Elsevier

Dental Abstracts

Volume 60, Issue 4, July–August 2015, Pages 218-219
Dental Abstracts

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Determining working length

https://doi.org/10.1016/j.denabs.2014.08.043Get rights and content

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Background

Microorganisms in the root canal system are associated with root canal treatment failure, so it is mandatory to perform maximum disinfection and obturation of the root canal system. The apical constriction is generally selected as the point where root canal instrumentation and obturation ends, but it is difficult to identify this anatomic point clinically because it varies significantly in position and conformation. The working length, or distance between a coronal reference and the apical

Methods

The search included PubMed, Lilacs, Science Direct, Cochrane Collaboration, Evidence Based Dentistry, the Journal of Evidence-Based Dental Practice, and NHS Evidence along with a manual search and contact with authors of previous studies not in the electronic or manual search. A final sample of 21 studies covering 2424 teeth and 4657 root canals was selected. The studies included anterior teeth, premolars, and molars. Pulp diagnosis included normal pulp, pulpitis, necrosis, and previously

Results

Eleven studies used distance to the radiographic apex to assess how well EAL performed. Most established an acceptable radiographic range of 0.5 to 1.5 mm from the radiographic apex. The effectiveness of EALs was between 81.5% and 97% for this interval.

Two studies used the master cone adaptation phase of endodontic treatment to assess the efficacy of radiographic measurement or EAL in a range of 0.0 to 2.0 mm from the apex. The apex locator was successful in 90.4% of cases and radiography was

Discussion

Determining the working length through the use of EAL may be better than using radiography alone. There tends to be high agreement between the measurements obtained by the EAL and those achieved using radiography.

Clinical Significance

Apex locators seem to offer greater predictability than radiographs when determining the position of the apical constriction. When EALs are used, fewer radiographs are needed, which reduces the patient’s exposure to radiation. Working length determinations using

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Martins JNR, Marques D, Mata A, Caramês J: Clinical efficacy of electronic apex locators: Systematic review. J Endod 40:759-777, 2014

Reprints available from JNR Martins, Instituto de Implantologia of Lisbon, Av Columbano Bordalo Pinheiro, 50 – 5 e 6, 1070-064 Lisboa, Portugal; e-mail: [email protected]

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