Analysis of electronic apex locators in human teeth diagnosed with apical periodontitis

Abstract Electronic apex locators (EAL) have been used to establish the working length (WL) in root canal treatment. In teeth diagnosed with apical periodontitis, resorption of tooth apical structures can lead to difficulties to obtain an appropriate WL. The aim was to compare the capacity of three EAL's (Root ZX II, Raypex 6 and Endo-Eze Quill) to locate the tip of the K-file between 0 to -0.5 mm from the apical foramen (AF) on teeth diagnosed with asymptomatic apical periodontitis (AAP). Electronic working length was performed on 60 roots with AAP. A K-file #15 was inserted in the root canal until the apical foramen (AF) was located, and followed was re-adjusted to -0.5 mm through observation in EAL display. The K-file was fixed to the tooth with composite and teeth were extracted. The 4 apical millimeters were worn out until the K-file could be seen and were prepared and measured its distance to AF in a scanning electron microscope. Appropriate WL was when the tip of the K-file was located between 0 to -0.5 mm from AF. Results: Root ZX II showed significant difference (p<0.01) with the other two EALs. Root ZX II presented the better performance than Raypex 6 or Endo-Eze Quill in teeth with AAP.

Resumo Os localizadores eletrônicos apicais têm sido usados ​​para estabelecer o comprimento de trabalho no tratamento do canal radicular. Nos dentes diagnosticados com periodontite apical, a reabsorção das estruturas apicais dos dentes pode levar a dificuldades na obtenção de uma odontometria apropriada. Este estudo comparou três localizadores apicais (Root ZX II, Raypex 6 e Endo-Eze Quill) para localizar a ponta do instrumento K-file entre 0 a -0,5 mm do forame apical em dentes com diagnóstico de periodontite apical assintomática. O comprimento de trabalho eletrônico foi realizado em 60 dentes com periodontite apical assintomática. Uma lima K-file de número 15 foi inserida no canal radicular até a localização do forame apical, e seguida foi reajustada para -0,5 mm por meio de observação no visor do localizador eletrônico apical. A lima K-file foi fixada ao dente usando compósito, e a seguir os dentes foram extraídos. Os 4 milímetros apicais foram desgastados até que a lima K-file pudesse ser visualizada para as medidas de distância no forame apical por meio de microscópio eletrônico de varredura. O comprimento de trabalho apropriado foi determinado quando a ponta do instrumento estivesse localizada entre 0 a -0,5 mm do forame apical. O Root ZX II apresentou o melhor desempenho (p<0,01) que o Raypex 6 ou Endo-Eze Quill em dentes humanos com periodontite apical assintomática.

An In-vitro Evaluation of Auto Apical Reverse Motion of Tri Auto ZX at Working Length Determined by Dentaport Root ZX

Objective: To evaluate the auto apical reverse motion of Tri Auto ZX at working length determined by Dentaport Root ZX. Study design: Cross-sectional design. Place and duration of study: Department of Operative Dentistry, Islamic International Dental College, and the duration of study was 6 months. Materials and methods: Total 72 extracted teeth were used in the present study and standard access cavities were prepared in all the teeth. For in vitro working of Dentaport Root ZX and Tri Auto ZX an apparatus was designed which used normal saline as the conducting medium to ensure free movement of ions between electrodes of electronic apex locator (EAL). Working length was measured electronically using Dentaport Root ZX and noted as Electronic length (EL). The canals were then prepared using Protpaer files till F2 using Tri Auto ZX and the length at which it starts auto apical revere motion (AAR) was noted as AAR. Results: EL showed a mean of 14.69 ± 1.137 mm and SD of 1.137. Measurement at which Tri Auto ZX started its AAR motion showed that the minimum length of canal was 12.5 mm and maximum length was 17.5 mm with a mean of 14.687 ± 1.089 and SD of 1.087. The difference of root canal length measurements taken by EL and AAR motion of Tri Auto ZX showed a minimum difference of -1.5 mm and a maximum of 1 mm with mean difference of -0.014 ± 0.4819 mm. Out of 72 extracted teeth that were used in the present study the difference between EL and AAR was insignificant (p<0.05). Conclusion: In this study it was also established that not only Root ZX is capable of correct determination of the working length but its canal preparation module i.e. Tri Auto ZX is also capable of preparing the canal at the length determined by Root ZX.

In vivo assessment of accuracy of Propex II, Root ZX II, and radiographic measurements for location of the major foramen

OBJECTIVES: The aim of this in vivo study was to assess the accuracy of 2 third-generation electronic apex locators (EALs), Propex II (Dentsply Maillefer) and Root ZX II (J. Morita), and radiographic technique for locating the major foramen (MF). MATERIALS AND METHODS: Thirty-two premolars with single canals that required extraction were included. Following anesthesia, access, and initial canal preparation with size 10 and 15 K-flex files and SX and S1 rotary ProTaper files, the canals were irrigated with 2.5% sodium hypochlorite. The length of the root canal was verified 3 times for each tooth using the 2 apex locators and once using the radiographic technique. Teeth were extracted and the actual WL was determined using size 15 K-files under a × 25 magnification. The Biostat 4.0 program (AnalystSoft Inc.) was used for comparing the direct measurements with those obtained using radiographic technique and the apex locators. Pearson's correlation analysis and analysis of variance (ANOVA) were used for statistical analyses. RESULTS: The measurements obtained using the visual method exhibited the strongest correlation with Root ZX II (r = 0.94), followed by Propex II (r = 0.90) and Ingle's technique (r = 0.81; p < 0.001). Descriptive statistics using ANOVA (Tukey's post hoc test) revealed significant differences between the radiographic measurements and both EALs measurements (p < 0.05). CONCLUSIONS: Both EALs presented similar accuracy that was higher than that of the radiographic measurements obtained with Ingle's technique. Our results suggest that the use of these EALs for MF location is more accurate than the use of radiographic measurements.

Influence of Blood on the Accuracy of Raypex 5 and Root ZX Electronic Foramen Locators: An In Vivo Study

Abstract The aim of this study was to evaluate in vivo the accuracy of the Raypex 5 and Root ZX electronic foramen locators (EFLs) in the presence of blood in the root canal space. Forty single-canal teeth scheduled for extraction were selected. Access cavity was prepared and coronal enlargement was carried out. Approximately two drops of blood were collected by finger prick and injected into the root canal space. The electronic working length (EWL) of each tooth by each device was established twice before (NB group) and after (WB group) injecting blood into the root canal. The tooth was extracted and the actual working length (AWL) was determined. Data were analyzed using McNemar's test. The accuracy rates of Raypex 5 and Root ZX within 0.5 mm in the NB group were 88.9% and 91.5%, with 83.3% and 86.2% in the WB group, respectively. There were no significant differences between the accuracy of each EFL in the two groups (p>0.05). Considering the NB and WB groups, there were no statistically significant differences in the accuracy of the EFLs (p>0.05). The presence of blood in the root canal space did not influence the accuracy of the EFLs.

Resumo Este estudo objetivou avaliar in vivo a precisão dos localizadores foraminais eletrônicos (EFLs) Raypex 5 e Root ZX em presença de sangue no canal radicular. Foram utilizados 40 dentes unirradiculares destinados a extração. Foi preparada cavidade de acesso e feita ampliação coronária. Cerca de duas gotas de sangue obtidas por punção digital foram injetadas no canal. O comprimento eletrônico de trabalho (EWL) foi medido duas vezes antes (Grupo NB) e depois (Grupo WB) da injeção do sangue. O dente foi extraído e o comprimento real de trabalho (AWL) foi determinado. Os dados foram analisados com o teste de McNemar. As taxas de precisão a ±0,5 mm de Raypex 5 e Root ZX foram 88,9% and 91,5% no Grupo NB, e 83,3% e 86,2% para o Grupo WB, respectivamente. Não houve diferença significativa entre a precisão de cada um dos EFLs em ambos os grupos (p>0,05). Considerando os grupos NB e WB, não houve diferença significativa entre as precisões dos EFLs (p>0,05). A presença de sangue no canal radicular não influencou a precisão dos EFLs.

An In Vivo Study of Working Length Determination with a New Apex Locator

The success of an endodontic treatment relies on a correct working length determination. The canal terminus must be detected accurately and a precise control of the working length during the endodontic treatment must be maintained. The aim of this study was to investigate the working length determination in vivo with the Quill Apex Locator® for apical limit established at 1 mm short from the apical foramen (AF). Patients scheduled to dental extraction due to orthodontic or periodontal reasons were selected for this study, resulting in a sample of 24 root canals. Written informed consent was obtained from each patient before the treatment. After the administration of local anesthesia each tooth had its pulp cavity accessed. Next, the reading corresponding to the AF showed on the device's display was recorded and the file was removed. With the use of a digital caliper, 1 mm was subtracted from that first measurement. The file with the new measurement was introduced into to the root canal again then fixed with light curing flow composite and the tooth was extracted. Next, one of the apical third walls was worn out to visualize the instrument's point and the AF. The distance from the file tip to the AF was measured by scanning electron microscopy. The average of the measurements was 1.089±0.437 mm. The Bicaudal t-test showed no significant difference (p=0.338) between the experimental values and the hypothetical value tested at 1 mm. The present investigation confirmed that the Quill Apex Locator® was able to determine the working length with good reliability for the endodontic treatment, established at 1 mm short from the AF.

O sucesso do tratamento endodôntico depende da correta determinação do comprimento de trabalho. O término do canal deve ser detectado com precisão e o controle do comprimento de trabalho durante o tratamento deve ser mantido. A proposta dessa investigação foi avaliar a capacidade do localizador foraminal Quill® determinar o comprimento de trabalho, a partir da localização do forame apical, estabelecido no presente estudo em 1 mm aquém do forame apical. Pacientes com indicação para extração dental por motivos ortodônticos ou periodontais foram selecionados, resultando em uma amostra de 24 canais. O termo de consentimento livre e esclarecido foi obtido de cada paciente antes dos tratamentos. Após a administração de anestesia local, a cavidade pulpar foi acessada. Em sequência, as leituras correspondentes ao forame apical mostradas no display do aparelho foram registradas e a lima removida. Com o uso de paquímetro digital, 1 mm foi subtraído da primeira medida. A lima com a nova medida foi introduzida no canal radicular novamente, fixada com resina flow e então o dente foi extraído. Após, uma das paredes do terço apical foi desgastada para vizualização da ponta do instrumento e forame apical. A distância da ponta da lima ao forame apical foi mensurada no MEV. A média das medidas foi de 1,089mm (±0,437mm). O teste t Bicaudal mostrou não haver diferenças significantes (p=0,338) entre os valores experimentais e um valor hipotético testado de 1 mm. O localizador foraminal Quill® foi capaz de determinar um satisfatório comprimento de trabalho para o tratamento endodôntico, estabelecido em 1 mm aquém do forame apical.

Análise comparativa ex vivo da eficiência na odontometria de três localizadores apicais eletrônicos: root zx, bingo 1020 e ipex / Comparative analisys ex vivo of the accuracy of three apex locator: root zx, bingo 1020 and ipex

Introdução e Objetivo: O objetivo do presente estudo foi avaliar ex vivo a precisão da leitura de três localizadores apicais eletrônicos: Root ZX, Bingo 1020 e Ipex em relação à medida real dos dentes. Material e métodos: Foram selecionados 50 dentes pré-molares extraídos, unirradiculares. Após abertura coronária, a mensuração do comprimento do dente (CD) foi realizada diretamente pela inserção de uma lima K#10 no canal até que sua ponta fosse observada no forame apical com auxílio de uma lente de aumento (8X). Após a remoção da lima, seu comprimento foi registrado com precisão de 0,01 mm com uso de paquímetro digital. Em seguida, os dentes foram mensurados eletronicamente (CE) com os 3 localizadores apicais até atingir a marca 0 no visor de cada aparelho. As medidas obtidas eletronicamente foram comparadas com o CD e as diferenças analisadas pelo teste de Kruskal-Wallis e pelo teste de proporções (? = 0,05). Resultados: Verificou-se que o sistema Root ZX foi diferente do Ipex (p < 0,01) e o sistema Bingo apresentou resultado intermediário, mostrando-se estatisticamente semelhante aos sistemas Root ZX e Ipex (p > 0,05). Dentro do limite de tolerância de ± 1,0 mm, os resultados demonstraram uma precisão de 100% para o Root ZX, 94% para o Bingo e 90% para o Ipex quando comparados aos valores do CD. Porém, no limite de ± 0,5 mm a precisão obtida foi de 90% para o Root ZX, 68% para o Bingo e de 52% para o Ipex. Conclusão: Todos os dispositivos eletrônicos testados foram hábeis em determinar com precisão o comprimento do dente quando considerada uma variação de 1 mm em relação à posição do forame apical. Porém, quando considerada uma variação de 0,5 mm apenas o aparelho Root ZX mostrou-se preciso.

Introduction and Objective: The objective of this study was to evaluate ex vivo the reading accuracy of three electronic apex locators: Root ZX, Bingo 1020 and Ipex in respect to the real measure of the teeth. Material and methods: Fifty single root premolar teeth extracted were selected. After coronary access, the length tooth (LT) measurement was directly realized by insertion of a K#10 file until its tip was observed in the apical foramen with the help of a magnifying glass (8X). After removing the file, its length was recorded with accuracy of 0.01 mm using digital caliper. Then, the teeth were electronically measured (LE) whit three apex locators until to achieve the zero mark on the display of each unit. The measures electronically obtained were compared with the LT and the differences were analyzed by Kruskal-Wallis Test and Test of proportions (? = 0,05). Results: It was found that the Root ZX system was statistically different from Ipex (p <0.01), the Bingo system presented intermediary result and were statistically similar to the Root ZX and Ipex systems (p> 0.05). Within the limit of tolerance of ± 1.0 mm, the results showed an accuracy of 100% for ZX Root, 94% for Bingo and 90% for Ipex when compared to the LT values. However, in the limits of ± 0.5 mm the accuracy achieved was 90% for Root ZX, 68% for Bingo and 52% for the Ipex. Conclusion: It was concluded that all electronic devices tested were able in determining the precise tooth length when considered a variation of 1 mm from the position of apical foramen. But when considered a variation of 0,5mm only the unit Root ZX proved to be accurate.

An accuracy of the several electronic apex locators on the mesial root canal of the mandibular molar / 대한치과보존학회지

The aim of this study was to compare the length between the mesio-buccal and mesio-lingual canal of the mandibular molars before and after early coronal flaring at the different measuring time using several electronic apex locators. Fifty mandibular molars with complete apical formation and patent foramens were selected. After establishing the initial working length of the buccal and lingual canal of the mesial root using a surgical microscope (Carl Zeiss Co. Germany) at 25X with #15 K-file tip just visible at the foramen, radiographs were taken for the working length. After measuring the length of mesio-buccal and mesio-lingual canal (control group), the electronic lengths were measured at different times using several electronic apex locators (experimental groups; I-Root ZX, II-Bingo, III-Propex, IV-Diagnostic). After early coronal flaring using the K3 file, the additional electronic lengths were measured using the same manner. The results were as follows: One canal has a correct working length for the mesial root of the mandibular molar, it can be used effectively for measuring the electronic working length of another canal when the files are superimposed or encountered at the apex. In addition, the accuracy of the electronic apex locators was increased as the measurement was accomplished after the early coronal flaring of the root canal and the measuring time was repeated.