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

The difference distance between the apical foramen and the anatomical apex in primary teeth-An in vitro study

INTRODUCTION

The apex area in the primary teeth changes continuously due to the physiologic resorption, therefore; the apical foramen (AF) may not correspond to the anatomic apex (AA), which gives a big challenge to achieve successful endodontic treatment. The aim of this research was to study the difference distance (DD) between the position of the AA and AF, besides the difference acceptance (DA) in primary teeth, and the effect of the following variables: root canal curvature, resorption degree, and canal size on DD and DA separately.

METHODS

In this research, 180 root canals from 60 primary teeth were studied. Two lengths of each canal were measured by a K-file from a certain point in the crown; the first length was until the AA and the second was until the AF. Then DD was obtained by calculating the difference between those two lengths. Statistical analysis tests were done. A p value of <.05 was considered significant at a 95% confidence level.

RESULTS

The percentage of canals with 0 mm DD was 34.4%, while it was 1.1% with DD of 6 mm. The percentages of acceptable ( ≤ 2 mm) and unacceptable ( > 2 mm) difference were 84.4% and 15.6%, respectively. There was a significant difference in the DD value between the three groups of curvature degree and the three groups of canal size. There was a significant difference between the DA in the three groups of canal size.

CONCLUSION

DD has a wide variation value in primary teeth regardless of the degree of root resorption, which has not affected this value or the accepted difference; however, DD and acceptable difference values are somehow affected by the degree of root curvature and canal size. We recommend adding acceptable difference as a criterion when considering pulpectomy treatment in primary teeth.

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.

Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth

Background

In primary teeth, working length determination is complicated due to its continuous alteration in dimension, shape, and root apex position. Accurate working length determination is essential to achieve the optimal cleaning and disinfection of the canal. Despite the use of conventional radiographic method, newer methods are available to increase the accuracy of WL determination. This study aims to compare electronic apex locator (EAL) with radiographic method of WL determination and to evaluate its accuracy using cone-beam computed tomography (CBCT).

Materials and methods

Sixty root canals from 34 extracted primary teeth were included. Occlusal surfaces were flattened and access opening done for all the samples. Teeth were subjected to working length determination by conventional radiograph and EAL. Samples were then mounted on a U-shaped wax and subjected to CBCT. Results were recorded and statistically analyzed using ANOVA and ICC for quantitative data.

Result

The mean measurement of radiographic, EAL and CBCT methods are 11.708, 11.200, and 10.895, respectively. Mean measurements demonstrated significant difference (p < 0.05) between three methods. ICC demonstrated high correlation between EAL and CBCT with Cronbach's α value of 0.962 and moderate correlation were observed between radiographic method and CBCT (0.706) and EAL and radiographic method (0.763). EAL demonstrated 87% accuracy whereas radiographic method demonstrated 63% accuracy to the actual length as evaluated by CBCT.

Conclusion

EAL is more accurate than conventional radiographic method as evaluated by CBCT.

How to cite this article

Shibin J, GS P, M S, et al. Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth. Int J Clin Pediatr Dent 2022;15(S-1):S92-S96.