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Clinical evaluation of the accuracy of the Evident RCM Mark II Apex Locator.

The accuracy of the Evident RCM Mark II in locating the apical foramen was evaluated in 37 human teeth scheduled for extraction. After extraction, the difference between the position of the apical foramen determined electronically and its real anatomical location was measured under a binocular microscope, using a micrometer mobile in x, y, and z coordinates. The results show that in 86% (n = 37) of the cases, an accurate location +/- 0.5 mm of the apical foramen was obtained.

Adolescent↗

A clinical evaluation of the Endocater--an electronic apex locator.

The purpose of this study was to evaluate the accuracy of an electronic apex locator, the Endocater, in determining the location of the apical constriction or cementodentinal junction (CDJ). Measurements made by the Endocater were also compared with the adjustments recommended by an experienced endodontist. A total of 69 teeth with 99 canals from nine patients were evaluated. The results indicated that the evaluator was 95.8% and the Endocater 67.7% accurate in positioning the probe within +/- 1.000 mm from the CDJ. Thirty-three canals or 34.4% appeared to be clinically acceptable radiographically and no adjustments were deemed necessary by the evaluator. There was a significant difference (p less than 0.003) between the evaluator's ability to adjust the electronically generated file length radiograph to acceptable clinical standards and the Endocater's ability to determine the location of the CDJ. A total of 59 canals (59.6%) of the electronically determined working lengths were beyond the CDJ (n = 99). In 27 canals, the tip of the probe was greater than 1 mm beyond the constriction. Without radiographs to confirm working lengths, many canals in this study would have been overinstrumented. Future research with electronic apex locators is needed before accepting the technique as a substitution for radiographic working length determination.

Dental Pulp Cavity↗

Clinical evaluation of five electronic root canal length measuring instruments.

A previous in vitro study has shown high accuracy, but no clinically significant differences in a group of five electronic root canal length measuring instruments. The purpose of this study was to evaluate and compare the performance of the same group of instruments under clinical conditions and to correlate their accuracy to radiographic estimates of canal length. Five electronic root canal length measuring instruments were used to measure the working length to the "apex" in 20 single-rooted teeth scheduled for extraction. After extraction, the actual canal length was measured visually to a point just within the apical foramen. This length was compared with instrument length as determined electronically. The accuracy of the instruments in determining canal measurement within +/- 0.5 mm from the apical foramen varied from 55 to 75%. The differences between the instruments were not statistically significant. On average, all of the instruments except for the Endocater gave canal length measurements that were beyond the apical foramen. The variability of the measurements, which was comparable to that of estimates of canal length from preoperative radiographs, indicated that radiographic verification of the working length is still desirable.

Adult↗

Root canal system of the maxillary central incisor.

To better assess the efficacy of mechanical preparation of root canals, transparent specimens of 510 extracted maxillary central incisors were investigated for thickness and curvature of the root canal, condition of any accessory canals, and location of the apical foramen. Over 60% of the specimens showed accessory canals that are impossible to clean mechanically. Most lateral branches were small, 80% were the size of a #10 reamer or less, and only 3% were thicker than a #40 reamer. Apical foramina located away from the apex were observed in 45% of the teeth, although nearly 80% of all foramina were within approximately 0.5 mm of the apex, and 95% were within approximately 1.0 mm. Data on the thickness and curvature of the main canal showed that normally it is adequately prepared when reached with a #60 reamer to the apical constriction and supplemented by flare preparation.

Dental Pulp Cavity↗

An evaluation of the Apex Locator Endocater.

The purpose of this study was to relate the relationship of the apical constriction to the anatomical apex and to determine the ability of the Endocater (Hygenic Corp., Akron, OH), using commercially bonded coated probes to locate the position of the apical constriction, in permanent teeth that were intact and had not been subjected to previous endodontic manipulation. Using local anesthesia and rubber dam isolation, conventional access cavities were prepared at ultra high speed with water coolant in teeth treatment planned for extraction. The Endocater was used to determine the working length. The probes were sealed in place with autopolymerizing composite resin and the teeth extracted. The teeth were sectioned buccolingually, and the position of the probe in relation to the anatomical apex and apical constriction was measured with the use of an ocular microscope. In 17.1% of the canals, the probes bound in the coronal portion of the canals and would not reach the apical portion of the root. In those teeth in which the probes reached the apical portion of the root, the Endocater was able to locate the apical constriction within 0.5 mm in 93.4% of the canals.

Dental Pulp Cavity↗

Influence of the major and minor foramen diameters on apical electronic probe measurements.

There have been conflicting reports on the accuracy of electronic devices used for determining working length. The influence of the major and minor diameters on electronic probe measurements were evaluated to ascertain whether anatomical features of the apical portion of the canal might be responsible for these discrepancies. Forty-seven nonrestorable teeth selected from 22 patients were studied. Conventional access was made. A Kerr file was placed to a position 0.5 mm from the major foramen as registered by the Neosono-D apex locator. The electronic probe length was then measured. After the tooth was extracted, the file was fixed with autopolymerizing composite in the canal. A Buehler Isomet lapadary saw was used to prepare specimens to a thickness of 500 microns. A Bioquant II Image Analysis System was used to measure and record distances. It was found that as the width of the major foramen increased, the discrepancy between the electronic probe tip length induction and the actual position of the major foramen increased.

Dental Pulp Cavity↗

Comparison of the radiographic appearance of root canal size to its actual diameter.

Clinically, the apparent radiographic diameter size does not always seem to correspond to the true canal size. The objective of this study was to compare canal size on periapical radiographs with the actual canal diameter as determined histologically. Periapical radiographs were exposed on 36 teeth on 5 human cadavers. Mesial-to-distal boundaries of canals were measured in the cervical, middle, and apical thirds. The teeth were extracted, the roots histologically processed, and cross-sections made in the cervical, middle, and apical thirds. Measured values of diameter from radiographs were compared with true canal widths as measured from the corresponding level of histological sections by using a correlated t test. All sections of all roots demonstrated a canal histologically, although some regions had no canal visible radiographically. In general, there was statistically no difference (p less than 0.001) between the histological and radiographic measurements even when pulpal calcifications were present. However, in some roots there were marked discrepancies between radiographs and histological sections as to canal diameter.

Dental Pulp Calcification↗

Frequency, location, and direction of the lateral, secondary, and accessory canals.

Observation of 1,140 transparent teeth of adult humans was made to verify the frequency, location, and direction of the accessory, secondary, and lateral canals located at the radicular-apical area, at the body of the root, and in the base of the root. In 27.4% of the teeth studied, some type of ramification was observed; these ramifications were usually located in the apical area of the root. The premolars and molars showed the greatest variety of ramifications.

Adult↗