Comparison of digital radiography and apex locator with the conventional method in root length determination of primary teeth

Evaluation of Different Techniques of Working Length Determination in Comparison with CBCT

AIM

To estimate the working length of teeth using conventional tactile technique, radiovisiography technique, Apex locator, and confirmation of working length by cone beam computed tomography technique.

MATERIALS AND METHODS

Forty patients with the age group between 20 and 50 years with irreversible pulpitis were included in this study. After taking a preoperative radiograph, the procedure was started. The cavity wall buildup was done using composite in the cases needed and then rubber dam application was done. The working length of mesiobuccal and mesiolingual canal was taken using cone beam computed tomography and this was considered as the standard value. Then using tactile method, length of the canal was measured using radiovisiographic software followed by apexlocator.

RESULT

The Apex locator has showed best result as compared to tactile and radiovisiography.

CONCLUSION

Apex locator values were closest to cone beam computed tomography working length measurement values and electronic apexlocator can be used efficiently as an alternative method for working length determination. The quality of various techniques according to ranks of working length determination was found to be Cone beam computed tomography (CBCT) > Apexloc > Radiovisiography (RVG) > Tactile. Thus, Apex locator can be used as an alternative to cone beam computed tomography for working length determination.

Working length determination in primary teeth pulpectomy: A systematic review and meta-analysis

The present meta-analysis aimed to describe the methods to determine the working length in primary teeth pulpectomy, also evaluating and comparing their reliability. A systematic review was performed following the PRISMA Statement. The electronic search was conducted on PubMed, Scopus, Cochrane Library and Web of Science. After the screening protocol, a number of 14 studies were included in the qualitative analysis, while seven were included in the quantitative one. The mean working length determined by the electronic apex locator was 11.8 mm (9.0-15.55), while 12.42 mm (11.0-13.52) and 12.3 mm (9.73-15.93) were the mean working length observed with the conventional radiography and the digital radiography, respectively. No statistically significant difference was detected in quantitative analysis between the investigated methods. The present meta-analysis showed that electronic apex locator, conventional radiography and digital radiography are similar in determining working length in primary teeth.

Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies

BACKGROUND

The lack of a well-defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length.

OBJECTIVES

To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies.

METHODS

Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta-analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta-analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS-2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Twenty-nine studies were included in the qualitative analysis and twenty-three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta-analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within -0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome.

DISCUSSION

The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice.

CONCLUSIONS

Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth.

A Comparative Evaluation of Efficacy of Electronic Apex Locator, Digital Radiography, and Conventional Radiographic Method for Root Canal Working Length Determination in Primary Teeth: An In Vitro Study

Aim

Pulpectomy in the primary tooth has unique challenges due to morphological variations in root pattern and physiological root resorption. The electronic apex locator (EAL) is one of the recent methods to determine the estimation of working length without much radiation exposure to the patient as well as the operator. The present study was undertaken for evaluating and comparing the efficacy of EAL, conventional radiography, digital radiography, and actual visual method for the estimation of in the root canal working length (RCL) in extracted primary teeth.

Materials and methods

Ninety extracted, single-rooted primary teeth were selected. Working length estimation was done with an EAL, conventional, and digital radiographic method, and compared it with an actual visual method.

Results

Accuracy of EAL was observed to be 99.7% followed by digital radiograph (98.1%) and conventional radiograph (96.1%). Both EAL and digital radiographic methods showed a high correlation as compared to conventional. The comparative efficacy of an EAL with a visual method was found to be statistically non-significant (p > 0.005).

Conclusion

Root canal working length determined through the electronic method was found to be an accurate and effective tool in single-rooted primary teeth and can be indicated for clinical implementation in endodontic treatment of primary teeth.

How to cite this article

Sahni A, Kapoor R, Gandhi K, et al. A Comparative Evaluation of Efficacy of Electronic Apex Locator, Digital Radiography, and Conventional Radiographic Method for Root Canal Working Length Determination in Primary Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(5):523–528.

Evaluation of the accuracy of electronic apex locators, cone-beam computed tomography, and radiovisiography in primary teeth: An in vitro study

Electronic apex locators (EALs), cone-beam computed tomography (CBCT), and radiovisiography (RVG) claim to determine of working length (WL) in primary molar teeth. To evaluate the accuracy of WL determination by using three EALs, RVG, and CBCT imaging in extracted human primary molar teeth with/without root resorption. Twenty extracted primary molar teeth with resorption and 20 extracted primary molar teeth without resorption were used. After measuring actual lengths (AL) (Group 1), the electronic WL measurements were performed by using three different EALs [COXO C Smart-1 Pro (Group 2), iPex (Group 3), and Apex ID (Group 4)]. Two different image sets were obtained as follows: CBCT imaging (Group 5) and RVG (Group 6). AL measurements performed with an endodontic measuring ruler and compared with the EAL, CBCT, and RVG image measurements. For all groups, there were no significant differences between the teeth with resorption and without. There were no significant differences in measuring methods from AL and between the methods used (p > .05). When electronic and radiographic method were compared in different frequency ranges, there was no statistically significant difference (p > .05). This study showed that EALs, CBCT, and RVG have high accuracy in primary molar teeth both with resorption and without root resorption and can be used for determining WL.

A clinical evaluation of two electronic apex locators and conventional radiography in working length determination in primary molar and its influence on children's behavioral responses

BACKGROUND

Accurate root canal length determination, simplicity of the procedure, and patient's cooperation are important determinants in the success of endodontic treatment in primary teeth.

AIM

The aim of the study was to clinically compare the accuracy of Propex Pixi and Formatron D10 apex locators with conventional radiography in determining working length in mandibular primary second molars with and without varying degrees of physiological root resorption.

DESIGN

A nonrandomized clinical trial was conducted in 115 mandibular primary second molars indicated for pulpectomy in 90 pediatric dental patients. A single calibrated examiner determined the working length by conventional radiographic method and electronic apex locator (EAL) methods in a total of 376 canals. Behavior of the children during execution of each method in each tooth was recorded using the Frankl's behavior rating scale. The data obtained were tabulated and subjected to statistical analysis.

RESULTS

Significant correlation (intraclass correlation = 0.80 and 0.81, P < 0.001) could be detected between working length measurements obtained using Propex Pixi and Formatron D10 and measurements obtained using conventional radiography. Higher percentage of negative behaviors (negative and definitely negative) was observed during the conventional radiographic method (68.6%) as opposed to the Propex Pixi (16.5%) and Formatron D10 (20.8%) methods.

CONCLUSIONS

Both the apex locators were as accurate as conventional radiography in determining working length in primary teeth; Formatron D10 being more accurate than Propex Pixi. The EALs were far better accepted by children than conventional radiography.

Photodynamic therapy for endodontic treatment of primary teeth: A randomized controlled clinical trial

OBJECTIVES

This study aimed to evaluate the reduction in bacterial load following conventional endodontic treatment with and without antimicrobial photodynamic therapy (a-PDT) in primary teeth.

METHODS

Thirty primary anterior teeth with a diagnosis of pulp necrosis were selected. Patients were randomly allocated to two groups as follows: Group I, patients undergoing conventional root canal therapy (n = 15) and Group II, patients undergoing conventional root canal therapy combined with antimicrobial PDT (n = 15). For PDT, methylene blue, at a concentration of 0.005 %, was used as the photosensitizing agent, which was applied to the interior of the canal with a sterile paper cone for 3 min, followed by the administration of laser light for 40 s (wavelength: 660 nm, energy density: 4 J/cm², power: 100 mW), delivered in direct contact at the entrance to the root canal. Two microbiological samples of the intra-canal content were taken (one before and one immediately after treatment in both groups) using paper cones. Clinical follow-up involved the investigation of fistulas and mobility and was performed 1- and 3 months after treatment. Data were statistically analyzed.

RESULTS

The reduction in bacterial load was 93 % in Group I and 99 % in Group II, with no statistically significant difference.

CONCLUSIONS

Conventional treatment combined with antimicrobial PDT with parameters used in this study proved effective but presented equal efficacious capability to conventional endodontic treatment alone.

CLINICAL SIGNIFICANCE

The use of PDT has been studied in endodontic treatment protocols in permanent teeth. However, clinical trials in deciduous teeth are necessary for establishing the effectiveness and parameters of this application. The present study analyzes the results of PDT in the endodontic treatment of deciduous teeth.

A smart rotary technique versus conventional pulpectomy for primary teeth: A randomized controlled clinical study

Background

Techniques with adequate accuracy of working length determination along with shorter duration of treatment in pulpectomy procedure seems to be essential in pediatric dentistry. The aim of the present study was to evaluate the accuracy of root canal length measurement with Root ZX II apex locator and rotary system in pulpectomy of primary teeth.

Material and Methods

In this randomized control clinical trial complete pulpectomy was performed on 80 mandibular primary molars in 80, 4-6-year-old children. The study population was randomly divided into case and control groups. In control group conventional pulpectomy was performed and in the case group working length was determined by electronic apex locator Root ZXII and instrumented with Mtwo rotary files. Statistical evaluation was performed using Mann-Whitney and Chi-Square tests (P<0.05).

Results

There were no significant differences between electronic apex locator Root ZXII and conventional method in accuracy of root canal length determination. However significantly less time was needed for instrumenting with rotary files (P=0.000).

Conclusions

Considering the comparable results in accuracy of root canal length determination and the considerably shorter instrumentation time in Root ZXII apex locator and rotary system, it may be suggested for pulpectomy in primary molar teeth.

Key words:Rotary technique, conventional technique, pulpectomy, primary teeth.

Comparison of Digital Radiography, Conventional Film and Self-Developing Film for Working Length Determination

INTRODUCTION

Accurate measurement of working length of the root canal is an important factor in endodontic treatment, because it determines the level of cleaning and shaping of the canal. This can be performed using numerous methods including conventional, digital and self-developing methods, which are studied in this work.

METHODS AND MATERIALS

In this study, 50 maxillary molars with appropriate conditions for the analysis were collected and their mesiobuccal canal lengths were estimated by three different types of radiographs with and without file. Next, two endodontists and a radiologist reviewed all the images under the same conditions. The precise lengths of the canals were measured by removing teeth from their casts and direct observation. Finally, data regarding differences in radiographic length and actual length were examined by SPSS 16.0 software and Repeated Measures ANOVA test.

RESULTS

There was no significant difference in any of the radiographic states. The differences of root canal lengths were not significant for the first (endodontist) and third (endodontist) observers; whereas, there were significant differences for the second observer (radiologist). The differences were not significant for samples without files (P=0.89). However, the differences were significant for samples with files (P=0.03).

CONCLUSION

Since analysis showed that there were no significant differences between the results of digital radiography, conventional film and self-developing film methods in working length determination, the clinician can choose any of these methods according to the working conditions without being concerned about losing the accuracy.

A Comparative Evaluation of Accuracy of New-generation Electronic Apex Locator with Conventional Radiography to determine Working Length in Primary Teeth: An in vivo Study

Aims

The purpose of this study was to evaluate the accuracy of a new-generation electronic apex locator (iPex) to determine working length in primary teeth with or without root resorption as compared with the conventional radiographic method.

Materials and methods

A sample of 30 primary posterior teeth which are indicated for pulpectomy were selected for the study. After obtaining the informed consent from the parents, local anesthesia was administered. Access cavity was prepared with no.10 round bur. Initial exploration of the canals was done with no.10 K-file. Pulp was extirpated with a barbed broach followed by thorough irrigation of the canals with 0.9% saline. Initially, working length was obtained with iPex (new-generation by Nakanishi International) apex locator using no.10 K-file, which was then compared with conventional radiographic method (Ingle’s method).

Results

A total of 65 canals were available for the measurement. The data were analyzed using Statistical Analysis system and t-tests were carried out. There was no statistically significant difference found when using iPex apex locator for working length determination as compared with that of conventional radiographic method (p = 0.511).

Conclusion

Working length determined by iPex apex locator is comparable with that of conventional radiographic method, hence, can be used as an alternative in determining the working length of primary teeth.

How to cite this article

Bhat KV, Shetty P, Anandakrishna L. A Comparative Evaluation of Accuracy of New-generation Electronic Apex Locator with Conventional Radiography to determine Working Length in Primary Teeth: An in vivo Study. Int J Clin Pediatr Dent 2017;10(1):34-36.

Comparative evaluation of three methods to measure working length - Manual tactile sensation, digital radiograph, and multidetector computed tomography: An in vitro study

AIM

Compare the measurement of working length with three different methods manual tactile sensation, digital radiography and Mutidetector computed tomography(MDCT).

MATERIALS AND METHOD

40 human premolar extracted for orthodontic purpose were selected. Teeth were store in sodium chloride (0.9%) during the study. Access cavity was prepared and canal patency was seen with no 10 file in each tooth. Manually no 15 K file was inserted from access cavity until the tip was visible at the foramen, a silicon stopper was adjusted to the corresponding buccal cusp tip and the root canal length was measured. After that in each tooth with no-15 K file inserted from access cavity with stop at tip of buccal cusp until tip appear at foramen and x-ray was taken with digital radiograph (RVG,Satelac) and canal length was measured. After that all teeth are mounted in wax block,MDCT scan was done and in the scan images of teeth, root canal length is measured from buccal cusp tip to root end. After taking measurement of working length with all three methods and the data was stastically analyzed with One Way Analysis of variance (ANOVA) followed by Turkey's Test.

RESULTS

ANOVA and turkeys test showed that there was no significant difference in the measurements by the three procedures (p>0.05).

CONCLUSION

Working length measurement with MDCT scan and other two conventional methods does not show significant difference in measurement. Use of newer 3D imaging technique is useful in root canal treatment for measuring working length.

Measurement Reliability of the Remaining Dentin Thickness below Deep Carious Lesions in Primary Molars

Aim

This study was carried out to assess the reliability of measurements of the remaining dentin thickness under deep carious lesions as estimated from digital radiographs. The goal is to allow clinicians to correlate the radiographic measurement to the exact value of the remaining dentin thickness. The results obtained will be tested further in a study that will evaluate the histopathologic pulpal state according to the caries’ lesion depth.

Materials and methods

The study was conducted in the Pediatric Dentistry Department at the Lebanese University, in collaboration with the research platform of the same university. Fifty deciduous molars with deep caries on proximal surfaces liable to extraction were collected. Before extraction, a digital in vivo periapical radiograph was taken, followed by manual excavation of the caries. After excavation, another radiograph was taken before the tooth was sectioned through the deepest site of the lesion. Another radiograph was then obtained for each tooth fragment. To evaluate the exact thickness of the remaining dentin, each fragment was measured on a histologic macropho-tograph. The measurements were then compared statistically using a paired-samples t-test, and a correlation was sought.

Results

No significant difference was observed in the radiographs between the measurement of the remaining dentin thickness before and after the excavation of caries. In contrast, the radiographic measurements of remaining dentin thickness were underestimated by an average of 20% compared with those made with macrophotographs.

Limitations

Interpretation of radiographs varies from one practitioner to another and is a function of the operator’s visual acuity.

Conclusion

Measuring the residual dentin thickness on a radiograph underestimates the actual thickness by about 20%. Further studies are needed to confirm these results.

Clinical significance

Our results indicate that remaining dentin thickness is greater in reality than is shown on a radiograph. This information can help clinicians to refine their diagnoses and treatment plans.

How to cite this article: Berbari R, Khairallah A, Kazan HF, Ezzedine M, Bandon D, Sfeir E. Measurement Reliability of the Remaining Dentin Thickness below Deep Carious Lesions in Primary Molars. Int J Clin Pediatr Dent 2018;11(1):23-28.

Evaluation of the effectiveness of photodynamic therapy for the endodontic treatment of primary teeth: study protocol for a randomized controlled clinical trial

BACKGROUND

The elimination of pathogenic microorganisms from the root canal system is one of the major steps required for successful endodontic treatment. The aim of the proposed study is to conduct a randomized, controlled, clinical trial for the clinical and radiographic evaluation of the effectiveness of photodynamic therapy during the endodontic treatment of primary teeth.

METHODS

Thirty primary anterior teeth in children aged 3 to 6 years old will be randomly divided into 2 groups: a control group, which will receive conventional treatment, and an experimental group, which will be subjected to photodynamic therapy. Microbiological evaluations will be performed before and after endodontic treatment. Moreover, clinical and radiographic evaluations will be performed on the day of treatment as well as 1, 3 and 6 months after treatment. Comparisons will be made of the two study groups. The data will be tabulated and presented in a descriptive, analytical fashion. Depending on the distribution (normal or non-normal), either the t test, ANOVA or the Mann-Whitney test will be used for analysis of the variables. The Wilcoxon test will be used for comparisons before and after treatment. P values<0.05 (95% significance level) will be considered indicative of statistically significant differences.

DISCUSSION

As successful endodontic treatment is directly related to intra-canal bacterial disinfection and considering the difficult task of endodontic treatment in primary teeth, often due to difficulties in controlling young children, the internal anatomy of root canals and root resorption, the alternative of using PDT is a painless,easy-to-administer method that does not lead to microbial resistance and can assist in the achievement of successful endodontic treatment in primary teeth by eliminating the pain children can experience due to retreatment as well as premature tooth loss.

TRIAL REGISTRATION

The protocol for this study was registered with Clinical Trials number NCT02485210 on 30 july 2015.

Clinical evaluation of apex locator and radiography in primary teeth

AIM

The aim of this in vivo study was to evaluate the accuracy and reliability of electronic apex locater and radiographic determination of root canal length in primary teeth.

METHODOLOGY

A total of 32 human primary molar teeth (96 roots) were selected. After endodontic access preparation, root canals were irrigated with physiological saline solution. The access cavities were dried with cotton pellets and, the roots were dried with paper points before performing the electronic measurement. The root canal length measurements were first taken with an apex locater (EndoMaster), and then, a size ♯ 15 K-file was inserted into the root canal, and radiography was taken to determine the working length measurements. The measurement data were recorded and compared by one-way anova and Kruskal-Wallis tests. P < 0.05 was accepted for the significance.

RESULTS

The mean values for radiography were 13.23 ± 1.92 mm and for EndoMaster were 13.08 ± 1.77 mm. The accuracy of EndoMaster was 80.2% in correct measurements ±1 mm (P < 0.001).

CONCLUSION

The electronic apex locators could be useful in determining working length and thereby decreasing the need for radiographs and exposure to ionizing radiation in pediatric dental patients.

Efficiency of 2 electronic apex locators on working length determination: A clinical study

AIMS

The aim of this clinical study was to evaluate the clinical accuracy of two electronic apex locators (EALs).

MATERIALS AND METHODS

A total of 120 patients with 283 roots were randomized into three groups including, traditional radiographic method, EAL (Root ZX mini), and apex locating endodontic motor (VDW Gold) for working length (WL) determination. Root canals were instrumented to a size ProTaper F3 nickel titanium file. The obturation quality of matched tapered master cone (ProTaper F3) was determined for the accuracy of WL.

STATISTICAL ANALYSIS USED

Descriptive statistics were expressed as numbers and percentages. Pearson Chi-square test was used to determine for differences between groups. P < 0.05 was considered statistically significant for all tests.

RESULTS

There was no statistically significant difference between the three tested groups (P = 0.894).

CONCLUSIONS

The success of both apex locators was similar to the radiographic WL determination technique.

A comparative evaluation of electronic and radiographic determination of root canal length in primary teeth: An in vitro study

Aims:

The purpose of this in vitro study was to compare the root canal length determination by Electronic apex locator (EAL) (Raypex 5) and conventional radiography, and then compare them with the actual measurements obtained by direct visualization.

Settings and Design:

This study was conducted at the Department of Pedodontics and Preventive Dentistry, Government Dental College, Thiruvananthapuram, Kerala, India.

Subjects and Methods:

One hundred single rooted primary teeth extracted due to extensive caries, trauma, serial extraction or unwillingness of the parent to save the teeth were selected. The teeth were numbered and root canal length was determined using the visual, electronic and the radiographic methods. The actual, electronic and the radiographic measurements were recorded.

Statistical Analysis Used:

Data were analyzed using Intraclass correlation test and linear regression analysis.

Results:

The accuracy of EAL and radiographic methods were 92% and 72%, respectively within + 0.5 mm. Both the electronic and conventional radiographic methods showed a high correlation and agreement (ICC intraclass correlation coefficient = 0.99 and 0.98 respectively) with the actual measurements.

Conclusions:

EALs proved to be more accurate in determining the root canal length than the radiographic method.

Comparison of working length determination using apex locator, conventional radiography and radiovisiography: an in vitro study

AIM

The purpose of this study was to compare the working length determination done using three methods, namely, apex locator (Foramatron D-10, Parkell), radiovisiography (Planmeca) and conventional radiography (Prostyle intra, Planmeca).

MATERIALS AND METHODS

In this experiment, to determine the working length, 35 single-rooted teeth were selected and each tooth was subjected to all the three methods of the working length determination. This was compared with the actual working length measured utilizing ground sections of the individual teeth.

RESULTS

The results revealed that all the three methods located the apex nearly as accurately as the actual root canal length obtained by histological ground sectioning, and among three methods apex locator being the closest to the actual root canal length.

CONCLUSION

The study concludes that all the three techniques are equally effective in determining working length.