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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2005  |  Volume : 23  |  Issue : 3  |  Page : 124-125
 

An in vitro comparison of root canal measurement in primary teeth


Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Center, Bangalore, Karnataka, India

Correspondence Address:
Priya Subramaniam
Department of Pedodontics and Preventive Dentistry, The Oxford Dental College, Hospital and Research Center, 10th Mile, Hosur Road, Bommanahalli, Bangalore - 560 068, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.16883

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   Abstract 

To compare the accuracy of root canal lengths in primary teeth determined by tactile sense, electronic apex locator, conventional radiography, and digital radiography in primary teeth. The study sample consisted of twenty 20 extracted, single-rooted primary teeth. A comparison was made between the working length measurements obtained by tactile sensation, electronic apex locator, conventional film, and digital radiography, using stereomicroscopic measurements to obtain real canal length. The mean readings obtained were 15.91 ± 2.06 by tactile measurement, 15.94 94 ± 1.42 by apex locator, 16.06 ± 1.73 by conventional radiography, and 15.91 ± 1.60 by digital radiography. No statistically significant differences were seen between the techniques.


Keywords: Primary teeth, Eelectronic apex locator, Digital radiography, Primary teeth


How to cite this article:
Subramaniam P, Konde S, Mandanna D K. An in vitro comparison of root canal measurement in primary teeth. J Indian Soc Pedod Prev Dent 2005;23:124-5

How to cite this URL:
Subramaniam P, Konde S, Mandanna D K. An in vitro comparison of root canal measurement in primary teeth. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2020 Oct 28];23:124-5. Available from: https://www.jisppd.com/text.asp?2005/23/3/124/16883


In primary teeth, it is important to estimate the exact root canal length during endodontic therapy to avoid injury to the succedaneous tooth bud.[1] A technique to determine the root canal length must give precise, and reproducible results.[2] The tactile and conventional radiographic methods may be ineffective in this regard. Electronic apex locators do not produce pain and avoid unnecessary radiation, so they are recommended for use in children.[1] Digital radiography allows instant imaging and reduced radiation exposure.[3] The purpose of this study was to compare the accuracy of root canal lengths in primary teeth, determined by tactile sense, electronic apex locator, conventional radiography, and digital radiography in primary teeth.


   Materials and Methods Top


Twenty extracted, single-rooted primary teeth were numbered and kept in isotonic sodium chloride solution (NS, Baxter India Pvt. Ltd.) Access cavities were prepared using a Number 10 round-bur in a high-speed hand piece. Tactile measurements were completed first using a No. 8 K-file of 21 mm length (Mani Inc., Japan) to avoid possible loss of apical structures due to repetitive passage of instruments. Electronic measurements were done next using the Formatron D 10 electronic apex locator (Parkell Electronic Division, NY, USA), a third generation apex locator. The teeth were first embedded in alginate with 0.9% sodium chloride solution which acts as a conducting gel simulating the periodontium.[2] Following the manufacturer's instructions, measurements were taken after irrigation with 3% sodium hypochlorite and the canals were dried with a paper point, following the manufacturer's instructions.

The next step was to record radiographic measurements using the paralleling technique. The exposure factors and distances between the source and the tooth, and the tooth and the film were standardized. Digital radiographs were also taken simultaneously by replacing the film with the digital sensor (Cygnus Media, Cygnus Technologies, USA).

Finally, the actual canal length of each tooth was measured under stereomicroscopy using direct observation of the apical exit of the same file. Two readings were taken for each method, by the same operator, using the same metallic endodontic ruler. Digital radiographic measurements were taken using the on-screen image. The mean reading was calculated for each technique.

The Paired Student's t-test was used to test the significance of difference of means between each technique and actual canal length. Coefficient of variation was also calculated for each technique.


   Results Top


Using tactile measurements, the mean reading that was obtained was 15.91 ± 2.06. Apex locator measurements gave a mean reading of 15.94 ± 1.42. Conventional radiography resulted in a mean of 16.06 ± 1.73. Digital radiographic readings yielded a mean of 15.91 ± 1.60. These readings are represented in [Table - 1].

The differences of the mean values of each technique from the mean value of actual canal length (15.53 ± 2.64) are not statistically significant (P > 0.05), indicating the similarity of mean values of all the techniques to the actual canal length. In terms of probability, the higher similarity between apex locator measurements and actual canal length (P = 0.427), followed by digital radiography and actual canal length (P = 0.423) is observed [Table - 2].

This can also be supported by the internal stability of the measurements in terms of the coefficients of variation for the apex locator (8.90) and digital radiography (10.01) being less compared to tactile and conventional radiographic measurements [Table - 2].


   Discussion Top


Studies over the years have confirmed the reliability of electronic apex locators. Similarly, different studies that have compared digital and conventional radiography considered the reliability of the former technique to be equal to or even superior to that of conventional radiography.[4]

In this study, although high-reliability coefficients were observed in all the techniques, it was observed that apex locator and digital radiographic measurements were best related to actual canal length.

Although questions still exist as to whether the accuracy of apex locators can be affected by different types of electrolytes, foramen size, and pulp vitality, this study found the least magnitude of deviation from the mean in measurements by the apex locator.

Tactile determination of working length may give inaccurate results in case of incomplete pulp extripation, periapical lesions, physiologic resorption, and narrow and curved canals.

Conventional radiography as a method of determining the working length has shortcomings in that it depends on the child's co-operation as well as the operator's proficiency. In addition to this, minor degrees of resorption may not be visible, and overlapping by adjacent anatomical structures can obscure the clarity of the image.

The electronic apex locator is helpful in overcoming these shortcomings. The new generation of frequency-dependent apex locators is based on electrical principles that can detect the narrowest diameter of the canal even in the presence of moisture and conductive fluids. It is extremely useful in children who gag during radiography.

Digital radiography has many potential benefits in pediatric endodontics. Computers can enhance the contrast and brightness of the image, magnify the apical zone, store and transmit the image. Other advantages include the ease of repetitions, the elimination of chemical usage, and use of the image for patient education. The decreased exposure time also allows lower radiation dosage.

Hence, we can see that the incorporation of these new techniques of electronic apex locator and digital radiography can be of immense use in pediatric endodontic procedures. From the results of this in vitro study, it can be concluded that the digital radiographic and apex locator methods of determining the root canal length in primary teeth can be considered reliable and precise. Because these methods increase both the safety and comfort of endodontic treatment in children, their use should be further evaluated and certainly warrants more clinical studies.



 
   References Top

1.Katz A, Mass E, Kaufman AY. Electronic apex locator: A useful tool for root canal treatment in the primary dentition. Journal of Dentistry for Children, 1996;63:414-7.  Back to cited text no. 1  [PUBMED]  
2.Ounsi HF, Haddad G. In vitro evaluation of the reliability of the Endex electronic apex locator. Journal of Endodontics 1998; 4:120-1.  Back to cited text no. 2    
3.Lozano A, Forner L, Llena C. In vitro comparison of root-canal measurements with conventional and digital radiography. International Endodontic Journal 2002;35:542-50.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Martinez-Lozano MA, Forner-Navarro L, Sanchez-Cortes JL, Llena-Puy C. Methodological considerations in the determination of working length. International Endodontic Journal 2001;34:371-6.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]


Tables

[Table - 1], [Table - 2]


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