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O r ig in a l A r ti cl e
Comparison of working length determination
using apex locator and manual method ‑ ex vivo
study
Jhadye Alves Carneiro, Fredson Marcio Acris de Carvalho, André Augusto Franco Marques,
Emílio Carlos Sponchiado Júnior1, Lucas da Fonseca Roberti Garcia2, Leonardo Cantanhede Oliveira Gonçalves
Department of Endodontics, Superior School of Health Sciences, State University of Amazonas, 1Department of Endodontics, Federal University of
Amazonas, Manaus, AM, 2Department of Physiology and Pathology, Araraquara School of Dentistry, Univ Estadual Paulista, Araraquara, SP, Brazil

Abstract
Background: Electronic apex locators can be a useful adjunct with a high level of accuracy for determining the real root canal
length in clinical practice. Aim: The objective of this ex vivo study was to evaluate the accuracy of electronic apex locator
for real working length determination in comparison with a manual method. Materials and Methods: Forty 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, using as reference the exceeding of the file in the 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 The file was
retracted by 1 mm, and its extension was measured to determine the real working length.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. Results: Data were submitted to
statistical analysis (Wilcoxon–Mann–Whitney test, P > 0.05) and no significant difference was found between the electronic
and manual methods (P > 0.05). Conclusions: It may be concluded that the electronic apex locator is a reliable and accurate
method for determining the working length of root canals, optimizing the odontometric procedure in clinical practice.

Key words: Electronic apex locator, endodontics, working length

INTRODUCTION the real working length of the root canal, limiting the action
of instruments during biomechanical preparation and filling,
Endodontic therapy involves several steps.[1,2] One of the avoiding damage to the periapical tissues.[1‑4]
most important is odontometry, which seeks to measure
The working length is the distance from a coronary reference
Address for correspondence: to a point where instrumentation and root canal filling
Dr. Lucas da Fonseca Roberti Garcia, Rua Siró Kaku, n° should end.[5] The distance must be well established by the
72, Apto. 73, Bairro Jardim Botânico, CEP: 14021‑614, endodontist to prevent over‑instrumentation or over‑filling
Ribeirão Preto, São Paulo, Brazil.
E‑mail: drlucas.garcia@gmail.com This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
Access this article online tweak, and build upon the work non-commercially, as long as the author is credited and
the new creations are licensed under the identical terms.
Quick Response Code:
Website: For reprints contact: reprints@medknow.com
www.dmrjournal.org

How to cite this article: Carneiro JA, de Carvalho FM, Marques AA,
DOI: Junior EC, Garcia Ld, Goncalves LC. Comparison of working length
10.4103/2348-1471.184730 determination using apex locator and manual method - ex vivo study.
Dent Med Res 2016;4:39-43.

© 2016 Dentistry and Medical Research | Published by Wolters Kluwer ‑ Medknow 39

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Carneiro, et al.: Working length determination using apex locator

of the root canal, and favor the repair process of the apical
and remaining tissues.[5,6]
It is believed that the foramen is located at the limit of
cementum‑dentin junction, where the periodontal ligament
begins, and the dental pulp ends.[6] Several studies have
determined that the limit is 0.5 mm or 1.0 mm short of the
radiographic apex, but the ideal limits for instrumentation and
obturation of the root canal may range from 0.0 to 2.0 mm.[7‑9]
However, its exact location is still a clinical challenge for the
professional.[10]
Several techniques are used to determine the real working
length of the root canal; however, they have limitations.[10] The
main limitation of the digital sensitivity technique is the internal
morphology of root canals, which prevents the detection
of the apical constriction.[10] The radiographic evaluation,
despite being widely used, can present distortion, overlapping,
elongating, and interference of anatomical structures, making
it difficult to accurately determine the working length.[9]
Thus, electronic devices that act as apex locators were
developed with the purpose of minimizing the technical
limitations when determining the real working length of the
root canal.[11,12] Because electronic location is based on the
passage of alternating current impedance through dentin, it
has been hypothesized that apex locators locate the apical
foramen with more precision than other techniques.[11]
Currently, these devices have been increasingly used in
endodontic therapy, becoming indispensable in clinical
practice. Thus, this ex vivo study aimed to evaluate the accuracy
of an electronic apex locator to determine the real working
length using an extracted tooth model. The null hypothesis
tested was that there would be no difference between the
two methods in real working length measurement.
MATERIALS AND METHODS
the placement of the rubber stop during the measurement
of the working length, and to standardize the reference for
the apex electronic locator.
Each root canal was initially explored with the aid of a size
10 K‑type file  (Dentsply/Maillefer, Ballaigues, Switzerland),
throughout its length until beyond the apical foramen. Once
the limit had been exceeded, the file was retracted by 1 mm
and the stop was placed on the flat incisal surface. The file
was then removed from the root canal and with the aid of
a digital caliper (Digimess, Shinko Precision, Gaging, China),
the extension of the file was measured from the stop to the
active tip to determine the real working length [Figure 2].
After determining the real working length using the manual
method, electronic measurement of the working length of
the root canal was performed in the same teeth using the
Joypex 5 electronic apex locator (Denjoy Dental Co. Ltd,
Changsha, China) [Figure 3]. The teeth were inserted on
a base, consisting of a glass container with fresh alginate
saturated with a 0.9% sodium chloride solution to simulate
the periapical tissues (Rio Química, São José do Rio Preto, SP,
Brazil), so the entire root portion remained submerged and
stable. Joypex 5 lip clip was placed on the experimental base
to complete its circuit.[13] To maintain the root canal moist
and the pulp chamber dry before beginning the electronic
measurement, the canals were irrigated with 1 ml of 2.5%
sodium hypochlorite solution (Rio Química) and aspirated,
following the apex locator manufacturer’s recommendation.
A size 10 K‑type file was connected to the device and inserted
into the root canal until the 0.0 mark appeared on the device
display, indicating that the instrument had reached the limit
of the apical foramen.
The values obtained (mm) in the two measurement
techniques were recorded. The normal distribution of data
was measured using the Shapiro–Wilks test and the values

Forty single‑rooted teeth from the Tooth Bank of the State

University of Amazonas  (UEA) were used in the study
after approval from the Research Ethics Committee. The
teeth were kept immersed in 2.5% sodium hypochlorite
solution (Rio Química, São José do Rio Preto, SP, Brazil) for
6 h to remove remnants of periodontal ligament tissue and
other debris from the external root surface. Afterward, the
teeth were stored in 0.9% sterile saline solution at 9°C for
7 days [Figure 1].

Initially, coronal access was performed with round diamond

burs No. 1011 and 1012 (KG Sorensen, São Paulo, SP, Brazil)
coupled to a high‑speed handpiece (Model 605, Kavo, Joinville,
SC, Brazil) under abundant water cooling. Then, incisal
flattening of the tooth crowns was performed to facilitate Figure 1: Single‑rooted teeth selected for the study

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Carneiro, et al.: Working length determination using apex locator

Table 1: Values (mm) of real working length of root

canals obtained by manual and electronic measurement
methods (Wilcoxon–Mann–Whitney U-test, P<0.05)
Tooth Manual Electronic
technique apex locator
1 23.5 23.5
2 23.0 23.5
3 21.5 22.0
4 23.0 23.0
5 22.0 22.0
6 23.0 23.0
7 23.0 23.0
8 22.0 22.5
9 23.5 23.5
10 23.5 23.5
11 19.5 19.5
12 20.5 20.5
Figure 2: Joypex 5 electronic apex locator (Denjoy Dental Co.) used 13 20.0 19.5
in the study 14 21.0 21.0
15 20.0 20.0
obtained were statistically analyzed (Wilcoxon–Mann– 16 22.5 22.5
17 19.0 19.0
Whitney test at a 5% significance level) using the MINITAB 18 23.0 23.0
Release 14.1 Statistical Software (MINITAB Software Inc., 19 22.0 22.5
State College PA, USA). 20 19.5 19.5
21 21.5 22.5
22 19.5 19.5
RESULTS 23 21.5 21.5
24 22.0 22.0
25 22.0 22.5
The values obtained in the working length measurements, and 26 22.0 22.5
their comparisons are shown in Table 1. 27 23.0 23.0
28 23.0 23.0
No significant difference was found between manual and 29 22.5 22.5
30 23.0 23.0
electronic methods (P > 0.05). In 73% of the samples, 31 23.0 23.0
the values for real working length measurement were 32 22.0 22.0
similar (0.0 mm), in 23% a difference of 0.5 mm was found, 33 22.0 22.5
34 22.0 22.0
and in 5% a difference of 1.0 mm was found [Figure 4].
35 21.0 21.0
36 22.5 22.5
37 21.0 20.0
DISCUSSION 38 19.0 19.0
39 19.5 19.0
The objective of this ex vivo study was to evaluate the accuracy 40 21.0 21.0
of an electronic apex locator in comparison with a manual Mean value 21.70 21.76
Standard deviation 1.35 1.45
method. Based on the results obtained, it can be stated
P value = 0.672
that the null hypothesis tested was accepted, since the two
methods for working length measurement had no significant
difference. The aim of endodontic treatment is to remove reaction impairs the process of tissue repair in the periapical
all the pulp tissue, necrotic material, and microorganisms region, leading to treatment failure.[14]
from the root canal by cleaning and shaping it with specific
instruments.[1‑3] Only through odontometry is it possible to On the other hand, under‑filling must also be avoided, since
obtain the real working length of the root canal and thus, hermetic sealing failure in the apical region may allow survival
create conditions for it to be prepared within its apical limit and multiplication of residual bacteria and microorganisms,
and filled accordingly.[4,5] which may cause leakage of tissue fluids into the root canal,
leading to the appearance of periapical lesions.[10,14]
Over‑filling of the root canal is usually preceded by
over‑instrumentation, which is responsible for microorganisms Despite the results obtained in ex vivo studies should not be
and necrotic material transport beyond the apical foramen, directly extrapolated to clinical conditions, they still provide
making the postoperative period painful due to infection and important information to professionals. In this study, to
inflammation of the periapical tissues.[14] The inflammatory bring the test closer to the clinical reality, the periapical

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Carneiro, et al.: Working length determination using apex locator
a b c working length measurement
Figure 3: Root canals real length measurement by the manual method:
(a) visualization of the file exceeding the apical foramen. (b) magnified
visualization of the file exceeding the apex. (c) limit after withdrawal of
file (1 mm) and obtaining the real length of the root canal
conditions were simulated using fresh alginate, and the root
canals were maintained moist with 2.5% sodium hypochlorite
solution, following the recommendations of the apex locator
manufacturer.[9,14‑16]
The results obtained in this study do not corroborate
several previous studies, which presented precision rates
of 90% for apex locators.[9,15,16] In this study, only 73% of
the samples presented values equal to the manual method.
Several authors consider this margin of precision (90%) too
excessive, over‑estimating the capacity of apex locators.[14,17,18]
Furthermore, a manual method for real working length
measurement was used in this study to certify the values
obtained in the electronic method, ensuring more reliable
results.
Previous studies adopted radiographic methods to compare
the findings of electronic apex locators.[16‑18] It is known
that radiographic examination is still the most commonly
used method for determining the working length. However,
the obtainment of radiographs without any distortion or
overlapping of anatomical structures in the root apices is
challenging.[14‑16] Furthermore, radiographic visualization
of the apical constriction or even the foramen is difficult
because these do not always coincide with the radiographic
apex.[14]
The limitations of radiographic examination led to the
development of methods that seek greater precision during
odontometry.[10] Electronic methods allow the location of the
apical constriction with a substantial rate of success,[15,16] as
could be seen in this study. The speed and practicality of the
method associated with the ease of establishing the working
length at any operative step are significant advantages over
the radiographic method.[14]
Dentistry and Medical Research| Jul-Dec 2016 | Vol 4 | Issue 2
Figure 4: Values distribution (%) according to the method used for real
However, it is worth emphasizing that the use of electronic
apex locators does not eliminate the need for radiographic
evaluations, which are essential both for the diagnosis
and quality evaluation of the root canal filling, as well,
postoperative control. [17,18] Moreover, only using apex
locators is not recommended in clinical practice due to the
morphological changes in the root canal system and because
they do not provide any legal documentation, requiring an
initial, and final radiography of the endodontic treatment.[19]
Despite its relative importance and widespread use, Elayouti
et al.[20] demonstrated that in 51% of cases in which the working
length was determined radiographically, there was perforation
of the root apex during instrumentation. However, the root
apex was also perforated in 21% of the canals where the
working length was determined with electronic apex locator,
showing the inaccuracy of the technique and the need for both
methods. The combination of both techniques is the best
alternative to prevent placing instruments and filling material
beyond the apical foramen.[20]
Third generation electronic apex locators, as that one used in
this study, work on the principle that there is an impedance
mismatch between two electrodes, where one of the values is
calculated from a frequency of 1 kHz and the other from the
frequency of 5 kHz.[21] The impedance reaches its highest value
in the position of greater constriction of the canal, which often
coincides with the limit of the cementum‑dentin junction.[21]
Only with the advent of the third generation of electronic
apex locators was it possible to measure the length of the
root canal in the presence of irrigating solutions, secretions,
saliva, and blood.[17] These locators have a cable connected to
the device that divides into two, one being placed in contact
with the oral mucosa of the patient, and the other connected
to the endodontic file.[17]
Meares and Steiman[22] evaluated the influence of sodium
hypochlorite solution at different concentrations on the accuracy
42
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Carneiro, et al.: Working length determination using apex locator

of a third generation electronic apex locator and reported that
regardless of the irrigating solution and its concentration, the
determination of the real working length was accurate, results
which are similar to those found in the present study.
Despite the limitations of this ex vivo study, the electronic
device for measuring the root canal length presented
acceptable readings for root canal length determination in
single‑rooted teeth. However, it should not be conclude that
the electronic apex locator can replace radiographic evaluation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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