A comparison between two electronic apex locators: an in vivo investigation

AIM: To compare in vivo the Apex Finder and Root ZX electronic apex locators (EALs) at five different stages during root canal instrumentation. METHODOLOGY: The Apex Finder and Root ZX were used in 64 teeth with either vital or necrotic pulps. Informed consent was obtained by each patient under a study protocol approved by an ethical committee from the University of Trieste. Measurements were made: (stage 1) before instrumentation and irrigation; (stage 2) after brief filing, irrigation with 70% isopropyl alcohol and partial drying; (stage 3) after canal lubrication with EDTA gel (RC-Prep); (stage 4) after complete instrumentation and irrigation with NaOCl 5%; (stage 5) after drying of the final instrumented canal. Stages 2, 3 and 5 were considered low canal conductivity conditions and stage 4 as high. Teeth were then extracted and a size 15 K-file was inserted until its tip was observed under stereomicroscope to reach the foramen and the corresponding length was recorded to an accuracy of 0.25 mm and compared with values derived from the EALs. RESULTS: The data revealed 133 unstable measurements (out of 640): some (68) related to low canal conductivity conditions (more frequently for Root ZX, 67; P < 0.05), and others (63) related to NaOCl presence in the canal (more frequently for Apex Finder, 58; P < 0.05). Accuracy was calculated only on stable measurements. The Root ZX showed significantly (P < 0.05) more precise measurements overall (-0.03 +/- 0.39 mm) compared with the Apex Finder (-0.31 +/- 0.46 mm). Under dry canal conditions the Apex Finder provided the greatest accuracy (-0.0 +/- 0.21) compared with the Root ZX (-0.05 +/- 0.32) (significance P < 0.05). CONCLUSIONS: Under the five different clinical situations both EALs revealed accurate measurements. Apex Finder was negatively influenced by NaOCl in the root canal. The Root ZX was more frequently unable to reveal stable measurements in low conductivity canals.     

Accuracy of electronic apex locators using heat-treated Ni-Ti file

This study investigated the accuracy of two electronic apex locators (DentaPort and Bingo) using heat-treated nickel-titanium files. The true root canal length of 30 single-rooted teeth was determined using K files. Next, the electronically measured length was determined using two nickel-titanium files (ProGlider and HyFlex EDM Glide Path File) with two electronic apex locators at the ‘APEX’ marks. The accuracy of the electronic apex locator was evaluated by comparing the true root canal length and electronically measured length for each measurement. There was no significant difference between the measurements with two nickel-titanium files, and all differences between true root canal length and electronically measured length were within ±0.5 mm regardless of the type of nickel-titanium files or electronic apex locators. Based on the results, the heat treatment of the nickel-titanium files showed no adverse effects on the working length determination using electronic apex locators.     

Ex vivo evaluation of the accuracy of two electronic apex locators during root canal length determination in primary teeth

Aim To evaluate ex vivo the accuracy of two electronic apex locators during root canal length determination in primary incisor and molar teeth with different stages of physiological root resorption. Methodology One calibrated examiner determined the root canal length in 17 primary incisors and 16 primary molars (total of 57 root canals) with different stages of root resorption based on the actual canal length and using two electronic apex locators. Root canal length was measured both visually, with the placement of a K‐file 1 mm short of the apical foramen or the apical resorption bevel, and electronically using two electronic apex locators (Root ZX II – J. Morita Corp. and Mini Apex Locator – SybronEndo) according to the manufacturers’ instructions. Data were analysed statistically using the intraclass correlation (ICC) test. Results Comparison of the actual root canal length and the electronic root canal length measurements revealed high correlation (ICC = 0.99), regardless of the tooth type (single‐rooted and multi‐rooted teeth) or the presence/absence of physiological root resorption. Conclusions Root ZX II and Mini Apex Locator proved useful and accurate for apex foramen location during root canal length measurement in primary incisors and molars.     

In vivo comparison of the accuracy of two electronic apex locators

The aim of this study was to analyse in vivo the accuracy of two apex locators, Root ZX and Novapex, to determine the position of the apical constriction. Twenty-three human single-rooted teeth to be extracted for periodontal reasons constituted the experiment. Endodontic access was obtained and the apical constriction was determined by one of the apex locators after initial crown-down preparation. When the electronic marker indicated that the tip of the endodontic file was at the apical constriction, the teeth were filled with composite and then surgically removed. The presence of the endodontic file tip at the apical constriction was evaluated stereomicroscopically (30×) and confirming radiographs were exposed. The accuracy of Root ZX and Novapex was 91.7% and 81.8% respectively. Within the limits of this study, the evaluated apex locators have a similar clinical performance for the apical constriction location.     

An in vivo comparison of working length determination of two frequency-based electronic apex locators

Aim  To compare in vivo the accuracy of two electronic apex locators (EALs) by means of digital radiographic imaging system.
Methodology  Electronic working lengths of 831 canals were determined with the DentaPort ZX and Raypex 5 apex locators and confirmed radiographically. The radiographic images acquired with the aid of a digital radiographic imaging system (VisualiX eHD; Gendex Dental Systems, Des Plaines, IL, USA) were blindly analysed by two independent evaluators. The distance between the file tip and the radiographic apex was measured using dedicated software (VixWin Pro, Gendex Dental Systems, Des Plaines, IL, USA) and the mean distance achieved between different tooth type and EALs were compared statistically. Statistical analyses were performed using the t -test for independent samples and one-way anova with the null hypothesis set as 5%. Positive or negative values were recorded when the file tip was detected beyond or short of the radiographic apex, respectively.
Results  The mean distance between file tip and radiographic apex were −1.08 ± 0.73 and −1.0 ± 0.67 mm considering DentaPort ZX and Raypex 5 groups, respectively, with no significant differences ( P  > 0.05). No statistically significant differences were found amongst the same tooth type when comparing both groups ( P  > 0.05) or amongst different teeth type in the same group ( P  > 0.05).
Conclusions  Within the limitations of this in vivo study, the DentaPort ZX and Raypex 5 were similar in terms of accuracy.     

Determining the apical terminus of root-end resected teeth using three modern apex locators: a comparative ex vivo study

AIM: To assess ex vivo the accuracy of various electronic apex locators in locating the apical terminus of root-end resected teeth. METHODOLOGY: Ninety extracted human posterior teeth (182 root canals) were prepared to a minimum size of 40 and filled with gutta-percha and sealer. After resection of the apical 3 mm of the root, the root canal filling was removed using HERO rotary instruments. The size of the root canal at the apical terminus after removal of the filling ranged from size 50 to 90. The root canal length to the apical terminus was determined using 3 apex locators (Root ZX, Raypex4 and Apex Pointer). A new mounting model that utilized a micrometer was used to perform the measurements and to visually determine the actual position of the apical terminus. The frequency of locating the apical terminus and the corresponding 95% confidence interval (CI) were calculated. Additionally, the coefficient of repeatability of each apex locator and the limits of inter-operator agreement were determined. RESULTS: All apex locators showed an acceptable repeatability (0.02-0.03 mm coefficient of repeatability) and narrow limits of inter-operator agreement (+0.07 and -0.07 mm). The accuracy of determining the apical terminus within 1 mm in the root canal was as follows: Root ZX 90% (164/182 root-canals) [95%CI: 86-94%], Raypex4 74% (135/182 root-canals) [95%CI: 68-80%], and Apex Pointer 71% (129/182 root canals) [95%CI: 65-77%]. No over-instrumentation resulted when the Root ZX device was used. In contrast, using the Raypex4 or the Apex Pointer device resulted in over-instrumentation in 8 of 182 root canals (4%). CONCLUSIONS: Under the conditions of this study all three apex locators were able to detect the apical terminus of root-end resected teeth with an acceptable range. The Root ZX device was the most accurate without over-instrumentation of the root canals.     

Accuracy of four electronic apex locators: an in vitro evaluation

Abstract— In the present study, the accuracy and operator dependency of four electronic canal length measuring devices (Apex Finder AFA Model 7005, Apex-Finder, Neosono Ultima EZ and Apit 2) were compared under a set of specified conditions. The electronic apex locators were tested in unflared dry, flared wet and flared dry canals, and in a gelatin as well as in a sodium hypochlorite sponge model. Fifteen extracted single-canaled teeth were selected. The differences between canal lengths obtained by the electronic apex locators and actual canal lengths were scored. Only the Apex-Finder was found to be unreliable (measurements higher than ±0.5 mm from the apical foramen). This device was also found to be particularly dependent on operator. A ranking based on a precision of ± 0.1 mm from the apical foramen showed the Apex Finder AFA Model 7005 to be the most accurate. Early coronal flaring did not ensure better or more precise readings. The gelatin model was evaluated to be more suitable for testing electronic apex locators in vitro than the sodium hypochlorite model.     

Electronic apex locators

Prior to root canal treatment at least one undistorted radiograph is required to assess canal morphology. The apical extent of instrumentation and the final root filling have a role in treatment success, and are primarily determined radiographically. Electronic apex locators reduce the number of radiographs required and assist where radiographic methods create difficulty. They may also indicate cases where the apical foramen is some distance from the radiographic apex. Other roles include the detection of root canal perforation. A review of the literature focussed first on the subject of electronic apex location. A second review used the names of apex location devices. From the combined searches, 113 pertinent articles in English were found. This paper reviews the development, action, use and types of electronic apex locators.     

Ex vivo evaluation of the ability of four different electronic apex locators to determine the working length in teeth with various foramen diameters

BACKGROUND: The aim of this ex vivo study was to evaluate the accuracy of four electronic apex locators (EALs) to determine the working length in teeth with various foramen diameters. Our previous study revealed that electronically measured canal length was influenced by the root canal diameter. It is not known whether foramen size would interfere with the reading accuracy of an EAL. METHODS: A total of 36 extracted human lower single rooted premolar teeth were divided into four groups of nine teeth each. In groups A, B and C, the root canals were instrumented using #10-80, #10-100 and #10-120 K-files, and the tip of size #80, #100 and #120 K-files were permitted to pass through the apical foramen to a length of 1mm, respectively. In group D, the teeth were instrumented using #10-140 K-files and the tip of #140 K-file was permitted to pass through the apical foramen to a length of 5 mm. Thus, the average apical foramen diameters in groups A, B, C and D were approximately 0.82 mm, 1.02 mm, 1.22mm and 1.5 mm, respectively. The teeth were then mounted in 1% agar and four EALs were used: Root ZX, Foramatron D10, Apex NRG and Apit 7. For electronic measurement, sizes #10 and #80, #10 and #100, #10 and #120, and #10 and #140 K-files were used for groups A, B, C and D, respectively. During electronic measurement the canals were flushed with 6% sodium hypochlorite solution. RESULTS: Three-way ANOVA and Bonferroni test showed that EAL, file size and foramen size all had a significant influence on the measurement error (P<0.0001), with all the interactions between these three factors being significant (P<0.0001). CONCLUSIONS: The four EALs were unreliable to determine the working length of teeth with a wide apical foramen, when using a small size file. The Root ZX and Foramatron D10 showed significantly better scores than the other two EALs and may be more reliable to determine the working length of teeth with a wide apical foramen, if a tight-fit file is used.     

Ex vivo accuracy of three electronic apex locators: Root ZX, Elements Diagnostic Unit and Apex Locator and ProPex

AIM: To compare ex vivo the accuracy of three electronic apex locators (EALs): Root ZX, Elements Diagnostic Unit and Apex Locator and ProPex. METHODOLOGY: Electronic working length determination was carried out in 40 extracted teeth using an ex vivo model. After access preparation, a first operator determined the reference length (AL) for each tooth under a 30x stereomicroscope using the apical constriction as the apical landmark. All teeth were then measured with each EAL and the results obtained were compared with the corresponding AL. The AL was subtracted from the electronically determined distance. The measurements exceeding the AL were recorded as positive (long) and the measurements short of the AL were recorded as negative. Data were analyzed using the Friedman Test and Tukey multiple range test for nonparametric correlation amongst groups. Statistical significance was considered at P < 0.05. RESULTS: Comparing the differences between measurements obtained with the three EALs and those obtained with the stereomicroscope, the percentage of measurements within +/-0.5 mm of the AL was 97.37% (84.22% within 0.5 mm short of AL) for the Root ZX, 94.28% (88.57% within 0.5 mm short of AL) for the Elements and 100% (35.9% within 0.5 mm short of AL) for the ProPex. The mean difference between the AL and the lengths measured by the Root ZX, the Elements and the ProPex were, respectively, -0.157 +/- 0.228, -0.103 +/- 0.359 and 0.307 +/- 0.271 mm. CONCLUSIONS: The results of the present study confirm that the EALs determined the canal length within +/-0.5 mm from the apical constriction in the majority of cases. The majority of the ProPex readings were long.     

In vivo comparison of working length determination with two electronic apex locators

AIM: To compare the accuracy of two electronic apex locators (EALs) in the same teeth in vivo. METHODOLOGY: The working lengths in 20 teeth with a single canal were determined with two different EALs (Root ZX; J. Morita Corporation, Tokyo, Japan and Raypex 5 VDW, Munich, Germany) before extraction. When the first EAL was used the files were advanced until the display indicated the 'apical constriction'. The files were then fixed in removable and replaceable light curing composite patterns. The procedure was repeated in the same tooth with the second EAL and a different file. The teeth were then extracted and the apical 4 mm of the root canals were exposed. After that the apical parts with the repositioned files in the canals were digitally photographed under a light microscope. On the images the minor diameter and the major foramen of each sample were marked and the respective distances of the file tips from these positions were measured with a computer program. Subsequently the values of the two groups of EALs were compared using a paired sample t-test. RESULTS: The minor foramen was located within the limits of +/-0.5 mm in 75% of the cases with the Root ZX and in 80% of the cases with Raypex 5. The paired sample t-test showed no significant difference between the EALs regarding determination of the minor foramen. CONCLUSION: The use of EALs is a reliable method for determining working length. The differences between the two EALs were not statistically significant.     

Ex vivo comparison of two electronic apex locators with different scales and frequencies

AIM: To compare ex vivo the accuracy of two impedance quotient apex locators with different scales and frequencies of the measuring circuit. METHODOLOGY: In each root of 193 extracted human teeth, electronic working length determination (ELD) was carried out with a newly constructed measuring unit. In all cases, ELD was performed using the apex locators Justy II (Hager & Werken, Duisburg, Germany) and Raypex (VDW, Munich, Germany) on the scale points (sp) 0/0.5/1 of each device. A Miller Needle reaching working length was fixed with composite. The corresponding sp and the differences to the other sp were recorded. After histological preparation of the apical region, the teeth were examined under a light microscope. The distances of the Miller Needle tips to the target intervals 'minor foramen-major foramen' and 'apical canal constriction' (apical constriction) were determined for each sp for both devices. The data were statistically analysed by a chi-square test. RESULTS: Precise determination of the target interval 'minor foramen-major foramen' was successful with Raypex 4 in 94.8% (sp 1), 90.7% (sp 0.5) and 72.5% (sp 0) of cases and with Justy II in 59.6% (sp 1), 92.2% (sp 0.5) and 68% (sp 0) of cases. No measurement carried out by Raypex 4 and by Justy II on sp 1 was beyond the major apical foramen. However, on sp 0.5, there were eight measurements for Raypex 4 and four measurements for Justy II beyond the major apical foramen. Overinstrumentation was also recorded for sp 0 in 49 specimens (Raypex 4) and 59 specimens (JustyII). The major apical constriction was met exactly by Raypex 4 in 50.7% (sp 1), 14% (sp 0.5) and 5.2% (sp 0) of cases and by Justy II in 32.1% (sp 1), 23.8% (sp 0.5) and 4.1% (sp 0) of cases. The differences between the determination made with the sp suggested by the manufacturers for Raypex 4 (sp 1) and Justy II (sp 0.5) were not significant (P > 0.05) for the target interval 'minor foramen-major foramen' and significant (P 相似文献   

根尖定位仪测量根尖破坏牙根管长度的准确性研究

目的 比较Root ZX,Propex,Justy Ⅱ和 Raypex5 4种根尖定位仪测量根尖受破坏牙齿工作长度的准确性.方法 将53颗离体牙沿釉牙骨质界截冠、去髓,根管预备到25#,使用Root ZX(A组),Propex(B组),Justy Ⅱ(C组)和 Raypex5(D组) 4种根尖定位仪分别测量每个根管的工作长度;再使用超声倒预备工作尖将以上各牙沿根尖孔破坏根尖狭窄部,再次用4种根尖定位仪测量工作长度.结果 所得数据与解剖镜下测量的实际数据进行比较,根尖完整时A、B、C、D4组数据在-0.5～0.5 mm误差范围内的百分数分别为86.3%、88.8%、85.0%、88.8%.根尖破坏时A、B、C、D4组数据在-0.5～0.5 mm误差范围内的百分数分别为16.7%、20.5%、10.3%、48.7%,在-1～1 mm误差范围内的百分数分别为74.4%、52.6%、57.7%、91.0%.结论 4种根尖定位仪对于根尖破坏的牙齿测量准确性比根尖完整的牙齿要低,相比之下Raypex5的准确性比较高.     

Accuracy of three electronic apex locators in anterior and posterior teeth: an ex vivo study

Introduction

The aim of this study was to determine in anterior teeth, bicuspids, and molars (1) the accuracy of 3 different electronic apex locators (EALs) in detecting the apical foramen and (2) the accuracy of digital radiography in determining the working length (WL), compared with visible control under a microscope.

Methods

By using radiovideography (RVG), we measured the lengths of 120 root canals with 3 different EALs (Endex, ProPex II, and Root ZX) and compared them with the actual lengths. The accuracy of EALs and RVG was related to each dental category. An endodontic training kit (Pro-Train) was used during experimental procedures.

Results

Statistical analysis showed that the 3 EALs and RVG were less accurate in anterior teeth and molars than in bicuspids. The paired-sample t test showed no statistically significant difference between mesiodistal plane and buccolingual plane digital radiography in all groups.

Conclusions

The 3 EALs tested were more accurate in detecting the apical foramen in bicuspids than in both molars and anterior teeth. Radiographic measurements were not reliable for determining WL in all dental groups in both radiographic planes.