Methods Of Working Length Determination Research Articles

Comparative evaluation of digital radiography, electronic apex locator and simultaneous working length determination on postoperative pain after root canal treatment: a randomized clinical trial.

The study aimed to compare postoperative pain after root canal preparation using three different methods of working length determination. 60 patients diagnosed with symptomatic irreversible pulpitis were randomly divided into three groups based on the method of working length (WL) determination. Group 1: digital radiograph (DRG), Group 2: electronic apex locator (EAL), Group 3: the simultaneous working length control (SLC) method using an endomotor with an integrated apex locator. The root canal treatments were completed in a single visit, and patients were asked to record their pain response using the Visual Analog Scale (VAS) at 6, 24, 48, and 72 hours postoperatively. Group 1 (DRG) recorded the highest postoperative pain score, while the lowest was recorded by Group 3 (SLC). There was a statistically significant difference in the VAS pain scores between DRG and SLC (p<0.05) at 6-, 24- and 48-hour intervals. Within the limitations of this study, it can be concluded that the SLC can be a helpful working length determination technique to reduce postoperative pain.

Prevalence of Teaching Apical Patency and Various Instrumentation and Obturation Techniques in United States Dental Schools: Two Decades Later

IntroductionMaintaining apical patency has been advocated to minimize canal transportation, ledge formation, and loss of working length, despite increasing debris extrusion. A previous study in 1997 by Cailleteau and Mullaney reported 50% of United States dental schools taught patency. This present study aimed to evaluate recent trends in endodontic education in United States dental schools, in relation to the prevalence of maintaining apical patency and examining the primary methods of working length determination, instrumentation, obturation, and temporization. MethodsA survey of 20 questions was distributed to 65 schools via e-mail and was available from July 2021 to September 2021. ResultsSeventy-three percent of the 46 responding schools reported that they teach patency, with 8% of this number reporting that they do so exclusively to endodontic residents. Notably, a significantly lower number of schools reported teaching patency exclusively to endodontic students compared with the Cailleteau and Mullaney study despite a significantly higher percentage of schools teaching patency overall. The most common method used to determine working length was an electronic apex locator at the 0.5 reading. Vortex Blue was the most commonly used file system used by both predoctoral and postdoctoral programs. Lateral condensation was the primary obturation technique taught in predoctoral programs, whereas warm vertical condensation was the primary obturation technique in postdoctoral programs. The study also found that 57% of schools reported using intraorifice barriers, and the most common temporary filling was glass ionomer. ConclusionsA greater portion of schools teaches patency compared with the previous study in 1997. The data collected in this survey may serve as a baseline for similar studies in the future regarding changes in endodontic education over time.

Nationwide Trends of Modern Endodontic Practices Related to Working Length, Instrumentation, Magnification, and Obturation: A Comparative Cross-Sectional Survey Comparing Endodontic and Non-Endodontic Specialties Practicing Root Canal Treatment in India.

The present study was designed to assess trends in contemporary endodontic practice regarding the techniques and materials used in endodontic therapy among dental practitioners from various regions of India. A cross-sectional questionnaire-based study was conducted amongst dentists who were pursuing postgraduates in endodontics (PG Endo) and other branches (PG-OB), specialists from other branches (MDS-OB) and specialists in endodontics (MDS-Endo) in various dental colleges representing East, West, North, South, and Central zones through an e-survey using Google forms. State-wise postgraduate dental college lists were obtained from the Dental Council of India (DCI) website. Using a multistage cluster random sampling method and considering the unanticipated response rate, emails were sent to 2100. A 29-item close-ended questionnaire, framed according to different aspects of endodontic treatment, was used to record the responses. When the distribution of the groups of dentists was compared, the central zone had the highest number of PG-OB (44.2%) and the lowest number of MDS-Endo (8.4%). The electronic apex locator (EAL) method of working length determination has been reported less among MDS-Endo than MDS-OB. The difference between the usage of various methods for working length determination was significant among the different groups in all the zones. (p < 0.0001) Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. The majority of dental practitioners preferred a combination method of instrumentation. Zone-wise comparisons among dentists showed the majority of general dental practitioners preferred the combination method (radiographs and electronic apex locator) for working length determination. Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. All dental practitioners did not so commonly use magnification in all the zones. The single cone technique was the most opted by dental practitioners of all the zones.

Accuracy of Working Length Determination of Curved Canal Using Digital and Film-Based Radiography

Introduction: Digital and film-based radiography are the most common methods of working length determination. The objective of this study was to compare the accuracy of working length determination of curved canals using digital and film-based radiography. Materials &amp; Methods: This experimental and interventional study, included forty teeth with curved canals conducted at the Dentistry Faculty of Isfahan University of Medical Sciences, in 2018. After access cavity preparation, the direct observation method of the apical tip of the file in the root apex determined the actual working length. Teeth were mounted in acrylic blocks. Canal curvature was calculated based on Schneider’s method using software of indirect digital radiography. Images gathered by E-speed film and digital sensors. A pre-curved file was used to measure the working length of film-based images. In digital radiography, a digital caliper was used to measure the working length with three and six clicks. Data were analyzed by repeated measure analysis, paired t-test, and Intraclass Correlation Coefficient. The Level of significance was set at 0.001. Results: All groups overestimated the actual length although there weren’t any significant differences (p value &gt; 0.05). Paired t-test didn’t show any significant differences between digital and film-based groups (p value &gt; 0.05). Conclusion: Considering several advantages of digital radiography over the film-based method, it is the preferred method for working length determination of curved canals.

Current trends in endodontic practice, adaptation to new technologies and attitude of dental practitioners towards endodontic standards in Sri Lanka

Objectives: The study were to describe the current endodontic practices among the dental surgeons in Sri Lanka, and to determine the association between years of practice and choice of endodontic materials and equipment. Materials and Methods: A postal survey was conducted to assess the current trends in endodontic practice, adaptation to new technologies and attitude of dental practitioners towards endodontic standards in Sri Lanka. Data were analyzed using SPSS 20. Results and Discussion: The total response rate was 38.75%.Most of the respondents were females (58.5%), with only a bachelor degree (63.9%) and practicing in the government hospitals (80.4%).The majority preferred to complete endodontic treatment within 3 appointments. Low level of rubber dam use was a striking feature noted. Most of them used manual instruments manipulated with a filing technique. A high percentage (MWP-63.2% PP- 61.3%) used tactile sensation as a method of working length determination and only a few (MWP-21.8% PP-32.8%) used apex locators. The first choice of root canal irrigant was sodium hypochlorite (MWP-76.4% PP-80.4%). The most popular obturation technique was cold lateral condensation in the MWP as 57.7% and 58.3% in the PP. The majority seem to overuse antibiotics.None of the respondents in the PP used endodontic microscopes but 12.3% used intraoral cameras. There was a significant correlation (p<0.05) between using rubber dam in the MWP and using Ni-Ti rotary instruments, using K files, performing step-back technique, using sodium hypochlorite root canal irrigant in the PP, with years of professional activity. Conclusion : The results of this study shows that the standard guidelines and new technologies for endodontic treatment are not implemented by many practitioners of Sri Lanka and the importance of continuing dental education for practitioners to update their knowledge. Keywords ­ Attitude, Dental Surgeons, Endodontology, Guidelines

Evaluation of undergraduate Endodontic teaching in dental schools within Spain.

To evaluate the current situation of undergraduate endodontic teaching in Spanish dental schools. An online version, translated into Spanish, of a survey conducted in the UK (Int Endod J 52, 2019, 1077) was sent via email to the undergraduate endodontic programme leads in all 23 Spanish dental schools. The response rate was 96%. In 95% of dental schools, endodontics is taught in the fourth year. Students treat simple root canal treatment cases in 100% of schools and only in 40% treat moderate cases. In 65% of schools, students are supervised by full-time professors who are specialists in Endodontics, significantly more frequently in private dental schools (P=0.002). Spanish dental schools use both rotary and reciprocating instrumentation systems during endodontic training, with consistency on methods of working length determination, use of silicate-based endodontic cements, irrigating solutions, inter-visit medicaments and canal filling techniques. No type of magnification is used in 90% of dental schools, and only 25% use ultrasonic instruments. Private dental schools have a significantly better staff: student ratio during clinical practice (P=0.041), spend significantly more hours in clinical training (P=0.04) and have significantly greater number of clinical areas specifically dedicated to Endodontics (P=0.010). Undergraduate endodontic teaching in Spanish dental schools follows the key recommendations of the ESE Undergraduate Curriculum Guidelines (Int Endod J 46, 2013, 1105), being, in most respects, comparable to that carried out in the UK (Int Endod J 52, 2019, 1077). The use of magnification and ultrasonic instruments needs to be increased. Private schools reported better results than public schools in some of the variables that were analysed.

Evaluation of tactile sensation for apical root canal Obturation

An accurate Working length is absolutely necessary for successful root canal treatment.Obturation of the root canal system forms the final Stage of root canal therapy and its success depends on obtaining perfect apical seal. The aim of this study is to evaluate the effect of tactile sensation in obtaining an optimum obturation. Three hundred and fifty radiograph of root filled teeth taken after obturation of clinical cases evaluated in this study. The root canal prepared and the length was determined by the tactile sensation. After the obturation final radiograph to evaluate the obturation in the apical area was recorded. The films (284 radiographs included in the study) were divided according to the sex, position in the jaws and the type of tooth. Two observers evaluate the radiograph for apical obturation separately. Three categories were used: The first category, which is given a score of zero for optimal obturation(1) mm from the anatomical apex, The second category, which is given a score of one, is regarded as an underfilled root canal filling which is more than (1) mm from the anatomical apex. And finally the third category which is given a score of two which is regarded as an overfilled filling when there is extension of the filling material beyond the anatomical apex. The data were tabulated and a non-parametric chi square analysis was used for statistical test. The percentage of optimum apical obturation was found in (66.55%) of cases while those scored (1)was (28.9%) and those scored (2) was (46%). The analysis showed that there was no effect of the sex of the patient or between both jaws or with regard tooth type. The result of the study showed that, under the circumstances of this work, the tactile sensation produce results as effective as other methods of working length determination and could be justified, under the circumstances that limit the availability of other methods for working length determination and in particular the X - ray machine for the general dentist in Iraq upon which a harsh sanction is imposed which include scientific and health sanction.

Apex Locator - Booster to Dentist : Literature Review

Successful root canal treatment depends on thorough cleaning &amp; shaping and 3- dimensional fluid impervious obturation of tooth within the confines of canals. To achieve this objective the apical constriction must be detected accurately during canal preparation and precise control over working length during the procedure must be maintained. There are many methods of working length determination including radigraphs and electronic method(apex locator). Introduction of apex locators have definitely served as an effective adjuvant to radiographs.

Evaluation of Apical Extent of Root Canal Instrumented Manually Using FlxoFile and Rotary Using ProTaper by the Aid of Dental Operating Microscope (An In Vitro Study)

Purpose: This study was designed to evaluate the influence of different apical limits of working lengths, electronic and radiographic methods of working length determination, maual and rotary root canal instrumentation on the apical extent of root canal filling material. Materials and Methods: Forty five roots of maxillary central incisors with mature apices were selected and divided into two groups: Group I ( 30 roots), and Group II (15 roots) according to the method of working length determination (electronic or radiographic respectively). Each main group was divided into three equal groups according to the apical limit of working Each group at main group (I) were subdivided into two equal subgroups: 1 and 2 (5 each) according to instrumentation system; rotary proTaper system or Flex-o-file while all roots at group (II) were cleaned & shaped with Flex-o-file. Each canal was obturated. The roots were longitudinally splitting .Under a surgical microscope, the integrity of apical constriction was observed and photographed. The distance between the apical terminus of the root canal filling and the apical foramen were measured and photographed by stereomicroscope. Results: ANOVA test revealed significant difference on the distance between the apical terminus of the root canal filling and the apical foramen were preserved at the three apical limits when working length and rotary canal preparation were carried by Tri Auto ZX headpiece, and when root canal were prepared by Flex-O-file after radiographic working length determination. Under different variables of this study, the integrity of apical constriction showed no significant difference. Conclusion: Electronic working length determination method is more accurate than radiographic method. Tri Auto ZX apex locating headpiece is a reliable method for electronic working length determination, and rotary root canal preparation.

Ex vivo investigation on the postoperative integrity of the apical constriction after the sole use of electronic working length determination

AimThe present study investigated the accuracy of root canal preparation with regard to the integrity of the apical constriction (AC) using two different working length determination approaches: (1) the electronic method of working length determination (EWLD), and (2) the radiologic “gold standard” method (GS). MethodologySimulation models were constructed by arranging extracted human teeth by means of silicon bolstered gingiva masks, along with a conductive medium (alginate). Electronic working length determination (group 1; EWLD) and radiologic plus initial electronic working length determination for posterior comparability (group 2; GS) preceded manual root canal preparation of teeth in both groups. Master cones were inserted according to working lengths obtained from the group specific method. Subsequently, root apices (n=36) were longitudinally sectioned using a diamond-coated bur. The distance between the achieved apical endpoint of the endodontic preparation and the apical constriction (AC) was measured using digital photography. Then, distances between radiologically identified apical endpoints and AC (GS–AC) were compared with the corresponding distances EWLD–AC. Moreover, the postoperative status of the AC was examined with regard to both preparation approaches. ResultsDifferences between distances GS–AC and EWLD–AC were not statistically significant (p >0.401) (Mann-Whitney-U). Among EWLD samples, 83% of the master cones exhibiting tugback at final insertion terminated close to the apical constriction (±0.5 mm), and no impairment of the minor diameter’s integrity was observed. ConclusionsThe sole use of EWLD allowed for a high accuracy of measurements and granted precise preparation of the apical regions.

Development and Evaluation of an Endodontic Simulation Model for Dental Students

The aims of this study were to develop an endodontic simulation model able to implement the electronic method of working length determination (electronic apex locators, EALs) in a dental school, to evaluate the practicality of this tool for dental students, and to compare the accuracy of working length measurements achieved by the EAL and the radiographic method. A new simulation model was constructed by embedding extracted human teeth in a self-cured resin, along with a conductive medium. After radiographic and electronic working length determinations, root canal instrumentation was performed by students at a dental school in Austria according to the working lengths obtained from the EAL. Subsequently, root apices (n=44) were longitudinally sectioned using a diamond coated bur. Measurements of the distance between the anatomical root apex (ARA) and the apical constriction (AC) as well as between ARA and the ascertained apical point of endodontic instrumentation were performed using digital photography and a 3D computer-assisted design software. The distance between ARA and the radiologic (ARA-R) or electrometric (ARA-EL) readings of the apical point of endodontic instrumentation was compared with the actual distance ARA-AC. The accuracy of both methods was determined. The difference between the actual distance ARA-AC and the targeted radiological distance was statistically significant (p=0.0001), as was the measured distance between ARA-R and ARA-EL (p=0.016). The electronic method seems to be more precisely referring to the AC (R(2)=0.0198) than the radiographic method (R(2)=0.0019). These results suggest that the endodontic simulation model described in this study can be successfully used in preclinical dental education.

Accuracy of Different Methods of Working Length Determination in Endodontics

Background: Accurate assessment of the working length determines the success and prognosis of endodontic treatment. There are no systematic reviews comparing the accuracy of different methods of working length determination in endodontics Aim: To evaluate clinical studies on the accuracy of different methods used for working length determination in endodontics. Search strategy: Search was conducted on Pub med central, Medline and Mesh data base for the related topic from 1991 to 2012. Articles were selected, if they met the following criteria: clinical trials, clinical studies, randomized controlled trials and controlled clinical trials. Results: There is no significant difference between conventional methods and electronic apex locators in the accuracy of working length determination. But electronic apex locators and digital radiographic methods were found to be beneficial from the perspective of radiation dose reduction. Conclusion: Electronic apex locators are not superior to radiographs in determining working length. Long term follow up studies evaluating post operative success comparing electronic apex locators and radiographic methods are needed to appreciate the best method of working length determination in endodontics.

A Survey of Endodontic Practices among Dentists in Nigeria

To investigate the pattern of routine endodontic practices among Nigerian dentists. This study was a questionnaire-based survey of samples of dentists in the Nigerian cities of Enugu and Benin. The self-administered questionnaire contained 25 close-ended questions with multiple choice options. The data collected included demographic details of respondents, root canal preparation techniques, irrigants and intracanal medicaments used, the number of appointments, method of working length determination, root filling techniques, cements used, and the scope of treatment performed. Most respondents used sodium hypochlorite as the irrigant, the step back technique for canal preparation, and lateral condensation with a zinc oxide-eugenol-based sealer for obturation. Most respondents did root canal treatment on all types of teeth and used radiographs to determine the working length 70% of the time. Most respondents followed up their patients for less than 12 months and most treated teeth with periapical areas larger than 10 mm by root canal therapy combined with apical surgery. Most Nigerian dentists use step back technique for canal preparation and lateral condensation for obturation. Endodontic practice by Nigerian dentists differs from some established practice quality guidelines in many other countries, particularly in nonperfusion of modern techniques into practice, popularity of antibiotic use for endodontic emergencies and a high rate of perforations.

Histomorphometric Study of the Root Apex of Mandibular Premolar Teeth: An Attempt to Correlate Working Length Measured with Electronic and Radiograph Methods to Various Anatomic Positions in the Apical Portion of the Canal

One aim of this study was to attempt to relate the position of the cementodentinal junction (CDJ) and the apical constriction to that of the apical foramen in mandibular premolars, as well as to measure the canal diameter at these various points. Another aim was to evaluate how electronic working length determination by Root ZX and radiographic method of working length determination correlated to the location of these various positions. The results showed that CDJ was detected at average distance of 0.3 mm from apical foramen with average canal diameter of 0.32 mm, whereas the apical constriction was detected at average distance from apical foramen of 1.2 mm with canal diameter of 0.22 mm. There was a statistically significant difference between file-tip position from apical foramen in group I working length measured by Root ZX and group II working length measured radiographically. Also this significant difference was found between file-tip position in both groups and CDJ and apical constriction. The average canal diameter at 0.5, 1, and 1.5 mm from apical foramen was 0.33 ± 0.11, 0.28 ± 0.06, and 25 ± 0.05 mm, respectively.

Comparison between two methods of working length determination and its effect on radiographic extent of root canal filling: a clinical study [ISRCTN71486641

BackgroundObtaining a correct working length is critical to the success of endodontic therapy. Different methods have been used to identify this crucial measurement. The Aim of this clinical study was to compare the effect of working length determination using apex locator alone or in combination with working length radiograph on the apical extent of root canal filling.MethodsA total number of 66 patients, 151 canals were randomized into two groups, In group (I) working length was determined by apex locator alone, while in group (II) working length was determined by apex locator confirmed by working length radiograph, length of obturation was assessed, and the total number of radiographs was recorded. The data were analyzed using SAS system and T. tests were carried out. Statistical significance was considered to be P ≤ 0.05.ResultsSixty seven canals in group I were treated with a mean distance from the tip of root canal filling to radiographic apex -0.5 mm ± 0.5 and a mean of a total number of radiographs of 2.0, while in group II eighty four canals were treated with a mean distance from the tip of root canal filling to radiographic apex -0.4 mm ± 0.5 and a mean of a total number of radiographs of 3.2. There was no statistically significant difference in the mean distance from the tip of root filling to radiographic apex between group I and group II (P > 0.05).ConclusionThe practice of using electronic apex locator in the determination of working length is useful and reliable with no statistical difference of the radiographic extent of root canal filling when using apex locator alone or in combination with working length radiograph. Under the clinical conditions of this study, it is suggested that the correct use of an apex locator alone could prevent the need for further diagnostic radiographs for determination of working length. This method can be useful in patients who need not to be exposed to repeated radiation because of mental, medical or oral conditions.

The modification of the refractive index of fluorite by heavy ion bombardment: J P Capuron et al, Vide, 29 (171–172), 1974, 337–340 ( in French)

Apical constriction has been proposed as the most appropriate apical limit for the endodontic working length. Despite being the most used, some limitations are attributed to the radiographic method of working length determination. It lacks precision because it is based on the average position of the apical constriction. The electronic apex locators have been presented as an alternative to the odontometry performed by radiography. These devices detect the transition of the pulp to the periodontal tissue, which is anatomically very close to the apical constriction and may perform with improved accuracy.A systematic review was performed to compare the radiographic and electronic methods. Clinical studies that compared both methods were searched for on 7 electronic databases, a manual search was performed on the bibliography of articles collected on the electronic databases, and the authors were contacted to ask for references of more research not detected on the electronic and manual search.Twenty-one articles were selected. The majority were comparative or evaluation studies, and very few clinical studies comparing both methods are available. Several methodological limitations are present on the collected articles and debated in this review.Although the available scientific evidence base is short and at considerable risk of bias, it is still possible to conclude that the apical locator reduces the patient radiation exposure and also that the electronic method may perform better on the working length determination. At least one radiographic control should be performed to detect possible errors of the electronic devices.

Experimental investigation of ion bombardment of cathodes in crossed electric and magnetic fields: V J Maljugin et al, Proc of 11th Internat Conf on Phenom in Ioniz Gases, Prague 1973, 86

Apical constriction has been proposed as the most appropriate apical limit for the endodontic working length. Despite being the most used, some limitations are attributed to the radiographic method of working length determination. It lacks precision because it is based on the average position of the apical constriction. The electronic apex locators have been presented as an alternative to the odontometry performed by radiography. These devices detect the transition of the pulp to the periodontal tissue, which is anatomically very close to the apical constriction and may perform with improved accuracy.A systematic review was performed to compare the radiographic and electronic methods. Clinical studies that compared both methods were searched for on 7 electronic databases, a manual search was performed on the bibliography of articles collected on the electronic databases, and the authors were contacted to ask for references of more research not detected on the electronic and manual search.Twenty-one articles were selected. The majority were comparative or evaluation studies, and very few clinical studies comparing both methods are available. Several methodological limitations are present on the collected articles and debated in this review.Although the available scientific evidence base is short and at considerable risk of bias, it is still possible to conclude that the apical locator reduces the patient radiation exposure and also that the electronic method may perform better on the working length determination. At least one radiographic control should be performed to detect possible errors of the electronic devices.