REVIEW OF LITERATURE

Ebrahim A.K, et al., (2007) evaluated the accuracy of five electronic apex locators (EALs) in
determining the working length (WL) of teeth after removal of the root canal obturation
materials. A total of 32 extracted straight, single-rooted teeth were used. One group (n = 6)
served as control, while the other group (n = 26) was the experimental group. In the experimental
group, the root canals were obturated using vertically compacted gutta-percha with AH 26 sealer.
The difference (D) between the AL and the electronically determined length (EDL), AL–EDL,
was calculated and recorded for each measurement. In both groups, statistically significant
differences were found among the EALs (P < 0.01). The author concluded that Dentaport
ZXTM®, ProPex and Foramatron D10 were more accurate than the other two EALs in
determining the WL in teeth after removal of the root canal obturation materials. However, the
Apex NRG and Apit 7 were also reliable for determination of the WL in majority of the cases.
Chhabra A, et al., (2017) determined the accuracy of two different apex locators for
measurement of working length during root canal retreatment of mandibular molars with two
different file systems in an ex vivo study. About 60 samples of extracted mandibular first molars
were selected. Tooth length was re-measured and recorded as the retreatment tooth length (RTL).
Then electronic measurements were taken with Root ZX and Apex ID apex locator as suggested
by the instrument display. There was a significant difference between Apex ID apex locator with
M2 retreatment files readings. The author concluded that Root ZX apex locator was more
accurate as compared to Apex ID apex locator in determining the working length in teeth after
removing the root canal obturating material using two different files
.

Shanmugaraj M, et al., (2007) determined the accuracy to measure the working length of root
canal using tactile method, electronic apex locator and radiographic method. Also in vivo, the
author compared the lengths so measured to the actual working length, ex vivo, after extraction.
About 30 single-rooted teeth scheduled for extraction were selected for the study. Working
length was determined by tactile method, by using Ingle’s radiographic method and by using a
Foramatron-IV digital apex locator. The teeth were then extracted and the actual working length
was determined by placing an endodontic file in the root canal 0.5 mm short of the apex. The
results indicated that among the three methods, the electronic apex locator showed the highest
accuracy and the highest reliability for working length determination.

Vasconcelos BC, et al., (2013) evaluated, ex vivo, the precision of five electronic root canal
length measurement devices (ERCLMDs) with different operating systems: the Root ZX, Mini
Apex Locator, Propex II, iPex, and RomiApex A-15, and the possible influence of the
positioning of the instrument tips short of the apical foramen. About 42 mandibular bicuspids
had their real canal lengths (RL) previously determined. The results depicted that the
measurements performed at 0.0 and -1.0, the precision rates for the ERCLMDs were found to be
73.5% and 47.1% (Root ZX), 73.5% and 55.9% (Mini Apex Locator), 67.6% and 41.1% (Propex
II), 61.7% and 44.1% (iPex), and 79.4% and 44.1% (RomiApex A-15), respectively, with ±0.5
mm of tolerance. It was concluded that all the ERCLMDs provided acceptable measurements at
the 0.0 position. However, at the -1.0 position, the ERCLMDs had a lower precision, with
statistically significant differences for the Propex II, iPex, and RomiApex A-15.

Saxena D, et al., (2017) evaluated the accuracy of iRoot, iPex II, and Propex pixi apex locator
using histological sections as the gold standard. About 30 patients indicated for extraction of
single-rooted permanent teeth with single canal system were selected. Measurements of mean
WLs within ±0.5 mm of minor diameter were 90% acceptable for iRoot, 86.66% for iPex II, and
80% for Propex pixi when compared with mean MDL as obtained from the histological sections.
All apex locators showed acceptable level of accuracy which clearly indicated their reliability in
determining the WL. The results showed that the measurements of mean WLs within ±0.5 mm of
minor diameter were 90% acceptable for iRoot, 86.66% for iPex II, and 80% for Propex pixi
when compared with mean MDL as obtained from the histological sections. The author
concluded that all apex locators have been shown to produce acceptable level of accuracy which
clearly indicates their reliability in determining the WL.
Saraf PA, et al., (2017) estimated the accuracy of six apex locators with intra oral periapical
(IOPA) radiograph in multirooted teeth. A total of 90 multirooted teeth (maxillary and
mandibular molars) with irreversible, infected or necrotic pulp tissue and completely formed
roots were included in this study and were divided randomly into six groups (Root ZX II,
Raypex 6, I-Root, Romiapex A-15, Sybron Endo Mini and Root ZX mini). The working length
was determined using six different apex locators, and the accuracy of the apex locators was
compared with IOPA radiographs, to be categorized as accurate, short, and long or beyond. The
results showed that out of 270 canals, about 233 (86.3%) canals exhibited acceptable working
length, 28 (10.4%) canals exhibited short working length, and only 9 (3.3%) canals exhibited
working length beyond the apex. Therefore, the author recommended that radiograph and apex
locators are the best combinations in accurately determining the working length.

Khandelwal D, et al., (2015) evaluated the accuracy of the Raypex 5 (VDW, Munich, Germany)
and Apex NRG XFR (Medic NRG Ltd, Tel Aviv, Israel) electronic apex locators (EALs) in
determination of working length when compared with radiographs. About 25 human single-
rooted teeth were selected, and the access cavity was prepared. The working length (WL) was
determined radiographically and electronically by using 2 EALs. The files were fixed at the WL,
and the teeth were extracted. It was found from the results that there was no significant
difference between the Raypex 5 and the Apex NRG XFR devices with respect to their accuracy
in determining the final WL. When comparison of EALs and radiographic measurements with
control measurements was done accuracy results were found to be 20%, 36%, and 52% for the
Raypex 5, Apex NRG XFR, and radiography, respectively. It was concluded that both the EALs
had the same accuracy in determination of WL when compared with radiography.

Saraswathi V, et al., (2016) compared the accuracy of two generations of apex locators in teeth
with simulated apical root resorption. About 40 maxillary central incisors were selected and after
access preparation, were embedded in an alginate mold. On achieving partial set, teeth were
removed, and a 45° oblique cut was made at the apex. The teeth were replanted and stabilized in
the mold, and WL was determined using two generations of apex locators (Raypex 5 and Apex
NRG XFR). Actual length of teeth (control) was determined by visual method. The results
showed that Raypex 5 and Apex NRG were accurate for only 33.75% and 23.75% of samples,
respectively. However, with ± 0.5 mm acceptance limit, they showed an average accuracy of
56.2% and 57.5%, respectively. There was no significant difference in the accuracy between the
two apex locators. The author concluded that neither of the two apex locators were 100%
accurate in determining the WL.