REVIEW OF LITERATURE

Mittal P, et al., (2016) evaluated the accuracy of a 6th generation apex locator, digital
radiograph, paper point and tactile technique for their ability to determine the working length in
teeth with open apices. About 40 single-rooted maxillary anterior teeth were selected after
excluding the teeth with curved roots. To simulate immature open apices, the apical 3–5 mm of
the roots were removed such that ISO #80 file passed through the canal without any hindrance.
Based on the method used to determine the working length, teeth were divided into five study
groups and one control group. The author found that within ±0.5 mm, combined electronic,
tactile and paper point working length (CETPPWL) method showed 99.5% of accuracy.
Radiographic working length (RWL) using paralleling technique gave the least accurate result
(around 78%) for all groups. It was concluded that for teeth with open apices, working length
determination is a challenge. No single method was accurate. Combination of use of apex
locator, tactile and paper point method was recommended.

Mohan MG, et al., (2013) reviewed clinical studies on the accuracy of different methods used
for working length determination in Department of Endodontics and Conservative Dentistry.
Literature search was conducted on Pub med central, Medline and Mesh data base for the related
topic from 1991 to 2012. It was found that there was no significant difference between
conventional methods and electronic apex locators in the accuracy of working length
determination. But electronic apex locators and digital radiographic methods were found to be
beneficial from the perspective of radiation dose reduction. The author concluded that electronic
apex locators were not superior to radiographs in determining working length. Long term follow
up studies evaluated post-operative success that compared electronic apex locators and
radiographic methods which are needed to appreciate the best method of working length
determination.
Bhat KV, et al., (2017) evaluated the accuracy of a new-generation electronic apex locator
(iPex) to determine working length in primary teeth with or without root resorption as compared
with the conventional radiographic method. Total 30 primary posterior teeth which were
indicated for pulpectomy were selected for the study. Initially, working length was obtained with
iPex (new-generation by Nakanishi International) apex locator using no.10 K-file, which was
then compared with conventional radiographic method (Ingle’s method). A total of 65 canals
were available for the measurement. The results indicated that there was no statistically
significant difference found when using iPex apex locator for working length determination as
compared with that of conventional radiographic method (p = 0.511). Working length
determined by iPex apex locator is comparable with that of conventional radiographic method,
hence, can be used as an alternative in determining the working length of primary teeth.

Chaudhary S, et al., (2018) compared the accuracy of Propex II and iPex II electronic apex
locator (EAL) in determining the WL under clinical conditions, to that of radiographic working
length (RWL) using stainless steel (SS) and nickel–titanium (NiTi) hand files. About 37 patients,
with 60 anterior teeth (60 canals) scheduled for endodontic treatment participated in this study
after ethical approval. Electronic working length (EWL) was determined by the Propex II and
iPex II according to manufacturer’s instructions using SS Hand K-files and NiTi Hand files.
RWL was determined after EWL determination. The results obtained with each EAL with SS
and NiTi files were compared with RWL. No significant difference was found between the EWL
and RWL and between SS and NiTi files for WL determination (p > 0.05) as well. It was
concluded that both were clinically acceptable EAL for WL determination and both SS hand K-
file and NiTi file can be used interchangeably without compromising the WL during treatment.

Taneja S et al., (2017) determined the accuracy in measuring the working length by using
CanalPro, Apex ID and Root ZX mini Apex locators in different simulated clinical conditions.
About 60 freshly extracted single-rooted teeth were equally assigned to three groups according to
simulated clinical conditions: Group 1; Presence of irrigant, Group 2; open apex, Group 3;
presence of blood and pulp. The working length was determined with all the apex locators and
was then compared with actual working length of the tooth. The results showed that the accuracy
in working length measurement by Root ZX mini was 100%, 60% and 80%; Apex ID was 100%,
80% and 90% and CanalPro was 100%, 90% and 90% in group 1, group 2 and group 3
respectively within ± 0.5 mm of AL. The author concluded that CanalPro showed highest
accuracy in all conditions with accepted accuracy above 90%.

Carneiro JA, et al., (2016) evaluated the accuracy of electronic apex locator for real working
length determination in comparison with a manual method. About 40 single rooted teeth were
used in this study. After coronal access, manual measurement of the real working length of each
root canal was performed by placing a size 10 K file, used as a reference in the exceeding of the
file in apical foramen. The file was retracted by 1 mm, and its extension was measured to
determine the real working length. The electronic measurement of the working length was
performed in the same teeth using the Joypex 5 electronic apex locator. There was no significant
difference found between the electronic and manual methods (P > 0.05). It was concluded that
the electronic apex locator was a reliable and accurate method for determining the working
length of root canals, optimizing the odontometric procedure in clinical practice.