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Barakat RM, Almohareb RA, Alharbi AO, Alhazmi A, Alomar R. Comparative Accuracy and Reliability of Three Electronic Apex Locators in Determining the Apical Constriction of Molar Canals: A Micro-CT Evaluation. J Clin Med 2024; 13:5199. [PMID: 39274411 PMCID: PMC11396558 DOI: 10.3390/jcm13175199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/25/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Determining the correct apical limit for root canal treatment is essential for its success. This study evaluates the accuracy of three electronic apex locators (EALs) in locating the apical constriction (AC) in molar canals. Methods: Forty extracted human mandibular molars were scanned using micro-CT, and endodontic access cavities were created. Teeth were mounted in alginate, and three EALs-Root ZX-mini, Root ZX-II, and Sirona integrated apex locator-were used to measure the canal working length in dry canals and with EDTA gel. Micro-CT scans were performed with files in place, and the distance from the AC was calculated. Measurements within 0.1-0.5 mm were categorized as 'close'. Those extending beyond towards the major foramen were categorized as 'beyond', otherwise they were classified as 'far'. Data analysis was conducted with a level of significance set at 5%. Results: Most readings for all EALs were in the 'close' category, with significant differences between devices (p < 0.0001). Root ZX-mini and Root ZX-II had 74.4% and 72.5% 'close' readings, respectively, versus 51% for Sirona integrated. Accuracy did not differ significantly between dry and EDTA-treated canals (p = 0.306). All EALs demonstrated excellent operator reliability (ICC 0.996-1.00). Conclusions: All EALs accurately determined AC, unaffected by lubricants. However, Root ZX-mini and Root ZX-II outperformed Sirona integrated. All EALs showed consistent reliability.
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Affiliation(s)
- Reem M Barakat
- Dental Clinics Department, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Rahaf A Almohareb
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Arwa O Alharbi
- Dental Intern, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia
| | - Asma Alhazmi
- Dental Intern, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia
| | - Reem Alomar
- Dental Intern, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia
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2
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Eren İ, Sarıyılmaz Ö, Eren H, Sarıyılmaz E, Uslu G. Can ultrasonography be used to determine working length in endodontic treatment? An in vitro study. Odontology 2024; 112:453-459. [PMID: 37819467 DOI: 10.1007/s10266-023-00858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
This study was conducted to evaluate efficacy of ultrasonography (USG) in determining working length in in-vitro conditions. Twenty five access cavities of maxillary incisor teeth were opened and actual working lengths (AWL) were measured with dental operating microscope. The working length were then measured with an electronic apex locator and USG. USG and apex locator measurements were statistically analyzed using one sample t-test and compared with AWL. The mean AWL measurment was 20.68 mm. USG measured the working length slightly longer (21.09 mm) than the measurements of apex locator (20.64 mm). Statistical analysis showed that the USG method provided similar measurements to electronic apex locators and with no statistical difference with actual working length (P < .05). USG emerges as a promising method for working length measurement that allows simultaneous visualization of root tip anatomy in cases where electronic apex locators may be insufficient and there is buccal cortical bone loss.
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Affiliation(s)
- İrem Eren
- Faculty of Dentistry, Department of Endodontics, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Öznur Sarıyılmaz
- Faculty of Dentistry, Department of Endodontics, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hakan Eren
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Çanakkale Onsekiz Mart University, Kepez Çanakkale TR, Sahilyolu Cd No:5, 17100, Çanakkale, Turkey.
| | - Evren Sarıyılmaz
- Faculty of Dentistry, Department of Endodontics, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Gülşah Uslu
- Private Practice, Idadent Diş Kliniği, Çanakkale, Turkey
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3
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Siddiqui AY. Influence of Embedding Medium on iPex Electronic Apex Locator Accuracy: An Ex Vivo Comparative Study Using Alginate, Saline, and Gelatin Models. J Contemp Dent Pract 2023; 24:733-738. [PMID: 38152904 DOI: 10.5005/jp-journals-10024-3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM Accurate working length determination during root canal treatment is essential for achieving successful outcomes. This study aimed to evaluate the impact of embedding medium on the accuracy of iPex electronic apex locator (EAL). MATERIALS AND METHODS Sixty-one extracted single-rooted teeth were decoronated and coronally flared with Gates-Glidden burs. Actual canal length (ACL) was obtained by introducing a size 8 K-file until its tip reached the most coronal border of the apical foramen. This step was performed thrice and then averaged. Deducting 0.5 mm from the ACL provided the working length (WL). The teeth were randomly placed in plastic containers filled with freshly mixed alginate, gelatin, or saline, with the lip clip placed in the medium. The blinded operator obtained electronic measurements using iPex by advancing a K-file with a size compatible with the canal attached to the file clip and advanced until the 0.0 mark, then withdrawn to the 0.5 mark. This step was performed thrice and then averaged. Data were analyzed using ANOVA and Tukey's post hoc test, with significance level set at 5% (α = 0.05). RESULTS The mean difference between WL and iPex length obtained in the gelatin model was significantly longer than the difference with mean iPex length in alginate (p = 0.005) and in saline (p < 0.001). There was no significant difference between iPex readings obtained in alginate and saline (p = 0.249). CONCLUSION The use of freshly mixed alginate or saline for ex vivo assessment of iPex is recommended, whereas the use of gelatin could increase the chances of readings longer than looked for. CLINICAL SIGNIFICANCE Identifying the optimum embedding medium for ex vivo testing of EALs permits the comparison and assessment of several factors affecting EALs' precision under standardized conditions. This helps in understanding EAL performance in vivo and in optimizing its clinical utilization.
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Affiliation(s)
- Amna Y Siddiqui
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, Phone: +966555531081, e-mail: , https://orcid.org/0000-0003-0817-7129
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4
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Cîmpean SI, Chisnoiu RM, Colceriu Burtea AL, Rotaru R, Bud MG, Delean AG, Pop-Ciutrilă IS. In Vitro Evaluation of the Accuracy of Three Electronic Apex Locators Using Different Sodium Hypochlorite Concentrations. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050918. [PMID: 37241150 DOI: 10.3390/medicina59050918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The aim of this study was to compare the accuracy of three types of electronic apex locators (EALs) when two different concentrations of NaOCl irrigation solutions are used by two operators. Materials and Methods: After creating the access cavities for 20 single rooted extracted teeth, the actual canal length (ACL) of each canal was determined visually using a #10 file and magnification. The teeth were subsequently inserted in plastic molds filled with alginate. The electronic measurement of root canal length (EWL) was performed using three different electronic apex locators: Root ZX II, Apex ID, and Dual Pex. Two independent operators, an endodontic specialist with 20 years practice and an undergraduate student in the final year of study, performed the irrigation procedures with two different concentrations of NaOCl (2% and 5.25%), and then measured the EWL using each of the EALs. The accuracy of all EALs, was determined in each case by subtracting the EWL from the ACL. Statistical analyses were performed using one-way ANOVA test. Results: In the presence of 2% NaOCl solution, for a margin error of ±0.5 mm, Root ZX II, Apex ID, and Dual Pex presented an accuracy of 90%, 80%, and 85% respectively. The increase in the concentration of the irrigation solution affected the accuracy of Root ZX II and Apex ID for both operators, diminishing it to 75% for the same margin error, but improved Dual Pex's accuracy to 100%. Conclusions: The best accuracy in working length determination was obtained by Root ZX II for 2% NaOCl solution and by Dual Pex for 5.25% NaOCl solution with no significant statistical difference when compared.
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Affiliation(s)
- Sanda Ileana Cîmpean
- Department of Odontology, Endodontics and Oral Pathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Radu Marcel Chisnoiu
- Department of Odontology, Endodontics and Oral Pathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Adela Loredana Colceriu Burtea
- Department of Odontology, Endodontics and Oral Pathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Rareș Rotaru
- Student at Faculty of Dental Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania
| | - Marius Gheorghe Bud
- Department of Odontology, Endodontics and Oral Pathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Ada Gabriela Delean
- Department of Odontology, Endodontics and Oral Pathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Ioana-Sofia Pop-Ciutrilă
- Department of Odontology, Endodontics and Oral Pathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
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5
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De-Deus G, Cozer V, Souza EM, Silva EJNL, Wigler R, Belladonna FG, Simões-Carvalho M, Versiani MA. Micro-CT study of the in vivo accuracy of a wireless electronic apex locator. J Endod 2022; 48:1152-1160. [PMID: 35780927 DOI: 10.1016/j.joen.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study aimed to compare the in vivo accuracy of Wirele-X and RootZX II electronic apex locators (EALs) in determining the position of the major foramen using micro-CT as analytical tool. METHODS Eleven vital teeth from 5 patients planned for extraction were used. After conventional access cavity preparation, root canals were flared and negotiated up to the apical third with sizes 08 and 10 K-files followed by irrigation with 2.5% NaOCl. K-type files were used to determine the working length of the selected canals using Root ZX II and Wirele-X apex locators until their numeric displays read '0.0'. After fixing the silicon stop to the file, teeth were extracted and imaged in a micro-CT device using a double-scan protocol. Image stacks, with and without the file in the root canal, were then co-registered and the measurement error calculated as the absolute difference between the tip of the file and the major foramen. Positive and negative values were recorded when the file tip was detected beyond or short the major foramen, respectively. Accuracy was determined on stable measurements within ± 0.5 mm when the file tip did not extend beyond the major foramen. The Chi-square test was applied to compare the ability of the EALs to detect the position of the major foramen, while T test for dependent variables was used to verify differences in the two measurements obtained in each tooth. Significance level was set at 5%. RESULTS Within a tolerance level of ± 0.5 mm, no significant differences were observed between the tested EALs regarding the absolute distance values (p=0.82) or in their ability to detect the position of the major foramen (Χ2=0.2588; p=0.6109). The accuracy of the Root ZX II and the Wirele-X apex locators within ± 0.5 mm were 81.8% and 90.9%, respectively. CONCLUSIONS Root ZX II and Wirele-X performed similarly regarding the in vivo detection of the major foramen. Using strict criteria, the accuracy of the Root ZX II and the Wirele-X apex locators were 81.8% and 90.9%, respectively.
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Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
| | - Viviany Cozer
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | - Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil; Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Ronald Wigler
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Marco Aurélio Versiani
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil; Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil
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6
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Godiny M, Hatam R, Safari-Faramani R, Khavid A, Rezaei MR. Influence of Apical Patency, Coronal Preflaring and Calcium Hydroxide on the Accuracy of Root ZX Apex Locator for Working Length Determination: An In Vitro Study. JOURNAL OF ADVANCED ORAL RESEARCH 2021. [DOI: 10.1177/23202068211036139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: One of the main steps in a successful endodontic treatment is determining the correct working length (WL) of the root canal. In this regard, electronic apex locators (EAL) have been widely used for measuring the WL. The accuracy of EALs in determining the WL may be influenced by various factors. This study is aimed to evaluate the effects of apical patency, coronal preflaring, and calcium hydroxide on the accuracy of the EAL. Materials and Methods: In this in vitro study, 20 central incisor single-rooted human teeth with fully formed apex were considered. Then, samples were randomly divided into two study groups, ten samples in each group. The WL was determined and recorded at 0.5 mm distance to the apex using Root ZX apex locator before and after creating patency, coronal preflaring, and calcium hydroxide administration. All WLs were measured separately for each tooth and reviewed independently by two experienced operators with extensive experience in using EALs. Paired t test and Wilcoxon signed-rank test were applied and the significant level was at .05. Results: Statistical analysis of the obtained data showed a significant decline in the WL after apical patency and coronal preflaring ( P < .05). Moreover, WL exhibited a significant enhancement after calcium hydroxide application ( P < .05). Conclusion: Apical patency and coronal preflaring increased the accuracy of apex locators in determining the WL of the teeth. Besides, calcium hydroxide residues in the root canal reduced the accuracy of the apex locator.
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Affiliation(s)
- Mostafa Godiny
- Endodontics Department, Faculty of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Hatam
- Endodontics Department, Faculty of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Atefeh Khavid
- Oral and Maxillofacial Radiology Department, Faculty of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Reza Rezaei
- Student Research Committee, Dental School, Kermanshah University of Medical Sciences, Kermanshah, Iran
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7
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Bernardo RCFD, Alves LS, Bruno AMV, Coutinho TMC, Gusman H. The accuracy of electronic apex locators for determining working length: An in vitro study with artificial teeth. AUST ENDOD J 2020; 47:217-221. [PMID: 33368839 DOI: 10.1111/aej.12455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
This study aimed to determine the accuracy of four electronic apex locators (EALs) (I-Root, Propex Pixi, Novapex and Bassi iRoot Apex), using artificial mandibular and maxillary permanent molars. The root length (RL) from 40 artificial teeth was initially determined with Kerr hand files. Then, the electronic RL were obtained for the same root canals with each EAL, and the results were compared with those obtained using hand files. The accuracy of the EALs was determined through analysis of the divergences observed in relation to the lengths obtained with files. All EALs were effective for determining the RL in the artificial teeth, showing results similar to those obtained by hand. The Bassi iRoot Apex had higher accuracy (96.7%) than the Propex Pixi (89.1%) and Novapex (85.8%) (P < 0.05). Based on the results, all EALs tested had a similar performance, and artificial teeth may be used to determine the accuracy of these devices.
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Affiliation(s)
- Raquel C F D Bernardo
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Louise S Alves
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adilia M V Bruno
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thais M C Coutinho
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heloisa Gusman
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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8
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The Precision of Propex Pixi with Different Instruments and Coronal Preflaring Procedures. Eur Endod J 2019; 4:75-79. [PMID: 32161891 PMCID: PMC7006547 DOI: 10.14744/eej.2019.52724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to evaluate the influence of the instrument regarding the apical fit and type of the alloy and coronal preflaring procedures in the accuracy of Propex Pixi. Methods A total of 40 extracted human single-rooted permanent teeth with apical diameters of 200 µm were selected. A #10 K-file was inserted in the root canal until its end could be observed by a dental microscope to obtain the actual working length (WL). Electronic measurements were performed using Propex Pixi to the root apex ("0.0"). Different file alloys (stainless steel [SS] and nickel titanium [NiTi]) and sizes (#10, #15, and #20) were used before and after coronal flaring. Statistical analysis was performed by a factorial analysis of variance (P≤0.05). Results Results showed that the measurements of electronic length (EL) were closer to the actual working length (WL) after coronal flaring (P<0.05). A significant intraclass correlation was observed between EL and WL. In addition, results showed no significant differences between files with different sizes or alloys. Conclusion Under the conditions of this study, Propex Pixi demonstrated adequate precision. Its accuracy was enhanced by coronal preflaring procedures regardless of the instrument type used (SS or NiTi) and the apical fit.
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9
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AlRahabi MK. Evaluation of complications of root canal treatment performed by undergraduate dental students. Libyan J Med 2018; 12:1345582. [PMID: 28678645 PMCID: PMC5508642 DOI: 10.1080/19932820.2017.1345582] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study evaluated the technical quality of root canal treatment (RCT) and detected iatrogenic errors in an undergraduate dental clinic at the College of Dentistry, Taibah University, Saudi Arabia. Dental records of 280 patients who received RCT between 2013 and 2016 undertaken by dental students were investigated by retrospective chart review. Root canal obturation was evaluated on the basis of the length of obturation being ≤2 mm from the radiographic apex, with uniform radiodensity and good adaptation to root canal walls. Inadequate root canal obturation included cases containing procedural errors such as furcal perforation, ledge, canal transportation, strip perforation, root perforation, instrument separation, voids in the obturation, or underfilling or overfilling of the obturation. In 193 (68.9%) teeth, RCT was adequate and without procedural errors. However, in 87 (31.1%) teeth, RCT was inadequate and contained procedural errors. The frequency of procedural errors in the entire sample was 31.1% as follows: underfilling, 49.9%; overfilling, 24.1%; voids, 12.6%; broken instruments, 9.2%; apical perforation, 2.3%; and root canal transportation, 2.3%. There were no significant differences (p > 0.05) in the type or frequency of procedural errors between the fourth- and fifth-year students. Lower molars (43.1%) and upper incisors (19.2%) exhibited the highest and lowest frequencies of procedural errors, respectively. The technical quality of RCT performed by undergraduate dental students was classified as ‘adequate’ in 68.9% of the cases. There is a need for improvement in the training of students at the preclinical and clinical levels.
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Affiliation(s)
- Mothanna K AlRahabi
- a Department of Restorative Dentistry Science, College of Dentistry , Taibah University , Madinah Al Munawwarah , Saudi Arabia
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10
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Orosco FA, da Silva GF, Weckwerth PH, Lopes MTM, Garcia AMR, Duarte MAH, de Moraes IG. Influence of different sized files on the accuracy of two electronic apex locators. AUST ENDOD J 2017; 44:251-254. [PMID: 28940563 DOI: 10.1111/aej.12235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the impact of different file sizes on the accuracy of two electronic apex locators (EALs). Thirty extracted human single-rooted permanent mandibular incisors were used. A #10 K-file was inserted in the root canal until its end could be observed (using a light microscope) through the apical foramen. One millimetre was subtracted to establish working length (WL). Electronic readings were performed using MiniApex Locator or Root ZX II, from #10 K-file to #130 K-file. Statistical analysis was performed by two-way anova and Tukey test (P ≤ 0.05). From #60 to #130 K-file, observed differences were noted between the values obtained with both EALs and WL (P ≤ 0.05). The MiniApex Locator showed increased means when measurements were made with #50 to #70 and with #120 (P = 0.008) and #130 (P = 0.005) K-files. File sizes influenced the accuracy of EALs - the greater the instrumentation size, the higher mean differences compared to WL.
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Affiliation(s)
- Fernando A Orosco
- Pro-Rectory of Research and Post Graduation, Universidade do Sagrado Coração, Bauru, Brazil
| | - Guilherme F da Silva
- Pro-Rectory of Research and Post Graduation, Universidade do Sagrado Coração, Bauru, Brazil
| | - Paulo H Weckwerth
- Pro-Rectory of Research and Post Graduation, Universidade do Sagrado Coração, Bauru, Brazil
| | - Maria Thereza M Lopes
- Pro-Rectory of Research and Post Graduation, Universidade do Sagrado Coração, Bauru, Brazil
| | - Alan M R Garcia
- Pro-Rectory of Research and Post Graduation, Universidade do Sagrado Coração, Bauru, Brazil
| | - Marco Antônio H Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Ivaldo G de Moraes
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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11
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Aguiar BA, Reinaldo RS, Frota LMA, do Vale MS, de Vasconcelos BC. Root ZX Electronic Foramen Locator: An Ex Vivo Study of Its Three Models' Precision and Reproducibility. Int J Dent 2017; 2017:5893790. [PMID: 28367215 PMCID: PMC5359448 DOI: 10.1155/2017/5893790] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/14/2017] [Accepted: 02/23/2017] [Indexed: 11/17/2022] Open
Abstract
Although Root ZX is considered the gold standard electronic foramen locator (EFL), two variations of this device were launched, however without different operating mechanisms. This investigation aims to evaluate the precision of Root ZX (RZX), Root ZX II (RII), and Root ZX Mini (RM) EFLs. After access cavity preparation, 32 mandibular single rooted human premolars had their real length measured with the aid of a #15 K-type manual file under magnification (25x). Electronic measurements were performed by the devices in an alternate order until the apical foramen was reached (0.0). Each measurement was performed with adjusted file to the real length of the teeth and verified with a digital caliper. The accuracy of the EFLs was 68.8% (RZX), 65.8% (RII), and 68.8% (RM), considering ±0.5 mm as a margin of tolerance. The mean errors of the devices were 0.37 ± 0.25 mm (RZX), 0.41 ± 0.34 mm (RII), and 0.32 ± 0.28 mm (RM). ANOVA and Tukey test were applied to analyze the obtained data, which showed that there were no statistically significant differences among the locators (P > .05). It can be concluded that the three tested devices demonstrated precise measurements of the real length of the canal without performance differences among them.
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Affiliation(s)
| | | | | | - Mônica Sampaio do Vale
- School of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Campus Fortaleza, Fortaleza, CE, Brazil
| | - Bruno Carvalho de Vasconcelos
- Postgraduate Program in Dentistry, Federal University of Ceará, Fortaleza, CE, Brazil
- School of Dentistry of Sobral, Federal University of Ceará, Campus Sobral, Sobral, CE, Brazil
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12
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Aggarwal V, Singla M, Bhasin SS. Influence of instrument size and varying electrical resistance of root canal instruments on accuracy of three electronic root canal length measurement devices. Int Endod J 2016; 50:506-511. [PMID: 27079789 DOI: 10.1111/iej.12649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the influence of instrument size and the effect of the electrical resistance of endodontic instruments on the accuracy of three electronic root canal length measurement devices (ERCLMDs). METHODOLOGY Thirty single-rooted extracted human teeth were divided into three groups (n = 10) on the basis of the ERCLMD used: Root ZX II (J. Morita, Kyoto, Japan); ProPex (Dentsply Maillefer, Ballaigues, Switzerland); and iPex II (NSK, Tochigi, Japan). The electronic working length measurements (EWL) were made with K-files in the sequence sizes 08, 10, 15, 20, 25 and 30. The actual working length (AWL) was calculated by fixing a size 30 K-file in the canal and exposing the apical 5 mm of the root. The minor foramen was identified under an optical microscope, and its distance from the file tip was calculated. The accuracy of the ERCLMDs was evaluated in terms of percentages of accurate measurements (0.0 mm tolerance) and measurements with tolerance limits of ±0.5 mm and ±1.0 mm. The findings were analysed with the McNemar test, Pearson's chi-square tests and two-way analysis of variance. The multiple comparison procedures were carried out using Holm-Sidak method. The maximum electrical resistance tolerated by ERCLMDs was evaluated by connecting commercially available resistors between the file clip and the root canal instrument. The resistance was gradually increased until it started to affect the ERCLMD readings. RESULTS The ERCLMDs were able to actually locate the minor foramen in 7% of samples. File size did not affect the accuracy of ERCLMDs (P > 0.05). Overall, the ERCLMDs gave 65% readings within a tolerance limit of ±0.5 mm and 90% within a tolerance of ±1.0 mm. The electrical resistance of endodontic files was less than the maximum electrical resistance tolerated by ERCLMDs (0.6-1 Ω vs. 2500-4000 Ω). CONCLUSIONS The size of the root canal instrument did not affect the accuracy of ERCLMDs in this laboratory study.
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Affiliation(s)
- V Aggarwal
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - M Singla
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, India
| | - S S Bhasin
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Saatchi M, Rahimi I, Khademi A, Farhad AR, Nekoofar MH, Dummer PMH. Influence of tooth length on the accuracy of the Root ZX electronic apical foramen locator: an ex vivo study. Acta Odontol Scand 2015; 73:101-6. [PMID: 25299599 DOI: 10.3109/00016357.2014.956144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Electronic apical foramen locators are now widely used to determine working length. This study was designed to determine whether tooth length influenced the accuracy of the Root ZX device. MATERIALS AND METHODS Forty extracted maxillary canine teeth with a length range of 27-29 mm were selected. Access cavities were prepared and coronal flaring of canals performed. The teeth were mounted in self-polymerizing acrylic resin to facilitate horizontal sectioning except for the apical 3-4-mm portion of the root and embedded in alginate as the electronic medium. Electronic measurements were taken at the major foramen, 'zero' reading using the Root ZX and compared with the actual root canal length. The teeth were sectioned 3 mm from the coronal reference point to create a second group with shorter length; these reductions in the length continued six times in all to create seven groups of 40 specimens each. The actual and electronic lengths of specimens in each group were measured. Data were analyzed by Pearson's correlation coefficient. RESULTS Identical measurements between the actual and electronic root canal length from the longest to the shortest groups were 12.5%, 10.0%, 20.0%, 27.5%, 37.5%, 35.0% and 45.0%, respectively. There was a mild negative correlation between the precise measurements of the Root ZX and root canal lengths in the seven groups (r = -0.964, p < 0.001). CONCLUSION Under the conditions of the study, the Root ZX device was more accurate in shorter teeth compared to longer ones.
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Affiliation(s)
- Masoud Saatchi
- Torabinejad Dental Research Center, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences , Isfahan , Iran
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Uzunoglu E, Eymirli A, Uyanik MÖ, Çalt S, Nagas E. Calcium hydroxide dressing residues after different removal techniques affect the accuracy of Root-ZX apex locator. Restor Dent Endod 2014; 40:44-9. [PMID: 25671212 PMCID: PMC4320276 DOI: 10.5395/rde.2015.40.1.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/11/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study compared the ability of several techniques to remove calcium hydroxide (CH) from the root canal and determined the influence of CH residues on the accuracy of the electronic apex locator. MATERIALS AND METHODS Root canals of 90 human maxillary lateral incisors with confirmed true working length (TWL) were prepared and filled with CH. The teeth were randomly assigned to one of the experimental groups according to the CH removal technique (n = 14): 0.9% saline; 0.9% saline + master apical file (MAF); 17% ethylenediamine tetraacetic acid (EDTA); 17% EDTA + MAF; 5.25% sodium hypochlorite (NaOCl); 5.25% NaOCl + MAF. Six teeth were used as negative control. After CH removal, the electronic working length was measured using Root-ZX (Morita Corp.) and compared with TWL to evaluate Root-ZX accuracy. All specimens were sectioned longitudinally, and the area of remaining CH (CH) and total canal area were measured using imaging software. RESULTS The EDTA + MAF and NaOCl + MAF groups showed better CH removal than other groups (p < 0.05). Root-ZX reliability to prevent overestimated working length to be > 85% within a tolerance of ± 1.0 mm (p < 0.05). There was strong negative correlation between amount of CH residues and EAL accuracy (r = -0.800 for ± 0.5 mm; r = -0.940 for ± 1.0 mm). CONCLUSIONS The mechanical instrumentation improves the CH removal of irrigation solutions although none of the techniques removed the dressing completely. Residues of CH medication in root canals affected the accuracy of Root-ZX adversely.
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Affiliation(s)
- Emel Uzunoglu
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Ayhan Eymirli
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Mehmet Özgür Uyanik
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Semra Çalt
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Emre Nagas
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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da Silva TM, Alves FRF. Ex vivo accuracy of Root ZX II, Root ZX Mini and RomiApex A-15 apex locators in extracted vital pulp teeth. J Contemp Dent Pract 2014; 15:312-4. [PMID: 25307812 DOI: 10.5005/jp-journals-10024-1534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of this study was to compare, ex vivo, the accuracy of three electronic apex locators (EALs), Root ZX II, Root ZX Mini and RomiApex A-15, in detecting the apical foramen (AF). Forty extracted single-Rooted human teeth with vital pulp were used in this study. After access preparation, the Root canal length of each tooth was measured by placing a #10 file until the tip was visible at the AF under a stereomicroscope. The teeth were subsequently embedded in an alginate model. In each Root canal, all three EALs were used to determine the working length, which was defined as the zero reading or equivalent. The distance between the file tip and AF was measured to an accuracy of 0.01 mm. Results were analyzed using analysis of variance and the Chi-squared test. Root ZX II, Root ZX Mini and RomiApex A-15 were accurate within 0.5 mm, 62.5, 56.2, 50% of the time. No significant differences were found between the three EALs (p > 0.05). Considering all EALs, the mean distance from the file tip to AF was 4.49 mm. The accuracy of the three EALs evaluated in this study was not statistically significantly different. The 'Apex' or '0.0' marks of the EALs do not indicate the AF itself, but just a position coronal 0.49 mm to the AF. Using a tolerance of ± 0.5 mm from the actual lengths, the ZX II yielded the most acceptable measurements.
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Affiliation(s)
- Thaís M da Silva
- PhD Student, Department of Endodontics, Faculty of Dentistry, Estécio de Sé University, Rio de Janeiro, RJ, Brazil
| | - Flávio R F Alves
- Professor, Department of Endodontics, Faculty of Dentistry, Estécio de Sé University, Rio de Janeiro, RJ, Brazil, e-mail:
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Vasconcelos BCD, Bueno MDM, Luna-Cruz SM, Duarte MAH, Fernandes CADO. Accuracy of five electronic foramen locators with different operating systems: an ex vivo study. J Appl Oral Sci 2013; 21:132-7. [PMID: 23739852 PMCID: PMC3881880 DOI: 10.1590/1678-7757201302188] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 02/09/2013] [Indexed: 11/22/2022] Open
Abstract
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.
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Soares RMV, Silva EJNL, Herrera DR, Krebs RL, Coutinho-Filho TS. Evaluation of the Joypex 5 and Root ZX II: anin vivoandex vivostudy. Int Endod J 2013; 46:904-9. [DOI: 10.1111/iej.12078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/02/2013] [Indexed: 11/26/2022]
Affiliation(s)
- R. M. V. Soares
- Department of Restorative Dentistry; Endodontic Division; State University of Rio de Janeiro; Rio de Janeiro; Brazil
| | - E. J. N. L. Silva
- Department of Restorative Dentistry; Endodontic Division; State University of Rio de Janeiro; Rio de Janeiro; Brazil
| | - D. R. Herrera
- Department of Restorative Dentistry; Endodontic Division; State University of Rio de Janeiro; Rio de Janeiro; Brazil
| | - R. L. Krebs
- Department of Restorative Dentistry; Endodontic Division; State University of Rio de Janeiro; Rio de Janeiro; Brazil
| | - T. S. Coutinho-Filho
- Department of Restorative Dentistry; Endodontic Division; State University of Rio de Janeiro; Rio de Janeiro; Brazil
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Duran-Sindreu F, Stöber E, Mercadé M, Vera J, Garcia M, Bueno R, Roig M. Comparison of In Vivo and In Vitro Readings When Testing the Accuracy of the Root ZX Apex Locator. J Endod 2012; 38:236-9. [DOI: 10.1016/j.joen.2011.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/04/2011] [Accepted: 10/16/2011] [Indexed: 11/28/2022]
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González Sánchez JA, Duran-Sindreu F, de Noé S, Mercadé M, Roig M. Centring ability and apical transportation after overinstrumentation with ProTaper Universal and ProFile Vortex instruments. Int Endod J 2012; 45:542-51. [DOI: 10.1111/j.1365-2591.2011.02008.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evaluation of the Raypex 5 and the Mini Apex Locator: An In Vivo Study. J Endod 2011; 37:1349-52. [DOI: 10.1016/j.joen.2011.06.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/07/2011] [Accepted: 06/23/2011] [Indexed: 11/20/2022]
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Stöber EK, Duran-Sindreu F, Mercadé M, Vera J, Bueno R, Roig M. An Evaluation of Root ZX and iPex Apex Locators: An In Vivo Study. J Endod 2011; 37:608-10. [DOI: 10.1016/j.joen.2011.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/25/2011] [Accepted: 02/03/2011] [Indexed: 11/16/2022]
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Oliveira ML, Ambrosano GMB, Almeida SM, Haiter-Neto F, Tosoni GM. Efficacy of several digital radiographic imaging systems for laboratory determination of endodontic file length. Int Endod J 2011; 44:469-73. [DOI: 10.1111/j.1365-2591.2011.01860.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carvalho ALP, Moura-Netto C, Moura AAMD, Marques MM, Davidowicz H. Accuracy of three electronic apex locators in the presence of different irrigating solutions. Braz Oral Res 2010; 24:394-8. [PMID: 21180958 DOI: 10.1590/s1806-83242010000400004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 08/27/2010] [Indexed: 11/22/2022] Open
Abstract
The present study compared the accuracy of three electronic apex locators (EALs) - Elements Diagnostic®, Root ZX® and Apex DSP® - in the presence of different irrigating solutions (0.9% saline solution and 1% sodium hypochlorite). The electronic measurements were carried out by three examiners, using twenty extracted human permanent maxillary central incisors. A size 10 K file was introduced into the root canals until reaching the 0.0 mark, and was subsequently retracted to the 1.0 mark. The gold standard (GS) measurement was obtained by combining visual and radiographic methods, and was set 1 mm short of the apical foramen. Electronic length values closer to the GS (± 0.5 mm) were considered as accurate measures. Intraclass correlation coefficients (ICCs) were used to verify inter-examiner agreement. The comparison among the EALs was performed using the McNemar and Kruskal-Wallis tests (p < 0.05). The ICCs were generally high, ranging from 0.8859 to 0.9657. Similar results were observed for the percentage of electronic measurements closer to the GS obtained with the Elements Diagnostic® and the Root ZX® EALs (p > 0.05), independent of the irrigating solutions used. The measurements taken with these two EALs were more accurate than those taken with Apex DSP®, regardless of the irrigating solution used (p < 0.05). It was concluded that Elements Diagnostic® and Root ZX® apex locators are able to locate the cementum-dentine junction more precisely than Apex DSP®. The presence of irrigating solutions does not interfere with the performance of the EALs.
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de Vasconcelos BC, do Vale TM, de Menezes AST, Pinheiro-Junior EC, Vivacqua-Gomes N, Bernardes RA, Hungaro Duarte MA. An ex vivo comparison of root canal length determination by three electronic apex locators at positions short of the apical foramen. ACTA ACUST UNITED AC 2010; 110:e57-61. [DOI: 10.1016/j.tripleo.2010.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 02/12/2010] [Accepted: 03/02/2010] [Indexed: 11/15/2022]
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Ding J, Gutmann JL, Fan B, Lu Y, Chen H. Investigation of apex locators and related morphological factors. J Endod 2010; 36:1399-403. [PMID: 20647105 DOI: 10.1016/j.joen.2010.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the ability of three electronic apex locators (EALs) to detect the minor foramen and morphological influencing factors relative to working length determination. METHODS Three hundred fifty-six extracted teeth were decoronated, and the coronal portion of the canal was flared. The distance between the major foramen and the file tips (DMFF) was determined by different EALs. The relationship between the DMFFs determined by the EAL and the morphological features of the root apex was analyzed by linear regression analysis. RESULTS The average DMFFs were 0.261 mm, 0.376 mm, and 0.383 mm for the Root ZX (J. Morita, Kyoto, Japan), Raypex 5 (VDW, Munich, Germany), and Elements Apex Locator (SybronEndo, Anaheim, CA), respectively. The file tips determined by EALs were much closer to the major foramen in teeth with a "lateral major foramen" (p < 0.001). The area and diameters of the minor foramen were significantly related to the variation of the DMFFs determined by EALs. CONCLUSION When the "minor foramen" reading was given, the file tip connected to the Root ZX was much closer to the major foramen than the other two EALs. The minor foramen's morphology and the major foramen's location were both important influencing factors on the performance of EALs.
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Affiliation(s)
- Jiangfeng Ding
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
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Pascon EA, Marrelli M, Congi O, Ciancio R, Miceli F, Versiani MA. Anin vivocomparison of working length determination of two frequency-based electronic apex locators. Int Endod J 2009; 42:1026-31. [DOI: 10.1111/j.1365-2591.2009.01615.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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