Electronic Root Canal Length Measurement Research Articles

A laboratory study of the accuracy of three electronic apex locators: influence of embedding media and radiographic assessment of the electronic apical limit.

To evaluate several factors that might interfere with the use of electronic root canal length measurement devices (ERCLMDs) in a laboratory setting, including two different embedding media (alginate and electroconductive gel), three different types of devices and the radiographic view on the assessment of the electronic readings. Thirty single-rooted extracted human mandibular premolars were selected. After access and canal pre-flaring, a size 10 K-file was inserted in the canal up to the major apical foramen under magnification (×10), and this length was recorded as the actual length (AL) of the canal. Teeth were mounted on a specific endodontic training kit platform (ProTrain). Two different embedding media (electroconductive gel and alginate) and three different ERCLMDs: Apex ID (SybronEndo, Glendora, CA, USA), CanalPro Apex Locator (Coltene-Endo, Cuyahoga Falls, OH, USA) and the Root ZX II (J. Morita, Tokyo, Japan), were tested. Following the measurement at the 0.5 mark of each ERCLMD using alginate, two periapical radiographs (bucco-lingual and proximal views) were taken. The difference between the electronic readings and the AL, as well as the distance from the file tip to the apex of the roots on the radiographs, was calculated. Data were analysed statistically (two-way anova, Tukey's and chi-squared tests) at 5% significance level. The incidence of over-extended readings was significantly greater (P<0.05) when using the ProTrain electroconductive gel, except for Root ZX II at the 0.5 mark. Root ZX, CanalPro and Apex ID had similar accuracy when the 0.0/APEX mark was used to locate the foramen. For the radiographic method, no difference was found between the devices or radiographic views. Compared with alginate, the conductive gel of the ProTrain kit negatively affected most of the electronic readings. The three evaluated ERCLMDs had similar accuracy in locating the apical foramen when using the mark 0.0/APEX and alginate as the embedding media. Although the ProTrain platform allows radiographs to be exposed in both bucco-lingual and proximal views, no difference was found between the views when evaluating the apical limit provided by the 0.5 mark in mandibular premolars embedded in alginate.

Consistency of electronic measurements of endodontic working length when using multiple devices from the same manufacturer—an in vitro study

To assess the consistency of electronic determination of endodontic working length obtained from four identical electronic root canal length measurement devices (ERCLMD) from five different types of ERCLMD each under various in vitro conditions. Eight extracted teeth, seven single-rooted teeth, and one molar were accessed. Root length was measured and instruments were inserted and fixed with the tip placed beyond and short of the apical constriction, in roots with an artificial perforation or an open apex. Devices tested were Root ZX (Morita, Kyoto, Japan), Dentaport ZX (Morita), Apex ID (SybronEndo, Glendora, USA), ProPex II (Dentsply Maillefer, Victoria, Australia), and Raypex 6 (VDW-Antaeos, Munich, Germany). Teeth were irrigated with different solutions (NaOCl, EDTA, CHX). ERCLMDs were connected and measurements were recorded. Consistency was classified by the scores 0-4. Comparisons were carried out using the Kruskal-Wallis test (α = 0.05). For multiple testing, the level of significance was adjusted and analysis was performed using the Mann-Whitney U test. Among the five types of ERCLMD, Apex ID and Raypex 6 showed the highest consistency. There was no statistically significant difference between the settings and conditions. Raypex 6 showed the highest consistency for measurements in case of a perforation. Different devices from one type of ERCLMD show a high consistency. Nevertheless, general statements on the accuracy of one type of ERCLMD taken from studies investigating only one device per type should be drawn with caution. The study refers to the reliability and repeatability of determination of endodontic working length by using ERCLMDs.

Determination of the Accuracy of 5 Electronic Apex Locators in the Function of Different Employment Protocols

IntroductionThe aim of this study was to evaluate the accuracy of 5 electronic apex locators (EALs): Root ZX II (RZX; J Morita, Tokyo, Japan), Raypex 6 (RAY; VDW GmbH, Munich, Germany), Apex ID (AID; SybronEndo, Orange, CA), Propex II (PRO; Dentsply Maillefer, Ballaigues, Switzerland), and Propex Pixi (PIXI, Dentsply Maillefer) when used in the following protocols: (1) −1.0, insertion up to 1.0 mm below the apical foramen (AF); (2) 0.0/−1.0, insertion until the AF and withdrawn 1.0 mm short of the AF; (3) 0.0, insertion until the AF; and (4) over/0.0, insertion until “over” and withdrawal to AF. MethodsThirty human lower premolars had coronary accesses and cervical and middle thirds preparations performed, allowing AF standardization (200 μm). Using an alginate experimental model, root canal length (RCL) measurements were performed sequentially with EALs following each of the protocols. ResultsConsidering the suggested protocols, the lowest mean error values were observed in 0.0, 0.10 mm (RZX), 0.13 mm (RAY), 0.16 mm (AID), 0.23 mm (PRO), and 0.10 mm (PIXI), without a significant difference for over/0.0 (P > .05). Comparing the results obtained in 0.0 with those found in −1.0 and 0.0/−1.0, significant differences were observed for most EALs (P < .05). For the comparison between EALs, significant differences were observed only in protocols −1.0 and over/0.0 (P < .05). ConclusionsUnder the conditions of the study, it was concluded that, regardless of the mechanism of the device, the best results were found when electronic RCL measurement was performed at the AF; furthermore, the electronic withdrawal did not offer any additional advantage over the reach of the AF.

Comparison of four electronic root canal length measurement devices

Objective: The objective of this study is to evaluate the performance of four electronic root canal length measurement devices (ERCLMDs) [Root ZX, Raypex 6, ProPex II, and VDW Gold with ERCLMD] in wet and dry root canals with different major foramen diameters, in association with three file positions within the final 1 mm of canals.Materials and methods: Fifty roots were divided into five groups that were instrumented apically to the terminus diameter using K-files 15, 20, 30, 40, and 60. ERCLMD measurements were made when the file tip was at major foramen, 0.5 mm and 1.0 mm short of the foramen, when the apex touched to the surface of saline or was immersed 3 mm into saline, and when the canal was dry or was irrigated with saline. The differences between the electronic lengths and the actual lengths were calculated. The data were analyzed using the three-, two-, and one-way ANOVA and the LSD test (p < .05).Results: Overall, the four ERCLMDs demonstrated 12.8% unstable and beyond the foramen measurements (11.3%). About 85% of the beyond the foramen measurements had foramen diameters 0.40 and 0.60. ERCLMD comparisons related to the file positions in the foramen diameters showed significant differences between ERCLMDs in each foramen diameter (p < .05).Conclusions: All ERCLMDs provided highly accurate measurements within the final 1 mm of the foramen. Wet or dry canals and apex conditions did not adversely affect the accuracy of the ERCLMDs’ readings. ProPex II located the file positions in the teeth with different foramen diameters more accurately than the other ERCLMDs.

Comparison of Two Electronic Root Canal Length Measurement Devices: The Differences between Ratio Two Impedance Frequencies and Multi Frequencies

Accuracy electronic root canal length measurement devices were important for root canal treatment. Aim: To evaluate and compare accuracy of the two electronic root canal length measurement devices; two frequencies impedance ratio and multi frequencies. Methods: Forty anterior teeth were sectioned on their cervical area. All samples were measured root canal length by radiographic. On the second phase, all the samples were measured by two frequencies impedance ratio and multi frequencies electronic devices. In the final phase, the teeth were split vertically and actual lengths were measured. All measurement by radiographic and electronic method was subtracted with actual length. Statistical analysis was performed using Chi-square and the Kolmogorov-Smirnov test. Results: Accuracy of the two frequencies impedance ratio 50% and multi frequencies 47.5%. No statistical significance between two frequencies impedance ratio and multi frequencies. Conclusions: There is no difference between ratio two impedance frequencies and multi frequencies.

Influence of Apical Periodontitis on the Accuracy of 3 Electronic Root Canal Length Measurement Devices: An In Vivo Study

IntroductionThe aim of this in vivo study was to evaluate the influence of apical periodontitis (AP) on the accuracy of Dentaport ZX (J Morita, Kyoto, Japan), Raypex 5 (VDW, Munich, Germany), and i-Root (S-Denti, Seoul, Korea) electronic root canal length measurement devices (ERCLMDs). MethodsThirty-two single-rooted teeth scheduled for extraction, consisting of 16 teeth with AP and 16 teeth with normal periapex (NP), were selected. The access cavity was prepared, and the coronal portion of the canal was flared. The electronic working length (EWL) was determined by each ERCLMD according to each manufacturer's instructions. Each tooth was extracted, and the actual working length (AWL) was determined by inserting a size 15 K-file until the tip could be seen at a position tangential to the major foramen and then 0.5 mm was subtracted from the measurement. The distance from the file tip (EWL) to the point 0.5 mm coronal to the major foramen (AWL) was calculated. Data were analyzed using the nonparametric Fisher exact test and the chi-square test. Statistical significance was set at P < .05. ResultsThe accuracies of Dentaport ZX, Raypex 5, and i-Root within ±0.5 mm in the AP group were 93.8%, 81.3%, and 75.0%; they were 93.3%, 86.7%, and 73.3% in the NP group, respectively. There were no significant differences between the accuracy of each device in the 2 groups (P > .05). Considering the 2 groups of AP and NP, there were no statistically significant differences in the accuracy of the ERCLMDs (P > .05). ConclusionsThe presence of AP did not influence the accuracy of ERCLMDs.

Evaluation of an improved endodontic teaching model: do preclinical exercises have an influence on the technical quality of root canal treatments?

To investigate whether the preclinical application of an electronic root canal length measurement device (ERCLMD) leads to more accurate working length (WL) determinations in a preclinical endodontic course and if this exercise effects the technical quality of root canal procedures when treatments are performed on patients for the first time. Root canal treatments performed by two consecutive groups of third year students (group 1: n = 39, group 2: n = 44) were compared in the preclinical course and when root canal treatments were performed on patients in the following term. Two different teaching models were applied in the preclinical endodontic course. WL in group 1 was determined with radiographs only. The teaching model applied in group 2 allowed the application of an ERCLMD. When treatments were performed on patients, both groups used the same technique to determine WL. It was first determined using an ERCLMD and verified radiographically. Master cone and root filling lengths were evaluated using radiographs, and comparisons between both groups were made using Fischer's exact test. Root fillings performed by students of group 2 were more often classified as acceptable. This observation was made in the preclinical endodontic course and when treatments were performed on patients. The application of an ERCLMD in combination with radiographs is more accurate to determine WL than radiographs alone. Students practiced the use of ERCLMDs with the new model and benefited from this experience when performing their first root canal treatments on patients.

Effect of solvents on the accuracy of the Mini Root ZX apex locator

To evaluate ex vivo, the effects of three solvents on the accuracy of a contemporary electronic root canal length measurement device (ERCLMD), the Mini Root ZX. The actual working length (AWL) of 56 extracted maxillary incisor teeth were measured with an ERCLMD. All root canals were prepared with the ProTaper system to AWL. Of them, 20 were filled with gutta-percha and a resin-based sealer (Group A), 20 with gutta-percha and a zinc oxide/eugenol-based sealer (Group B), and 16 roots were used as the control group (Group C). Removal of the root filling and repreparation processes were performed using the ProTaper system. Guttasolv and Resosolv were used as the solvents in Group A and Guttasolv and Endosolv E in Group B. After the removal of the root fillings had been achieved, the same ERCLMD was used to measure the working length (WL). Differences between AWL and WL measurements were analysed by paired t-test, and the accuracy of ERCLMD was assessed using chi-squared tests. There were significant differences between AWL and WL measurements in subgroups A2 (Resosolv group) and B2 (Endosolv E group). In these subgroups, WL was shorter than AWL (P<0.05). Also, the accuracy of the Resosolv group was significantly lower than the others (P<0.05) at a ±0.5mm margin of error. Removing root fillings may require use of a solvent. In these cases, ERCLMDs may exhibit a lower accuracy, thus operators must exercise additional care when measuring the working length using ERCLMDs.

Accuracy of five electronic foramen locators with different operating systems: an ex vivo study

Objective:The aim of this study was to evaluate, ex vivo, the precision of five electronic root canal length measurement devices (ERCLMDs) with different operating systems: the Root ZX, Mini Apex Locator, Propex II, iPex, and RomiApex A-15, and the possible influence of the positioning of the instrument tips short of the apical foramen.Material and Methods:Forty-two mandibular bicuspids had their real canal lengths (RL) previously determined. Electronic measurements were performed 1.0 mm short of the apical foramen (-1.0), followed by measurements at the apical foramen (0.0). The data resulting from the comparison of the ERCLMD measurements and the RL were evaluated by the Wilcoxon and Friedman tests at a significance level of 5%.Results:Considering the measurements performed at 0.0 and -1.0, the precision rates for the ERCLMDs were: 73.5% and 47.1% (Root ZX), 73.5% and 55.9% (Mini Apex Locator), 67.6% and 41.1% (Propex II), 61.7% and 44.1% (iPex), and 79.4% and 44.1% (RomiApex A-15), respectively, considering ±0.5 mm of tolerance. Regarding the mean discrepancies, no differences were observed at 0.0; however, in the measurements at -1.0, the iPex, a multi-frequency ERCLMD, had significantly more discrepant readings short of the apical foramen than the other devices, except for the Propex II, which had intermediate results. When the ERCLMDs measurements at -1.0 were compared with those at 0.0, the Propex II, iPex and RomiApex A-15 presented significantly higher discrepancies in their readings.Conclusions:Under the conditions of the present study, all the ERCLMDs provided acceptable measurements at the 0.0 position. However, at the -1.0 position, the ERCLMDs had a lower precision, with statistically significant differences for the Propex II, iPex, and RomiApex A-15.

Evaluation of the Joypex 5 and Root ZX II: an in vivo and ex vivo study

To evaluate in vivo and ex vivo the accuracy of the multifrequency electronic root canal length measurement device (ERCLMD) Joypex 5 and compare it with the Root ZX II. The ex vivo methodology for evaluation of the accuracy of ERCLMDs was also validated by comparison with in vivo results. Twenty single-rooted human teeth that were scheduled for extraction were selected. Working length measurements were performed in vivo with the Joypex 5 and Root ZX II. After the teeth were extracted, each canal was measured with the ERCLMDs ex vivo. Then, a size 15 K-file was used to determine the reference working length (RWL), which was established 0.5 mm from the major foramen by direct observation. The measurements of working length obtained with the different methods and ERCLMDs were compared by analysis of variance and Tukey's test at P < .05. Statistical correlations were also performed. No significant difference was observed between in vivo and ex vivo measurements or the different types of ERCLMDs. The Bland-Altman plot confirmed the agreement of different methods and ERCLMDs to measure canal length. The R(2) coefficient obtained in both situations, comparing the ERCLMDs, was close to 1, denoting a strong agreement between measurements obtained with the Joypex 5 and Root ZX II and between in vivo and ex vivo methodologies. The Joypex 5 and Root ZX II had similar accuracy in determining working length of root canals. The ex vivo methodology for evaluation of the accuracy of ERCLMDs was validated when compared with the in vivo results.

In Vivoaccuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II

<i>In Vivo</i>accuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II

In vivo accuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II

To compare in vivo three different electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II. Thirty single-rooted permanent teeth scheduled for extraction because of periodontal disease were selected from 10 adult patients (ranging from 45 to 67 years) and divided into three groups of 10 teeth. Before the extraction, an access cavity was prepared and the crown was adjusted to establish a stable reference point for all measurements. The working length in Group 1 was determined using the Dentaport ZX apex locator. A K-file with the largest diameter that could reach the last green bar on the screen was stabilized in the canal using a dual-curable flow resin composite. The same procedure was used for the Raypex 5 (the file reached the last yellow bar) and Propex II (0.0 orange bar) apex locators. The teeth were then extracted and cleared. The distance between the tip of the file and the major foramen was then calculated for each tooth using digital photography according to Axiovision AC software (Carl Zeiss). Positive values were assigned when the file tip passed beyond the major foramen, negative values when the tip was short of the foramen and zero value when the file tip and the foramen coincided. Statistical analysis was performed using the chi-squared test or Fisher's exact test (P ≤ 0.05). Dentaport ZX, Raypex 5 and ProPex ΙΙ produced, respectively, 6, 2 and 4 out of 10 correct measurements, 0, 6 and 5 long measurements and 4, 2, and 1 short measurements. The differences between the three electronic root canal length measurement devices were not significant (P = 0.507). Under the in vivo conditions of this study, the three electronic root canal length measurement devices were not significantly different in terms of locating the major foramen.

An In Vitro Evaluation of Performance of Two Electronic Root Canal Length Measurement Devices during Retreatment of Different Obturating Materials

Introduction The purpose of this in vitro evaluation was to study the accuracy of Root ZX and ProPex system during retreatment of canals obturated with different obturating materials (gutta-percha + zinc oxide–eugenol sealer, gutta-percha + AH plus sealer, and Resilon + Epiphany sealer). Methods Sixty human mandibular premolar roots were instrumented with Rotary ProTaper until size F4 under copious irrigation. After instrumentation, actual working length was directly measured by using #15 FlexoFile. Electronic working length was taken with the help of Root ZX and ProPex. Teeth were divided into 3 groups and obturated by using lateral condensation of gutta-percha + zinc oxide–eugenol sealer (group I), gutta-percha + AH plus sealer (group II), and Resilon + Epiphany sealer (group III). After 7 days, the obturating materials were removed by using Gates-Glidden burs and K-files. A new electronic working length was taken. Original and post-treatment electronic working lengths were compared with actual working length. Accuracy of both electronic root canal length measurement devices was calculated for tolerance limits of ±0.5 mm and ±1.0 mm. Accuracy was compared by using χ 2 tests, and difference between actual working length and original and post-treatment electronic working lengths was compared by using Student t test. Results The accuracy of electronic root canal length measurement devices before root canal obturation was 83.3% and 93.3% for Root ZX and ProPex, respectively, for a tolerance limit of ±0.5 mm and 100% for a tolerance limit of ±1.0 mm. There was no statistically significant effect of different obturating materials tested in this study on the accuracy of Root ZX and ProPex for tolerance limits of ±0.5 mm and ±1.0 mm. Student t test revealed insignificant differences between the mean of actual working length and original and post-treatment electronic working lengths. Conclusions Root ZX and ProPex can be a useful adjunct with a high accuracy rate during root canal preparation and retreatment.

Accuracy of two root canal length measurement devices integrated into rotary endodontic motors when removing gutta‐percha from root‐filled teeth

To evaluate ex vivo the accuracy of the integrated electronic root canal length measurement devices within TCM Endo V and Tri Auto ZX motors whilst removing gutta-percha and sealer from filled root canals. Forty freshly extracted maxillary and mandibular incisor teeth with mature apices were selected. Following access cavity preparation, the length of the root canals were measured visually 0.5 mm short of the major foramen (TL). The canals were prepared using the HERO 642 system and then filled with gutta-percha and AH26 sealer using a lateral compaction technique. After 7 days the coronal temporary filling was removed and the roots mounted in an alginate experimental model. The roots were then randomly divided in two groups. The access cavities were filled with chloroform to soften the gutta-percha and allow its penetration using the Tri Auto ZX and the TCM Endo V devices in groups 1 and 2, respectively. The 'automatic apical reverse function' (ARL) of both devices was set to start at the 0.5 setting and the rotary instrument inserted inside the root canal until a beeping sound was heard and the rotation of the file stopped automatically. Once the auto reverse function had been initiated, the foot pedal of the motor was inactivated and the rubber stop placed against the reference point. The distance between the file tip and rubber stop was measured using a digital calliper to 0.01 mm accuracy (ARL). Then, a size 20, 0.02 taper instrument was attached to each device and inserted into the root canals without rotary motion until the integrated ERCLMDs positioned the instrument tips at the 0.5 setting as suggested by the devices. This length was again measured using a digital calliper (EL). The Mann-Whitney U-test was used to investigate statistical differences between the true canal length and those indicated by the two devices when used in 'automatic ARL and when inserted passively (EL). In the presence of gutta-percha, sealer and chloroform, the auto-reverse function for the Tri Auto ZX and TCM Endo V, set to start at 0.5 level, was initiated beyond the foramen in 60% and 95% of the samples, respectively during active (rotary) penetration of the instruments. There was a statistically significant difference between the devices for the mean discrepancies between the length at which the auto reverse function was initiated and the true length (P < 0.001). Electronic detection of the apical terminus when the instruments were introduced passively (not rotating) was beyond the foramen in 20% and 37% of cases in the Tri Auto ZX group and the TCM Endo V group, respectively. There was a statistically significant difference between the devices for the mean discrepancies between the electronically determined (passive) length and true length (P < 0.01). The auto reverse function of the Tri Auto ZX and TCM Endo V devices, set to start at 0.5 level, were initiated beyond the foramen in the majority of root-filled teeth during active (rotating) penetration of root filling material. Thus, this automatic function must be used with caution when removing gutta-percha root fillings. There were significant differences between the accuracy of measurements in active (rotating) and passive (not-rotating) modes; both devices were more accurate when used in passive mode. However, the Tri Auto ZX was significantly more accurate in a greater proportion of cases.

Electronic root canal length measurement before and after experimentally induced pulpitis and apical periodontitis in dogs

The aim of the study was to examine the influence of the state of the pulp and apical periodontium on the results of electronic root canal length measurement (ERCLM) with a resistance measuring device in dogs. Pulpitis and apical periodontitis were induced by pulp exposure and contamination by the oral flora in the premolar teeth of six mongrel dogs, comprising four experimental groups (36 root canals). In a control group, measured lengths of teeth with uninfected pulps were performed on the first experimental day (44 root canals). In all animals the ERCLMs were performed on teeth with healthy pulps, and at the end of the experimental period (20, 35, 50 and 65 days) following pulp exposure. The point of measuring canal lengths was the anatomical obstacle above the apical delta. Electronically measured lengths (EML) were compared between each other and with the root canal length established by tactile-sense measurement verified radiographically. The EMLs were less accurate in teeth with healthy pulps and teeth with pulpitis in the third experimental group (dif=2.27 x 2.65 mm(2); t test, p<0.05), while they were most precise after 65 days in teeth with completely necrotic pulp and established chronic apical periodontitis (dif=0.54 x 1.36 mm(2); t test, p>0.05). These results suggest that the state of the pulp and periapical tissue may have an influence on the ERCLM.

The fundamental operating principles of electronic root canal length measurement devices

It is generally accepted that root canal treatment procedures should be confined within the root canal system. To achieve this objective the canal terminus must be detected accurately during canal preparation and precise control of working length during the process must be maintained. Several techniques have been used for determining the apical canal terminus including electronic methods. However, the fundamental electronic operating principles and classification of the electronic devices used in this method are often unknown and a matter of controversy. The basic assumption with all electronic length measuring devices is that human tissues have certain characteristics that can be modelled by a combination of electrical components. Therefore, by measuring the electrical properties of the model, such as resistance and impedance, it should be possible to detect the canal terminus. The root canal system is surrounded by dentine and cementum that are insulators to electrical current. At the minor apical foramen, however, there is a small hole in which conductive materials within the canal space (tissue, fluid) are electrically connected to the periodontal ligament that is itself a conductor of electric current. Thus, dentine, along with tissue and fluid inside the canal, forms a resistor, the value of which depends on their dimensions, and their inherent resistivity. When an endodontic file penetrates inside the canal and approaches the minor apical foramen, the resistance between the endodontic file and the foramen decreases, because the effective length of the resistive material (dentine, tissue, fluid) decreases. As well as resistive properties, the structure of the tooth root has capacitive characteristics. Therefore, various electronic methods have been developed that use a variety of other principles to detect the canal terminus. Whilst the simplest devices measure resistance, other devices measure impedance using either high frequency, two frequencies, or multiple frequencies. In addition, some systems use low frequency oscillation and/or a voltage gradient method to detect the canal terminus. The aim of this review was to clarify the fundamental operating principles of the different types of electronic systems that claim to measure canal length.

Root canal length measurement in teeth with electrolyte compensation.

Electronic root canal length measurement devices have made it easier and faster to measure the root canal length of a tooth compared with the conventional radiographic method. Of these electronic apex locators, the frequency-dependent type features greater accuracy and convenience in operation. However, its accuracy is still influenced by the presence of blood and/or the various electrolytes used in root canal therapy. This study describes the development of a new frequency-dependent electronic apex locator featuring electrolyte compensation, utilising an impedance ratio and voltage difference technique to minimise the influence of electrolytes on the accuracy of root canal length measurement. The errors for distances from file tips to apical constrictions were determined in vivo with the device operating with electrolyte compensation. The measured lengths were compared with the true lengths of the extracted teeth determined using a microscope. The mean error was +0.14+/-0.27mm, and 95.2% of the measurements were within the clinical tolerance of +/-0.5mm. It was also found that the degree of accuracy was not dependent on the size of the apical foramen (p = 0.74).

Detection of a transitional ion concentration zone during electronic measurement of root canal length: a study in vitro.

The aim of this study was to examine the importance of a transitional ion concentration zone at the apical foramen during electronic root canal length measurement (ERCLM). The model comprised 21 extracted single-rooted human teeth, divided into two experimental groups and one control group, each of seven teeth. The anatomical tooth length was determined from the site of reference on the tooth crown to the canal orifice and was measured using an endodontic file and a vernier caliper. Two aqueous solutions of various NaCl, KCl and CaCl2 concentrations were mixed with agar. The Na+, K+ and Ca++ concentrations corresponded to the average value of each group as determined by atomic spectrophotometry evaluation of the extirpated human pulps. The agar containing cations was injected into the root canals after their preparation to a foramen diameter of 0.70 mm. The control teeth were then completely immersed in agar having the same concentration of cations as the agar inside the canal. In the first experimental group (group 1), the teeth were immersed in agar so that the ion concentration was higher inside the canal; in the second experimental group (group 2), the concentrations were reversed. In all three groups, ERCLM was performed by an EED 11--resistance type device. Length d1 was defined as the length of the root when measured to a value one degree less than the test value. Length d2 was defined as the length of the root inducted by the test value, which corresponded to the resistance of the periapical agar. In group 1 the average d1 length was 0.44 +/- 1.05 shorter than the anatomical foramen (AF), and in group 2, 1.11 +/- 0.43 mm longer than AF. In the control group the d1 length was on average--3.02 +/- 3.72 mm from the AF. The d1 values of all groups were not statistically significantly different from the anatomical length (AL). In all three experimental groups the d2 length was statistically significantly different from the AL (P < 0.05, t-test); group 1 d2 = AL + 6.32 +/- 1.38 mm; group 2 d2 = AL + 6.27 +/- 1.47; control group d2 = AL + 9.15 +/- 1.00 mm. The results of this study indicated that when the electroconductive medium in the canal had a different ion concentration than the periapex, and the canal orifice had a wide diameter (0.70 mm), the transitional concentration zone influenced the accuracy of measurement during ERCLM with a resistance type device. When ion concentrations inside and outside the canal were identical, in teeth with a wide foramen diameter (0.70 mm or more) the lack of a transitional ion concentration zone meant that the length of the root canal could not be determined by ERCLM.

Influence of the concentration of ions and foramen diameter on the accuracy of electronic root canal length measurement—An experimental study

Investigations on the concentration of cations in human pulp have shown that pathological changes in the pulp lead to changes in the concentration of ions in the tissue. Consequently, its electrophysiological characteristics are changed, which affects the accuracy of electronic root canal length measurements (ERCLMs). The aim of this study was to examine the effect of concentrations of Na+, K+, and Ca2+ cations in medium within the canal and around the tooth, and also foramen diameter, on the accuracy of ERCLMs. The model comprised 21 extracted single-rooted human teeth divided into two experimental groups and one control group, with seven teeth each. Two aqueous solutions of different concentrations of NaCl, KCl, and CaCl2 were mixed with agar. The concentrations of Na+, K+, and Ca2+ corresponded to the results of analyses performed by atomic spectrophotometry on the extirpated human pulps. Agar containing cations was injected into the root canal prepared with a foramen diameter of 0.25 mm. In the control group, the teeth were then completely immersed in agar of the same concentration of cations as the agar inside the canal. In the first experimental group (group 1), the concentration of ions was higher inside the canal, compared with the concentration outside the canal. In the second experimental group (group 2), the order of concentrations was inverse. In all three groups, ERCLMs was performed in the previously described model. Then, the size of the apical foramens was enlarged and ERCLMs repeated at foramen diameters of 0.45 mm and 0.70 mm diameters, respectively. Results indicate that at 0.25 diameters, the most accurate measurements were taken when the concentrations of ions inside the canal were higher than outside the canal (Xdif = 1.39 +/- 1.21 mm) (group 1). At diameters of 0.45 and 0.70 mm, no significant differences were found (p < 0.05) between the experimental groups (error amounted to Xdif = 6.27 +/- 1.47 mm). In the control group measurement, error increased with enlargement of the foramen.