tablet can be used in the dental operatory without the fear ofcausing electromagnetic interference in electronic working length determination.

Clinical Accuracy of Electronic Apex Locator in Measuring Working Length during Root Canal Treatment

Obtaining a correct working length is critical to success of endodontic therapy. The procedure for establishment of working length should be performed using techniques that have been proven to give valuable and accurate results and methods that are practical and efficacious. The development of the electronic apex locator has helped to assess the working length more accurate and predictable. So the objective of this in vivo-ex vivo study was to evaluate the clinical accuracy of electronic apex locator in measuring the working length of the root canal in vivo, and comparing the lengths so measured, to the actual working length, ex vivo and after extraction. Electronic apex locator C-Root-I VI (Foshan COXO Medical Instrument Co. China) was used to measure the working length in 100 root canals (one palatal canal and one buccal canal in fifty maxillary 1st premolar) in vivo before extraction, that were scheduled for orthodontic treatment in twenty-five patients. Teeth were then extracted and apical constrictions were identified by careful preparation of the apical 4 mm of all the roots. Actual working lengths were determined by adjusting an endodontic file in the root canal upto the constriction from the coronal reference point. Electronic working lengths obtained in vivo were then compared for coincidence with the actual lengths thus measured after extraction (ex vivo). The data were statistically analysed by a paired Student 't' test and Pearson correlation-coefficient test. In 14 canals out of 100 electronic working lengths (EWL) truly coincided with actual working length (AWL). Eighty two canals out of 100, EWLs were &lt;0.5 mm short in measurement than AWLs but the difference with AWL was statistically insignificant (p &gt;0.01). Only in 4 canals (4%) EWLs were either &gt;0.5mm short or more than AWL, thereby fail to meet the criteria of acceptable range of coincidence (⩽0.5 mm from the apical constriction). On reliability analysis, all (100%) electronic working length significantly correlate with the actual working length (r=0.971). Within a clinically acceptable range of ⩽0.5 mm, C Root I apex locator device showed a high degree of success (96%) in determination of working length during root canal treatment.

Determination of apical constriction and apical foramen using electronic apex locator in vivo: Comparison between vital and nonvital teeth

Introduction: The aims of the present study were (1) to compare the in vivo accuracy of electronic apex locator (EAL) to locate the apical foramen and apical constriction (AC) in vital and nonvital teeth and (2) to measure and compare the distance between the AC and apical foramen based on EAL readings and those obtained by direct observation under stereomicroscope following extraction of the tooth. Materials and Methods: A sample of 40 teeth scheduled for extraction independent of the study from patients in the age range of 45–65 years was selected and divided into two groups (Group I – vital and Group II – nonvital). The AC and apical foramen were located using Root ZX II (J. Morita Corp, Kyoto, Japan) in both the groups and then by direct observation under stereomicroscope following extraction. Results: Fischer's exact test found no statistically significant difference in the ability of EAL to locate AC and apical foramen when compared between vital and nonvital teeth. Likewise, no statistically significant difference was found in the distance between the AC and apical foramen as measured by EAL in vivo and that measured by direct observation under stereomicroscope following extraction in vital (P = 0.412) and nonvital (P = 0.719) teeth (paired t-test). Conclusion: The study supports that EAL measures the location of AC and apical foramen with similar accuracy in vital and nonvital teeth. Furthermore, the distance between the two is reliable when compared with the actual distance observed under stereomicroscope supporting its widespread usage in clinical endodontics.

The effect of Wi-Fi signals on the measurement accuracy of electronic apex locator during root canal therapy

The effect of Wi-Fi signals on the measurement accuracy of electronic apex locator during root canal therapy