Apex Locator Research Articles

A comparison of MRI-based pelvic floor support measures between young and old women with prolapse.

We sought to 1) test the hypothesis that young women (≤45years) with pelvic organ prolapse have a higher prevalence of major levator ani muscle (LAM) defects than old women (≥70years) with prolapse and 2) compare level II/III measurements between young and old women with prolapse and age-matched controls to evaluate age-related mechanistic differences in the disease process. A secondary analysis examined four groups of parous women: young prolapse (YPOP, n = 17); old prolapse (OPOP, n = 17); young controls (YC, n = 15); old controls, (OC, n = 13). Prolapse was defined as any compartment at or beyond the hymen with vaginal bulge symptoms. Genital hiatus (GH) was measured on clinical exam. Major LAM defects and level II/III measurements (UGH: urogenital hiatus, LA: levator area, and apex location) were assessed on MRI at rest and strain, and the difference (Δ) between measurements calculated. Principal component analysis was used to evaluate levator plate (LP) shape. Major LAM defects occurred in 42% of YPOP and 47% of OPOP (p > .99). GHrest was 1.5cm larger in OPOP versus YPOP (p < .001) and 2cm larger in OPOP versus OC (p < .001). Regardless of prolapse status, LArest and UGHrest on MRI increased with age. YPOP had larger ΔLA (p = .04), ΔUGH (p = .03), and Δapex than OPOP (p = .01). Resting LP shape was more dorsally oriented in OPOP versus YPOP (p = .02) and OC versus YC (p = .004). Prolapse in young women cannot be solely explained by a higher LAM defect prevalence. GH size and other measures of level II/III pelvic support worsen with age regardless of prolapse status.

Clinical Accuracy and Precision of 3 Multifrequency Electronic Apex Locators Assessed through Micro–Computed Tomographic Imaging

IntroductionThis study aimed to compare the in vivo accuracy and precision of 3 electronic apex locators (EALs) in determining the position of the major foramen using micro–computed tomographic (micro-CT) technology. MethodsAfter access preparation of 23 necrotic or vital teeth from 5 patients, canals were negotiated, and hand files were used to determine the position of the foramen with 3 EALs: Propex Pixi (Dentsply Maillefer, Ballaigues, Switzerland), Woodpex III (Woodpecker Medical Instrument Co, Guilin, China), and Root ZX II (J Morita, Tokyo, Japan). After fixing the silicon stop to the file, teeth were extracted and scanned in a micro-CT device with and without the instrument inserted into the canal. Data sets were coregistered, and the accuracy and precision of the EALs were determined at a tolerance level of ±0.5 mm by measuring the distance from the tip of the instruments to a tangential line crossing the margins of the foramen. Statistical comparisons were performed using Friedman with post hoc related samples sign and Spearman tests (α = 5%). ResultsA significant difference was detected comparing the accuracy of Root ZX II (100%), Woodpex III (86.96%), and Propex Pixi (52.17%) (P < .05). There was a lack of significance in the relationship between the pulp status and the accuracy of the tested EALs (P > .05). Propex Pixi was significantly less precise than Root ZX II (P < .05), whereas no difference was found between Woodpex III and Root ZX II or Propex Pixi (P > .05). ConclusionsEALs presented similar precision, but Woodpex III and Root ZX II showed better accuracy to determine the position of the apical major foramen than Propex Pixi.

Incidence and Intensity of Pain Following Endodontic Treatment by Different Instrumentation Techniques in Teeth With Periapical Lesion.

This study was carried out to compare the effectiveness of hand and rotary instrumentation techniques on postoperative pain in asymptomatic necrotic premolars with periapical lesions and instrumented by a modified step-back technique using a K file, crown down by continuous rotary motion technique using ProTaper Universal (Dentsply Mailefer, Ballaigues, Switzerland), and with the reciprocation technique using WaveOne (Dentsply Sirona, Charlotte, NC, USA). For this study, 66 premolars with single roots and canals were chosen. The procedure was completed in a single visit. Following access opening, the working length was initially determined using an apex locator and then confirmed after inserting K file #10 by radiograph. The canal was cleaned and shaped using a grouping system. After the masterapical preparation, the canal was dried by paper point and obturated with gutta-percha and AH plus sealer, an epoxide-amine resin pulp canal sealer. In order to confirm the obturation, a radiograph was taken. After that, a permanentrestoration material was used to seal the access cavity. Following that, patients to whom the visual analog scale (VAS) had already been explained were contacted by phone at six, 12, 24, and 48 hours. In this study, compared to a stainless steel instrumentation technique, WaveOne instrumentation caused more noticeable pain. The results of the current study showed that, on average, postoperative pain scores decreased over the course of the 12to 48-hour period, reaching a minimum or a maximum at 48 hours (p<0.01). Postoperative pain was produced by all instrumentation methods used in the study. In comparison to ProTaper and WaveOne, instrumentation using the modified step-back technique with K files caused less pain, especially over the course of a 24-hour period.

Variations in structural support site failure patterns by prolapse size on stress 3D MRI.

Our objective was to develop a standardized measurement system to evaluate structural support site failures among women with anterior vaginal wall-predominant prolapse according to increasing prolapse size using stress three-dimensional (3D) magnetic resonance imaging (MRI). Ninety-one women with anterior vaginal wall-predominant prolapse and uterus in situ who had undergone research stress 3D MRI were included for analysis. The vaginal wall length and width, apex and paravaginal locations, urogenital hiatus diameter, and prolapse size were measured at maximal Valsalva on MRI. Subject measurements were compared to established measurements in 30 normal controls without prolapse using a standardized z-score measurement system. A z-score greater than 1.28, or the 90th percentile in controls, was considered abnormal. The frequency and severity of structural support site failure was analyzed based on tertiles of prolapse size. Substantial variability in support site failure pattern and severity was identified, even between women with the same stage and similar size prolapse. Overall, the most common failed support sites were straining hiatal diameter (91%) and paravaginal location (92%), followed by apical location (82%). Impairment severity z-score was highest for hiatal diameter (3.56) and lowest for vaginal width (1.40). An increase in impairment severity z-score was observed with increasing prolapse size among all support sites across all three prolapse size tertiles (p < 0.01 for all). We identified substantial variation in support site failure patterns among women with different degrees of anterior vaginal wall prolapse using a novel standardized framework that quantifies the number, severity, and location of structural support site failures.

Electronic Apex Locators and their Implications in Contemporary Clinical Practice: A Review

Background:The apical extent of instrument termination and final root-filling procedures have been found to be key prognostic factors in relation to the outcome of root canal treatment. The precise location of this termination point has always been a challenge in clinical endodontics. Until the introduction of contemporary electronic apex locators (EALs), conventional radiography was traditionally used to determine the working length. Since their inception more than 50 years ago, EALs have drawn a great deal of attention.Objective:The literature pertaining to these devices is saturated yet inexhaustive and controversial. While most reviews try to summarize this topic entirely, the scope of the subject makes this close to impossible. Most systematic reviews report a lack of high-quality evidence, making it impossible to reach a meaningful conclusion. This review of literature focuses on electronic apex location and its accuracy, specifically in relation to variables in the clinical setting that a practitioner might encounter while using this device.Methods:Electronic database searches were undertaken using a combination of key search words to find relevant studies about EALs.Results:The PubMed (MEDLINE) search engine was used to find studies published in the English language with no restrictions for time. Articles that were found to be most pertinent were chosen and included in the review.Conclusion:EALs are indispensable to the practice of endodontics; however, the adjunct use of radiographs remains a reasonable practice.

Comparative evaluation of working length determined using integrated apex locator and root ZX mini under various irrigating solutions: An in vivo study.

Electronic apex locators (EALs) are frequently used as adjuvant to radiographs in working length (WL) determination. The introduction of integrated apex locators (IALs) further simplified the root canal treatment by continuous monitoring of the apex while root canal shaping. The aim of this study was to evaluate the efficacy of radiographs, EAL, and IAL in determining the WL in the presence of various irrigants. The present in vivo study was carried out on 30 patients who were divided into 10 in each group, based on the type of irrigant used; 0.9% saline (Group 1), 0.2% chlorhexidine (Group 2), and 2.5% of sodium hypochlorite (NaOCL) (Group 3). In each group, WL is determined using conventional radiographs, Root ZX Mini (EAL), and CanalPro CL2i (IAL). Kruskal-Wallis test and Friedman's two-way ANOVA test were used for statistical analysis. Mean WL was comparably lower with Root ZX Mini, while the WL by CanalPro CL2i and the radiographic method were comparable. In all methods, the type of solutions used did not influence the WL, with a higher mean WL when NaOCL is used as an irrigant. Nevertheless, the above comparisons were not statistically significant. the irrigation solutions employed in this study had no impact on the performance of apex locators and radiographs.

Case report: Endodontic treatment of a permanent maxillary first molar with three roots and six root canals

Purpose: This study aimed to report the diagnosis and management of a permanent maxillary first molar (PMFM) with unusually complex root canal morphology.&#x0D; Case report: A 30-year-old male patient was referred to the endodontic department to continue endodontic treatment of the left PMFM. The referring dentist could not establish the patency of the canals in the mesiobuccal and distobuccal roots. Radiographically, the tooth had three almost straight roots associated with periapical radiolucencies, indicating periapical periodontitis. The examination of the pulp chamber floor, using a dental operating microscope, revealed the presence of six root canal orifices, three in the mesiobuccal root, two in the distobuccal root, and one in the palatal root. No confluence of multiple canals was detected using the electronic apex locator and K-files. The canals were shaped and cleaned with reciprocating nickel-titanium instruments and obturated using gutta-percha cones and a bioceramic sealer. After 2 years, the patient was asymptomatic and the tooth was clinically and radiographically without pathological findings.&#x0D; Conclusions: Careful examination of the pulp chamber floor using magnification and illumination is important for successfully managing complex canal morphologies. During endodontic treatment, dentists must consider that the PMFM may have more than four root canals.

Accuracy of the electronic apex locator, tactile, and radiographic methods in working length determination.

Determination of working length (WL) is necessary for the successful outcome of root canal treatment (RCT). Common methods in WL determination include tactile, radiographic, and electronic apex locators (EAL). The aim of this study was to compare three methods of WL determination to the actual visualization of the apical constriction (AC). Consecutive patients with indications for extraction of single-rooted single canal teeth at the University of Ghana Dental School clinic were randomly assigned to three groups. In-vivo root canal WL was determined by tactile sensation, digital radiography, and a 5th generation EAL (Sendoline S5). Files were cemented in the canals after the in-vivo measurements. The apical 4-5 mm of the roots was trimmed to expose the inserted files and the AC. Actual WL, as determined by visualization of the AC, was done using a digital microscope. Different WLs were then compared for the various groups, and the mean actual canal lengths were reported. EAL accurately predicted the AC in 31 (96.9%) teeth, while the digital radiographic and tactile sensation methods accurately predicted the constriction in 19 (59.4%) and 8 (25%) teeth, respectively, in the study population. The mean working canal lengths for single-rooted teeth showed no observable difference among sexes, age categories, and side of the jaw. The EAL provided more reliable and accurate WL measurements for single-rooted teeth among Ghanaians, compared to digital radiography and tactile methods.

Comparative analysis of root canal length determination using cone-beam computerized tomography and apex locator

Introduction. Determining the length of the root canal is one of the key factors that can affect the outcome of endodontic therapy. Incorrectly determined working length results in underfilled or overfilled canal. The aim of this work was to verify the effectiveness of cone-beam computerized tomography (CBCT) and apex locators in determining working length of the root canal. Material and method. Endodontic procedure was performed according to established endodontic protocol on 98 teeth. Teeth were divided into two groups: single-rooted and multi-rooted teeth. In both groups, working length was measured with an apex locator (Woodpex III) and CBCT (Planmeca Viso). In multi-rooted teeth, the canals were classified according to their morphological position into the groups Lingvomesial (LM), Buccomesial (BM), Bucodistal (BD), Palatal (P) and Distal (D) canals. Root canal length was determined by a dentist using apex locator at the University of Banja Luka while CBCT analysis was performed by a radiology engineer at the 3DENT radiology center in Banja Luka. Results. CBCT odontometry had small deviations from apex locator odontometry. The mean value of the absolute difference between CBCT measurement and apex locator measurement was the smallest in the group of linguomesial canals (0.284 mm), and the largest in the group of distal canals of the lower molars (1.939 mm). Based on the results of the Mann-Whitney U test, it was concluded that there was no statistically significant difference (p &gt; 0.05) in measured length of the root canal between the two methods in all groups of roots of multi-rooted teeth as well as in the group of single-rooted teeth. Conclusion. CBCT odontometry is as reliable as apex locator odontometry.

Comparative evaluation of accuracy of different generations of electronic apex locator in determining the correct working length: A systematic review and meta-analysis

ABSTRACT Aim: Different approaches are used to determine the working length of the root canal. The current and most widely researched are the electronic apex locators (EALs). Since the early apex locators were developed in 1942, several generations had their qualities and shortcomings developed. Thus, a comparative evaluation of the accuracy of different generations of EALs in determining the correct working length: Systemic review and meta-analysis to analyze individual studies quantitively and draw conclusions on the best generation of apex locator currently used. Materials and Methods: A comprehensive search was conducted on different electronic databases and by manual search. Studies comparing third and fifth generations with fourth-generation apex locators were subject to strict inclusion criteria followed by data extraction and meta-analysis. Results: Following the meta-analysis, the accuracy is fifth&gt;fourth&gt;third generation of apex locators. Conclusion: Analysis of individual studies quantitatively will give a better understanding of which devices to use to accurately determine the working length.

Comparative evaluation of the accuracy of Propex PixiTM and CanalProTM electronic apex locators in primary anterior teeth

Aim: To evaluate and compare in vitro, the accuracy of two different electronic apex locators, i.e., Propex PixiTM and CanalProTM in primary anterior teeth. Methodology: A total of 60 primary teeth sample has been selected using a convenience sampling method. Samples were divided into two experimental groups in which, Group 1 belong to Propex PixiTM apex locator, and Group 2 CanalProTM. The mean values with standard deviations of electronic working length by using Propex PixiTM and CanalProTM with that of stereomicroscopic actual working length were calculated and compared Results: There was statistically significant difference between values obtained by the two electronic apex locators and actual length Conclusion: A strong correlation was seen between the two electronic methods and AL and also in between the two EALs, showing the possibility of their use to measure the root canal length.

Süt Molarlarda Dört Farklı Apeks Bulucunun Doğruluğu: Bir İn Vitro Çalışma

Objective: The aim of this study is to compare and evaluate the accuracy of 4 different electronic apex locators (EALs) (Root ZX Mini, Raypex 6, Propex Pixi, and E-Pex Pro) in primary molars with and without root resorption. Material and Methods: Forty-eight mandibular primary molar teeth with (24 teeth) and without (24 teeth) physiological root resorption, each with 4 root canals, were included in the study (96 canals in with resorption group and 96 canals in without resorption group) (n=192 root canals). The actual working length (AWL) was determined by subtracting 0.5 mm from the measured length for each canal. The differences between AWL and electronic working length readings of the 4 EALs and accuracy rates within specified tolerance intervals (TI; ±0.5 and ±1.0 mm) were calculated. Results: The presence of resorption in the teeth significantly affected the measurement using Root ZX Mini (p<0.05). In teeth without resorption, all EALs yielded an accuracy rate of 100% at ±1.0 mm TI, whereas the accuracy rates ranged from 91.7% to 95.8% at ±0.5 mm TI. In teeth with resorption, EALs yielded accuracy rates of 74.0%-65.6% at ±1.0 mm TI and 52.1%- 60.4% at ±0.5 mm TI. Conclusion: At ±0.5 mm TI, Raypex 6 had greater accuracy in teeth without root resorption, whereas Propex Pixi had greater accuracy in teeth with root resorption. Apex locator preference may vary depending on the presence or absence of resorption.

Comparison of working length determination with four electronic apex locators

Comparison of working length determination with four electronic apex locators

Accuracy of Different Apex Locators on Presence of Newer Irrigants: An In vitro Study

Accuracy of Different Apex Locators on Presence of Newer Irrigants: An In vitro Study

Evaluation of accuracy of an electronic apex locator in presence of sodium hypochlorite in primary teeth with and without resorption.

This study compared the accuracy of Root ZX mini apex locator in presence of sodium hypochlorite (NaOCl) in primary molars with and without apical resorption. Sixty-four extracted primary lower molar teeth with 32 root resorption and 32 without resorption were selected. To determine the actual working length (AWL), a K-file was inserted into the root canal until the tip of the file was visible at the major foramen or the resolution level. It was then withdrawn 1 mm. This value was recorded as AWL. The teeth were then divided subgroups (with/without NaOCl). To determine the electronic working length, a Root ZX mini apex locator in canals with/without NaOCl was used. A K-file was inserted into the canal to just beyond the foramen, as indicated by the flashing "APEX" bar, and the electronic working length was determined by subtracting 1 mm from this length. The deviation of the Root ZX mini measurement from the AWL was determined. Student's t-test was used for statistical analysis. In teeth with no resorption, the measurement accuracy rates (within+/-0.5 mm) of non-NaOCl and NaOCl groups were 84.37% and 81.25%, respectively (p > 0.05); within+/-1 mm, the non-NaOCl and NaOCl demonstrated 100% and 96.87% accuracy, respectively (p > 0.05). In teeth with resorption, the measurement accuracy rates (within+/-0.5 mm) was 81.25% for the non-NaOCl and 62.50% for the NaOCl, respectively (p < 0.05). The measurement accuracy rates (within+/-1 mm) of the non-NaOCl and NaOCl was 96.87% and 84.37%, respectively (p < 0.05). The presence of NaOCl in the root canal affected the accuracy of the Root ZX mini in primary teeth with apical resorption, but not in teeth without resorption.

Influence of the Position of the Apical Foramen on the Accuracy tf Electronic Apex Locator

Influence of the Position of the Apical Foramen on the Accuracy tf Electronic Apex Locator

Effect of Preflaring on Accuracy of Endodontic Length Determination by Four Electronic Apex Locators

Objective: Root canal anatomy significantly impacts the working length determination. This study aimed to investigate the effect of the preflaring technique on the accuracy of four electronic apex locators. Methods: Forty-five single-canal central maxillary teeth were selected. The working length was measured before and after the coronal preparation by four types of electronic apex locators in the range of ±0.5 and ±1 mm matched for the apical constriction. The actual working length was calculated under a microscope. Data were analyzed using ICC and paired t-tests in SPSS16. A p &lt; 0.05 was considered significant. Results: The accuracies of Root ZX, DTE, Denjoy, and Coxo apex locators in the range of ± 0.05 mm were 71.1, 93.3, 84.4, and 75.6% before preflaring, and 82.2, 93.3, 97.8, and 100% after that. The corresponding values in the range of ±1 mm were 86.7, 97.8, 93.3, and 100% before and 97.8, 100, 100, and 100% after preflaring. Significant differences were found between the working lengths measured by the four devices and the actual working lengths before and after preflaring. Conclusion: The preflaring technique could impact the performance of apex locators in determining the working length and may be advocated for better outcomes.

Classification(s) of Cervical Deformity.

Cervical spine deformities (CSD) are complex surgical issues with currently heterogenous management strategies. The classification of CSD is still an evolving field. Rudimentary classification schemas were initially proposed in the late 20th century but were largely informal and based on the underlying etiology (i.e. , postsurgical, traumatic, or inflammatory). The first formal classification schema was proposed by Ames et al. in 2015 who established a standard nomenclature for describing these deformities. This classification system established 5 deformity descriptors based on curve apex location (cervical, cervicothoracic, thoracic, craniovertebral junctional, and coronal deformities) and 5 deformity modifiers which helped surgeons utilize a standard language when discussing CSD patients. Koller et al. in 2019 subsequently established a classification system for patients with rigid cervical kyphosis based on regional and global sagittal alignment. Most recently, Kim et al. in 2020 proposed an updated classification system utilizing dynamic cervical spine imaging to guide surgical treatment of CSD patients. It identified 4 major groups of deformities - (1) those with "flat-neck" deformities caused by cervical lordosis T1 slope mismatch; (2) those with focal kyphotic deformities between 2 cervical vertebrae; (3) those with cervicothoracic deformities caused by large T1 slope; and (4) those with coronal deformities. Group 2 deformities most often required combined anterior-posterior approaches with short constructs, and group 3 deformities most often required posterior-only approaches with 3-column osteotomies.

Overview of instrumentation used in endodontics

The fundamentals of root canal therapy include thorough cleaning, suitable shape, and total root canal filling. There are numerous tools at our disposal to help us achieve these goals. A complicated range of files, filling techniques, and modern materials have been designed to speed up the process, increase its dependability, and enable the clinician to properly treat challenging patients and intricate anatomies. Hand instruments include barbed broaches, reamers, and files such as K-file, K-flex file, Flexofile, and Hedstrom files. Nickel-titanium alloys have been used to replace stainless steel in the production of endodontic equipment. Compared to stainless steel tools, these lead to more straightening of canal curvature, centering, tapering, and leading to a superior preparation. In an effort to speed up preparation of canals and lessen operator fatigue, a wide variety of electric power-run tools have been created like reciprocating handpieces, rotary NiTi files and handpieces. Accurate root canal length measurement is crucial to the effectiveness of root canal therapy. Radiography and the application of an electronic apex locator are the two methods used most frequently to confirm canal length. Instruments needed for filling canals are dependent on the procedure chosen to fill the root canal. Hand or finger spreader with a pointed tip are used in lateral condensation; hand or finger pluggers with blunt, flat ends are employed in vertical condensation; thermomechanical compaction uses an engine-powered compactor, thermoplasticized injectable gutta-percha and gutta-percha carrier devices. Careful use of canal preparation, sterilization, and obturation techniques, together with the appropriate instrument selection and use, can significantly increase the likelihood that endodontic procedures will be successful.

Accuracy of Three Types of Apex Locators versus Digital Periapical Radiography for Working Length Determination in Maxillary Premolars: An In Vitro Study.

This study aimed to compare the accuracy of three types of apex locators versus digital radiography for working length (WL) determination. This experimental study was conducted on 58 extracted maxillary premolars. The teeth were decoronated, the access cavity was prepared, and WL was determined using a #15 K-file to serve as reference. The WL was then measured by Woodpex V, Woodpex III, and Root ZX apex locators in the presence of 0.9% saline, and also on a photostimulable phosphor plate (PSP) digital radiograph taken by the parallel technique. The values were compared with the actual WL using the paired t-test (alpha = 0.05). Digital radiography, Root ZX, Woodpex V, and Woodpex III determined the WL within ±0.5 mm from the actual value in 84.48%, 100%, 89.66%, and 87.93% of the cases, respectively. Woodpex V (p = 0.039), Woodpex III (p = 0.001), and Root ZX (p = 0.001) significantly over-estimated the WL. The WL measured on digital radiographs was not significantly different from the actual WL (p = 0.213). The position of the apical foramen (central/lateral) had no significant effect on the accuracy of WL determination by different techniques (p >0.05). Within the limitations of this in vitro study, all the tested modalities showed acceptable accuracy for WL determination in maxillary premolars.