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Langaliya AK, Patel N, Chaudhari E, Kothari A, Patel S, Rathod P. Comparative Evaluation of Different Apex Locators as a Diagnostic Tool to Detect Root Perforations: An In Vitro Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S828-S830. [PMID: 38595600 PMCID: PMC11000906 DOI: 10.4103/jpbs.jpbs_1045_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 04/11/2024] Open
Abstract
Aim The purpose of this study was to determine how effectively four distinct apex locators could diagnose root perforations in terms of accuracy and repeatability. Materials and Methods Eighty mandibular premolars with a single root were instrumented. The distal face of the root was perforated at both the apical and middle thirds, five millimeters from the apical terminus. K-files connected to apex locators were used for detection on teeth set in an alginate-filled box. Results The current research showed that all four apex locators accurately detected root canal perforations. Conclusion This study's findings show that all four apex locators were able to accurately and successfully identify root canal perforations.
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Affiliation(s)
- Akshayraj K. Langaliya
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Neeta Patel
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Ekta Chaudhari
- Department of Conservative Dentistry and Endodontics, Siddhpur Dental College, Siddhpur, Gujarat, India
| | - Anjali Kothari
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Shwetika Patel
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Pratiksha Rathod
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
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Harorlı H, Koç S, Kuştarcı A. In Vitro Comparison of the Accuracy of Cone-Beam Computed Tomography Scanning and Electronic Apex Locators in Detection of Simulated Root Perforations in Different Localizations. J Endod 2023; 49:1676-1681. [PMID: 37739340 DOI: 10.1016/j.joen.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION This study aimed to compare the accuracy of cone-beam computed tomographic (CBCT) scanning and 2 different electronic apex locators (EALs) in the detection of simulated root canal perforations in different localizations. METHODS Eighty human mandibular premolars were prepared and divided into 2 groups according to the localization of the perforation area, having a 1-mm diameter. The distance between the occlusal edge and the beginning of the perforation was measured under a stereomicroscope (actual working length) using 2 EALs (Propex II [Dentsply Maillefer, Ballaigues, Switzerland] and Dentaport ZX [J. Morita, Tokyo, Japan]) (electronic working length) and CBCT images (CBCT working length). The calculations were made by subtracting the actual working length from the electronic working length and the CBCT working length to determine the differences. RESULTS In the apical third perforation group, there was a significant difference between Dentaport ZX and CBCT imaging. There was no significant difference between Dentaport ZX and Propex II and Propex II and CBCT measurements. In the middle third perforation group, Propex II was significantly more successful than CBCT imaging. In addition, there was no significance between the accuracy of Propex II in detecting the perforation area between the apical third perforation group and the middle third perforation group. CBCT imaging was more accurate in detecting the perforation area in the apical third perforation group than in the middle third perforation group. CONCLUSIONS In cases in which the root canal perforation was in the apical third of the root, both the EAL and CBCT imaging were successful in determining the perforation area, whereas the success rate of all devices used in this study decreased when the perforation area was in the middle third of the root.
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Affiliation(s)
- Hatice Harorlı
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Simay Koç
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey.
| | - Alper Kuştarcı
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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Zanza A, Reda R, Testarelli L. Endodontic Orthograde Retreatments: Challenges and Solutions. Clin Cosmet Investig Dent 2023; 15:245-265. [PMID: 37899987 PMCID: PMC10612510 DOI: 10.2147/ccide.s397835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.
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Affiliation(s)
- Alessio Zanza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Reda
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
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Ghoncheh Z, Kaviani H, Soleimani S, Nasri S, Malekpour F, Afkhami F. Assessment of the diagnostic accuracy of strip and furcal perforations in different sizes by cone beam computed tomography. Oral Radiol 2023; 39:654-660. [PMID: 36961620 DOI: 10.1007/s11282-023-00681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Root perforation is an adverse event that may accidentally occur during root canal treatment and can adversely affect the treatment plan and tooth prognosis. This study aimed to assess the accuracy of cone beam computed tomography (CBCT) for detecting the strip and furcal perforations with different sizes. METHODS The mesiolingual canals of 155 extracted human mandibular first molars were instrumented and randomly divided into four experimental groups and one control group (n = 31). Furcal (in the pulp chamber floor) and strip perforations with 0.5, 1, 1.5, and 2 mm in diameter were manually created. The teeth were randomly mounted in bovine ribs and scanned using CBCT. Two radiologists unaware of the study groups observed the images and reported the greatest perforation diameter. The inter-observer agreements were calculated. The diagnostic accuracy was compared for furcal and strip perforations with different sizes. RESULTS The inter-observer agreement for detecting furcal and strip perforations with different sizes were good. The diagnostic accuracy was 100% for the absence of perforation in each group. CONCLUSIONS CBCT can detect the absence of perforation with high accuracy. The diagnostic accuracy of CBCT in the presence of strip and furcal perforation with different sizes was not significant.
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Affiliation(s)
- Zahra Ghoncheh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh Kaviani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Fatemeh Malekpour
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Afkhami
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Koç S, Kuştarcı A, Er K. Accuracy of different electronic apex locators in determination of minimum Root perforation diameter. AUST ENDOD J 2023; 49 Suppl 1:179-186. [PMID: 36354104 DOI: 10.1111/aej.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
This study aims to evaluate the ability of Raypex 6, Propex Pixi, Dentaport ZX, Apex ID, Propex II and Dr.'s Finder NEO to detect minimum root canal perforation diameter. One hundred single-rooted, extracted human teeth were artificially perforated by 5 burs in different diameters (0.25-1.25 mm) in 5 mm above the apex. Twenty teeth were assigned to each group. The actual canal lengths (AL) were measured under stereomicroscope followed by a measurement of electronic canal length (EL) using each electronic apex locator (EAL). None of the EALs were able to detect the perforation at diameters of 0.50 and 0.25 mm. Although all EALs used in our study were unable to detect perforations at diameters of 0.5 mm and 0.25 mm, they were highly successful in the determination of simulated root perforations at diameters of 1.25, 1 and 0.75 mm.
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Affiliation(s)
- Simay Koç
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Alper Kuştarcı
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Kürşat Er
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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Clauder T. Present status and future directions - Managing perforations. Int Endod J 2022; 55 Suppl 4:872-891. [PMID: 35403711 DOI: 10.1111/iej.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/31/2022]
Abstract
Root perforations are severe complications and are associated with compromised endodontic treatment outcomes, especially when bacterial infection is allowed to establish. Perforations may occur due to pathological processes or treatment consequences. Various dental materials have been proposed over the years for perforation repair with varying degrees of success. The use of bioactive materials, such as mineral trioxide aggregate (MTA) and other calcium-silicate cements, promotes a favourable environment for regeneration and has been used successfully for perforation repair. This is in contrast to materials used previously that often led to unpredictable outcomes. With the increasing range of new bioactive endodontic materials available, the number of potential materials being used for repair of root perforations is growing. Though promising to date, there is little evidence to support the use of most of these new materials. The aim of this narrative review is to provide the background, clinical techniques and outcome of nonsurgical and surgical perforation repair.
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Dumani A, Ates AA, Ucan CS, Yilmaz S, Unal I, Yoldas O. The influence of MTAD and QMix on the accuracy of electronic apex locator in locating simulated perforations. Niger J Clin Pract 2022; 25:281-285. [PMID: 35295049 DOI: 10.4103/njcp.njcp_1444_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims and Background The aim of this study was to evaluate the accuracy of the electronic actual length in detecting artificial perforations of the root canal in the presence of saline solution (NaCl, (Eczacibasi, Istanbul, Turkey), chlorhexidine [CHX (Werax, Tunadent, Izmir, Turkey)], QMix (Dentsply Tulsa, Maillefer, Ballaigues, Switzerland), and MTAD (Dentsply, Tulsa Dental, Tulsa, OK, USA). Materials and Methods The root canals of 25 single-rooted extracted human teeth were perforated artificially in the middle section of the root. The actual lengths up to the perforation site were measured and then, the teeth were embedded in an alginate mold. Electronic measurements of the perforations were obtained by an electronic apex locator according to the manufacturers' recommendations under dry conditions and in the presence of NaCl, CHX, MTAD, and QMix using a #20 K-file. Each canal was irrigated with distilled water and then dried with paper points between the measurements. Statistical analyses were performed using the Friedman test and Spearman Rank correlation coefficient to assess the correlations between the measurement methods. Results Highest correlation between the actual length and the electronic measurement was observed under dry conditions and NaCl solution (r: 0.932, r: 0.940 respectively), and the least correlation was observed with MTAD solution (r: 0.697) using statistical analysis. Moreover, the accuracy of the electronic apex locator with different irrigation solutions was statistically different from each other (P = 0.001). Conclusion The most accurate electronic measurements of artificial perforation were obtained under dry conditions or with NaCl.
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Affiliation(s)
- A Dumani
- Department of Endodontics, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - A A Ates
- Department of Endodontics, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey
| | - C S Ucan
- Department of Endodontics, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - S Yilmaz
- Department of Endodontics, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - I Unal
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - O Yoldas
- Department of Endodontics, Faculty of Dentistry, Cukurova University, Adana, Turkey
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DOĞAN T, UĞUR AYDIN Z, ALTUNBAŞ D. The Effect of Various Canal Contents on the Accuracy of Two Electronic Apex Locators in Detecting Different Size of Root Perforations. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.739588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mahmoud O, Awad Abdelmagied MH, Dandashi AH, Jasim BN, Tawfik Kayali HA, Al Shehadat S. Comparative Evaluation of Accuracy of Different Apex Locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and Periapical Radiograph-In Vitro Study. Int J Dent 2021; 2021:5563426. [PMID: 34054960 PMCID: PMC8112958 DOI: 10.1155/2021/5563426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed to validate the accuracy of working length (WL) measurements obtained with the newly introduced Propex IQ apex locator and to compare it with the latest generations of other electronic apex locators, CBCT, and conventional periapical radiographs by using the actual WL measurements obtained by using an endodontics microscope as a reference. MATERIALS AND METHODS Thirty-five extracted single-rooted human mandibular first premolars with curvatures from 10° to 20° were selected according to the inclusion and exclusion criteria and cut at the cementoenamel junction to achieve a standard reference point for WL determination. The actual WL was obtained by inserting a size-15 k-file in the root canal until the tip of the file was visible under an endodontic microscope. The definitive WL was measured using Propex IQ (Dentsply Sirona), Raypex 6 (VDW Dental), Root ZX (Morita), and Apex ID (Kerr Dental). In addition, radiographic WL was obtained using periapical radiographs and CBCT. One-way ANOVA was used for comparisons of the WL values, with a p value < 0.05. The percentage of success of each method for determination of the definitive WL was assessed using cross-tabulation and chi-square tests. RESULTS CBCT radiographs and Propex IQ apex locator yielded the most accurate WL measurements in comparison with the actual WL measurements (p < 0.05). Raypex 6, Root ZX, and Apex ID yielded more accurate WL measurements than conventional periapical radiographs (p < 0.05). Periapical radiographs yielded the least accurate WL measurements in comparison with the actual WL values (p < 0.05). CONCLUSIONS Within the limitations of this study, the Propex IQ apex locator showed higher accuracy than Raypex 6, Root ZX, and Apex ID for WL determination in the root canal. Nevertheless, CBCT radiographs yielded the maximum accuracy for WL measurements.
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Affiliation(s)
- Okba Mahmoud
- Clinical Sciences Department, Faculty of Dentistry, Ajman University, Ajman, UAE
| | | | | | - Bakr Nssaief Jasim
- Clinical Sciences Department, Faculty of Dentistry, Ajman University, Ajman, UAE
| | | | - Saaid Al Shehadat
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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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; 5:6-9. [PMID: 32342031 PMCID: PMC7183797 DOI: 10.14744/eej.2019.07279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/22/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: The study aimed to compare and evaluate the accuracy of iPex, Root ZX mini, and Epex Pro Electronic apex locators (EALs) in diagnosing root perforations in both dry and in different wet conditions: 5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and 17% Ethylenediaminetetraacetic acid (EDTA). Methods: Thirty extracted, human single rooted mandibular premolars were artificially perforated with a diameter of 1.5 mm in middle third of root. Actual canal lengths (ALs) in millimetre (mm) were evaluated for all teeth up to perforation location, and alginate mould were used to embed the teeth. After this, the electronic measurements were calculated by all EALs up to perforation site using a 20 K-file in both dry and wet canal conditions. Up to the perforation sites, the ALs were subtracted from the electronic length. Statistical analyses were done using One-way ANOVA with post hoc tukey’s test for pairwise comparison and the level of significance was set at 0.05. Results: All three EAL’s detected canal perforations which were clinically acceptable. There was significant difference for dry and wet conditions. Most accurate measurement were seen in dry canals for all three EALs. Root ZX mini in dry condition showed most accurate reading and there was a significant difference when compared with other groups. No significance difference was observed in iPex and Epex Pro Apex locator, and between NaOCl and CHX, CHX and EDTA. Conclusion: Perforations were determined within a clinical acceptable range of 0.03–0.05 mm by all three EALs. Root ZX mini in dry canals gave most accurate measurement. The presence of irrigating solution influenced the accuracy of all the apex locators.
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Khatri M, Ghivari S, Pujar M, Faras R, Gopeshetti P, Vanti A. Accuracy of two electronic apex locators in locating root perforations in curved canals in dry and wet conditions: A comparative in vitro study. Dent Res J (Isfahan) 2019. [DOI: 10.4103/1735-3327.270779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Altunbaş D, Kuştarcı A, Toyoğlu M. The Influence of Various Irrigants on the Accuracy of 2 Electronic Apex Locators in Locating Simulated Root Perforations. J Endod 2017; 43:439-442. [PMID: 28104321 DOI: 10.1016/j.joen.2016.10.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was to assess the accuracy of the Dentaport ZX (Morita Co, Kyoto, Japan) and the Rootor (Meta Biomed, Cheongwon-gun, Korea) electronic apex locators (EALs) in detecting root perforations in dry conditions and in the presence of the following irrigation solutions: 2.5% sodium hypochlorite (NaOCl), 0.9% saline solution (NaCl), and 17% EDTA. METHODS Twenty extracted, single-rooted human teeth were perforated artificially in the middle section. The actual canal lengths (ALs) up to the perforation site were determined, and then the teeth were embedded in an alginate mold. The electronic measurements of the perforations were obtained using a size 20 K-file by each EAL in various conditions. For each tooth, the AL was subtracted from the electronic length of the perforation. Statistical analyses were performed using the Friedman and Wilcoxon signed rank tests at a significance level of P < .05. RESULTS The most accurate measurements for both EALs were obtained in dry conditions. Among the irrigation solutions in the Dentaport ZX group, EDTA gave the most accurate results, and NaOCl gave the least accurate ones. However, measurements with NaCl were closer to the AL than those obtained with EDTA for the Rootor group. Significant differences were noted among the EALs when the measurements were taken with NaOCl, NaCl, and EDTA (P < .05). CONCLUSIONS The Dentaport ZX was more accurate compared with the Rootor in the presence of different irrigants. The content of the root canal affected the accuracy of both EALs. The most accurate measurements were obtained in dry canals.
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Affiliation(s)
- Demet Altunbaş
- Department of Endodontics, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey.
| | - Alper Kuştarcı
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Mustafa Toyoğlu
- Oral and Dental Health Center, Republic of Turkey Ministry of Health, Sivas, Turkey
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The Use of Micro–Computed Tomography to Determine the Accuracy of 2 Electronic Apex Locators and Anatomic Variations Affecting Their Precision. J Endod 2016; 42:1263-7. [DOI: 10.1016/j.joen.2016.04.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/18/2022]
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