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Background Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length (WL) are used. However, it is still controversial which method provides the most accurate measurements. Aim To investigate the compatibility of the electronic apex locator (EWL) and simultaneous working length determination (SWL) methods in single-root teeth in comparison with the radiographic working length determination (RWL) method and to determine which one produced more effective results in terms of postoperative pain. Materials & methods One hundred patients scheduled for root canal treatment (RCT) were randomly assigned to one of the three groups according to the working length measurement method (EWL, SWL or RWL). After WL determination with assigned method, root canals were prepared and then obturated. Age, gender, simplified oral hygiene index (OHI-S), oral and dental examinations and Visual Analogue Scale (VAS) results of all participants were recorded. The incidence and intensity of postoperative pain were rated on a Visual Analogue Scale (VAS) by patients 6, 12, 24, 48 h and 7 days after RCT. The number of analgesic tablets (400 mg Ibuprofen) taken by patients was also recorded. Data were analyzed using the chi-square, One- way ANOVA and Kruskal-Wallis tests. Bland-Altman and Passing-Bablock regression analysis were used as method comparison techniques. Results It was determined that the number of patients receiving analgesia and the total number of analgesia doses were higher in EWL and RWL groups compared to SWL group ( p  < 0.0001). When the WL values at which the treatment was applied were compared in the patient groups; WL values of EWL group were statistically lower than SWL group ( p  < 0.01). While there was no difference between the preoperative VAS scores of the groups ( p  = 0.7590), the postoperative 6th and 12th hour VAS scores of SWL group were lower than those of EWL and RWL groups ( p  = 0.005 and p  = 0.0002, respectively). Again, the VAS scores of SWL group at the 24th and 48th postoperative hours were lower than those of RWL group ( p  < 0.05). According to the Bland-Altman and Passing-Bablock regression analysis results, although there was no statistically significant difference between the EWL and SWL methods ( p  = 0.471), the bias value of -0.1190 was well below the acceptable total error (0.1648). Additionally, a strong relationship was found between EWL and SWL methods ( r  = 0.9698, r 2  = 0.9406, p  < 0.001). Therefore, statistically these two methods were considered compatible with each other. It was determined that there was a statistically significant bias (0.340, p  < 0.0001) between the RWL and SWL methods, exceeding the total error. Conclusions As a result, it was determined that the SWL method, which is used to determine working length for the success of endodontic treatment, can be used as an alternative to the EWL method thus producing more effective results in the management of postoperative pain. However, in addition to the method used, the technology of the device developed for this method should not be ignored. Clinical relevance Precise knowledge of the apical construction, which determines the end of the area for canal preparation and filling, is essential for the success of root canal treatment and the management of postoperative pain. For this purpose, devices based on various methods that determine the working length are used. However, it is still controversial which method provides the most accurate measurements. This study found that the simultaneous working length determination method can be used as an alternative to the electronic working length determination method and produces more effective results in the management of postoperative pain. Another important outcome of this study is that the Total Allowable Error (TEa) for the electronic apex locator method, which is accepted as the reference, has been calculated for the first time. Other methods have been evaluated according to this reference method. This is a first in literature.

Access cavity preparation is an important part of endodontic therapy, affecting the effectiveness of canal instrumentation and the durability of the tooth over time. Currently, most access preparation protocols are based on information from a Western population and do not address the anatomical differences of different ethnic groups. This retrospective CBCT study assessed specific odontometric measurements in maxillary anterior teeth—central incisors, lateral incisors and canines—using an Indian population to help identify a clinically relevant and conservative access cavity preparation. A total of six hundred cone-beam computed tomography (CBCT) images of maxillary central incisors, lateral incisors, and canines ( n  = 200 per tooth) were evaluated. Three measurements were made in sagittal view: the distance from the central fossa to the pulp chamber roof (CF–PC), the incisal edge to pulp chamber (IE–PC), and the central fossa to cingulum (CF–C). These images were obtained from Indian individuals aged 18 to 25 years. Differences attributable to sex-based variation, and between teeth, were statistically significant ( p  < 0.05). The lateral incisors had the largest amount of anatomical variability, while the canines had the steepest trajectory of access. These findings provide the first population-based CBCT base-line morphometric values for maxillary anterior teeth in India, and a practical guide to help achieve safe access design that is mindful of tooth anatomy and minimizes the invasiveness of the access.

Objective: It is aimed to examine the tooth sizes of digital models of patients with different malocclusions with the help of three-dimensional measurement software. Methods: Digital models of 252 patients aged between 13 and 25 years of age were included. According to the Angle classification, three different malocclusion groups were allocated such that there were 84 patients in each group, plaster models of patients scanned with the three-dimensional model browser 3Shape R700 3D Scanner (3Shape A/S Copenhagen, Denmark) and transferred to the digital format. 3Shape Ortho Analyzer (3Shape A/S Copenhagen, Denmark) software was used for making the necessary tooth size measurements. Results: When the measurements were evaluated, it was determined that significant changes occurred between tooth sizes of individuals with different malocclusions. Generally, higher values were observed in mesiodistal and buccolingual tooth dimensions of class II individuals compared to other groups. There was no difference between the groups in the anterior ratio values, but when the overall ratio values were evaluated among the groups, a statistically significant difference was determined. Class II malocclusion group was found to have a significantly lower overall ratio of occurrence. Conclusion: Individuals with different malocclusions differ in tooth size.

Objective This study aimed to assess the influence of cone-beam computed tomography (CBCT) device type, voxel resolution, and segmentation software on the accuracy of tooth volume measurements. Materials and methods Thirty extracted single-rooted human incisor teeth were included. Physical volumes were determined using the Archimedes water displacement method (WDM) as the gold standard. Each tooth was scanned using two CBCT devices (Planmeca Promax 3D-Mid and NewTom 5G-XL) at two voxel sizes (0.1-mm and 0.2-mm). Segmentation was performed using two semi-automatic software programs: 3D Slicer and ITK-SNAP. Volumetric deviations from WDM were statistically analyzed using repeated-measures ANOVA, with the significance level set at p  < 0.05. Results Although the differences between the two CBCT devices ( p  = 0.431) and voxel sizes ( p  = 0.070) were not statistically significant, a trend toward improved volumetric accuracy was noted with the Planmeca Promax 3D-Mid device and the 0.1 mm voxel size. In contrast, a statistically significant difference was found between the segmentation programs ( p  < 0.001). ITK-SNAP consistently produced higher volume deviations compared to both 3D Slicer and the gold-standard WDM. The most accurate results were achieved using the Planmeca Promax 3D-Mid device, a 0.1 mm voxel size, and the 3D Slicer software, with no statistically significant deviation from WDM ( p  = 0.467). Conclusion CBCT device selection and voxel size (0.1-mm vs. 0.2-mm) did not significantly affect volumetric accuracy in single-rooted incisor teeth. However, the choice of segmentation software played a critical role, with 3D Slicer providing measurements closest to the gold standard. These findings highlight the importance of software selection in CBCT-based volumetric measurements for dental applications, though the results may be limited to teeth with similar anatomical complexity (e.g., single-rooted incisors).

This study evaluated whether Triton, a newly introduced all-in-one irrigant, affects the accuracy of electronic working length determination, and compared two electronic apex locators (Ai-Pex, Propex Pixi) under different irrigant conditions. Forty-four extracted single-rooted human teeth were embedded in alginate. Actual working length was determined under a dental operating microscope. Specimens were assigned to four groups (Triton, 17% ethylenediaminetetraacetic acid, 10% citric acid, dry canal). Electronic working lengths were measured with Ai-Pex and Propex Pixi using #15 K-files. Statistical analyses were performed using one-way and two-way analysis of variance (ANOVA) following normality assessment, with statistical significance set at < 0.05. No significant differences occurred among Triton, ethylenediaminetetraacetic acid, and citric acid groups ( > 0.05). Dry canal measurements were significantly longer than the actual working length measured under a dental operating microscope ( < 0.05). Both apex locators showed comparable accuracy. Triton did not reduce apex locator precision, supporting its potential as a time-saving irrigant that permits simultaneous irrigation and measurement. Further clinical validation is required.

Background The aim of this in vitro study was to use micro-computed tomography (µCT) to determine the anatomical position corresponding to the ‘apical constriction’ (AC) reading of three different electronic apex locators (EALs) in extracted human molars. Materials and methods Fifty-six extracted human molars (138 canals) were scanned using µCT to assess apical morphology (presence/absence of a single AC) and, for canals with a single AC, to measure the distance from the major apical foramen (AF) to the narrowest diameter (Md). Using a modified mounting model (MM), the distance from the AF to the EAL’s ‘AC’ reading (Ld) was measured for three devices: Root ZX II, Raypex 6, and Elements Apex Locator. Ld values were compared among the EALs within morphological subgroups using one-way analysis of variance (ANOVA) and the Least Significant Difference (LSD) post-hoc test. Significance was set at P  < 0.05. Results No statistically significant differences were found among the mean Ld readings of the three EALs, either overall or within the ‘AC present’ and ‘AC absent’ morphological subgroups (P > 0.05). Within the ‘AC present’ group, mean Ld values for the Elements Apex Locator and Raypex 6 were significantly shorter (coronal) than the mean µCT-measured distance Md ( P  = 0.005 and P  = 0.008, respectively). In contrast, the mean Ld for Root ZX II did not differ significantly from the mean Md ( P  = 0.095). Conclusions The ‘AC’ reading of the three EALs generally indicated a position slightly coronal to the major apical foramen, irrespective of AC presence. While the three EALs provided comparable readings relative to each other, their accuracy in corresponding to the anatomical AC (when present) varied in this in vitro model, with Root ZX II showing closer agreement with µCT findings.

Background This study aimed to determine normative values for mesiodistal and buccolingual crown diameters of permanent teeth in the Turkish population and compare them with values reported in previous studies for other populations and the Turkish population. Materials and methods The mesiodistal and buccolingual diameters of permanent teeth were measured using digital calipers from dental cast models of 200 patients. The data analysis was conducted employing the SPSS 21 package software. The descriptive statistics were obtained for all parameters. Student t-test was utilized to compare the measurements between male and female patients. A paired t-test was used to compare the right and left side teeth. The significance level was set at 0.05. Results A total of 4800 teeth were measured. Men’s tooth sizes were larger than women’s tooth sizes. A stronger sexual dimorphism was observed in the buccolingual diameter in comparison to the mesiodistal diameter. No clinically significant differences were observed between antimeric teeth. In the maxilla and mandible, the first molars were found to have the largest mesiodistal and buccolingual diameters, whereas mandibular central teeth had the smallest diameters. Conclusions Current norm values of mesiodistal and buccolingual diameters of permanent teeth in the Turkish population were established. The norm values presented are close to the tooth dimensions in studies carried out on other populations. Compared to previous studies, there is an increase in mesiodistal diameters in the Turkish population, with this increase being more pronounced in males. The mean mesiodistal and buccolingual diameters of permanent teeth can be useful for orthodontists, prosthodontists, anatomists, anthropologists, and forensic dentistry specialists.

Background and Objectives: To achieve success in endodontic treatment, it is essential to properly perform the steps of shaping, cleansing and obturation. Determining the working length of the canal is, therefore, a process that must be precise and accurate. Electronic apex locators are a useful tool for the clinician to best perform this step of endodontic treatment. Materials and Methods: The purpose of the following umbrella review is to evaluate, through data in the literature, the degree of accuracy of apex locators. Results: Seven systematic reviews were included in the following umbrella review. Five compare the accuracy of apex locators versus radiographic techniques, two compare different types of electronic apex locators, and two analyze the determination of working length in primary teeth. Conclusions: From the results obtained from the following umbrella review, albeit at low levels of evidence, the methods for determining working length using electronic apex locators and other methods, particularly using radiographic evaluation, are equally valid.

The aim of this study is to investigate the accuracies and the agreements of the 3D Endo software, conventional CBCT software Romexis Viewer at three voxel sizes, and the EAL ProPex Pixi in endodontic length measurements. Three hundred and twenty-nine root canals in 120 intact human extracted molars were accessed. The actual lengths (AL) and electronic lengths (EL) were measured using the ruler and electronic apex locator (EAL), respectively. Teeth were scanned using the CBCT at different voxel sizes (0.075, 0.10, and 0.15 mm). Root canal lengths were measured using 3D Endo with proposed length (3D-PL) by software, corrected length (3D-CL), Romexis Viewer. The Fisher’s exact test, paired t-test and Bland–Altman plots were calculated to detect the agreements of the four methods with AL measurements. The ProPex Pixi measurements obtained the highest accuracy in the range of ± 0.5 mm. There was agreement between the 3D-PL and the 3D-CL with AL measurements at voxel size of 0.15 mm and at voxel size of 0.10 mm, respectively. The CBCT Romexis Viewer measurements agreed with AL at three voxel sizes. The conventional CBCT measurements using Romexis Viewer and dedicated software did not reach to the 100% accuracy in the range of ± 0.5 mm.