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Alafandy AS, Makieh RE. The difference distance between the apical foramen and the anatomical apex in primary teeth-An in vitro study. Clin Exp Dent Res 2023; 9:913-921. [PMID: 37703170 PMCID: PMC10582222 DOI: 10.1002/cre2.784] [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: 12/06/2022] [Revised: 06/28/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
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.
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Affiliation(s)
| | - Ramah Eimad Makieh
- Pediatric Dentistry DepartmentDamascus UniversityDamascusSyrian Arab Republic
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Paradiso D, Tullio A, Bensi C. Working length determination in primary teeth pulpectomy: A systematic review and meta-analysis. AUST ENDOD J 2023; 49:444-454. [PMID: 35770609 DOI: 10.1111/aej.12652] [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: 04/28/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Daniele Paradiso
- Maxillo-Facial Surgery Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Antonio Tullio
- Maxillo-Facial Surgery Unit, S. Maria della Misericordia Hospital, Perugia, Italy
- Maxillo-Facial Surgery, University of Perugia, Perugia, Italy
| | - Caterina Bensi
- Maxillo-Facial Surgery Unit, S. Maria della Misericordia Hospital, Perugia, Italy
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Vitali FC, Santos PS, Cardoso M, Massignan C, da Fonseca Roberti Garcia L, Bortoluzzi EA, da Silveira Teixeira C. Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies. Int Endod J 2022; 55:989-1009. [PMID: 35808837 DOI: 10.1111/iej.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Filipe Colombo Vitali
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Pablo Silveira Santos
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Mariane Cardoso
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Carla Massignan
- Department of Dentistry, University of Brasilia, Brasilia, Distrito Federal, Brazil
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Alencar NAD, Vitali FC, Santos PS, Bolan M, Cardoso M. Influence of the method for determining working length on the obturation level of primary molars. Braz Oral Res 2022; 36:e086. [PMID: 35703711 DOI: 10.1590/1807-3107bor-2022.vol36.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Efficient working length determination is essential for a successful endodontic treatment. The purpose of the present study was to evaluate whether the method for determining the working length of root canals (radiographic or electronic) influences the obturation level of primary molars. Thus, a controlled, triple-blind, randomized clinical trial was conducted. Sixty-four children aged 6 to 9 years with an indication for primary molar pulpectomy were included. Participants were divided into two groups according to the method used to determine the working length of the root canals: (G1) radiographic and (G2) using an electronic apex locator. The study had 3 operators: #1 performed the clinical procedures, except the electronic measurement; #2 performed radiographic measurement and final evaluation of obturation level; and #3 performed eligibility criteria and electronic measurement. Adequacy of obturation level was evaluated based on the final conventional radiography and it was recorded as acceptable or unacceptable (short or overfilled). Data were analyzed with repeated measures logistic regression. There was no difference between the obturation level of primary molars measured by radiographic and electronic methods (p > 0.05). The other investigated variables (age, tooth type, dental arch position, last instrumentation file, and canal location) also did not influence the obturation level (p > 0.05). In conclusion, both measurement methods resulted in similar adequacy of obturation level in primary molars after pulpectomy.
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Affiliation(s)
| | - Filipe Colombo Vitali
- Universidade Federal de Santa Catarina - UFSC, Department of Dentistry , Florianopolis , SC , Brazil
| | - Pablo Silveira Santos
- Universidade Federal de Santa Catarina - UFSC, Department of Dentistry , Florianopolis , SC , Brazil
| | - Michele Bolan
- Universidade Federal de Santa Catarina - UFSC, Department of Dentistry , Florianopolis , SC , Brazil
| | - Mariane Cardoso
- Universidade Federal de Santa Catarina - UFSC, Department of Dentistry , Florianopolis , SC , Brazil
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Shibin J, GS P, M S, S N, Adimoulame S, M K. Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth. Int J Clin Pediatr Dent 2022; 15:S92-S96. [PMID: 35645504 PMCID: PMC9108823 DOI: 10.5005/jp-journals-10005-2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- John Shibin
- Department of Pedodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Prathima GS
- Department of Pedodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Suganya M
- Department of Pedodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Nandhakumar S
- Department of Pedodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Sanguida Adimoulame
- Department of Pedodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Kavitha M
- Department of Pedodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
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Davalbhakta RN, Gokhale NS, Hugar SM, Badakar CM, Gowtham A, Soneta SP. Comparative evaluation of root ZX Mini® apex locator and radiovisiography in determining the working length of primary molars: An In Vivo study. J Oral Biol Craniofac Res 2021; 11:257-262. [PMID: 33680750 PMCID: PMC7918273 DOI: 10.1016/j.jobcr.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/02/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Working length determination is a crucial step for success of pulpectomy. Various new modalities have been developed. The newest technology includes EAL. Electronic apex locators require less chair side time, do not produce pain and avoid unnecessary radiation which makes it more superior in paediatric endodontic procedures. AIM To evaluate and compare Root ZX mini apex locator and Radiovisiography (RVG) for determining working length in primary molars. MATERIALS AND METHODS A sample of 30 primary molar teeth was subjected to working length determination by Root ZX mini and RVG. The data was collected and then tabulated and subjected to statistical analysis. RESULTS On comparison among two groups, it was found there was no difference between the efficiency of modalities. A positive correlation was seen among Root ZX mini and RVG (ICC = 0.99). CONCLUSION Root ZX mini and radiovisiography are seen to be precise in determination of working length in primary molars. It can be said that Root ZX mini i. e the electronic apex locators can be used as an adjunct to Radiovisiography and conventional radiography.
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Affiliation(s)
- Rucha N. Davalbhakta
- Department of Pedodontics and Preventive Dentistry, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, India
| | - Niraj S. Gokhale
- Department of Pedodontics and Preventive Dentistry, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, India
| | - Shivayogi M. Hugar
- Department of Pedodontics and Preventive Dentistry, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, India
| | - Chandrashekhar M. Badakar
- Department of Pedodontics and Preventive Dentistry, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, India
| | - A. Gowtham
- Department of Pedodontics and Preventive Dentistry, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, India
| | - Sanjana P. Soneta
- Department of Pedodontics and Preventive Dentistry, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, India
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Kayabasi M, Oznurhan F. Evaluation of the accuracy of electronic apex locators, cone-beam computed tomography, and radiovisiography in primary teeth: An in vitro study. Microsc Res Tech 2020; 83:1330-1335. [PMID: 32589353 DOI: 10.1002/jemt.23524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Mevlut Kayabasi
- Department of Pediatric Dentistry, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
| | - Fatih Oznurhan
- Department of Pediatric Dentistry, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey
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Brum ICS, Maia CA, Diniz MVT, Fernandes AM, Fernandes MLDMF. Agreement Between Working Length Measurements in Primary Teeth Obtained by Radiographs or Apical Locators. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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de Alencar NA, Oriano MD, Bolan M, Cardoso M. Is there any difference in length measurement methods for pulpectomies in primary teeth?-A double-blind, controlled clinical trial. Int J Paediatr Dent 2019; 29:712-719. [PMID: 31356705 DOI: 10.1111/ipd.12567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 07/01/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Working length is an important step in primary teeth pulpectomy. AIM To evaluate whether there is a significant difference in the accuracy of electronic apex locators compared to the conventional radiography in working length measurements. DESIGN Sixty-four children (192 canals) between 5 and 9 years of age with indication for pulpectomy of a primary molar were included after eligibility criteria. A radiographic measurement was obtained from pre-operative radiography from the cusp tip to the apex or resorption of the root. The electronic measurement was obtained from a complete measurement of the canal with an electronic device up to the apex. Data were analysed with Bland-Altman plots and Wilcoxon test. Statistical significance was set at P ≤ .05. RESULTS Statistically, there is not any significant difference between radiographic and electronic measurements for the palatal canal or distal canal, as well as mesiobuccal canals (P > .05). Statistically, there, however, is a significant difference between the measurements for the distobuccal canal and mesiolingual canal measurements (P < .05). High internal consistency for both radiographic and electronic methods was achieved (α ≅ 1). CONCLUSIONS Electronic and radiographic methods are similar in determining the length measurement of the root canals in primary teeth pulpectomies, except in distobuccal or mesiolingual canals.
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Affiliation(s)
- Nashalie Andrade de Alencar
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Marcela D'Avila Oriano
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Michele Bolan
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Mariane Cardoso
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Adriano LZ, Barasuol JC, Cardoso M, Bolan M. In vitro comparison between apex locators, direct and radiographic techniques for determining the root canal length in primary teeth. Eur Arch Paediatr Dent 2019; 20:403-408. [DOI: 10.1007/s40368-018-00413-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
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