The Journal of Contemporary Dental Practice

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  25 (2024)
Volume  24 (2023)
Volume  23 (2022)
Volume  22 (2021)
Volume  21 (2020)
Volume  20 (2019)
Volume  19 (2018)
Volume  18 (2017)
Volume  17 (2016)
Volume  16 (2015)
Volume  15 (2014)
Volume  14 (2013)
Volume  13 (2012)
Volume  12 (2011)
Volume  11 (2010)
Volume  10 (2009)
Volume  9 (2008)
Volume  8 (2007)
Volume  7 (2006)
Volume  6 (2005)
Volume  5 (2004)
Volume  4 (2003)
Volume  3 (2002)
Volume  2 (2001)
Volume  1 (1999)
Related articles

VOLUME 24 , ISSUE 10 ( October, 2023 ) > List of Articles

ORIGINAL RESEARCH

Influence of Embedding Medium on iPex Electronic Apex Locator Accuracy: An Ex Vivo Comparative Study Using Alginate, Saline, and Gelatin Models

Amna Y Siddiqui

Keywords : Apex locators, Electronic apex locator, Electronic working length, Embedding medium, Endodontics, iPex, Working length determination

Citation Information : Siddiqui AY. Influence of Embedding Medium on iPex Electronic Apex Locator Accuracy: An Ex Vivo Comparative Study Using Alginate, Saline, and Gelatin Models. J Contemp Dent Pract 2023; 24 (10):733-738.

DOI: 10.5005/jp-journals-10024-3583

License: CC BY-NC 4.0

Published Online: 05-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: Accurate working length determination during root canal treatment is essential for achieving successful outcomes. This study aimed to evaluate the impact of embedding medium on the accuracy of iPex electronic apex locator (EAL). Materials and methods: Sixty-one extracted single-rooted teeth were decoronated and coronally flared with Gates-Glidden burs. Actual canal length (ACL) was obtained by introducing a size 8 K-file until its tip reached the most coronal border of the apical foramen. This step was performed thrice and then averaged. Deducting 0.5 mm from the ACL provided the working length (WL). The teeth were randomly placed in plastic containers filled with freshly mixed alginate, gelatin, or saline, with the lip clip placed in the medium. The blinded operator obtained electronic measurements using iPex by advancing a K-file with a size compatible with the canal attached to the file clip and advanced until the 0.0 mark, then withdrawn to the 0.5 mark. This step was performed thrice and then averaged. Data were analyzed using ANOVA and Tukey's post hoc test, with significance level set at 5% (α = 0.05). Results: The mean difference between WL and iPex length obtained in the gelatin model was significantly longer than the difference with mean iPex length in alginate (p = 0.005) and in saline (p < 0.001). There was no significant difference between iPex readings obtained in alginate and saline (p = 0.249). Conclusion: The use of freshly mixed alginate or saline for ex vivo assessment of iPex is recommended, whereas the use of gelatin could increase the chances of readings longer than looked for. Clinical significance: Identifying the optimum embedding medium for ex vivo testing of EALs permits the comparison and assessment of several factors affecting EALs’ precision under standardized conditions. This helps in understanding EAL performance in vivo and in optimizing its clinical utilization.

HTML PDF Share
  1. Sjögren U, Hägglund B, Sundqvist G, et al. Factors affecting the long-term results of endodontic treatment. J Endod 1990;16(10):498–504. DOI: 10.1016/S0099-2399(07)80180-4.
  2. American Association of Endodontists. Glossary of Endodontic Terms, 10th ed.; Chicago, IL, USA: AAE, 2020. Available from: https://www.aae.org/specialty/clinical-resources/glossary-endodontic-terms/.
  3. 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. DOI: 10.1046/j.1365-2591.1998.00183.x.
  4. Alothmani OS, Chandler NP, Friedlander LT. The anatomy of the root apex: A review and clinical considerations in endodontics. Saudi Endod J 2013;3(1):1–9. DOI: 10.4103/1658-5984.116273.
  5. ElAyouti A, Weiger R, Löst C. The ability of root ZX apex locator to reduce the frequency of overestimated radiographic working length. J Endod 2002;28(2):116–119. DOI: 10.1097/00004770-200202000-00017.
  6. Martins JNR, Marques D, Mata A, et al. Clinical efficacy of electronic apex locators: Systematic review. J Endod 2014;40(6):759–777. DOI: 10.1016/j.joen.2014.03.011.
  7. Alothmani OS, Friedlander LT, Chandler NP. Radiographic assessment of endodontic working length. Saudi Endod J 2013;3(2):57–64. DOI: 10.4103/1658-5984.118145.
  8. Shirazi Z, Al-Jadaa A, Saleh AR. Electronic apex locators and their implications in contemporary clinical practice: A review. Open Dent J 2023;17(1). DOI: 10.2174/18742106-v16-e221227-2022-67.
  9. European Society of Endodontology. Quality guidelines for endodontic treatment: Consensus report of the European Society of Endodontology. Int Endod J 2006;39(12):921–930. DOI: 10.1111/j.1365-2591.2006.01180.x.
  10. ElAyouti A, Connert T, Dummer P, et al. A critical analysis of research methods and experimental models to study working length determination and the performance of apex locators – A narrative review with recommendations for the future. Int Endod J 2022;55(Suppl 2):281–294. DOI: 10.1111/iej.13738.
  11. Gordon MP, Chandler NP. Electronic apex locators. Int Endod J 2004;37(7):425–437. DOI: 10.1111/j.1365-2591.2004.00835.x.
  12. Nasiri K, Wrbas KT. Accuracy of different generations of apex locators in determining working length: A systematic review and meta-analysis. Saudi Dent J 2022;34(1):11–20. DOI: 10.1016/j.sdentj.2021.09.020.
  13. Tsesis I, Blazer T, Ben-Izhack G, et al. The precision of electronic apex locators in working length determination: A systematic review and meta-analysis of the literature. J Endod 2015;41(11):1818–1823. DOI: 10.1016/j.joen.2015.08.012.
  14. Alothmani OS. The accuracy of Root ZX electronic apex locator. Saudi Endod J 2012;2(3):115–130. DOI: 10.4103/1658-5984.112702.
  15. Aurelio JA, Nahmias Y, Gerstein H. A model for demonstrating an electronic canal length measuring device. J Endod 1983;9(12): 568–569. DOI: 10.1016/S0099-2399(83)80063-6.
  16. Iparraguirre Nuñovero M, Piasecki L, Segato A, et al. A laboratory study of the accuracy of three electronic apex locators: Influence of embedding media and radiographic assessment of the electronic apical limit. Int Endod J 2021;54(7):1200–1206. DOI: 10.1111/iej. 13507.
  17. Duran-Sindreu F, Stöber E, Mercadé M, et al. Comparison of in vivo and in vitro readings when testing the accuracy of the Root ZX apex locator. J Endod 2012;38(2):236–239. DOI: 10.1016/j.joen.2011. 10.008.
  18. Siddiqui AY, Alothmani OS. Influence of hand file size on the accuracy of Root ZX and iPex electronic apex locators: An in vitro study. Cureus 2023;15(5):e39662. DOI: 10.7759/cureus.39662.
  19. Ebrahim AK, Yoshioka T, Kobayashi C, et al. The effects of file size, sodium hypochlorite and blood on the accuracy of Root ZX apex locator in enlarged root canals: An in vitro study. Aust Dent J 2006;51(2):153–157. DOI: 10.1111/j.1834-7819.2006.tb00419.x.
  20. Soares RMV, Silva EJNL, Herrera DR, et al. Evaluation of the Joypex 5 and Root ZX II: An in vivo and ex vivo study. Int Endod J 2013;46(10):904–909. DOI: 10.1111/iej.12078.
  21. Baldi JV, Victorino FR, Bernardes RA, et al. Influence of embedding media on the assessment of electronic apex locators. J Endod 2007;33(4):476–479. DOI: 10.1016/j.joen.2006.12.024.
  22. Chen E, Kaing S, Mohan H, et al. An ex vivo comparison of electronic apex locator teaching models. J Endod 2011;37(8):1147–1151. DOI: 10.1016/j.joen.2011.03.032.
  23. Wolf TG, Krauß-Mironjuk A, Wierichs RJ, et al. Influence of embedding media on the accuracy of working length determination by means of apex locator: An ex vivo study. Sci Rep 2021;11(1):1–10. DOI: 10.1038/s41598-021-82942-6.
  24. Aggarwal V, Singla M, Bhasin SS. Influence of instrument size and varying electrical resistance of root canal instruments on accuracy of three electronic root canal length measurement devices. Int Endod J 2017;50(5):506–511. DOI: 10.1111/iej.12649.
  25. de Vasconcelos BC, Bueno MM, Luna-Cruz SM, et al. Accuracy of five electronic foramen locators with different operating systems: An ex vivo study. J App Oral Sci 2013;21(2):132–137. DOI: 10.1590/1678-7757201302188.
  26. de Vasconcelos BC, do Vale TM, de Menezes AST, et al. An ex vivo comparison of root canal length determination by three electronic apex locators at positions short of the apical foramen. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110(2):e57–e61. DOI: 10.1016/j.tripleo.2010.03.005.
  27. Puri N, Chadha R, Kumar P, et al. An in vitro comparison of root canal length determination by DentaPort ZX and iPex apex locators. J Conserv Dent 2013;16(6):555–558. DOI: 10.4103/0972-0707. 120953.
  28. León-López M, Cabanillas-Balsera D, Areal-Quecuty V, et al. Influence of coronal preflaring on the accuracy of electronic working length determination: Systematic review and meta-analysis. J Clin Med 2021;10(13):2760. DOI: 10.3390/jcm10132760.
  29. Melo AM, Vivacqua-Gomes N, Bernardes RA, et al. Influence of different coronal preflaring protocols on electronic foramen locators precision. Braz Dent J 2020;31:404–408. DOI: 10.1590/0103-6440202003282.
  30. Diemer F, Plews E, Georgelin-Gurgel M, et al. Effect of sodium hypochlorite concentration on electronic apex locator reliability. Materials 2022;15(3):863. DOI: 10.3390/ma15030863.
  31. Alothmani OS, Siddiqui AY. Accuracy of Root ZX electronic apex locator in relation to two different employment protocols: An in vitro study. Cureus 2023;15(9):e44659. DOI: 10.7759/cureus.44659.
  32. Venturi M, Breschi L. A comparison between two electronic apex locators: An ex vivo investigation. Int Endod J 2007;40(5):362–373. DOI: 10.1111/j.1365-2591.2006.01229.x.
  33. Cianconi L, Angotti V, Felici R, et al. Accuracy of three electronic apex locators compared with digital radiography: An ex vivo study. J Endod 2010;36(12):2003–2007. DOI: 10.1016/j.joen.2010.08.036.
  34. Felippe WT, Felippe MC, Reyes Carmona J, et al. Ex vivo evaluation of the ability of the ROOT ZX II to locate the apical foramen and to control the apical extent of rotary canal instrumentation. Int Endod J 2008;41(6):502–507. DOI: 10.1111/j.1365-2591.2008.01386.x.
  35. Lucena-Martin C, Robles-Gijon V, Ferrer-Luque CM, et al. In vitro evaluation of the accuracy of three electronic apex locators. J Endod 2004;30(4):231–233. DOI: 10.1097/00004770-200404000-00012.
  36. Pascon EÁ, Marrelli M, Congi O, et al. An ex vivo comparison of working length determination by 3 electronic apex locators. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108(3):e147–e151. DOI: 10.1016/j.tripleo.2009.04.040.
  37. Plotino G, Grande NM, Brigante L, et al. Ex vivo accuracy of three electronic apex locators: Root ZX, elements diagnostic unit and apex locator and ProPex. Int Endod J 2006;39(5):408–414. DOI: 10.1111/j.1365-2591.2006.01095.x.
  38. Kaufman AY, Keila S, Yoshpe M. Accuracy of a new apex locator: An in vitro study. Int Endod J 2002;35(2):186–192. DOI: 10.1046/j.1365-2591.2002.00468.x.
  39. Campbell D, Friedman S, Nguyen H, et al. Apical extent of rotary canal instrumentation with an apexlocating handpiece in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85(3):319–324. DOI: 10.1016/s1079-2104(98)90016-6.
  40. Versiani MA, Santana BP, Caram CM, et al. Ex vivo comparison of the accuracy of Root ZX II in detecting apical constriction using different meter's reading. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108(1):e41–e45. DOI: 10.1016/j.tripleo.2009.03.009.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.