Apex Locator Research Articles

Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth.

BackgroundIn primary teeth, working length determination is complicated due to its continuous alteration in dimension, shape, and root apex position. Accurate working length determination is essential to achieve the optimal cleaning and disinfection of the canal. Despite the use of conventional radiographic method, newer methods are available to increase the accuracy of WL determination. This study aims to compare electronic apex locator (EAL) with radiographic method of WL determination and to evaluate its accuracy using cone-beam computed tomography (CBCT).Materials and methodsSixty root canals from 34 extracted primary teeth were included. Occlusal surfaces were flattened and access opening done for all the samples. Teeth were subjected to working length determination by conventional radiograph and EAL. Samples were then mounted on a U-shaped wax and subjected to CBCT. Results were recorded and statistically analyzed using ANOVA and ICC for quantitative data.ResultThe mean measurement of radiographic, EAL and CBCT methods are 11.708, 11.200, and 10.895, respectively. Mean measurements demonstrated significant difference (p < 0.05) between three methods. ICC demonstrated high correlation between EAL and CBCT with Cronbach's α value of 0.962 and moderate correlation were observed between radiographic method and CBCT (0.706) and EAL and radiographic method (0.763). EAL demonstrated 87% accuracy whereas radiographic method demonstrated 63% accuracy to the actual length as evaluated by CBCT.ConclusionEAL is more accurate than conventional radiographic method as evaluated by CBCT.How to cite this articleShibin J, GS P, M S, et al. Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth. Int J Clin Pediatr Dent 2022;15(S-1):S92-S96.

POS-523 Incidental Finding of Dextrocardia with Situs Inversus and the absent left kidney in a 55-year-old Nepali woman, a case report

Dextrocardia is an abnormal congenital positioning of the heart: instead of the heart forming in the fetus on the left side, it flips over and forms on the right side. Situs Inversus is a congenital condition in which the main visceral organs are reversed or mirrored from their usual positions. If both conditions are present it is called situs inversus totalis. 54 years old G5P4(2213) woman, government worker presented to an outpatient clinic with complaints of dysuria, frequency, hesitancy, suprapubic burning sensation, and mild chest pain in January 2016. The patient did not have any cardiopulmonary symptoms like chronic coughs, nasal congestion, and palpitations. Physical examination of the cardiovascular system revealed a normal pulse rate of 70 beats per minute and her blood pressure was 100/60mmHg. Her lungs were clear on auscultation. There was no pedal edema or any signs of fluid overload. Routine urine analysis revealed protein 1+, with no sugar, no white cell count, and negative nitrites. Renal function test showed mildly elevated creatinine of 138.0umol/L with eGFR of 49ml/min using Cockcroft-Gault equation, sodium of 141.0 mEq/L, K 5.2mEq/L, blood urea 9.7mmol/L. Routine chest X-ray revealed heart apex in the right side and gastric air bubble seen below right hemidiaphragm. Abdominal and pelvic ultrasound revealed the liver presented in left hypochondrium with normal texture. The spleen was noted in right hypochondrium with normal texture. The right kidney was normal approx 9.7cm in size, the outline was smooth and regular with maintained corticomedullary differentiation, with no hydronephrosis. The left kidney was not visualized. The urinary bladder was normal in outline, distensibility, and thickness. The uterus was anteverted with a regular outline and normal endometrial echo complex. Computed tomography scan with contrast of abdomen was done which revealed the liver was present in the left hypochondrium and the spleen was present in the right hypochondrium, inferior vena cava on left side and aorta on the right side. The left kidney and ureter were not visualized. Normal right pelvicalyceal system and excretion from the right kidney were noted. The above-mentioned patient did not have any cyanosis, cough, sinusitis, or recurrent chest or urinary tract infections. To diagnose situs inversus, thorough physical examination, chest X-ray, ultrasonography, computed tomography, or magnetic resonance imaging are necessary (8,9,10). These imaging modalities help to evaluate the structures of the internal organs, such as the location of cardiac apex, the site of aorta relative to midline, the location of the stomach, the liver, and gallbladder, presence and appearance of the spleens, and presence of the kidneys and vascular structures (8,9,10). Dextrocardia with situs inversus is a rare congenital malformation that must be fully evaluated when there is a suspicion because in some cases it can have deadly results. Apart from detailed medical history and physical examinations, imaging modalities should be used for reaching the diagnosis. Routine and regular follow-ups must be arranged for the patients who have this condition.

Effect of Sodium Hypochlorite Concentration on Electronic Apex Locator Reliability.

This ex vivo study aimed to measure the performance of an electronic apex locator (EAL) in the presence of sodium hypochlorite irrigants with different concentrations. Two EALs (Root ZX Mini and Locapex 6) were used to locate the apical foramen in 10 extracted single-rooted teeth in the presence of 0.5%, 2.5% and 5% sodium hypochlorite. Visual working lengths were also determined using #10 K-file under a microscope before the electronic measurements were made. The performance of both EALs was compared for the electronic working lengths determined under the different concentrations of sodium hypochlorite. A multiple-way ANOVA and PLSD Fisher’s test with an α risk fixed at 5% were conducted. There were no statistical differences in the working lengths determined by both EALs between the three groups with different concentrations of sodium hypochlorite and their visual control measurements. When a ± 0.5 mm margin was applied, the Root ZX Mini and the Locapex 6 presented 88% and 83% accuracy, respectively. Sodium hypochlorite concentration in irrigants does not affect the accuracy and reliability of either the Root ZX Mini or the Locapex 6. Electronic apex locators are reliable with any concentration of sodium hypochlorite irrigants.

Influence of type of metal alloy and penetration limit in determining the working length with two apex locators

This ex vivo study aimed to evaluate the precision of two electronic foramen locators (Root ZX mini and RomiApex A15) inserting the manual Flexofile or NiTi endodontic files until reaching the apical foramen or surpassing it. Sixty mesial root canals of mandibular molars were selected. Root canal real length measurement and odontometry were performed after the access cavity surgery, cervical pre-flaring, and apical preparation. The precision of the electronic foramen locators was verified at each instrumentation phase, comparing the electronic measurements with the real length. The 3-way ANOVA test was used to evaluate the error of electronic measurements, and a significance level was set at 5%. At the first odontometry, the RZX was significantly more precise than the A15 (p&lt;0,0001). After the second odontometry, the best results were observed when the penetration limit was restricted to the apical foramen. After the third odontometry, statistical differences were found for apex locator (p&lt;0,0001), penetration limit (p&lt;0,05), and metallic alloy (p=0,01). Manual instruments used to perform the odontometry should be inserted only until the foramen level. The use of NiTi files improves the precision of electronic foramen locators.

How does magnetically controlled growing rods insertion affect sagittal alignment in ambulatory early onset scoliosis patients?

The importance of sagittal alignment restoration in early onset scoliosis (EOS) management has rarely been investigated to date. The aim was to report the influence of magnetically controlled growing rods (MCGR) insertion on the sagittal alignment of EOS patients. All consecutive ambulatory patients operated with MCGR rods between 2011 and 2018 were retrospectively included in four institutions. Standing biplanar radiographs were performed preoperatively, in the early postoperative period and at latest follow-up. Global and local sagittal parameters, spinal global shape and harmony were investigated. A total of 37 ambulatory EOS patients were included (mean age at surgery 8.5 (± 2) years). 70% had a balanced construct postoperatively. Both MaxTK (- 17°, p = 0.02) and MaxLL (- 15°, p = 0.001) were significantly reduced, particularly at the instrumented levels. The number of vertebrae included in the lumbar lordosis significantly increased (+ 2 levels, p = 0.02), as well as the thoraco-lumbar inflexion point (+ 2 levels, p < 0.001) and the kyphosis apex (+ 1 level, p < 0.001). Overall mechanical failure rate was 40.5%, and radiological PJK was observed in 43% of the patients, with 11 remaining asymptomatic. Patients with initial hyperkyphosis (> 50°) developed more complications (62% vs. 28%, p = 0.04). MCGR insertion flattened the spine in EOS, at both instrumented and non-instrumented levels. Overall spinal harmony was modified, with a cranial shift of the thoraco-lumbar inflexion point and the thoracic kyphosis apex, associated with a lengthening of the lumbar lordosis. The rate of complication remained high, some explanations being found in the radiological changes reported such as the preoperative location of the TK apex. IV.

The interaction effects of rocker angle and apex location in rocker shoe design on foot biomechanics and Achilles tendon loading

The influences of rocker shoes on foot biomechanics were controversial because the interaction between two design factors—rocker angle and apex location, was usually omitted. This study investigated the interaction effects of rocker angle and apex location on plantar foot pressure, metatarsophalangeal/ankle angle, and Achilles tendon force during walking. Ten participants performed walking trials under six rocker shoe conditions: 2 rocker angles (mild and severe) ​× ​3 apex locations (distal, standard, and proximal), wherein the plantar foot pressure was measured and the movement data were processed by musculoskeletal modeling to report joint angle and Achilles tendon force. A two-way ANOVA repeated measures was used for statistics. Significant interaction effects were reported in examinations of forefoot pressure, midfoot pressure, and metatarsophalangeal dorsiflexion. The standard apex significantly reduced peak forefoot and midfoot pressures (p ​= ​0.008–0.034, Hedges'g ​= ​0.75–0.84), which was further decreased by a severe rocker angle (p ​= ​0.006, Hedges'g ​= ​0.51–0.81). Moving the apex proximally reduced Achilles tendon forces (p ​< ​0.001, Hedges' g ​= ​0.80) and facilitated both metatarsophalangeal dorsiflexion and ankle plantarflexion during push-off (p ​= ​0.003–0.006, Hedges' g ​= ​0.03–0.82). Rocker angle seemed to have fewer effects on ankle joint angle and Achilles tendon force. We concluded that apex location was likely the dominant design factor of the rocker sole in influencing foot biomechanics, yet its interactions with rocker angle should be considered. The configuration of the two features could be varied to possess different therapeutic merits and adapt to specific application purposes.

A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction.

ObjectivesAlthough computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.MethodsIn this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared.ResultsTwenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments.ConclusionsWe developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.

The Effect of Long Service Life on the Accuracy of Dentaport ZX Electronic Apex Locator.

Electronic apex locators are among the most acceptable instruments for determining root canal length. The present study aimed to evaluate the effect of long service life on the accuracy of the Dentaport Root ZX (DP ZX) electronic apex locator (EAL). In this study, fifty single-rooted freshly extracted human teeth were used. After determining the root canal length with a K-file and a dental operative microscope, the canals were measured with four separate DP ZX apex locators (two with more than 6 years of life service while two others had less than 6 years of life service). Data were analyzed by repeated ANOVA measurement. No significant difference was found between the EALs with different years of life services (P=0.62). All EALs could determine root canal length with high accuracy of more than 94%. Based on the results of this in vitro study, the long service life had no significant impact on the accuracy of DP ZX EALs in terms of root canal length determination.

Comparison of Accuracy of Dentaport ZX, Rootor and E-Pex Pro Electronic Apex Locators in Two Simulated Clinical Conditions: An In Vitro Study

Background:The aim of this in vitro study was to determine the accuracy in measuring the working length (WL) using Dentaport ZX, Rootor, and a newly introduced budget friendly electronic apex locator (EAL), E-Pex Pro in two commonly simulated clinical conditions (in the presence of irrigant and blood).Materials and Methodology:Eighty-eight single-rooted premolars were randomly assigned to two groups according to simulated clinical conditions: Group 1: Presence of irrigant (5% NaOCl) and Group 2: Presence of blood. WL was determined with all three EAL and was then compared with actual length (AL) of the tooth, which was measured using Vision Inspection System. The difference between the length measured by EAL and AL was tabulated and statistically analyzed using one-way analysis of variance (ANOVA) with post hoc Dunnett's test. All testing was done using two-sided tests at alpha 0.05 (95% confidence level). Thus, the criteria for rejecting the null hypothesis were “P < 0.05.”Results:Measurement using Dentaport ZX, Rootor, and E-Pex Pro had an accuracy of 99.79%, 99.69%, and 99.64%, respectively, in Group 1 and 99.95%, 99.7%, and 99.74%, respectively, in Group 2. ANOVA revealed that the mean error value is least for Dentaport ZX followed by Rootor and then E-Pex pro EAL.Conclusion:Dentaport ZX gave better results both in the presence of NaOCl and blood followed by Rootor and E-Pex Pro EALs.

Influence of heat treatment of nickel-titanium instruments on the accuracy of an electronic apex locator integrated with endodontic motor.

Manufacturers have produced a wide variety of nickel-titanium (NiTi) alloys, but the available literature is limited on the accuracy of some integrated electronic apex locators (EAL) used with different NiTi heat treatments in working length (WL) determination. This study aims to evaluate ex vivo , the influence of different heat treatments of NiTi instruments, and the diameter of the apical preparation on the accuracy of an EAL used during root canal preparation using an integrated EAL and motor unit. Nineteen extracted human mandibular incisors were included in the study. The WL control was determined by the visual method. Instruments of Mtwo, Reciproc, Reciproc Blue, WaveOne Gold, Twisted File Adaptive, and Hyflex CM systems, with diameters from 0.25 mm to 0.50 mm, were used to measure WL during root canal preparation. The electrical resistivity of instruments with a diameter of 0.25 mm from each system was evaluated using an Inductance, Capacitance, and Resistance (LCR) meter. Data were statistically analyzed using Fisher's exact test and Kruskal-Wallis test. The different heat treatments and different diameters did not influence the precision of the EAL (P > 0.05). The heat treatment and the diameter of the apical preparation did not influence the accuracy of WL determination by an EAL integrated with the endodontic motor.

Effects of three different embedding media on the accuracy of different electronic apex locators: An in vitro study

Effects of three different embedding media on the accuracy of different electronic apex locators: An in vitro study

Influence of the method for determining working length on the obturation level of primary molars.

Efficient working length determination is essential for a successful endodontic treatment. The purpose of the present study was to evaluate whether the method for determining the working length of root canals (radiographic or electronic) influences the obturation level of primary molars. Thus, a controlled, triple-blind, randomized clinical trial was conducted. Sixty-four children aged 6 to 9 years with an indication for primary molar pulpectomy were included. Participants were divided into two groups according to the method used to determine the working length of the root canals: (G1) radiographic and (G2) using an electronic apex locator. The study had 3 operators: #1 performed the clinical procedures, except the electronic measurement; #2 performed radiographic measurement and final evaluation of obturation level; and #3 performed eligibility criteria and electronic measurement. Adequacy of obturation level was evaluated based on the final conventional radiography and it was recorded as acceptable or unacceptable (short or overfilled). Data were analyzed with repeated measures logistic regression. There was no difference between the obturation level of primary molars measured by radiographic and electronic methods (p > 0.05). The other investigated variables (age, tooth type, dental arch position, last instrumentation file, and canal location) also did not influence the obturation level (p > 0.05). In conclusion, both measurement methods resulted in similar adequacy of obturation level in primary molars after pulpectomy.

Location of the Maxillary Posterior Tooth Apices to the Sinus Floor in an Egyptian Subpopulation Using Cone-beam Computed Tomography.

The aim of this study was to evaluate the location of the apices of the maxillary posterior teeth to the maxillary sinus floor (MSF), the symmetry between both sides and the possible variations between males and females using cone-beam computed tomography (CBCT) in an Egyptian subpopulation. CBCT images were collected from 120 patients (240 second premolars, 480 1st and 2nd molars, 1680 roots). The proximity of roots of maxillary second premolar and 1st and 2nd molars to the floor of the sinus was categorized into three categories: inside the sinus floor (IS), touching the sinus floor (TS) or outside the sinus floor (OS). The correlation of the distance with gender was analyzed as well as for symmetry. Friedman's test was used to compare between different roots and the Dunn's test was used for pair-wise comparisons when Friedman's test was significant. The Mann-Whitney U test was used to compare males and females. The significance level was set at P≤0.05. The highest prevalence of roots outside the sinus was found with second premolar (right and left) followed by palatal roots of right and left second molar. In addition, the highest prevalence of roots inside the sinus was found with mesiobuccal roots of maxillary second molar followed by the palatal root of maxillary first molar. There was no statistically significant difference between males and females or between both sides. Neither gender nor side variations regarding the proximity to the maxillary sinus floor were observed.

Accuracy of Four Apex Locators in Premolars with Root Resorption: An In vitro Study.

The aim of the present in vitro study was to compare the accuracy of the working length measurements of four foramen locators: Root ZX mini, Raypex 6, Woodpex III and Propex Pixi in uniradicular premolars with simulated root resorption. For this study, 30 single-rooted permanent premolars were selected. The samples were divided into two groups: 15 teeth with simulated external root resorption and 15 teeth with internal resorption. Each sample was immersed in containers with alginate covering only the root part. Measurements were acquired from the four foramen locators and compared with the working length measurements that have been previously obtained with the direct visual technique and the use of a Digital USB Microscope under 5×. Next, the Shapiro-Wilk normality test was applied. The ANOVA test and t-test for related samples were performed, in order to analyze the measurements obtained. In the teeth with external resorption, no statistically significant differences in the measurements were obtained with Raypex 6 and Propex Pixi foramen locators, but there were statistically significant differences with Root ZX mini and Woodpex III Root Zx mini [Root Zx mini (P=0.040) and Woodpex III (P=0.000)]. On the other hand, in the samples with internal root resorption, there were no statistically significant differences in measurements with the Root ZX mini, Propex Pixi and Raypex 6 foramen locators. However, there were significant differences with Woodpex III. Based on this in vitro study, Raypex 6 had the highest accuracy in premolars with simulated external resorption and Root ZX mini was the most accurate in teeth with simulated internal resorption. Furthermore, external root resorption affects the accuracy of foramen locators more than internal resorption.

Postoperative pain after endodontic treatment of necrotic teeth submitted to large apical preparation using oscillatory kinematics.

BackgroundRegardless of the technique applied for chemomechanical preparation, postoperative pain is a very relevant matter in endodontics. Objective: To evaluate postoperative pain after endodontic treatment of necrotic teeth submitted to large apical preparation (LAP) using oscillatory kinematics. Material and MethodsThe sample included 60 asymptomatic necrotic teeth with or without apical radiolucency, and with normal periodontal status, referred for endodontic treatment. Following initial procedures, the position and approximate size of the apical constriction were determined by using an apex locator and K Flexofiles, respectively. The chemomechanical preparation was conducted using oscillatory kinematics and 2.5ml of 2.5% NaOCl at each file change to achieve LAP, and the filling was done with Tagger’s hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment to request their classification of postoperative pain, and data were submitted to statistical analysis. ResultsOnly 3 patients (5%) reported severe pain after 72 hours. Moderate pain was reported by 17, 9 and 1 patient after 24, 48 and 72 hours, respectively (P = 0.000). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (P = 0.001), and 48 and 72 hours (P = 0.014). Age and tooth type did not influence the postoperative pain, regardless of time (P> 0.05). After 72 hours, women experienced significantly more pain than men (P = 0.012), and teeth without periradicular lesion were more sensitive that teeth with perirradicular lesion (P = 0.027). ConclusionsAcute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth submitted to LAP using oscillatory kinematics. Key words:Endodontic treatment, oscillatory kinematics, postoperative pain, pulp necrosis.

Accuracy of working length measurement by Raypex 6: Electronic apex locator versus actual measurements under stereomicroscope

Background/Aim: This study aimed to evaluate the precision of the Raypex 6 apex locator in locating the apical constriction (AC) and major foramen (MF) during a root canal treatment compared with a microscopic evaluation. Another aim of the present study was to evaluate the accuracy of the Raypex 6 in the presence of different irrigating solutions (NaOCl, saline, EDTA, etidronic acid-HEBP). Material and Methods: One hundred and nine patients were included in this study and were randomly assigned into four groups according to the irrigation solution used; NaOCl, EDTA, HEBF and saline. Electronic MF (EMF) and AC (EAC) were measured by using Raypex 6. The teeth were extracted. The apical 3 mm of each canal was trimmed to expose the file tip. The samples were observed under a stereomicroscope, and the actual length of MF (ALMF) and AC (ALAC) were measured. The data were analyzed by using x2 test, and significance was set at P&lt; 0.05. Results: The Raypex 6 was accurate 71.4% of the time to ±0.5mm and 93.3% of the time to ±1mm in determining the ALAC. While similar ALAC-EAC differences were observed in EDTA, NaOCl, and saline groups (p= 0.230), the highest differences were seen in the HEBP group (p= 1.000). The precision of Raypex 6 in determining the working length measurement depends on the type of irrigation. All solutions allowed reliable detection of AC. However, HEBF significantly increased the risk of overpreparation. Conclusions: Raypex 6 can be recommended for clinical use and its accuracy is not affected by the type of irrigant when locating MF.

Comparative evaluation of working length determination in deciduous teeth with tactile method, conventional radiography, radiovisiography and apex locator: In-vitro study

Comparative evaluation of working length determination in deciduous teeth with tactile method, conventional radiography, radiovisiography and apex locator: In-vitro study

Comparative evaluation of the final working length using apex locator, endomotor integrated apex locator and radiography

Comparative evaluation of the final working length using apex locator, endomotor integrated apex locator and radiography

Endodontic treatment during pregnancy: case series and literature review

ABSTRACT The aim of this paper is to provide a scientific basis for conducting safe root canal treatment in pregnant women, illustrating with case reports treated in the extension project Maternal-Child Dental Care at the Federal University of Pelotas. The scientific bases address the main doubts of professionals when performing prenatal dental care: use of radiographic examination, local anesthetics, prescription of medications, among other essential factors in the care of pregnant women. The assisted pregnant women sought care with dental pain. In two cases symptomatic irreversible pulpitis was diagnosed, while a third was experiencing acute apical periodontitis. Endodontic procedures were performed under controlled and standardized conditions. The root canals were prepared in a single session, using mechanical instrumentation with reciprocating kinematics (Wave One® Gold Primary - Dentsply Sirona), and the root canal length was determined by an electronic apex locator FinePex (Schuster). Root canal filling was performed by the single cone technique with Wave One® gutta-percha points. After endodontic treatment, coronal sealing was performed with composite resin A2 Z350 XT (3M ESPE). The care related to the gestational condition is highlighted, and the patients remain under monitoring. It is concluded that the use of apical locators and mechanical instrumentation, using reciprocating files associated with the single cone obturation technique with a standardized cone for each system, represents advances for the accomplishment of endodontic treatment in pregnant patients due to the shorter clinical time and greater comfort of the procedure.

Comparative Evaluation of Using Cone Beam Computerized Tomography (CBCT) and Conventional Radiography Confirmed with Apex Locator for Working Length Determination in Curved Root Canals (Clinical Study)

Comparative Evaluation of Using Cone Beam Computerized Tomography (CBCT) and Conventional Radiography Confirmed with Apex Locator for Working Length Determination in Curved Root Canals (Clinical Study)