In vivo assessment of the impedance ratio method used in electronic foramen locators.

BACKGROUND: The results of an in vivo study on the "ratio method" used in electronic foramen locators (EFL) are presented. EFLs are becoming widely used in the determination of the working length (WL) during the root canal treatment. The WL is the distance from a coronal reference point to the point at which canal preparation and filling should terminate. The "ratio method" was assessed by many clinicians with the aim of determining its ability to locate the apical foramen (AF). Nevertheless, in vivo studies to assess the method itself and to explain why the "ratio method" is able to locate the apical foramen and is unable to determine intermediate distances were not published so far. METHODS: A developed apparatus applies an electrical current signal with constant amplitude of 10 µARMS through the endodontic file within the root canal. The applied current signal is composed by summing six sine waves, from 250 Hz to 8 kHz. Data were acquired with the endodontic file tip at 7 different positions within root canals. In the frequency domain the quotients between the amplitude of a reference frequency and the amplitudes of the other frequencies components were calculated. Twenty one root canals were analyzed in vivo, during the endodontic treatment of twelve teeth of different patients, with age between 20 to 55 years. RESULTS: For the range of frequencies used in the commercial EFLs and for distances ranging from -3 mm to -1 mm of the AF, the impedance of the root canal is mainly resistive. However, when the file tip gets closer to AF, the root canal electrical impedance starts to change from a mainly resistive to a complex impedance. This change in the measured root canal impedance starts when the file tip is near -1.0 mm from the AF, getting stronger as the file tip gets closer to the AF. This change in the impedance behavior affects the ratio (quotient) of the impedance measured at different frequencies. Through graphic analysis it is demonstrated why EFLs based on the ratio method are unable to accurately measure any distances between - 3.0 and -0.5 mm from the apical foramen. The only reliable measurement is the 0 mm distance, which is when the file tip is at the AF. CONCLUSIONS: The electrical impedance values of 21 root canals were in vivo studied. The results confirm the ability of EFLs that are based on the ratio method to accurately locate the AF position and explain why they are unable to determine the file tip position along the root canal.

In vivo determination of the frequency response of the tooth root canal impedance versus distance from the apical foramen.

Working length (WL) determination is a key factor to the endodontic therapy or root canal treatment success. Almost all therapy procedures depend on this measure and the wrong WL determination may produce severe consequences, like post-therapeutic pain and the need of a new root canal treatment. Electronic foramen locators (EFL) have been replacing the traditional radiographic imaging as they are faster, easier to use and have a higher success rate when measuring WL. EFLs are based on the root canal impedance assessment between two electrodes: one fixed on the endodontic file that is inserted into the root canal, and the other positioned at oral mucosa membrane. There are only few reported studies that qualify or quantify the root canal impedance characteristics. The present work aims to determine the module of tooth root canal frequency response. The preliminary results show the frequency response module variation as a function of endodontic file position inside the root canal and reinforce the methods based on relative impedance over frequency analysis used in modern EFLs.