International Journal of Clinical Pediatric Dentistry

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VOLUME 15 , ISSUE S1 ( Special issue-1 (Pediatr Endodont), 2022 ) > List of Articles


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

John Shibin, Prathima GS, Suganya M, Nandhakumar S, Kavitha M

Keywords : Electronic apex locator, Primary teeth, Pulpectomy, Working length

Citation Information :

DOI: 10.5005/jp-journals-10005-2330

License: CC BY-NC 4.0

Published Online: 28-02-2022

Copyright Statement:  Copyright © 2022; The Author(s).


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.

  1. Kumar LV, Sreelakshmi N, Reddy ER, et al. Clinical evaluation of conventional radiography, radiovisiography, and an electronic apex locator in determining the working length in primary teeth. Pediatr Dent 2016;38(1):37–41. PMID: 26892213.
  2. Oznurhan F, Ünal M, Kapdan A, et al. Clinical evaluation of apex locator and radiography in primary teeth. Int J Paediatr Dent 2015;25(3):199–203. DOI: 10.1111/ipd.12128
  3. Raghu KN, Daniel JG, Razvi S, et al. In vivo evaluation of the accuracy of working length determination using an electronic apex locater IPEX (NSK) on vital uninfected teeth and teeth with radiographic evidence of periapical lesions. J Int Soc Prev Community Dent 2014;4(6):S204–S208. DOI: 10.4103/2231-0762.149042
  4. Wankhade AD, Kumar R, Singh RK, et al. Root canal length determination by different methods in primary teeth: an in vivo study. Pediatr Dent 2013;35(2):E38–E42. PMID: 23635968.
  5. Dandempally A, Muppa R, Duddu MK, et al. Formulating a regression equation for determination of working length in primary molars using apex locators: a clinical study. Eur Arch Paediatr Dent 2013;14(6):369–374. DOI: 10.1007/s40368-013-0011-1
  6. Mello-Moura AC, Moura-Netto C, Araki AT, et al. Ex vivo performance of five methods for root canal length determination in primary anterior teeth Int Endod J 2010;43(2):142–147. DOI: 10.1111/j.1365-2591.2009.01667.x
  7. Leonardo MR, Silva LA, Nelson-Filho P, et al. Ex vivo accuracy of an apex locator using digital signal processing in primary teeth. Pediatr Dent 2009;31(4):320–322. DOI: 10.1111/j.1365-2591.2007.01366.x
  8. Beltrame AP, Triches TC, Sartori N, et al. Electronic determination of root canal working length in primary molar teeth: an in vivo and ex vivo study Int Endod J 2011;44(5):402–406. DOI: 10.1111/j.1365-2591.2010.01839.x
  9. Senthil D, Eagappan AS, Sathiyajeeva J, et al. Comparison of the accuracy of Propex II electronic apex locator and conventional radiography for working length determination in primary anterior teeth. J Int Oral Health 2016;8(6):729–732. DOI: 10.2047/jioh080617
  10. Dean JA, Avery DR, McDonald RE. Radiographic techniques. In McDonald and Avery's Dentistry for the child and Adolescent.9th ed. India: Elsevier Mosby.2011:47–63.
  11. Pinheiro SL, Bincelli IN, Faria T, et al. Comparison between electronic and radiographic method for the determination of root canal length in primary teeth RSBO RevistaSul–Brasileira de Odontologia 2012;9(1):11–16. ISSN: 1984-5685.
  12. Chougule RB, Padmanabhan MY, Mandal MS. A comparative evaluation of root canal length measurement techniques in primary teeth. Pediatr Dent 2012;34(3):e53–e56. PMID: 22795146.
  13. 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. DOI: 10.5005/jp-journals-10005-1403
  14. Nellamakkada K, Patil SS, Kakanur M, et al. 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. J Indian Soc Pedod and Prev Dent 2020;38(2):158–163. DOI: 10.4103/JISPPD.JISPPD_28_20
  15. Odabaş ME, Bodur H, Tulunoğlu O, et al. Accuracy of an electronic apex locator: a clinical evaluation in primary molars with and without resorption. J Clin Pediatr Dent 2011;35(3):255–258. DOI: 10.17796/jcpd.35.3.7w71656740286960
  16. Angwaravong O, Panitvisai P.Accuracy of an electronic apex locator in primary teeth with root resorption Int Endod J 2009;42(2):115–121. DOI: 10.1111/j.1365-2591.2008.01476.x
  17. Krishnan IS, Sreedharan S. A comparative evaluation of electronic and radiographic determination of root canal length in primary teeth: an in vitro study. Contemp Clin Dent 2012;3(4):416–420. DOI: 10.4103/0976-237X.107430
  18. Tosun G, Erdemir A, Eldeniz AU, et al. Accuracy of two electronic apex locators in primary teeth with and without apical resorption: a laboratory study Int Endod J 2008;41(5):436–441. DOI: 10.1111/j.1365-2591.2008.01389.x
  19. 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 Micros Res Tech 2020;83(11);1330–1335. DOI: 10.1002/jemt.23524
  20. Tinaz AC, Alacam T, Topuz O. A simple model to demonstrate the electronic apex locator Int Endod J 2002;35(11):940–945. DOI: 10.1046/j.1365-2591.2002.00576.x
  21. Nguyen HQ, Kaufman AY, Komorowski RC, et al. Electronic length measurement using small and large files in enlarged canals Int Endod J 1996;29(6):359–364. DOI: 10.1111/j.1365-2591.1996.tb01398.x
  22. Berman LH, Fleischman SB. Evaluation of the accuracy of the Neosono-D electronic apex locator J Endod 1984;10(4):164–167. DOI: 10.1016/S0099-2399(84)80121-1
  23. Hulsmann M, Pieper K. Use of an electronic apex locator in the treatment of teeth with incomplete root formation. Dent Traumatol 1989;5(5):238–241. DOI: 10.1111/j.1600-9657.1989.tb00368.x
  24. Janner SF, Jeger FB, Lussi A, et al. Precision of endodontic working length measurements: a pilot investigation comparing cone-beam computed tomography scanning with standard measurement techniquesJ Endod 2011;37(8):1046–1051. DOI: 10.1016/j.joen.2011.05.005
  25. de Morais AL, de Alencar AH, de Araújo Estrela CR, et al. Working length determination using cone-beam computed tomography, periapical radiography and electronic apex locator in teeth with apical periodontitis: a clinical study Iran Endod J 2016;11(3):164–168. DOI: 10.7508/iej.2016.03.003
  26. Shanmugaraj M, Nivedha R, Mathan R, et al. Evaluation of working length determination methods: an in vivo/ex vivo study. Indian J Dent Res 2007;18(2):60–62. DOI: 10.4103/0970-9290.32421
  27. Ghaemmaghami S, Eberle J, Duperon D. Evaluation of the Root ZX apex locator in primary teeth. Pediatr Dent 2008;30(6):496–498. PMID: 19186775.
  28. Bahrololoomi Z, Soleymani AA, Modaresi J, et al. Accuracy of an electronic apex locator for working length determination in primary anterior teeth. J Dent (Tehran) 2015;12(4):243–248. PMID: 26622278.
  29. Adriano LZ, Barasuol JC, Cardoso M, et al. 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(5):403–408. DOI: 10.1007/s40368-018-00413-5
  30. Ghule KD, Naik S. Comparing the accuracy of cone-beam computed tomography and electronic apex locator for root canal length determination in primary teeth. J Indian Soc Pedod Prev Dent 2019;37(2):157–161. DOI: 10.4103/1319-2442.261334
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