An evaluation of the accuracy of Root ZX according to the conditions of major apical foramen

Shin-Young Park; Dong-Kyun Lee; Ho-Keel Hwang

doi:10.5395/rde.2012.37.2.68

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Research Article An evaluation of the accuracy of Root ZX according to the conditions of major apical foramen: Shin-Young Park, DDS, Dong-Kyun Lee, DDS, Ho-Keel Hwang, DDS, PhD; 2012;37(2):-73.
DOI: https://doi.org/10.5395/rde.2012.37.2.68
Published online: May 18, 2012

Department of Conservative Dentistry, Chosun University School of Dentistry, Gwangju, Korea.

Correspondence to Ho-Keel Hwang, DDS, PhD. Professor, Department of Conservative Dentistry, Chosun University School of Dentistry, 375 Seosuk-dong, Dong-gu, Gwangju, Korea 501-825. TEL, +82-62-220-3840; FAX, +82-62-223-9064; rootcanal@hanmail.net

• Received: October 14, 2011 • Revised: November 7, 2011 • Accepted: November 16, 2011

©Copyights 2012. The Korean Academy of Conservative Dentistry.

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Abstract
REFERENCES

Abstract

Objectives
The purpose of this study was to assess the accuracy of Root ZX (J. Morita Corp.) according to the location of major foramen and open apex.
Materials and Methods
81 mandibular premolars with mature apices were selected. After access preparation, 27 teeth were instrumented to simulate open apices. 54 teeth were classified according to location of major foramen under surgical microscope (×16). The file was fixed at the location of apical constriction by Root ZX using glass ionomer cement. The apical 4 mm of the apex was exposed and photo was taken and the distance from file tip to the major foramen was measured by calibrating metal ruler on graph paper. The results were statistically analyzed using ANOVA and Scheffe test at p < 0.05 level.
Results
Mean distance from file tip to major foramen was 0.308 mm in Tip foramen group (I), 0.519 mm in Lateral foramen group (II) and 0.932 mm in open apex group (III). Root ZX located apical constriction accurately within ± 0.5 mm in group I of 85.71%, in group II of 59.09%, and in group III of 33.33%. There was a statistically significant difference between group I and III (p < 0.05).
Conclusion
Root ZX located apical constriction accurately regardless of location of major foramen. However, Root ZX couldn't find it in open apex. Clinicians have to use a combination of methods to determine an appropriate working length at open apex. It may be more successful than relying on just electronic apex locator.
Keywords: Accuracy; Electronic apex locator; Major foramen; Open apex

Figure 1

An open apex model. (a) The canals were instrumented with a #2 Peeso reamer to the actual length; (b) A divergent open apex was prepared by retrograde apical preparation with a .04/50 K3 file inserted to the length of the cutting blade; (c) Simulated open apex model.

Figure 2

Tip foramen (group I), in which major foramen is located at the tip along the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 3

Lateral foramen (group II), in which major foramen deviates from the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 4

Simulated open apex (group III). File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Table 1

Distance from file tip to major foramen (mm)

^*A significant difference was found between group I and group III (p < 0.05).

SD, standard deviation.

Table 2

Position of file tip relative to major foramen

^*Negative value indicates file tip short from major foramen.

d, distance from file tip to major foramen.

No potential conflict of interest relevant to this article was reported.

Figure 1

Figure 2

Tip foramen (group I), in which major foramen is located at the tip along the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 3

Lateral foramen (group II), in which major foramen deviates from the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 4

Simulated open apex (group III). File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Table 1

Distance from file tip to major foramen (mm)

^*A significant difference was found between group I and group III (p < 0.05).

SD, standard deviation.

Table 2

Position of file tip relative to major foramen

^*Negative value indicates file tip short from major foramen.

d, distance from file tip to major foramen.

REFERENCES

1. Ding J, Gutmann JL, Fan B, Lu Y, Chen H. Investigation of apex locators and related morphological factors. J Endod. 2010;36: 1399-1403.Article PubMed
2. Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. a histological study. Int Endod J. 1998;31: 394-409.Article PubMed
3. Suzuki K. Experimental study on iontophoresis. J Jpn Stomatol. 1942;16: 411-417.
4. Sunada I. New method for measuring the length of the root canal. J Dent Res. 1962;41: 375-387.Article PDF
5. Kobayashi C, Suda H. New electronic canal measuring device based on the ratio method. J Endod. 1994;20: 111-114.Article PubMed
6. Kobayashi C. Electronic canal length measurement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79: 226-231.Article PubMed
7. Green D. Stereomicroscopic study of 700 root apices of maxillary and mandibular posterior teeth. Oral Surg Oral Med Oral Pathol. 1960;13: 728-733.Article PubMed
8. Dummer PM, McGinn JH, Rees DG. The position and topography of the apical canal constriction and apical foramen. Int Endod J. 1984;17: 192-198.Article PubMed
9. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc. 1955;50: 544-552.Article PubMed
10. Torabinejad M, Walton RE. Endodontics: principles and practice. 2009;4th ed. Missouri: Saunders Elsevier; 29-34.
11. Herrera M, Abalos C, Planas AJ, Llamas R. Influence of apical constriction diameter on Root ZX apex locator precision. J Endod. 2007;33: 995-998.Article PubMed
12. Stein TJ, Corcoran JF, Zillich RM. Influence of the major and minor foramen diameters on apical electronic probe measurements. J Endod. 1990;16: 520-522.PubMed
13. Fouad AF, Rivera EM, Krell KV. Accuracy of the Endex with variations in canal irrigants and foramen size. J Endod. 1993;19: 63-67.PubMed
14. Huang L. An experimental study of the principle of electronic root canal measurement. J Endod. 1987;13: 60-64.Article PubMed
15. Hachmeister DR, Schindler WG, Walker WA 3rd, Thomas DD. The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification. J Endod. 2002;28: 386-390.Article PubMed
16. Cho JH, Kum KY, Lee SJ. In vitro evaluation of accuracy and consistency of four different electronic apex locators. J Korean Acad Conserv Dent. 2006;31: 390-397.Article
17. Ponce EH, Vilar Fernández JA. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod. 2003;29: 214-219.Article PubMed
18. Sjogren U, Hägglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16: 498-504.Article PubMed
19. Pagavino G, Pace R, Baccetti T. A SEM study of in vivo accuracy of the Root ZX electronic apex locator. J Endod. 1998;24: 438-441.Article PubMed
20. Goldberg F, De Silvio AC, Manfré S, Nastri N. In vitro measurement accuracy of an electronic apex locator in teeth with simulated apical root resorption. J Endod. 2002;28: 461-463.Article PubMed
21. Nguyen HQ, Kaufman AY, Komorowski RC, Friedman S. Electronic length measurement using small and large files in enlarged canals. Int Endod J. 1996;29: 359-364.Article PubMed
22. Kim BH, Lee YK, Kim YS. A study on the accuracy of the ROOT-ZX in the canal with mechanically formed constriction. J Korean Acad Conserv Dent. 1999;24: 628-632.
23. Czerw RJ, Fulkerson MS, Donnelly JC. An in vitro test of a simplified model to demonstrate the operation of electronic root canal measuring devices. J Endod. 1994;20: 605-606.Article PubMed
24. Cho YL, Son WH, Hwang HK. An accuracy of the several electronic apex locators on the mesial root canal of the mandibular molar. J Korean Acad Conserv Dent. 2005;30: 477-485.Article
25. Lee SJ, Nam KC, Kim YJ, Kim DW. Clinical accuracy of a new apex locator with an automatic compensation circuit. J Endod. 2002;28: 706-709.Article PubMed
26. Ounsi HF, Naaman A. In vitro evaluation of the reliability of the Root ZX electronic apex locator. Int Endod J. 1999;32: 120-123.Article PubMed
27. Mayeda DL, Simon JH, Aimar DF, Finley K. In vivo measurement accuracy in vital and necrotic canals with the Endex apex locator. J Endod. 1993;19: 545-548.Article PubMed
28. Herrera M, Abalos C, Planas AJ, Llamas R. Influence of apical constriction diameter on Root ZX apex locator precision. J Endod. 2007;33: 995-998.Article PubMed
29. Shabahang S, Goon WW, Gluskin AH. An in vivo evaluation of Root ZX electronic apex locator. J Endod. 1996;22: 616-618.Article PubMed
30. Tselnik M, Baumgartner JC, Marshall JG. An evaluation of root ZX and elements diagnostic apex locators. J Endod. 2005;31: 507-509.Article PubMed
31. Meredith N, Gulabivala K. Electrical impedance measurements of root canal length. Endod Dent Traumatol. 1997;13: 126-131.Article PubMed
32. Nekoofar MH, Ghandi MM, Hayes SJ, Dummer PM. The fundamental operating principles of electronic root canal length measurement devices. Int Endod J. 2006;39: 595-609.Article PubMed
33. Berman LH, Fleischman SB. Evaluation of the accuracy of the Neosono-D electronic apex locator. J Endod. 1984;10: 164-167.Article PubMed
34. Saito T, Yamashita Y. Electronic determination of root canal length by newly developed measuring device. Influences of the diameter of apical foramen, the size of K-file and the root canal irrigants. Dent Jpn (Tokyo). 1990;27: 65-72.PubMed
35. Huang L. An experimental study of the principle of electronic root canal measurement. J Endod. 1987;13: 60-64.Article PubMed
36. ElAyouti A, Weiger R, Löst C. Frequency of overinstrumentation with an acceptable radiographic working length. J Endod. 2001;27: 49-52.PubMed

Tables & Figures

Figure 1

Figure 2

Tip foramen (group I), in which major foramen is located at the tip along the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 3

Lateral foramen (group II), in which major foramen deviates from the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 4

Simulated open apex (group III). File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Table 1

Distance from file tip to major foramen (mm)

^*A significant difference was found between group I and group III (p < 0.05).

SD, standard deviation.

Table 2

Position of file tip relative to major foramen

^*Negative value indicates file tip short from major foramen.

d, distance from file tip to major foramen.

Figure 1

Figure 2

Tip foramen (group I), in which major foramen is located at the tip along the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 3

Lateral foramen (group II), in which major foramen deviates from the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 4

Simulated open apex (group III). File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Table 1

Distance from file tip to major foramen (mm)

^*A significant difference was found between group I and group III (p < 0.05).

SD, standard deviation.

Table 2

Position of file tip relative to major foramen

^*Negative value indicates file tip short from major foramen.

d, distance from file tip to major foramen.

REFERENCES

1. Ding J, Gutmann JL, Fan B, Lu Y, Chen H. Investigation of apex locators and related morphological factors. J Endod. 2010;36: 1399-1403.Article PubMed
2. Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2. a histological study. Int Endod J. 1998;31: 394-409.Article PubMed
3. Suzuki K. Experimental study on iontophoresis. J Jpn Stomatol. 1942;16: 411-417.
4. Sunada I. New method for measuring the length of the root canal. J Dent Res. 1962;41: 375-387.Article PDF
5. Kobayashi C, Suda H. New electronic canal measuring device based on the ratio method. J Endod. 1994;20: 111-114.Article PubMed
6. Kobayashi C. Electronic canal length measurement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79: 226-231.Article PubMed
7. Green D. Stereomicroscopic study of 700 root apices of maxillary and mandibular posterior teeth. Oral Surg Oral Med Oral Pathol. 1960;13: 728-733.Article PubMed
8. Dummer PM, McGinn JH, Rees DG. The position and topography of the apical canal constriction and apical foramen. Int Endod J. 1984;17: 192-198.Article PubMed
9. Kuttler Y. Microscopic investigation of root apexes. J Am Dent Assoc. 1955;50: 544-552.Article PubMed
10. Torabinejad M, Walton RE. Endodontics: principles and practice. 2009;4th ed. Missouri: Saunders Elsevier; 29-34.
11. Herrera M, Abalos C, Planas AJ, Llamas R. Influence of apical constriction diameter on Root ZX apex locator precision. J Endod. 2007;33: 995-998.Article PubMed
12. Stein TJ, Corcoran JF, Zillich RM. Influence of the major and minor foramen diameters on apical electronic probe measurements. J Endod. 1990;16: 520-522.PubMed
13. Fouad AF, Rivera EM, Krell KV. Accuracy of the Endex with variations in canal irrigants and foramen size. J Endod. 1993;19: 63-67.PubMed
14. Huang L. An experimental study of the principle of electronic root canal measurement. J Endod. 1987;13: 60-64.Article PubMed
15. Hachmeister DR, Schindler WG, Walker WA 3rd, Thomas DD. The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification. J Endod. 2002;28: 386-390.Article PubMed
16. Cho JH, Kum KY, Lee SJ. In vitro evaluation of accuracy and consistency of four different electronic apex locators. J Korean Acad Conserv Dent. 2006;31: 390-397.Article
17. Ponce EH, Vilar Fernández JA. The cemento-dentino-canal junction, the apical foramen, and the apical constriction: evaluation by optical microscopy. J Endod. 2003;29: 214-219.Article PubMed
18. Sjogren U, Hägglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16: 498-504.Article PubMed
19. Pagavino G, Pace R, Baccetti T. A SEM study of in vivo accuracy of the Root ZX electronic apex locator. J Endod. 1998;24: 438-441.Article PubMed
20. Goldberg F, De Silvio AC, Manfré S, Nastri N. In vitro measurement accuracy of an electronic apex locator in teeth with simulated apical root resorption. J Endod. 2002;28: 461-463.Article PubMed
21. Nguyen HQ, Kaufman AY, Komorowski RC, Friedman S. Electronic length measurement using small and large files in enlarged canals. Int Endod J. 1996;29: 359-364.Article PubMed
22. Kim BH, Lee YK, Kim YS. A study on the accuracy of the ROOT-ZX in the canal with mechanically formed constriction. J Korean Acad Conserv Dent. 1999;24: 628-632.
23. Czerw RJ, Fulkerson MS, Donnelly JC. An in vitro test of a simplified model to demonstrate the operation of electronic root canal measuring devices. J Endod. 1994;20: 605-606.Article PubMed
24. Cho YL, Son WH, Hwang HK. An accuracy of the several electronic apex locators on the mesial root canal of the mandibular molar. J Korean Acad Conserv Dent. 2005;30: 477-485.Article
25. Lee SJ, Nam KC, Kim YJ, Kim DW. Clinical accuracy of a new apex locator with an automatic compensation circuit. J Endod. 2002;28: 706-709.Article PubMed
26. Ounsi HF, Naaman A. In vitro evaluation of the reliability of the Root ZX electronic apex locator. Int Endod J. 1999;32: 120-123.Article PubMed
27. Mayeda DL, Simon JH, Aimar DF, Finley K. In vivo measurement accuracy in vital and necrotic canals with the Endex apex locator. J Endod. 1993;19: 545-548.Article PubMed
28. Herrera M, Abalos C, Planas AJ, Llamas R. Influence of apical constriction diameter on Root ZX apex locator precision. J Endod. 2007;33: 995-998.Article PubMed
29. Shabahang S, Goon WW, Gluskin AH. An in vivo evaluation of Root ZX electronic apex locator. J Endod. 1996;22: 616-618.Article PubMed
30. Tselnik M, Baumgartner JC, Marshall JG. An evaluation of root ZX and elements diagnostic apex locators. J Endod. 2005;31: 507-509.Article PubMed
31. Meredith N, Gulabivala K. Electrical impedance measurements of root canal length. Endod Dent Traumatol. 1997;13: 126-131.Article PubMed
32. Nekoofar MH, Ghandi MM, Hayes SJ, Dummer PM. The fundamental operating principles of electronic root canal length measurement devices. Int Endod J. 2006;39: 595-609.Article PubMed
33. Berman LH, Fleischman SB. Evaluation of the accuracy of the Neosono-D electronic apex locator. J Endod. 1984;10: 164-167.Article PubMed
34. Saito T, Yamashita Y. Electronic determination of root canal length by newly developed measuring device. Influences of the diameter of apical foramen, the size of K-file and the root canal irrigants. Dent Jpn (Tokyo). 1990;27: 65-72.PubMed
35. Huang L. An experimental study of the principle of electronic root canal measurement. J Endod. 1987;13: 60-64.Article PubMed
36. ElAyouti A, Weiger R, Löst C. Frequency of overinstrumentation with an acceptable radiographic working length. J Endod. 2001;27: 49-52.PubMed

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Effect of file size in measuring electronic working length of teeth with open apex
Ryeon Jin, Ju-Hee Jeong, A-Ra Cho, Hyoung-Hoon Jo
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An evaluation of the accuracy of Root ZX according to the conditions of major apical foramen

Restor Dent Endod. 2012;37(2):68-73. Published online May 18, 2012

DOI: https://doi.org/10.5395/rde.2012.37.2.68

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Figure

An evaluation of the accuracy of Root ZX according to the conditions of major apical foramen

Figure 1 An open apex model. (a) The canals were instrumented with a #2 Peeso reamer to the actual length; (b) A divergent open apex was prepared by retrograde apical preparation with a .04/50 K3 file inserted to the length of the cutting blade; (c) Simulated open apex model.

Figure 2 Tip foramen (group I), in which major foramen is located at the tip along the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 3 Lateral foramen (group II), in which major foramen deviates from the main axis of root. File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 4 Simulated open apex (group III). File was fixed in the position and the distance from file tip to major foramen was measured (×25).

Figure 1

Figure 2

Figure 3

Figure 4

An evaluation of the accuracy of Root ZX according to the conditions of major apical foramen

Table 1

Distance from file tip to major foramen (mm)

^*A significant difference was found between group I and group III (p < 0.05).

SD, standard deviation.

Table 2

Position of file tip relative to major foramen

^*Negative value indicates file tip short from major foramen.

d, distance from file tip to major foramen.

Table 1 Distance from file tip to major foramen (mm)

^*A significant difference was found between group I and group III (p < 0.05).

SD, standard deviation.

Table 2 Position of file tip relative to major foramen

^*Negative value indicates file tip short from major foramen.

d, distance from file tip to major foramen.