Working Length

Determination
••
• • '----CHAPTER

o Introduction and History o Radiographic Method of Working Length

o Definitions Determination
o Significance of Working Length o Electronic Apex Locators
o Different Methods of o Summary
Working Length Determination o Bibliography

INTRODUCTION AND HISTORY DEFINITIONS

Determination of an accurate working length is one of the most
critical steps of endodontic therapy. The cleaning, shaping and
obturation of root canal system cannot be accomplished
accurately unless working length is determined precisely.
Prognosis and microbiologic studies as well as histologic
experiments involving healing after obturation show that it is
preferable to confine instruments, irrigating solutions and
obturating materials to the canal space. Thus we can say that
predictable endodontic success demands an accurate determi-
nation of working length of root canal and strict adherence
to it, in order to create a small wound site and good healing
conditions.
According to endodontic glossary working length is defined
as "the distance from a coronal reference point to a pointat
which canal preparation and obturation should terminate"
(Fig. 15.1).
Reference point: Reference point is that site on occlusal or the
incisal surface from which measurements are made. A reference
point is chosen which is stable and easily visualized during
preparation. Usually this is the highest point on incisal edge
of anterior teeth and buccal cusp of posterior teeth (Fig.15.2).
Reference point should not change between the appointments.

Historical perspectives
At the end of Working length was usually calculated
nineteenth cenrury when file was placed in the canal and
patient experienced pain.
1899 Kells Introduced X-rays in dentistry
1918 Hatton Microscopically studied the diseased
periodontal tissues.
1929 Collidge Studied the anatomy of root apex in
relation to treatment problem.
1955 Kuttler Microscopically investigated the root
apices.
1962 Sunada Found electrical resistance between
periodontiwn and oralmucousmembrane.
1969 Inove Significant contribution in evolution of
Electronic apex locator

Before we discuss various methods of determination of

Fig. 15.1: Working length distance is defined as the distance from coronal
working length, we need to understand the anatomic consi- referencer point to a point where canal preparation and obturation should
deration regarding it. terminate
 :E
o
~
::::J
Minor apical cc
diameter r
CD
::::J
cc
g.

Fig. 15.3: Minor apical diameter

Fig. 15.2: Usually the reference point is highest point on incisal

edge of anterior teeth and cusp tip of posterior teeth

Thereforein case of teeth with undermined cusps and fillings,

theyshould be reduced considerably before access preparation.

Anatomic apex is "tip or end of root determined morpho-

logically".

Radiographic apex is "tip or end of root determined radio-

graphically".

Apicalforamen is main apical opening of the root canal which

maybe located away from anatomic or radiographic apex.

Apical constriction (minor apical diameter) is apical portion A Root apex B Apical constriction
of root canal having narrowest diameter. It is usually 0.5 -1 mm D Cementum
C Root canal
shortof apical foramen (Fig. 15.3). The minor diameter widens
E Dentin F Apical foramen
apicallyto foramen, i.e. major diameter (Fig. 15.4).
Cementodentinal junction is the region where cementum Fig. 15.4: Anatomy of root apex
and dentin are united, the point at which cemental surface
terminatesat or near the apex of tooth. It is not always necessary
thatCDJ always coincide with apical constriction. Location of
CDJranges from 0.5 - 3 mm short of anatomic apex (Fig. 15.5).

SIGNIFICANCEOF WORKING LENGTH

I Working length determines how far into canal, instruments
can be placed and worked.
I It affects degree of pain and discomfort which patient will
experience following appointment by virtue of over and
under instrumentation.
I If placed within correct limits, it plays an important role
in determining the success of treatment.
I Before determining a definite working length, there should Fig. 15.5: CDJ needs not to terminate at apical constriction.
It can be 0.5-3 mm short of the apex
be straight line access for the canal orifice for unobstructed
penetration of instrument into apical constriction.
I Once apical stop is calculated, monitor the working length cleaning and underfilling. Apical leakage may occur into
periodically because working length may change as curved uncleaned and unfilled space short of apical constriction.
canal is straightened. It may support continued existence of viable bacteria and
I Failure to accurately determine and maintain working length contributes to the periradicular lesion and thus poor success
mayresult in length being over than normal which will lead rate.
to postoperative pain, prolonged healing time and lower
success rate because of incomplete regeneration of Working Width
cementum, periodontal ligament and alveolar bone. Working width is defined as "initial and post instrumentation
I When working length is made short of apical constriction horizontal dimensions of the root canal system at working length
it may cause persistent disc 0mfort because of incomplete and other levels".
4
201
 en Consequences of over-extended working length Advantages of Wide Apex
o
E Perforation through apical construction Complete removal of infected dentin
o Over instrumentation
"0 Better disinfection of canal at apical third.
o
"0 Overfilling of root canal
c
w Increased incidence of postoperative pain Disadvantages
'0 Prolonged healing period
~ Lowersuccessrate due to incompleteregenerationof cementum, Increased chances of extrusion of irrigants and obturating
o
o
.0 periodontal ligament and alveolar bone. material
X
a.>
f-
Not recommended for thermoplastic obturation
Consequences of working short of actual working length More chances of preparation errors.
• Incomplete cleaning and instrumentation of the canal
• Persistent discomfort due to presence of pulpal remnants DIFFERENT METHODS OF
• Underfilling of the root canal WORKING LENGTH DETERMINATION
• Incomplete apical seal
• Apicalleakagewhich supports existence of viable bacteria, this Various methods for determining working length include using
further leads to poor healing and periradicular lesion. average root lengths from anatomic studies, preoperative
radiographs, tactile sensation, etc. Other common methods
Causes of loss of working length include use of paper point, working length radiograph, electronic
Presence of debris in apical 2-3 of canal apex locators or any combination of the above.
Failure to maintain apical patency In this era of improved illumination and magnification,
Skipping instrument sizes working length determination should be to the nearest
Ledge formation
1.5 mm. So to achieve the highest degree of accuracy a
Inadequate irrigation
combination of several methods should be used.
Instrument separation
Canal blockage.
Methods of determining working length
The minimum initial working width corresponds the initial Radiographic methods Non-radiographic methods
apical ftle size which binds at working length. The maximum • Grossman formula • Digital tactile sense
final working width corresponds to the master apical file size, • Ingle's method • Apical periodontal sensitivity
this master apical file size is usually three times than minimum • Weine'smethod • Paper point method
initial working width. • Kuttler's method • Electronic apex locators
• Radiographic grid
Determination of Minimum Initial Working Width • Endometric probe
• Direct digital radiography
It depends upon following factors: • Xeroradiography
Canal shape: It is easier to determine working width in round • Subtraction radiography
canals but variations occur in roots with oval, irregular or
flattened ribbon like canals. It is difficult to calculate width in Directional Stop Attachments
such canals thus resulting in discrepancy in value. This can Most commonly used stoppers for endodontic instruments are
further lead to incomplete cleaning and shaping and keyhole
silicon rubber stops, though stop attachments can be madeup
or dumbbell root canal preparation.
of metal, plastic or silicon rubber. Stop attachments can be
available in two shapes tear drop or round.
Significance of Working Width
Irrespective of shape, the stop should be placed perpendi-
To attain a round apical stop so as to achieve a three- cular to the instrument not at any other direction (oblique)so
dimensional impermeable seal. This round shape conforms as to avoid variation in working length. Advantage of using
to the round cross-sectional tip of gutta-percha tear shaped stopper is that in curved canal, it can be used to
Large working width of apical area removes more bacteria, indicate the canal curvature by placing its tear shape towards
and let the irrigants to reach apical area, more easily then the direction of curve.
in canals with small working width.
RADIOGRAPHIC METHOD OF
Advantages of Narrow Apex WORKING LENGTH DETERMINATION
Decreases risk of canal transportation Radiographic apex has been used as termination point in
Avoids extrusion of debris and obturating material. working length determination since many years and it has
showed promising results. But there are two school of thoughts
Disadvantages regarding this:
Incomplete removal of infected dentin Those who follow this concept say cementodentinal junction
Not ideal for lateral compaction is impossible to locate clinically and the radiographic apexis
Irrigants may not reach the apical-third of canal. the only reproducible site available for length determination.

202
 According to it, a patent root tip and larger files kept with in
the tooth may result in excellent prognosis.
Those who don't follow this concept say that position of
radiographic apex is not reproducible. Its position depends on
number of factors like angulation of tooth, position of film,
film holder, length of X-ray cone and presence of adjacent
anatomic structures, etc.
When radiographs are used in determining working length
the quality of the image is important for accurate interpretations.
Among the two commonly used techniques, paralleling Figs 15.6A and B: Reference point should not be made of fractured
techniques have been demonstrated as superior to bisecting angle tooth surface or carious tooth structure. These should be first removed
technique in determination and reproduction of apical anatomy. for avoiding loss in working length

As the angle increases away from parallel, the quality of image

decreases. This occurs because as the angle increases, the tissue
that X-rays must pass through includes a greater percentage of
bone mass, therefore the root anatomy becomes less apparent.

Parallel working length radiographs can be difficult to attain

because of disorientation, shallow palatal vault and tori, etc.
But good film holders like Endo Ray II film holder may help
in improving the results.
Before studying the X-rays for endodontics, under-standing
of buccal object rule is essential. The basic concept of the rule
is that as the vertical or horizontal angulation of X-ray tube
changes, the object buccal or closest to tube head moves to
opposite side of radiograph compared to the lingual object.
To separate buccal and lingual roots (for example in maxillary ':-':-J!~0.5mm
firstpremolar) to visualize the working length, tube head should to 1.0 mm
be moved from a 20° mesial angulation. This captures the buccal
Canal
root to the opposite or distal side of radiograph and lingual length
root on mesial side of the radiograph. It is also known as SLOB
rule that is same lingual opposite buccal.

When two superimposed canals are present (for example buccal

andpalatalcanals of maxillary premolar, mesial canals of mandibular
molar) one should take following steps:
a. Take two individual radiographs with instrument placed in each
canal.
b. Take radiograph at different angulations, usually 20° to 40° at
horizontal angulation. Figs 1S.7A to 0: Radiographic method
c. Insert two different instrument, e.g. K file in one canal, H ftle/ of working length determination
reamer in other canal and take radiograph at different angulations.
d. Apply SLOB rule, that is expose tooth from mesial or distal
horizontal angle, canal which moves to same direction, is lingual This measurement is used as estimated working length
where as canal which moves to opposite direction is buccal. which can then be confirmed by placing an endodontic
instrument into the canal and taking a second radiograph (Figs
A. Radiographic Methods lS.7A to D).
Before access opening, fractured cusps, cusps weakened by caries The instrument inserted in the canal should be large enough
or restorations are reduced to avoid fracture of weakened enamel not to be loose in the canal because it can move while taking
during the treatment. This will avoid the loss of initial reference the radiograph and thus may result in errors in determining
point and thus the working length (Figs lS.6A and B). the working length.
In this method, preoperative periapical radiograph is used Fine instruments are often difficult to be seen in a
to calculate the working length for endodontic treatment. radiograph. The new working length is calculated by adding
OrthoPantograph (OPG) radiographs are not advocated for or subtracting the distance between the instrument tip and
calculating tentative working length because of gross desired apical termination of the root.
magnification of 13-28 percent employed in OPG which will The correct working length is finally calculated by subtracting
lead to errors in calculation of accurate readings. 1 mm as safety factor from this new length. This technique
203
 en
was first introduced by John Ingle. Weine modified this
o subtraction rule (Figs lS.8A to C) as follows:
'E
o a. If radiograph shows absence of any resorption, i.e. bone
"0
o
"0 or root apex, shorten the length by 1 mm (Fig. lS.8A).
C
w b. If periapical bone resorption is present, shorten it by
'0 1.5 mm (Fig. IS.8B) .
.:.:.
o c. If both bone and root resorption is seen, shorten length
o
.0
X by 2 mm. This is done because if there is root resorption,
Q)
f- loss of apical constriction may occur in such cases (Fig.
IS.8C). Figs 15.8A to C: Modification in length by substraction
In curved canals, canal length is reconfirmed because final in case of root resorption
working length may shorten up to 1 mm as canal is straightened
out by instrumentation. If root contains two canals, the cone
By above, as we see those three variables are known and
should be positioned at 20 to 30° horizontal deviation from
by applying the formula, 4th variable, i.e. actual length of tooth
the standard facial projection.
can be calculated.
Radiographic method of length determination Actual length of the instrument x
1. Measure the estimated working length from preoperative Apparent length of tooth in radiograph
Actual length of tooth = ---------------
periapical radiograph. Apparent length of instrument in radiograph
2. Adjust stopper of instrument to this estimated working length
and place it in the canal up to the adjusted stopper.
3. Take the radiograph.
Disadvantages
4. On the radiograph measure the difference between the tip of 1. Wrong readings can occur because of:
the instrument and root apex. Add or subtract this length to a. Variations in angles of radiograph
the estimated working length to get the new working length. b. Curved roots
5. Correct working length is finally calculated by subtracting 1 mm c. S-shaped, double curvature roots.
from this new length.

Modification in the length subtraction (Fig. 15.8) Kuttler's Method

1. No resorption - subtract 1 mm According to Kuttler, canal preparation should terminate at
2. Periapical bone resorption - subtract 1.5 mm apical constriction, i.e. minor diameter. In young patients, average
3. Periapical bone + root apex resorption - subtract 2 mm
distance between minor and major diameter is 0.524 mm where
Advantages of radiographic methods of working length as in older patients it 0.66 mm.
determination
1. One can see the anatomy of the tooth Technique
2. One can find out curvature of the root canal Locate minor and major diameter on preoperative
3. We can see the relationship between the adjacent teeth and radiograph
anatomic structures.
Estimate length of roots from preoperative radiograph.
Disadvantages of radiographic methods of working length Estimate canal width on radiograph. If canal is narrow, use
determination 10 or 15 size instrument. If it is of average width, use 20
1. Varies with different observers or 25 size instruments. If canal is wide, use 30 or 35 size
2. Superimposition of anatomical structures instrument.
3. Two-dimensional view of three-dimensional object Insert the selected file in the canal up to the estimated canal
4. Cannot interpret if apical foramen has buccal or lingual exit length and take a radiograph.
5. Risk of radiation exposure
If file is too long or short by more than 1 mm from minor
6. Time consuming
diameter, readjust the file and take second radiograph.
7. Limited accuracy
If file reaches major diameter, subtract 0.5 mm from it for
Grossman Method/Mathematic Method of younger patients and 0.67 for older patients.
Working Length Determination
Advantages
It is based on simple mathematical formulations to calculate
the working length. In this, an instrument is inserted into the Minimal errors
canal, stopper is fixed to the reference point and radiograph Has shown many successful cases
is taken. The formula to calculate actual length of the tooth Rapid development of increases the chances of retaining
is as follows: obturating material.

Actual length of the tooth Apparent length of tooth in radiograph Disadvantages

Actual length of the Apparent length of instrument Time consuming and complicated
instrument in radiograph Requires excellent quality radiographs.
204
Radiographic Grid
It was designed by Everett and Fixott in 1963. It is a simple
method in which a millimeter grid is superimposed on the
radiograph.This over comes the need for calculation. But it
is not good method if radiograph is bent during exposure.
Endometric Probe
Inthismethod, one uses the graduations on diagnostic filewhich
arevisibleon radiograph. But its main disadvantage is that the
smallestfile size to be used is number 25.
Direct Digital Radiography
In thisdigitalimage is formed which is represented by spatially
distributedset of discrete sensors and pixels.
Two types of digital radiography:
a. Radiovisiography
b. Phosphor imaging system.
Xeroradiography
It is new method for recording images without film in which
the imaging is recorded on an aluminium plate coated with
seleniumparticles.
The plate is removed from the cassette and subjected to
relaxationwhich removes old images, then these are electro-
staticallycharged and inserted into the cassette. Radiations are
projectedon filmwhich cause selective discharge of the particles.
Thisforms the latent image and is converted to a positive image
by a process called 'development' in the processor unit.
Advantages
• This technique offers 'edge enhancement' and good detail.
• The abilityto have both positive and negative prints together.
• Improves visualization of files and canals.
• It is two times more sensitive than conventional D-speed
films,
Disadvantages
• Sincesaliva may act as a medium for flow of current, the
electric charge over the film may cause discomfort to the
patient.
• Exposure time varies according to thickness of the plate.
• The process of development cannot be delayed beyond
15 min.
B. Non-radiographic Methods
1. Digital tactile sense: In this clinician may see an increase
in resistance as file reaches the apical 2-3 mm.
Advantages
Time saving
o radiation exposure.
Disadvantages
Does not always provide the accurate readings
In case of narrow canals, one may feel increased
resistance as file approaches apical 2-3 mm.
In case of teeth with immature apex instrument can
:E
go periapically. o
2. Periodontal sensitivity test: This method is based on patient's ~
:::J
cc
response to pain. But this method does not always provide r
CD
the accurate readings, for example in case of narrow canals, :::J
cc
instrument may feel increased resistance as file approaches g
apical 2-3 mm and in case of teeth with immature apex
instrument can go beyond apex. In cases of canal with
necrotic pulp, instrument can pass beyond apical constriction
and in case of vital or inflamed pulp, pain may occur several
mm before periapex is crossed by the instrument.
3. Paper point measurement method: In this method, paper
point is gently passed in the root canal to estimate the
working length. It is most reliable in cases of open apex
where apical constriction is lost because of perforation or
re sorption. Moisture of blood present on apical part of
paper point indicates that paper point has passed beyond
estimated working length. It is used as supplementary
method.
ELECTRONIC APEX LOCATORS
Radiographs are often misinterpreted because of difficulty in
distinguishing the radicular anatomy and pathosis from normal
structures. Electronic apex locators (EAL) are used for
determining working length as an adjunct to radiography. They
are basically used to locate the apical constriction or
cementodentinal junction or the apical foramen, and not the
radiographic apex. Hence the term apex locator is a misnomer
one.
The ability to distinguish between minor diameter and major
diameter of apical terminus is most important for the creation
of apical control zone (Fig. 15.9). The apical control zone
is the mechanical alteration of the apical terminus of root canal
space which provides resistance and retention form to the
obturating material against the condensation pressure of
obturation. Various studies have shown that electronic apex
locators have provided more accurate results when compared
to conventional radiographs.
History of EALs goes back to 1918, when Custer first
reported the use of electronic current to determine working
length. In 1960's, Gordon reported the use of a clinical device
for electrical measurement of root canals.
Anatomical root apex
Fig. 15.9: Location of COJ
205
 (j)
In 1942, Suzuki's discovered that electrical resistance between Components of Electronic Apex Locators
o an instrument inserted into root canal and an electrode attached
.~ Lip clip
o to oral mucosa registered a constant value.
"0 File clip
o
"0 In 1962, Sunada using a direct current device with simple Electronic device
C
w circuit demonstrated that consistent electrical resistance between Cord which connects above three parts.
'0 periodontium and mucous membrane was 6.5 K ohms (Fig.
»:
o 15.10).
o
.0 Advantages of Apex Locators
X In 1970s, frequency measurements were taken through the
Q) Provide objective information with high degree of accuracy.
f- feedback of an oscillator loop by calibration at periodontal
Accurate in reading (90-98% accuracy)
pocket depth of each tooth.
Some apex locators are also available in combination with
In mid 80's, there occurred the development of a relative
pulp tester, so can be used to test pulp vitality.
value of frequency response method where apical constriction
was picked by filtering the difference between two direct Disadvantages
potentials after 1 Kl-Iz wave was applied to canal space. a. Can provide inaccurate readings in following cases:-
A third generation electronic apex locator was developed 1. Presence of pulp tissue in canal
in late 80's by Kobayashi. He used multiple channel impedance 11. Too wet or too dry canal
ratios based technology to simultaneously measure the 111. Use of narrow file
impedance of two different frequencies; calculate the quotient IV: Blockage of canal
of impedance and express it in terms of the position of v: Incomplete circuit
electrode, i.e. file in the canal. vi. Low battery
b. Chances of over estimation
Historical review of EALs
c. May pose problem in teeth with immature apex.
1918 - Custer - Use of electric current for working length
1942 - Suzuki - Conducted scientificstudy of apex locator
1960's - Gordon - Use of clinicaldevice for measurement of Uses of Apex Locators
length 1. Provide objective information with high degree of accuracy.
1962 - Sunada - Found electrical resistance between 2. Useful in conditions where apical portion of canal system
periodontium and oralmucous membranes is obstructed by:
1969 - Inove - Significant contribution in evolution of a. Impacted teeth
EAL b. Zygomatic arch
1996 - Pratten and - Compared the efficacy of three parallel
c. Tori
McDonald radiographs and Endex apex locators in
d. Excessive bone density
cadaver.
e. Overlapping roots
Thus, we can say that all of these apex locators function f. Shallow palatal vault.
by using human body to complete an electrical circuit. One side In such cases, they can provide information which
of apex locator circuit is connected to endodontic instrument radiographs cannot.
and other side is connected to patient's body. Circuit is completed 3. Useful in patient who cannot tolerate X-ray film placement
when endodontic instrument is advanced into root canal until because of gag reflex.
it touches the periodontal tissue. 4. In case of pregnant patients, to reduce the radiation
exposure, they can be valuable tool.
5. Useful in children who may not tolerate taking radiographs,
disabled patients and patients who are heavily sedated.
6. Valuable tool for:
a. Detecting site of root perforations (Fig. 15.13)
b. Diagnosis of external and internal resorption which have
penetrated root surface
c. Detection of horizontal and vertical root fracture
d. Determination of perforations caused during post
preparation
e. Testing pulp vitality
7. Helpful in root canal treatment of teeth with incomplete
root formation, requiring apexification and to determine
working length in primary teeth.

Contraindications to the Use of Apex Locator

Fig. 15.10: Diagrammatic representation of working Older apex locators were contraindicated in the patients who
of resistance type of apex locator have cardiac pacemaker functions. Electrical stimulation to such
206
patients could interfere with pacemaker function. But this
problem has been overcome in newer generation of apex
locators.
It has been shown that in teeth with periapical radiolucencies,
and necrotic pulps associated with root resorption, ete. the use
of apex locators is not much beneficial. In such cases there
isalterationof apical constriction and lack of viable periodontal o
CD

ligamenttissue to respond to EAL which may cause abnormally ID

long readings.
3
:::l
ao·
:::l
Classificationof EALs
This classification is based on type of the current flow and
opposition to current flow as well as number of frequencies Fig. 15.11A: File being introduced in the canal

involved.Following classification is modification of classification

givenby McDonald [DCNA 1992;36:293].

FirstGeneration Apex Locators

(ResistanceApex Locators)
Theyare also known as resistance apex locators which measure
opposition to flow of direct current, i.e. resistance. It is based
onthe principle that resistance offered by periodontal ligament
andoralmucous membrane is the same, i.e. 6.5 K ohms. Initially
Sonoexplorer was imported from Japan by Amadent, but
nowadaysfirst generation apex locators are off the practice.
Blood,pus, chelating agents, irrigants and other materials used
within the canal can give false readings.
Fig. 15.118: Steady increase in the reading as file approaches apex
Techniquefor Using Resistance Based EAL
1. Turn on the device and attach the lip clip near the arch
being treated. Hold a 15 number file and insert it
approximately 0.5 mm into sulcus of tooth (like PD probe).
Adjust the control knob until the reference needle is centered
on the meter scale and produces audible beeps. Note this
reading.
2. Prepare the access cavity and apply rubber dam and remove
pulp, debris, ete.
3. Using preoperative radiograph estimate the working canal
width.Clean the canal if bleeding form vital pulp is excessive,
dry it with paper points.
4. Insert the file into canal unless the reference needle moves
from extreme left to center of scale and alarm beeps sound.
Reset the stop at reference point and record the lengths
(Figs lS.11A to D).
5. Take the radiograph with file in place at the length indicated
by apex locator. If length is longer/shorter, it is possible
that preoperative film can be elongated or apex locator is
inaccurate.

Advantages
1. Easily operated
2. Digital read out
3. Audible indication
4. Detect perforation
5. Can be used with K-file.
6. May incorporate pulp tester.
207
 tn
Disadvantages Disadvantages
(J
.~ 1. Requires a day field 1. Requires lip clip
o
"0 2. Patient sensitivity 2. Chances of short circuit.
o
"0
C
3. Requires calibration Endex is original third generation apex locator which was
W
4. Requires good contact with lip clip described by Yamaoka et al. It uses two frequencies
'0
.x: 5. Cannot estimate beyond 2 mm. 5 and 1 KHz. As the instrument is moved apically, difference
o
o
.0 in impedance is noted. Commonly available third generation
X Second Generation Apex Locators
QJ apex locators are mentioned in below:
f- (Impedance Based Apex Locators)
They are also called as impedance apex locatorwhich measure Various third generation apex locators
opposition to flow of alternating current or impedance. A major Endex Original 3rd generation apex locator
disadvantage of second generation apex locators is that root eosomo Ultimo Apex locator with pulp tester
canal has to be free of electroconductive materials to obtain EZ apex locator
accurate readings. Presence of electroconductive irrigants Mark V plus Apex locator with pulp tester
changes the electric characteris tics and lead to inaccurate Root Zx Shaping and cleaning of root canalswith
readings. Various second generation apex locators are given simultaneous monitoring of working
below. length
Combination of Apex Locator and Endodontic Handpiece
Advantages Tri Auto Zx Cordless electrical handpiece with three
1. Does not require lip clip safety mechanism
2. No patient sensitivity Endy 7000 Reverses the rotation when tip reaches
3. Analog method. apical constriction
Sofy Zx Monitor the location of file during
Disadvantages instrumentation
1. 0 digital read out

2. Difficult to operate Fourth Generation Apex Locators

3. Canal should be free of electroconductive irrigants and tissue
fluids.
Various second generation apex locators
Sonoexplorer
The apex finder (has digital LED indicator and is self calibrating)
Endoanalyzer (combination of apex locator and pulp tester)
Digipex (has digital LED indicator but requires calibration)
Digipex II (combination of apex locators and pulp tester)
Formation IV (digital LED light and display, self calibrating).
Third Generation Apex Locators (Fig. 15.12)
They are also called frequency dependent apex locator. They
are based on the fact that different sites in canal give difference
in impedance between high (8 KHz) and low (400 Hz)
frequencies. The difference in impedance is least in the coronal
part of canal. As the probe goes deeper into canal, difference
increases. It is the greatest at cementodentinal junction.
Since impedance of a given circuit may be substantially
influenced by the frequency of current flow, these are also known
as frequency dependent. More appropriately, they should be
termed as "Comparative Impedance" because they measure
relative magnitudes of impedance which are converted into
length information.
Recently fourth generation electronic apex locators have been
developed which measure resistance and capacitance separately
rather than the resultant impedance value. There can be different
combination of values of capacitance and resistance that
provides the same impedance, thus the same foraminal reading.
But by using fourth generation apex locator, this can be broken
down into primary components and measures separately for
better accuracy and thus less chances of occurrence of errors.
Though it is claimed to provide high accuracy but more
studies are required for its confirmation.
Combination Apex Locators and
Endodontic Handpiece
Tri Auto Zx a Morita Calif) is cordless electric endodontic
handpiece with built in root ZX apex locator. It has three safety
mechanisms (Fig. 15.13).
Apex locator

Advantages
1. Easy to operate
2. Uses K-type ftle
3. Audible indication
4. Can operate in presence of fluids
5. Analog read out. - Fig. 15.12: Propex 11 apex locator
208

Fig. 15.13:Combination of apex locator and endodontic handpiece
Autostart stop mechanism: Handpiece starts rotation when
instrument enters the canal and stops when it is removed.
Autotorque reverse mechanism: Handpiece automatically stops
and reverses rotation when torque threshold (30 gm/cm) is
exceed.It prevents instrument breakage.
Autoapical-reverse mechanism: It stops and reverses rotation
wheninstrument tip reaches a distance from apical constriction
takenfor working length. It prevents apical perforation. Endy
7000 reverse the rotation when tip reaches the apical
constriction. Sofy Zx 0 Morita Calif) uses Root Zx to
electronicallymonitor the location of file tip during whole of
the instrumentation procedure.
BasicConditions for Accuracy of EALs
Whateveris the generation of apex locator; there are some basic
conditions,which ensure accuracy of their usage.
1. Canal should be free from most of the tissue and debris.
2. The apex locator works best in a relatively dry environment.
Butextremely dry canals may result in low readings, i.e. long
working length.
3. Cervicalleakage must be eliminated and excess fluid must
be removed from the chamber as this may cause inaccurate
readings.
4. If residual fluid is present in the canal, it should be of low
conductivity value, so that it does not interfere the
functioning of apex locator.
The descending order of conductivity of various
irrigating solutions is 5.25 percent NaOCI > 17 percent
EDTA > Saline.
5. SinceEALs work on the basis of contact with canal walls
and periapex. The better the adaptation of flie to the canal
walls, the more accurate as the reading.
6. Canals should be free from any type of blockage,
calcifications, ete.
7. Battery of apex locator and other connections should be
proper.
Basic conditions for accuracy of EAL
:E
• Canal should be free from debris o
• Canal should be relatively dry ~
:J
ca
• No cervical leakage r
CD
• Proper contact of file with canal walls and periapex :J
ca
g.
• No blockages or calcificationsin canal
SUMMARY
The most important thing to understand when determining
working length is morphology of apical one-third of the canal.
The consideration should be given to adopt the parameters of
0.5 - 0.0 mm (from the apical constriction) as most ideal termi-
nating point in canal. One should use as many of techniques
as possible during the course of treatment. First of all there
should be a stable coronal reference point. Next step is to
estimate working length from average anatomical length and
preoperative radiograph. Finally calculate the correct working
length using combination of various mentioned techniques, i.e.
tactile sense, radiography, electronic apex locators, ete. Multiple
measurements should be taken to determine accurate readings
of working length. With so many advances coming up in the
branch of endodontics we expect the future of apex locators
to provide accurate readings in all the conditions of root canal
without the need of calibrations.
QUESTIONS
Q. Define working length. What IS significance of
working length?
Q. Enumerate different methods of working length
determination. Write in detail Ingle's method of
working length determination.
Q. Classify apex locators. What are third generation apex
locators.
Q. Write short notes on:
a. Paper point sensitivity test
b. Advantages of apex locators
BIBLIOGRAPHY
1. Bramante CM, Berbert A. Critical evaluation of methods of
determining working length. Oral Surg 1974;37:463.
2. Cluster LE. Exact methods of locating the apical foramen.J
Nat Dent Assoc 1918;5:815.
3. 1ngleJ1, Bakland LK. Endodontic cavitypreparation. Textbook
of endodontics (5th edn). Philadelphia: BC Decker, 2002.
4. Kim E, Lee SJ.Electronic apex locator. Dent Clin North Am
2004;48(1):35-54.(Review).
5. Krithika AC,JandaswamyD, VelmuruganN, Krishna VG.Non-
metallic grid for radiographic measurement. Aust Endod J
2008;34(1):36-38.
6. Kuttler Y.Microscopicinvestigationof root apexes.J Am Dent
Assoc 1955;50:544-52.
7. McDonald NJ.The electronicdetermination of workinglength.
Dent Clin North Am 1992;36:293.
8. Sunada 1.New method for measuring the length of root canals.
J Dent Res 1962;41(2):375-87.
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