WORKING LENGTH

DETERMINATION
 CONTENTS
 INTRODUCTION
 ANATOMIC CONSIDERATIONS AND TERMINOLOGY
 HISTORICAL PERSPECTIVES
 REFERENCE POINTS
 STOP ATTACHMENTS
 BIOLOGIC RATIONALE
 CLINICAL CONSIDERATIONS
 METHODS OF CALCULATION OF WORKING LENGTH
 RADIOGRAPHIC METHODS
 NON-RADIOGRAPHIC METHODS
 CONCLUSION
 REFERENCES
 INTRODUCTION
The most important segment of endodontic treatment is
Root canal preparation.

one of the most important steps in canal preparation is

the calculation of working length
Seltzer et al were the first to report greater success in
terminating cleaning & obturating the root canal system just
short of the radiographic apex rather than overfilling or
underfilling.(Seltzer S et al.Biologic aspects of endodontics.III Periapical tissue
reactions to canal instrumentation.Part II.Oral Surg Oral Med Oral Pathol Endod
1968;26:694-705)

Sjogren et al reported the best outcome was achieved when

the canal filling was between 0-2mm short of radiographic
apex
According to Cohen and Burns, 1 mm of a canal with a
diameter of 0.25mm, which is the diameter of narrower
foramens, provides enough space to lodge nearly 80,000
streptococci, so filling should be at the apex.
 ANATOMIC CONSIDERATIONS
& TERMINOLOGIES USED
WORKING LENGTH
Defined in the Glossary of Endodontic terms as
“The distance from a coronal reference point to the point
at which canal preparation and obturation should
terminate” (the ideal apical reference point in the canal,
the “apical stop”)
• The anatomic apex - the tip or the end of the root
determined morphologically.
• The radiographic apex - the tip or end of the root
determined radiographically.
• Root morphology and radiographic distortion may cause
the location of the radiographic apex to vary from the
anatomic apex

6
 Apical foramen – the main apical opening of the root
canal.
• It is frequently eccentrically located away from the
anatomic or radiographic apex.
• Extensive study of Kuttler (1955) showed that this
deviation occurred in 68 to 80% of teeth.
• Most commonly the foramen opens 0.75 to 1mm short
of the root tip.
• However, the canal may even exit 3 mm short of the
apex.
Accessory foramen is an orifice on the surface of the
root communicating with a lateral or accessory canal.
• They may exist as a single foramen or as multiple
7
foramina.
 Apical constriction (minor apical diameter) –
The apical portion of the root canal having the
narrowest diameter.
• This position may vary but is usually 0.5 to 1.0
mm short of the center of the apical foramen.

The minor diameter widens apically to the

foramen (major diameter) and assumes a
funnel shape.
. The configuration of the area between the
minor and major diameter resembles that of a
morning glory flower appearance.

8
 Cementodentinal junction – It is the region where the dentin and
cementum are united, the point at which the cemental surface
terminates at or near the apex of a tooth.
• However, the CDJ - a histologic landmark that cannot be located
clinically or radiographically.
• Langeland reported that the cementodentinal junction does not
always coincide with the apical constriction.
• The location of the CDJ ranges from 0.5 to 3.0 mm short of the
anatomic apex.
Therefore, it is generally accepted that the apical
constriction is most frequently located 0.5 to 1.0
mm short of the radiographic apex, but with
variations.
9
The general trend is that :
• Apex to foramen distance is greater in posterior and older teeth
than in anterior and younger teeth.
• The apical constriction, when present, is the narrowest part of
the root canal with the smallest diameter of blood supply and
preparation to this point results in small wound site and optimal
healing conditions ( Ricucci & langeland 1998)
• The location of the apical constriction varies from root to root.
• Dummer et al (1984) classified the
apical constriction into 4 distinct
types.
oTraditional single constriction
oTapering constriction
oMulti constricted
oParallel constriction

He speculated that using this assumption that CDJ occurs at

apical constriction would lead to under preparation in type
B and over preparation in type D
 HISTORICAL PERSPECTIVES
Till the end of the 19th Century:

Working length was calculated to the site where patient experienced

the feeling of an instrument.

In 1899 :

Kell introduced application of X-ray to dentistry.

In early 1900’s :
Popular belief was dental pulp extend through the tooth past the
apical foramen, into the periapical tissue and narrowest diameter is at
foramen
In 1920’s :
Grove, et al., contraindicated filling till the radiographic
apex.
Grove concluded that pulp tissue could not extend beyond
the CDJ because the odontoblasts was not found beyond
the CDJ.

Hatton & Grove

Preparation beyond the natural constriction of the CDJ
would result in injury to the periapical tissues.

Blayney & Coolidge

Offered histologic evaluations indicating that filling
slightly short of the apex root tip gave the best results.
• Kuttler (1955)
– most comprehensive anatomic
microscopic study of the root tip and gave
detailed anatomic description of the root
tip – verified by many others later.

According to Kuttler, the narrowest

diameter of the canal is definitely not at
the site of exiting of the canal from the
tooth – but usually occurs within the
dentin, just prior to the initial layers of
dentin – referred – minor diameter

The diameter of the canal at the site of

exiting – major diameter – approx. twice
as wide as minor diameter
The average distance between the minor
diameter (apical constriction) and the
major diameter (apical foramen) –
0.524mm in 19-25 year old 14

0.659mm in 55 years and above

In 1962, Sunada:

Found electrical resistance between periodontium and oral

mucous membrane

In 1969, Inoue :

Significant contribution in evolution of Electronic Apex

Locators.
 REFERENCE POINTS
• Any measurement of length refers to the distance
between two points.
• One point of the measurement of the working
length refers to the end point of the preparation, the
other point may vary considerably
• The measurement should be made from a secure
reference point on the crown, in close proximity to
the straightline path of the instrument, a point that
can be identified and monitored accurately.
• A definite, repeatable plane of reference to an
anatomic landmark on the tooth – necessary. 16
• Coronal reference point on the tooth –
For anterior teeth - Incisal edge or adjacent
teeth or some projecting portion of the
remaining tooth structure
For 2 canal premolars –
- Buccal canal: buccal cusp tip,
- Palatal canal: either of the cusp tips
- For molars –
- cusp tips
- Marginal ridge of adjacent tooth 17
• It is imperative that teeth with
fractured cusps or cusps severely
weakened by caries or restoration be
reduced to a flattened surface,
supported by dentin.
• Failure to do so may result in cusps or
weak enamel walls being fractured
between appointments.
• Thus, the original site of reference is
lost. If this fracture goes unobserved,
there is the probability of over-
instrumentation and overfilling,
particularly when anesthesia is used.
 STOP ATTACHMENTS
• A variety of stop attachments are available.
• Least expensive and simplest to use - silicone rubber
stops.
• Several brands of instruments are now supplied with the
stop attachments already in place on the shaft.
• Special tear-shaped or marked rubber stops can be
positioned to align with the direction of the curve placed
in a pre-curved stainless steel instrument.
• The length adjustment of the stop attachments
should be made against the edge of a sterile
metric ruler or a gauge made specifically for
endodontics.
• Devices have been developed that assist in
adjusting rubber stops on instruments.
• It is critical that the stop attachment be
perpendicular and not oblique to the shaft of the
instrument.

Left, Stop attachment should

be placed perpendicular to the
long axis of the instrument.

Right, Obliquely placed stop

attachment varies the length
of tooth measurement by over
1mm
• Disadvantages of using rubber stops
- Time consuming,
- Rubber stops may move up or down the shaft, which may
lead to preparations short or past the apical constriction.
 BIOLOGIC RATIONALE FOR
WORKING LENGTH
Working length determines the extent of canal
cleaning and shaping.
This limits the penetration depth of subsequent
instruments and determines the ultimate form of the
shaping process.

The most clinically relevant working length

landmark is the apical constriction, regardless of
whether it is in dentin or cementum.
Apical constriction is the narrowest point of the canal
and therefore the narrowest diameter of blood supply.

Beyond the constriction the canal widens and develops

broad blood supply.
From a procedural perspective

It is advantageous to treat till the constriction because it

is a morphologic landmark that can be felt by the
experienced clinician.

Using the apical constriction as the working length land

mark is very desirable because it means that the
preparation will terminate at the narrowest canal
diameter and this preparation shape will help to
optimize the apical seal during filling procedure.
• It is not advisable to treat canals short of this end
point because lateral and accessory canals are more
common near the apex.
• Treating just 1-2mm short of apical constriction can
leave nearly 2-4mm of untreated canal such a length
could significantly increase the chances for persistent
periapical pathosis
 SIGNIFICANCE

• The calculation determines how far into the canal the

instruments are placed and worked

• How deeply into the tooth the tissues, debris,

metabolites, end products, and other unwanted items are
removed from the canal.

• It limits the depth to which the canal filling may be

placed
• It will affect the degree of pain and discomfort that the
patient will feel post-operatively.

• If calculated within correct limits it plays an important

role in determining success of the treatment.

• Conversely, if calculated incorrectly may doom the

treatment to failure.
 CLINICAL CONSIDERATIONS

• Before determining a definitive working length, the

coronal access to the pulp chamber must provide a
straight line pathway into the canal orifice.
• Modifications in access preparation may be required to
permit the instrument to penetrate, unimpeded, to the
apical constriction.
• As stated above, a small stainless steel K file
facilitates the process and the exploration of the canal.
• Once the apical restriction is established, it is extremely
important to monitor the working length periodically -
since the working length may change as a curved canal is
straightened
“a straight line is the shortest distance between two
points”
• The mean shortening of all canals in studies was found to
range from 0.40 mm to 0.63 mm.
The loss may also be related to
• The accumulation of dentinal and pulpal
debris in the apical 2 to 3 mm of the canal or
• Other factors such as failing to maintain
foramen patency, skipping instrument sizes, or
failing to irrigate the apical one-third
adequately.
• Occasionally, working length is lost owing to
ledge formation or to instrument separation,
and blockage of the canal.
 Failure to accurately determine and
maintain working length may result in

Length being too long

Lead to perforation

Over filling or over extension

Increased incidence of post operative

pain

Prolonged healing period

lower success rate

 Short of apical constriction

Persistent discomfort associated

with

incomplete apical seal

Apical leakage

Bacterial entry

Failure.
• Therefore, calculation of working length should be
performed with
- Skill
- Using techniques that have proven to give valuable
and accurate results &
- By methods that are practical and efficacious.
 IDEAL REQUIREMENTS FOR
DETERMINING WL INCLUDE (INGLE)–
Rapid and
Rapid and
accurate location Cost effective
periodic
of apical
monitoring
constriction

Patient and Minimal

Easy Ease of use in
clinician radiation to
measurements special patients
comfort patient

34
 CLASSIFICATION
Grossman –
• Radiographic method
• Electronic method

Ingle –
The most common methods are
• Radiographic methods,
• Digital tactile sense, and
• Electronic methods.
• Apical periodontal sensitivity and
• Paper point measurements have also been used.
 Weine –
Currently, there are 4 major, specific methods for
calculation of WL
1. Radiographic apex – filling to the tip of the root as
seen on the x-ray film
2. A specific distance from the radiographic apex
3. According to the studies of Kuttler
4. Use of an electronic apex locator
RADIOGRAPHIC –
• Grossman’s method
• Other formula based methods
• Ingle’s method
• According to Kuttler’s studies
• Wire Grid method

NON-RADIOGRAPHIC –
• Using digital tactile sense
• Apical periodontal sensitivity
• Paper point evaluation
• Electronic methods: based on resistance, impedance,
frequency
 RADIOGRAPHIC METHOD
• Radiographic apex used as termination point.
• Quality of image is important for accurate interpretations.
• When two superimposed canals present, either-
A. Take 2 individual radiographs with instrument placed in each canal
B. Take radiograph at different angulations, usually 20-40o at
horizontal angulations.
C. Insert two different instrument- K file in one canal, H file in other
canal and take radiographs 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
where as canal which moves to opposite is buccal.
 GROSSMAN’S METHOD
• Grossman (1970, 7th ed.) gave the following formula for determining
the correct length of the tooth –
Rule Of Proportion Basis

CLT = KLI × ALT

ALI
Where,
CLT= correct length of the tooth
KLI= known length of the
instrument in the tooth
ALT= apparent length of the
tooth on radiograph
ALI= apparent length of the
instrument on radiograph
 DISADVANTAGES

Wrong reading can occur because of :

1) Variations in angles of radiograph

2) Curved roots
3)s-shaped , double curvature canals
4)A small error will be multiplied
 OTHER FORMULA BASED METHODS

Best (1960)
• A steel pin measuring 10 mm is fixed to the labial
surface of the tooth with utility wax, keeping the pin
parallel to the long axis of the tooth. A radiograph is
taken.
• The radiograph obtained is carried to a gauge which
would indicate the tooth length.
• Bregman (1950) – devised a method –25 mm length flat probes –
having a steel blade fixed with acrylic resin as a stop leaving a free
end of 10mm for placement into the root canal.
• This probe is placed in the tooth until the metallic end touches the
coronal reference point.
• A radiograph is taken
• The length is calculated from following formula:

Actual Real instrument Length × Apparent length of tooth

length of the
tooth =
Apparent Instrument Length
 INGLE’S METHOD
• Methods requiring formulas to determine working length have
been abandoned.
• Bramante and Berbert reported great variability in formulaic
determination of working length, with only a small percentage of
successful measurements.
• The radiographic method known as the Ingle Method proved to
be “superior to others”
• It showed a high percentage of success with a smaller variability.
• This method, first proposed more than 40 years ago, has
withstood the test of time and has become the standard as the
most commonly used method of radiographic working length
estimation.
• The following items are essential to
perform this procedure:
1.Good, undistorted, preoperative
radiographs showing the total length and
all roots of the involved tooth.
2.Adequate coronal access to all canals.
3.An endodontic millimeter ruler.
4.Working knowledge of the average length
of all of the teeth.
5.A definite, repeatable plane of reference to
an anatomic landmark on the tooth, a fact
that should be noted on the patient’s
44
record.
• To establish the length of the tooth, a stainless steel
reamer or file with an instrument stop on the shaft is
needed.
• The exploring instrument size must be small enough to
negotiate the total length of the canal but large enough
not to be loose in the canal.
• A loose instrument may move in or out of the canal
after the radiograph and cause serious error in
determining the length of tooth.
• Moreover, fine instruments (Nos. 08 and 10) are often
difficult to see in their entirety in a radiograph.
• In a curved canal, a curved instrument is essential.
METHOD
 WEINE’S MODIFICATION -

• If radiographically, there is no
resorption of the root end or bone,
shorten the length by the standard
1.0 mm.
• If periapical bone resorption is
apparent, shorten by 1.5 mm, and
• if both root and bone resorption
are apparent, shorten by 2.0 mm
Weine’s recommendations
for determining working
length based on radiographic
evidence of root/bone
resorption.
WEINE’S METHOD (BASED ON
KUTTLER’S STUDIES)
• The basis for this method’s value are the measurements
provided by Kuttler relating to the distance between the
major & minor diameters.
• In younger patients, the distance between these two
points– approx. 0.5 mm
• In older patients, due to increased buildup of cementum,
the distance – approx. 0.67 mm
• The method given by Weine based on Kuttler’s
measurements is as follows -
Analyze C-L-E-W
• Identify the probable canal Configuration and any
common variants
• The estimated Lengths of the root(s)
• The site of Exiting the canal(s)
• The estimated Width of the canal(s)
Using the information from the straight and angled
radiographs about the expected canal configuration prepare a
correct access cavity.

i) Remove whatever pulp tissue and debris needs to be

removed prior to taking the length.

ii) Locate the major diameter and minor diameter on the pre-
op x ray.
iii)Estimate the length of the root (s) by measuring the
length with a –mm – ruler on the pre-op radiograph.
iv)Estimate the width of the canals (s) on the radiograph. If
the canal estimates is narrow, consider using a size 10 or
15 file, if average select – a size 20 or 25 file, if wide
choose a size 30 or 35, if very wide choose size 50 or
larger.
According to radiographic measurements set the stopper and
place the file in the access cavity and take an initial
radiograph
- if the file seems to stop at a length that could be accurate,
stop and take a radiograph rather than force the file into the
periapical tissues.
If the file appears too long or too short by more than 1 mm
from the minor diameter make the necessary changes and use
that as the calculated working length

If your file reaches the major diameter exactly, subtract

.5mm from the length if the patient is 35 years old or
younger. Reduce .67 mm from that length if the patient is
older.

If the file reaches the site that you believe is the minor
diameter use that as the calculated working length. If it is
obvious that a great deal of cementum has been deposited at
the root tip, subtract a greater amount from the site of the
major diameter to rectify the increased distance.
 WIRE GRID METHOD
• Everett and Fixot (1963) – introduced the
diagnostic x-ray grid for use with paralleling
technique
• This wire grid has lines running 1 mm apart,
lengthwise and cross wire
• Every 5th mm is accentuated by a heavier line –
to facilitate reading
• The grid – taped to the film and lies between the
object and the film so that the image of grid is
incorporated in the film
• Tooth length can be read directly from the
preoperative radiograph with the aid of a special
calibrated ruler
 ADVANTAGES OF RADIOGRAPHS
• To measure the length between two reference points
• Avoid inadvertent perforations
• To note presence of atypical anatomy
• The number of canals and roots
• Curvatures, bifurcations, lateral canals, pulp stones,
• Obstructions such as root canal fillings, posts, or
broken instruments
• Resorptions, decay, and periodontal disease
 DISADVANTAGES OF RADIOGRAPHS

• Radiation hazards patients as well as operator

• Probably time consuming
• Loss of bucco-lingual details
• If rubber dam in place – taking radiograph becomes
difficult
• Gag reflex
• Observer bias
EXPANDED RADIOGRAPHIC PARADIGMS
FOR DETERMINATION OF WORKING
LENGTH

• Xeroradiography
• Radiovisiography
 XERORADIOGRAPHY
• Xeroradiography – an electrostatic imaging system – that uses a
uniformly charged x-ray sensitive selenium alloy photoreceptor
plate in a light-proof cassette.
• When exposed to x-rays, the charge on the photoreceptor plate –
dissipated according to tissue density
• A latent electrostatic image produced
• This latent image then transformed into a visible image by
deposition of specially pigmented particles
• The visible image – transferred to a base sheet – that can be viewed
either by reflected light or a trans-illuminated light
• Cassettes are available in sizes corresponding to periapical film –
3mm thick, and can be used with a standard intra-oral holder
 ADVANTAGES:

• Produces image of superior quality due to the edge enhancement

property and sharper contrast
• Radiation levels are reduced to 1/3rd
• Rapid – require only 20 sec to produce a permanent dry image
• Economical – as photoreceptor plate are reusable, can be
reconditioned, recharged and reused more than 1000 times
• Processing do not require dark room
• No shelf life deterioration
 DISADVANTAGES:
• Large areas of bone > 2 cm are shown better with
conventional intra oral film technique than with
xeroradiography
• Greater degree of artefacts than in conventional
technique
Gratt found that
• Conventional radiographs showed better broad area
contrast while xeroradiographs showed better edge
contrast (enhancement)
60
 RADIOVISIOGRAPHY (RVG)
• RVG was first introduced commercially in 1989
by Trophie
• This system is comprised of three main components:
• Radio portion - a conventional x-ray head connected
to microprocessor - enables the unit to produce short
radiation exposure times. Instead of a conventional
silver halide-based film, the receptor is a sensor that
consists of a scintillation screen, a fibre optic
instrument, and a charged coupling device imaging
system.
• Visio section holds the signal - then converts it by
unit area into 256 shades of gray.
• Graphy portion of the system is a storage module
that can be connected to a final imaging display. The
module also can store the image electronically. 61
Features of RVG

• Image enhancement
• Aid in diagnosis of root canals with accuracy.
• RVG is as sensitive as conventional radiography for
detecting occlusal and proximal caries
• The image can be electronically adjusted in a number
of ways.
• Edge enhancement
Advantages of RVG
• Substantial dose reduction
• The production of instantaneous images.
• Control of contrast
• Ability to enlarge specific areas,
• Potential for computer storage.
Disadvantages
• Loss of resolution of RVG image from the screen to
video prints
DETERMINATION OF WORKING
LENGTH BY DIGITAL TACTILE SENSE
• Earliest method
• Although it may appear to be very simple, its accuracy
depends on sufficient experience.
• The clinician should be able to literally feel the foramen
by tactile sense.
• Confirmation may be done either by the radiographic or
electronic method.
• If the coronal portion of the canal is not constricted, an
experienced clinician may detect an increase in
resistance as the file approaches the apical 2 to 3 mm.64
• In apical region, the canal frequently constricts (minor
diameter) before exiting the root. There is also a tendency
for the canal to deviate from the radiographic apex in this
region
• An accuracy of just 64% (Seidberg et al, 1975)
• Another in vivo study found that the exact position of the
apical constriction could be located accurately by tactile
sense in only 25% of canals (Bal & Chaudhary, 1989)

• This method should be considered as supplementary to

high-quality, carefully aligned, parallel, working length
radiographs and/or an apex locator.
65
 DETERMINATION OF WORKING
LENGTH BY APICAL PERIODONTAL
SENSITIVITY
• This method of working length determination, based on
the patient’s response to pain, does not meet the ideal
method of determining WL.

• WL determination should be painless.

• Endodontic therapy has gained a notorious reputation for

being painful, and it is incumbent on dentists to avoid
perpetuating the fear of endodontics by inserting an
endodontic instrument and using the patient’s pain
reaction to determine working length.
66
• If an instrument is advanced in the canal toward
inflamed tissue, the hydrostatic pressure developed
inside the canal may cause moderate to severe,
instantaneous pain.

• At the onset of the pain, the instrument tip may still be

several millimeters short of the apical constriction.

• When pain is inflicted in this manner, little useful

information is gained by the clinician, and considerable
damage is done to the patient’s trust.

67
• When the canal contents are totally necrotic, however, the
passage of an instrument into the canal and past the apical
constriction may evoke only a mild awareness or possibly
no reaction at all. The latter is common when a
periradicular lesion is present because the tissue is not
richly innervated.

• Any response from the patient, even an eye squint or

wrinkling of the forehead, calls for reconfirmation of
working length by other methods available and/or
profound supplementary anesthesia.
DETERMINATION OF WORKING LENGTH
BY PAPER POINT MEASUREMENT
• The moisture or blood on the portion of
the paper point that passes beyond the
apex gives an estimation of WL or the
junction between the root apex and the
bone.
• In cases in which the apical constriction -
lost owing to resorption or perforation,
and in which there is no free bleeding or
suppuration into the canal, the moisture
or blood on the paper point is an estimate
that the preparation is overextended.
• This method, however, may give unreliable data –
• If the pulp not completely removed.
• If the tooth is pulpless but a periapical lesion rich in
blood supply present.
• If paper point is left in canal for a long time.
• This paper point measurement method is a
supplementary one.
• Paper points with the addition of millimeter markings –
These paper points have markings at 18, 19, 20, 22, and
24 mm from the tip – can be used to estimate the point
at which it passes out of the apex.
• The accuracy of these markings should be checked on a
millimeter ruler.
 DETERMINATION OF WORKING
LENGTH BY ELECTRONIC
METHODS
• Electronic apex locator (EAL) – Most important
advancement in the recent decades
• In today’s practice - one of the most important and
essential instrument in endodontic practice
• These devices all attempt to locate the apical
constriction, the cemento-dentinal junction, or the
apical foramen.
• Correct use of EAL always identifies the root end correctly
• Precision needed to minimize intervisit flare-ups, over-fillings
or under-fillings.

Use of EAL –
• pain-free treatments, rare flare-ups and long term healing
success
• Custer (1918) – first to report the use of electric
current to determine working length

• The scientific basis for apex locators originated with

research conducted by Suzuki (1942) – reported a
device that measured the electrical resistance between
the PDL and the oral mucosa of dogs– discovered that
the electric resistance between instrument inserted into
the RC and electrode applied at 0mm registered a
constant Value of 6.5 KΩ.
• Sunada (1962) – adopted the principle reported by Suzuki
and was the first to describe a simple clinical device to
measure working length in patients.

• He used a simple direct current ohmmeter to measure a

constant resistance of 6.5 kilo ohms between oral mucous
membrane and the periodontium regardless of the size or
shape of the teeth.

• The device used by Sunada in his research became the

basis for most apex locators.
• 1973 – Inoue – reported a modification – used an
audiometric component that permitted the device to
relate the canal depths to the operator via low
frequency audible sounds e.g. Sono-Explorer (Union
Broach, NY), Neosono (Amadent, NJ).
 BASIC PRINCIPLE
• All apex locators function by using human
body to complete an electric circuit.
• One side of the apex locator’s circuit is
connected to an endodontic instrument. The
other side is connected to the patient’s body,
either by a contact to the patient’s lip or by
an electrode held in the patient’s hand.
• The electrical circuit is complete when the
endodontic instrument is advanced apically
inside the root canal until it touches
periodontal tissue
• The display on the apex locator indicates
that the apical area has been reached.
 FIRST-GENERATION APEX
LOCATORS
• First-generation apex location devices, also known as
resistance apex locators
• Measure opposition to the flow of direct current or
resistance.
• When the tip of the reamer reaches the apex in the
canal, the resistance value is 6.5 kilo-ohms (current
40 mA)
• often yield inaccurate results in presence of
electrolytes, excessive moisture, vital pulp tissue,
exudates, blood
• Root canal meter (1969) ,Endodontic meter ,
Dento meter , Endo radar.
Disadvantages :
• Pain was often felt due to high current .
• These devices were found to be unreliable when
compared with radiographs.
• Many readings were significantly longer or
shorter than accepted working length.
(Tidmarsh et al 1985).
 SECOND-GENERATION APEX
LOCATORS
• Second-generation apex locators, also known as
impedance apex locators
• Measure opposition to the flow of alternating
current or impedance
• Impedance is comprised of resistance and
capacitance.
• Inoue developed the Sono-Explorer – one of the
earliest of the second-generation apex locators
• Uses the electronic mechanism that the highest
impedance is at the apical constriction where
impedance changes drastically
• The Apex Finder (Sybron Endo/Analytic; Orange, Calif.)
• The Endo Analyzer (Analytic/Endo; Orange, Calif.) -
combined apex locator and pulp tester
• The Digipex (Mada Equipment Co., Carlstadt, N.J.)
• The Digipex II
• The Exact-A-Pex (Ellman International, Hewlett, N.Y.)
• The Foramatron IV (Parkell Dental, Farmingdale, N.Y.)
• The Pio (Denterials Ltd., St. Louis, Mo.)
Disadvantages –
• The presence of tissue and electro-conductive irrigants in the
canal changes the electrical characteristics and leads to
inaccurate, usually shorter measurements.
• This created an awkward situation – Should canals be cleaned
and dried to measure working length, or should working length
be measured to clean and dry canals?
• Large files coated with Teflon to be used – difficult to use in
narrow canals, Teflon peeled off in curved canals
• Patient discomfort due to high current used
• Calibration had to be done before every use
 THIRD-GENERATION APEX
LOCATORS
• Frequency dependant apex locators –
• Introduced in 1990s
• Uses more advanced technology &
measures the impedance difference
between the two frequencies or the
ratio of two electrical impedances
• Since the impedance of a given circuit
is substantially influenced by the
frequency of the current flow, these
devices have been called “frequency
dependent”.
• In biologic settings, the reactive component facilitates the flow
of alternating current, more for higher than for lower
frequencies.
• Thus, a tissue through which two alternating currents of
differing frequencies are flowing will impede the lower-
frequency current more than the higher-frequency current.
• The reactive component of the circuit may change, for
example, as the position of a file changes in a canal. When this
occurs, the impedances offered by the circuit to currents of
differing frequencies will change relative to each other.
• This is the principle on which the operation of the “third-
generation” apex locators is based
• Endex (Osada Electric Co., Los Angeles, Calif. And Japan) –In
Europe and Asia, this device is available as the APIT
• The Neosono Ultima Ez Apex Locator (Satelec Inc; Mount Laurel,
N.J.)
• The Mark V Plus (Moyco/Union Broach, Miller Dental, Bethpage,
N.Y.)
• The JUSTWO or JUSTY II (Toesco Toei Engineering
Co./Medidenta, Woodside, N.Y. and Japan)
• The APEX FINDER A.F.A. (“All Fluids Allowed”—Model 7005,
Sybron Endo/Analytic; Orange, Calif.)
• The ROOT ZX (J.Morita Mfg. Co.; Irvine, Calif. And Japan),

85
• 1991 – Kobayashi et al – “ratio method” – basic
working mechanism of Root ZX (J Morita,
California) – this device measures the
impedances of 0.4 kHz and 8 kHz at the same
time, calculates the ratio of the impedances, and
expresses this ratio in terms of the file position in
the canal.
• The Root ZX is mainly based on detecting the
change in electrical capacitance that occurs near
the apical constriction
• Advantage: This ratio not affected by electrical
condition in the canal, calibration not necessary
each time, reported to be quite accurate in
various canal conditions
 FOURTH-GENERATION APEX
LOCATORS
The Bingo 1020 (Forum Engg. Tech., Israel) – uses two separate
frequencies 400Hz and 8 kHz, but only a single frequency at a
time.
• This eliminates the need for filters that separate the different
frequencies of the complex signal
• Position of the file tip is calculated based on the measurements
of the root mean square value of the signal.
• Manufacturer claims that a combination of these two techniques
increases the accuracy
ProPex (Dentsply maillefer) – works similar to Bingo, but uses a
multi-frequency approach – locate apical foramen with great
precision in any canal condition – ergonomic design
• .A significant disadvantage of the fourth generation devices is
that they need to perform in relatively dry or in partially dried
canals. In some cases, this necessitates additional drying, and
with heavy exudate or blood the method becomes
inapplicable.
V GENERATION APEX LOCATORS

To cope with the problems of 4th gen EAL, a measuring method has been
developed based on comparisons of the data taken of the electrical
characteristics of the canal and additional mathematical processing.
Apex locators of this type, which are known as fifth generation devices,
increase accuracy in determining the place of apical foramen by several
per cent.
Devices employing this method perform very well in the presence of blood
and exudate but they experience considerable difficulties while operating
in dry canals. Therefore, additional insertion of liquids in the canal is
exerted almost always. Ex: Raypex V, woodpex 3 gold, Roots, EMF 100
deluxe.
 VI GENERATION APEX
LOCATORS
Analysis of the advantages and disadvantages of apex
locators of fourth and fifth generation have led to the
invention of sixth generation apex locators(Adaptive apex
locators).
Can work in all canal conditions. Works by adapting to the
moisture or dryness in canal.

Uses both sunada and kobayashi principles.

 OTHER USES OF APEX LOCATORS

• Detection of root perforation

• Suspected periodontal or pulpal perforations. Can be
confirmed as a patent perforation will cause the
instrument to complete a circuit and indicate the
instrument is beyond the apex.
• Root fracture , cracks and internal or external
resorption can be recognized by the EAL .
Apex locators with other functions –
• EALs with additional functions developed in late 1990s
• Solfy ZX (J Morita) = ultrasonic handpiece + Root ZX
• Tri Auto ZX (J Morita) = Root ZX + cordless rechargeable
electric hand piece that uses a NiTi rotary file with 260 to
280 rpm
• When file reaches the required location, device allows the
file to rotate back out of the canal – prevent
overinstrumentation – also prevents fracture of the NiTi
rotary file
• Disadvantage: number of rpm reduces with increasing
pressure due to limitation of the rechargeable battery
• Elements Diagnostic Unit (Sybron Endo, California) = apex
locator + electric pulp tester
Common problems and problem solving
• Unstable signal with rapid wandering signs – remove metallic
restoration
• Sharp drop of signal at apical foramen – dry canal – gentle
irrigation of the canal
• Apex sign from the beginning – too much electrolyte in the
canal – irrigate gently with NaOCl & NaCl
 ADVANTAGES OF EALS
Devices are mobile, light weight and
easy to use
Much less time required
Additional radiation to the patient can
be reduced (particularly useful in cases
of pregnancy)
80 - 97 % accuracy observed
 DISADVANTAGES OF EALS
A learning curve required
Accuracy limited to mature root apices
Extensive periapical lesion can give faulty
readings
Weak batteries can affect accuracy
Can interfere with functioning of artificial
cardiac pacemakers – cautious use in such
patients
 COMPARISON OF ACCURACY OF TWO ELECTRONIC APEX
LOCATORS IN THE PRESENCE OF VARIOUS IRRIGANTS: AN IN
VITRO STUDY

• Aim: This study was designed to compare the accuracy of Root ZX

and SybronEndo Mini EALs, in the presence of various irrigants.
• Conclusion: The measurements of Root ZX in the presence of saline
& 1% NaOCl were closer to the AL and with no significant difference
between them, while significant differences were observed with 2%
CHX & 17% EDTA .Sybron Mini, in the presence of saline, 1% NaOCl
and 17% EDTA, gave measurements which were shorter than the AL,
whereas, in the presence of 2% CHX,WL was more accurate.
Although statistically significant differences existed between the
irrigants the majority of the readings were within the acceptable
range of ±0.5 mm for both EALs. overall accuracy of measurements
by Root ZX and Sybron Mini was 88.3% and 87.5%, respectively.
J Conserv Dent 2012;15:178-82
 AN IN VITRO EVALUATION OF THE
ACCURACY OF THE ROOT-ZX IN THE PRESENCE
OF VARIOUS AGENTS.

• The purpose of this study was to evaluate the accuracy of the Root
ZX in vitro in the presence of a variety of endodontic irrigants: Saline,
2% Lidocaine with 1:100,000 epi., 5.25% NaOCl, RC Prep & 3%
hydrogen peroxide.
RESULTS : The most deviation (raw numbers) occurred with NaOCl, but
it was not statistically significant. The Root ZX was able to
consistently determine the location of the apical foramen (within
approximately ±0.4mm) in the presence of any of the tested irrigants
(only fill the canal, not the chamber during EAL use).

J Endodon 2001;27:209-11
 EVALUATION OF WORKING LENGTH
DETERMINATION METHODS: AN IN VIVO / EX
VIVO STUDY.

• This comparative study was done to determine the accuracy in

measuring the working length of root canal using tactile method,
electronic apex locator and radiographic method, in vivo and
comparing the lengths so measured to the actual working length, ex
vivo, after extraction.
• The results indicated that among the three methods, the electronic
apex locator showed the highest accuracy and the highest reliability
for working length determination

Indian J Dent Res. 2007 Apr-Jun;18(2):60-2

 AN IN VIVO EVALUATION OF DIFFERENT
METHODS OF WORKING LENGTH
DETERMINATION

• The purpose of this in vivo study was to compare the ability

of digital tactile, digital radiographic and electronic
methods to determine reliability in locating the apical
constriction.
• RESULT : The percentage accuracy indicated that EAL
method (Root ZX) shows maximum accuracy, i.e. 99.85%
and digital tactile and digital radiographic method (DDR)
showed 98.20 and 97.90% accuracy respectively

J Contemp Dent Pract. 2013 Jul 1;14(4):644-8

 COMPARISON OF WORKING LENGTH DETERMINATION
USING APEX LOCATOR, CONVENTIONAL
RADIOGRAPHY AND RADIOVISIOGRAPHY: AN IN VITRO
STUDY.

•
• The purpose of this study was to compare
• the working length determination done using three methods,
namely, apex locator (Foramatron D-10, Parkell),
radiovisiography (Planmeca) and conventional radiography
• • Result: The results revealed that all the three methods located
the apex nearly as accurately as the actual root canal length
obtained by histological ground sectioning, and among three
methods apex locator being the closest to the actual root canal
length.

• Journal of contemporary dental practice july 201213(4)550

Precision of Endodontic Working Length Measurements:
A Pilot Investigation Comparing Cone-Beam Computed
Tomography Scanning with Standard Measurement
Techniques

• Study was conducted to evaluate the utility and precision

of already existing limited CBCT scans in measuring the
endodontic working length, and to compare it with
standard clinical procedures
• Result suggested that great correlation was found between
the endodontic working length as measured in the CBCT
images and the EAL

JOE August 2011

 CONCLUSION
• The CDJ or minor diameter is a practical and
anatomic termination point for the preparation
and obturation of the root canal – and this cannot
be determined radiographically.

• Modern apex locators can determine this

position with accuracies greater than 90% but
with some limitations.
• No individual method is truly satisfactory in
determining endodontic working length.
Therefore, combination of methods should be
used to assess the accurate working length.

• Knowledge of apical anatomy, prudent use of

radiographs and correct use of electronic apex
locator will assist practitioners to achieve
predictable results.
 REFERENCES
• Pathways of Pulp: Cohen
• Endodontics, John. I. Ingle, 5th edition.
• Endodontic therapy. Franklin S. Weine, 6th Edition.
• Principles & practice of endodontics; Walton & Torabinejad
• Louis I Grossman -11th addition
• Apex locators review – IEJ 2004 Vol.37
• Accuracy of new apex locator: an in vitro study. IEJ, 2002
,35,186-192.
• DCNA: MODERN ENDODONTIC PRACTICE JAN 2004
• ELECTRONIC APEX LOCATORS IEJ, 37,425-437, 2004