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Working Length

Determination

The first step in cleaning and shaping is

working length determination.

The word length is defined as the distance

between two fixed points.

There are two apices

recognized for any root:


1) Radiographic apex: which is the external
border of the root tip & is seen
radiographically.
2) Anatomical apex: which is the natural
apical constriction formed by the cementodentinal junction (narrowest part in the canal).

The tooth length is the distance between a

reference point coronally (such as the incisal


edge for anterior teeth and the cusp tip for
posterior teeth) and the radiographic apex.
The working length is the distance between

the reference point coronally and the


anatomical apex.

Significance of working length

determination:
1) Determine the instrument length in the canal.
2) Limits the depth to which the canal filling
maybe placed.
3) Limits the postoperative pain & discomfort as
instrumentation shorter than the apical
constriction leaves uncleaned space, while
beyond the apical constriction irritate the
periapical tissues, violate the apical zone
and affect the compaction of the filling
material against the apex.
4) Determination of the success of treatment.

Variation in the position of the


apical constriction in relation to
the radiographic apex:
The distance between the anatomic and
radiographic apex ranges from 0.5-2mm,
depending on;
a) Apical foramen is usually found 0.5-1mm short
from the radiographic apex ( no bone or root
resorption).
b) Bone but no root resorption 1.5mm from the
apex.
c) Bone and root resorption: 2mm from the apex.

Methods of working length


determination:
1) Radiographic method :
- Proper preoperative radiograph is taken.
- Proper sized file is inserted into the root
canal from the reference point to the:
* Estimated average length.
* Apical constriction as felt by the dentist.
* Patient sensation if healthy apical tissues
are present.

- Provisional working length x ray is taken


while the file is inserted in the canal.
- Adjustment for the working length is made
by subtraction or addition to the used file
length according to the proximity of the file
to the anatomical apex.
- Adjusted working length should be checked
radiographically.

2) Buccal object rule for


posterior teeth:
This method is used for the working length

determination in multi-rooted teeth.


If the radiograph is taken with zero horizontal
angulation this will lead to superimposition of
the buccal and palatal canals on the film.
This is why the buccal object rule is used
through directing the x ray cone mesially or
distally.

- It states that the most distant object from


the cone (always the lingual) moves towards
the direction of the cone in the film.
- Meaning that when the x ray cone is directed
from the mesial side, the lingual canal comes
mesially on the film while if the x-ray is
directed from the distal, the lingual canal
becomes distally on the film.
N.B: same lingual opposite buccal.

3) Electronic apex locators:


- They are electronic devices which are
designed to determine the canal length by
giving a reading when the file tip is at the
apical foramen as it reaches vital tissues.
- The principle is based on the electrical
resistance of different tissues. When the
circuit is complete, resistance decreases and
current begins to flow.

Old types were affected by the presence of

saliva, blood inside the canal while recent


types are not affected by them and work
efficiently in their presence.
As recent types depend on the electrical

impedance which is the different electric


resistance between the cervical and apical
dentin,
Apex locators are accurate but not superior to

radiograph.