Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Accuracy of Four Different Apex Locators in Primary Molars: An In Vitro Study
Süt Molarlarda Dört Farklı Apeks Bulucunun Doğruluğu: Bir İn Vitro Çalışma
Ebru AKLEYİNa, Merve YENİÇERİ ÖZATAb , Sadullah KAYAb
aDepartment of Pediatric Dentistry, Dicle University Faculty of Dentistry, Diyarbakır, Türkiye
bDepartment of Endodontics, Dicle University Faculty of Dentistry, Diyarbakır, Türkiye
Turkiye Klinikleri J Dental Sci. 2023;29(2):270-6
doi: 10.5336/dentalsci.2022-93044
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of this study is to compare and evaluate the accuracy of 4 different electronic apex locators (EALs) (Root ZX Mini, Raypex 6, Propex Pixi, and E-Pex Pro) in primary molars with
and without root resorption. Material and Methods: Forty-eight mandibular primary molar teeth with (24 teeth) and without (24 teeth) physiological root resorption, each with 4 root canals, were included in the study (96 canals in with resorption group and 96 canals in without resorption group) (n=192 root canals). The actual working length (AWL) was determined by subtracting 0.5 mm from the measured length for each canal. The differences between AWL and electronic working length readings of the 4 EALs and accuracy rates within specified tolerance intervals (TI; ±0.5 and ±1.0 mm) were calculated. Results: The presence of resorption in the teeth significantly affected the measurement using Root ZX Mini (p<0.05). In teeth without resorption, all EALs yielded an accuracy rate of 100% at ±1.0 mm TI, whereas the accuracy rates ranged from 91.7% to 95.8% at ±0.5 mm TI. In teeth with resorption, EALs yielded accuracy rates of 74.0%-65.6% at ±1.0 mm TI and 52.1%- 60.4% at ±0.5 mm TI. Conclusion: At ±0.5 mm TI, Raypex 6 had greater accuracy in teeth without root resorption, whereas Propex Pixi had greater accuracy in teeth with root resorption. Apex locator preference may vary depending on the presence or absence of resorption.

Keywords: Primary tooth; electronic apex locator; working length; pediatric endodontics
ÖZET
 Amaç: Bu çalışmanın amacı, kök rezorpsiyonu olan ve olmayan süt azı dişlerinde 4 farklı elektronik apeks bulucunun (EAB) (Root ZX Mini, Raypex 6, Propex Pixi ve E-Pex Pro) doğruluğunu karşılaştırmak ve değerlendirmektir. Gereç ve Yöntemler: Fizyolojik kök rezorpsiyonu olan (24 diş) ve olmayan (24 diş), her biri 4 kanallı 48 mandibular süt molar diş çalışmaya dâhil edildi (96 kanal rezorpsiyon grubu için ve 96 kanal rezorpsiyon bulunmayan grup için) (n=192 kök kanalı). Gerçek çalışma uzunluğu (GÇU), her kanal için ölçülen uzunluktan 0,5 mm çıkarılarak belirlendi. Dört apeks bulucunun, GÇU ve elektronik çalışma uzunluğu okumaları arasındaki farklar ve belirtilen tolerans aralıkları (TA; ±0,5 ve ±1,0 mm) dâhilindeki doğruluk oranları hesaplandı. Bulgular: Dişlerde rezorpsiyon varlığı, Root ZX Mini kullanılarak yapılan ölçümü önemli ölçüde etkiledi (p<0,05). Rezorpsiyonsuz dişlerde, tüm EAB'ler ±1,0 mm TA'da %100 doğruluk oranı sağlarken, doğruluk oranları ±0,5 mm TA'da, %91,7-95,8 arasında değişmiştir. Rezorpsiyonlu dişlerde EAB'ler, ±1,0 mm TA'da %74,0-65,6 ve ±0,5 mm TA'da %52,1-60,4 doğruluk oranları vermiştir. Sonuç: ±0,5 mm TA'da Raypex 6, kök rezorpsiyonu olmayan dişlerde daha fazla doğruluğa sahipken, Propex Pixi kök rezorpsiyonu olan dişlerde daha fazla doğruluğa sahiptir. Rezorpsiyon varlığı veya yokluğuna göre apeks bulucu tercihi değişebilir.

Anahtar Kelimeler: Süt dişi; elektronik apeks bulucu; çalışma uzunluğu; pediatrik endodonti
REFERENCES:
  1. Mc Donald RE, Avery DR, Dean JA. Dentistry for the Child and Adolescent. 8th ed. St. Lous, Mo, USA: Mosby; 2004.
  2. Morankar R, Goyal A. Clinical and radiographic characteristics of the primary teeth indicated for pulpectomy: a cross-sectional analysis. Int Healthc Res J. 2018;2(9):223-8. [Crossref] 
  3. American Academy of Pediatric Dentistry. Pulp Therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago: American Academy of Pediatric Dentistry; 2021. p.399-407.
  4. Dandempally A, Muppa R, Duddu MK, Bhupatiraju P, Nallanchakrava S. 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):369-74. [Crossref]  [PubMed] 
  5. Nowak A. The Handbook-Pediatric Dentistry. 2nd ed. Chicago: American Academy of Pediatric Dentistry; 1999.
  6. Katz A, Mass E, Kaufman AY. Electronic apex locator: a useful tool for root canal treatment in the primary dentition. ASDC J Dent Child. 1996;63(6):414-7. [PubMed] 
  7. Mello-Moura AC, Moura-Netto C, Araki AT, Guedes-Pinto AC, Mendes FM. Ex vivo performance of five methods for root canal length determination in primary anterior teeth. Int Endod J. 2010;43(2):142-7. [Crossref]  [PubMed] 
  8. Neena IE, Ananthraj A, Praveen P, Karthik V, Rani P. Comparison of digital radiography and apex locator with the conventional method in root length determination of primary teeth. J Indian Soc Pedod Prev Dent. 2011;29(4):300-4. [Crossref]  [PubMed] 
  9. Gordon MP, Chandler NP. Electronic apex locators. Int Endod J. 2004;37(7):425-37. [Crossref]  [PubMed] 
  10. Lateef AA, Thyab SA, Nadhum NS. Estimation of root canal working length using three different apex locators: an in-vitro study. Indian J Forensic Med. 2021;15(3):1169-73. [Link] 
  11. Brunton PA, Abdeen D, MacFarlane TV. The effect of an apex locator on exposure to radiation during endodontic therapy. J Endod. 2002;28(7):524-6. [Crossref]  [PubMed] 
  12. Haupt F, Hülsmann M. Consistency of electronic measurements of endodontic working length when using multiple devices from the same manufacturer-an in vitro study. Clin Oral Investig. 2018;22(9):3107-12. [Crossref]  [PubMed] 
  13. Rimondini L, Baroni C. Morphologic criteria for root canal treatment of primary molars undergoing resorption. Endod Dent Traumatol. 1995;11(3):136-41. [Crossref]  [PubMed] 
  14. Bilaiya S, Patni PM, Jain P, Pandey SH, Raghuwanshi S, Bagulkar B. Comparative Evaluation of Accuracy of Ipex, Root Zx Mini, and Epex Pro Apex Locators in Teeth with Artificially Created Root Perforations in Presence of Various Intracanal Irrigants. Eur Endod J. 2020;5(1):6-9. [Crossref]  [PubMed]  [PMC] 
  15. Goldberg F, De Silvio AC, Manfré S, Nastri N. In vitro measurement accuracy of an electronic apex locator in teeth with simulated apical root resorption. J Endod. 2002;28(6):461-3. [Crossref]  [PubMed] 
  16. Çalışkan S, Delikan E, Cantekin K. Evaluation of methods for determining working length in root canal treatment for primary molars: an in-vivo study. Cyprus J Med Sci. 2021;6(2):141-5. [Crossref] 
  17. Kielbassa AM, Muller U, Munz I, Monting JS. Clinical evaluation of the measuring accuracy of ROOT ZX in primary teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(1):94-100. [Crossref]  [PubMed] 
  18. Mello-Moura ACV, Borelli T, Matos R, Bonini GC, Moura-Netto C. How can we optimize endodontics in primary teeth? A reported case. Rev Assoc Paul Cir Dent. 2013;67(1):50-5. [Link] 
  19. Camp JH. Pulp therapy for primary and young permanent teeth. Dent Clin North Am. 1984;28(4):651-68. [Crossref]  [PubMed] 
  20. Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. A histological study. Int Endod J. 1998;31(6):394-409. [Crossref]  [PubMed] 
  21. Garcia-Godoy F. Evaluation of an iodoform paste in root canal therapy for infected primary teeth. ASDC J Dent Child. 1987;54(1):30-4. [PubMed] 
  22. Oznurhan F, Ünal M, Kapdan A, Ozturk C, Aksoy S. Clinical evaluation of apex locator and radiography in primary teeth. Int J Paediatr Dent. 2015;25(3):199-203. [Crossref]  [PubMed] 
  23. Ahmad IA, Pani SC. Accuracy of electronic apex locators in primary teeth: a meta-analysis. Int Endod J. 2015;48(3):298-307. [Crossref]  [PubMed] 
  24. Ounsi HF, Naaman A. In vitro evaluation of the reliability of the Root ZX electronic apex locator. Int Endod J. 1999;32(2):120-3. [Crossref]  [PubMed] 
  25. Angwaravong O, Panitvisai P. Accuracy of an electronic apex locator in primary teeth with root resorption. Int Endod J. 2009;42(2):115-21. [Crossref]  [PubMed] 
  26. Bodur H, Odabaş M, Tulunoğlu O, Tinaz AC. Accuracy of two different apex locators in primary teeth with and without root resorption. Clin Oral Investig. 2008;12(2):137-41. [Crossref]  [PubMed] 
  27. Hulsmann M, Pieper K. Use of an electronic apex locator in the treatment of teeth with incomplete root formation. Endod Dent Traumatol. 1989;5(5):238-41. [Crossref]  [PubMed] 
  28. Nelson-Filho P, Lucisano MP, Leonardo MR, da Silva RA, da Silva LA. Electronic working length determination in primary teeth by ProPex and Digital Signal Processing. Aust Endod J. 2010;36(3):105-8. [Crossref]  [PubMed] 
  29. Tosun G, Erdemir A, Eldeniz AU, Sermet U, Sener Y. Accuracy of two electronic apex locators in primary teeth with and without apical resorption: a laboratory study. Int Endod J. 2008;41(5):436-41. [Crossref]  [PubMed] 
  30. Beltrame AP, Triches TC, Sartori N, Bolan M. Electronic determination of root canal working length in primary molar teeth: an in vivo and ex vivo study. Int Endod J. 2011;44(5):402-6. [Crossref]  [PubMed] 
  31. Bertoli FMP, Bruzamolin CD, Baratto Filho F, da Silva DA, Tomazinho FFS, Gonzaga CC, et al. Performance in vitro of apex locators in determining root length in primary molars. Rev Gaúch Odontol. 2016;64(3):244-9. [Crossref] 
  32. Demiriz L, Kocak MM, Saglam BC, Kocak S. In vitro evaluation of the accuracy of ProPex II, Raypex 6 and iPex II electronic apex locators in primary molar teeth. J Health Res Rev. 2016;3(2):37-40. [Crossref] 
  33. Srivastava V, Jain N, Bagchi S, Negi MPS. Evaluation of the use of sixth generation apex locators as a diagnostic tool to detect root perforations. Int J Dent Med Spec. 2015;2(4):10-4. [Crossref] 

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