Length Determination with Radiographs

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  • #8894
    Anonymous
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    Apex locators have become commonplace in the clinical practice of endodontics. They have shown remarkable accuracy and reliability. Part of the skill in using an apex locator is understanding when the reading is reliable or not. There are certain conditions where an apex locator may not give a reliable reading and traditional length determination using radiographs is required.

    For radiographic length determination we rely upon our files and radiographs. For a quick review of terms, the radiographic apex is where the apex appears on the film. The anatomic apex is where the apical foramen is positioned, which may or may not be at the most apical part of the root. When using radiographs to determine the length of the root, it is recommended that we estimate the length of the root from 0.5mm-1.0mm from the radiographic apex.

    The reason for this estimation goes back to the early 1970’s.

    Palmer, Weine & Healy 1971 showed that when teeth are filled to the radiographic apex, the gutta percha is extruded out of the canal 50% of the time.

    Burch & Hulen 1972 found that the apical foramen deviated from the anatomic apex 78%-99% of the time.

    Because of these early length studies, it is recommended to estimate your length short by 0.5-1.0mm.

    #13661
    sushantpatel_doc
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    So which is a better tool in determining the length…apex locators or radiographs?

    #13662
    Anonymous

    In my view is that the accuracy of electronic apex locator is found to be optimum. This method of pulp space length estimation is found to be of great importance in cases where radiation can pose health risks. However a combination of methods can increase the accuracy of apical constriction
    location.

    #15751
    Drsumitra
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    The principle design and development of electronic apex locators date back to research
    undertaken by Suzuki in 1942. He found that electrical resistance between the periodontium and
    oral mucous membrane in dogs was a constant value.2
    Sunada, I. New method for measuring the length of the root canal. J Dent Res 1962; 41:375.
    This study carried Suzuki’s findings one step further. Using a simple DC ohmmeter, the electrical
    resistance between the periodontium and the oral mucous membrane was measured in 124 teeth.
    · Resistance between the periodontium and the oral mucous membrane in humans was constant at
    6.5 KW, regardless of the age of the patients or the shape and type of teeth. Contents of the canal
    (vital pulp vs. necrotic pulp) also had no effect upon the resistance.
    · Bottom Line: It was found that the resistance between the periodontium and the oral
    mucous membrane in humans was 6.5 KW

    Apex locators are also divided into 1
    st
    , 2
    nd
    , 3
    rd
    , and 4
    th
    generation.
    · First-generation apex location devices, also known as resistance apex locators, measure
    opposition to the flow of direct current or resistance. When the tip of the reamer reaches
    the apex in the canal, the resistance value is 6.5 kilo-ohms (current 40 mA).
    · Second-generation apex locators, also known as impedance apex locators, measure
    opposition to the flow of alternating current or impedance.
    · The principle on which “third-generation” apex locators are based requires a short
    introduction. In biologic settings, the reactive component facilitates the flow of
    alternating current, more for higher than for lower frequencies. Thus, a tissue through
    which two alternating currents of differing frequencies are flowing will impede the
    lower-frequency current more than the higher-frequency current. Since the impedance of
    a given circuit may be substantially influenced by the frequency of the current flow, these
    devices have been called “frequency dependent ”. Since it is impedance, not frequency
    that is measured by these devices, and since the relative magnitudes of the impedances
    are converted into “length” information, the term “comparative impedance” may be
    more appropriate.
    · The proposed “fourth-generation” apex locators are marketed by Sybron Endo and
    included the AFA Apex Finder and the Elements Diagnostic Unit. Both are ratio type
    Direct Current: Original Ohmmeters used by Suzuki and Sunada
    Resistance type:
    Root Canal Meter/The Endodontic Meter (Onuki)
    Sono Explorer (Salatec)
    Neosono-D, MC, and Ultima EZ (Amadent)
    Apex Finder (EIE – old version)
    Impedance type: Endocator (Hygienic) uses 400 kHz
    Subtraction
    (difference)
    type:
    Endex/Apit (Osada) uses 1kHz and
    5kHz
    Neosono Ultima EZ (Amadent)
    2
    frequencies
    Root ZX (J. Morita) uses 0.4kHz and
    8kHz
    Alternating
    Current:
    Frequency type:
    Ratio type:
    5
    frequencies
    The AFA Apex Finder (Sybron)
    Elements Diagnostic Unit (Sybron)3
    apex locators that determine the impedance at 5 frequencies and both have built-in
    electronic pulp testers.

     

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