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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.

Aim: The aim of this clinical study was to compare the effect of working length (WL) determination using electronic apex locator (EAL) or WL radiograph on the length adequacy of final WL. Materials and Methods: A total of 153 patients with 153 teeth with single canal were randomized into two groups; in Group 1, the WL was determined by WL radiograph; whereas in Group 2, it was determined by the Raypex5 EAL (VDW, Munich, Germany). Length adequacy was assessed in each group for master cone and categorized into short, acceptable, and over cases. Statistical Analysis Used: The data were statistically analyzed using the Pearson chi-square test at a significance level of P < 0.05. Results: There was no statistically significant difference between the groups in the rates of acceptable (Group 1 = 83.1% and Group 2 = 92.1%) and short cases (Group 1 = 3.9% and Group 2 = 5.2%). Over cases in master cone radiography were significantly more in Group 1 (13.1%) than Group 2 (2.6%) (P = 0.017). Conclusion: The results of our study have shown that under clinical condition, success of Raypex5 was comparable to the radiographic WL determination technique in terms of acceptable and short cases. However, there were significantly lesser over cases in EAL group, showing that EALs can avoid the overestimation of WL.

Background: The aim of this ex vivo study was to evaluate the accuracy of four electronic apex locators (EALs) to determine the working length in teeth with various foramen diameters. Our previous study revealed that electronically measured canal length was influenced by the root canal diameter. It is not known whether foramen size would interfere with the reading accuracy of an EAL. Methods: A total of 36 extracted human lower single rooted premolar teeth were divided into four groups of nine teeth each. In groups A, B and C, the root canals were instrumented using #10–80, #10–100 and #10–120 K‐files, and the tip of size #80, #100 and #120 K‐files were permitted to pass through the apical foramen to a length of 1mm, respectively. In group D, the teeth were instrumented using #10–140 K‐files and the tip of #140 K‐file was permitted to pass through the apical foramen to a length of 5mm. Thus, the average apical foramen diameters in groups A, B, C and D were approximately 0.82mm, 1.02mm, 1.22mm and 1.5mm, respectively. The teeth were then mounted in 1% agar and four EALs were used: Root ZX, Foramatron D10, Apex NRG and Apit 7. For electronic measurement, sizes #10 and #80, #10 and #100, #10 and #120, and #10 and #140 K‐files were used for groups A, B, C and D, respectively. During electronic measurement the canals were flushed with 6% sodium hypochlorite solution. Results: Three‐way ANOVA and Bonferroni test showed that EAL, file size and foramen size all had a significant influence on the measurement error (P<0.0001), with all the interactions between these three factors being significant (P<0.0001). Conclusions: The four EALs were unreliable to determine the working length of teeth with a wide apical foramen, when using a small size file. The Root ZX and Foramatron D10 showed significantly better scores than the other two EALs and may be more reliable to determine the working length of teeth with a wide apical foramen, if a tight‐fit file is used.

Key Points Apex locators are valid tools for use in root length determination in general dental practice. The use of apex locators may help reduce ionisation radiation exposure for patients undergoing root canal treatment. This study highlights the importance of randomised controlled trials in primary dental care settings. Objective To evaluate the ability of apex locators as a tool in determining working length in comparison to traditional working length radiographs in general dental practice. Design Randomised controlled clinical trial. Setting General dental practices in the North West of England. Subjects Adults requiring root canal treatment of at least one tooth with minimal or moderate difficulty. Intervention Root canal treatment was carried out with the working length determined by apex locator in the treatment group (AL), and periapical radiograph in the control group (PA). Outcome measure The acceptability of the master cone gutta percha measured from a radiograph before obturation was used as the primary outcome. Results Twenty-one of 23 fillings in the AL group were judged as acceptable, compared to 17 of 23 fillings in the PA group. This difference was not statistically significant. Conclusion In general dental practice, no significant difference was found in working length determined using apex locator combined with a master cone GP radiograph or using the conventional method. There is a need for larger trials to investigate these methods further.

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.

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).

Background To evaluate the accuracy of the electronic apex locators (EALs), and Cone-Beam Computed Tomography (CBCT) scanning, both in working length (WL) determination and in the detection of root canal perforations in retreatment cases. Methods Sixty human mandibular premolars were selected. After crown removal partially and canal access, root canals were instrumented and irrigated. The obturation process utilized gutta-percha and sealer with warm vertical compaction. Two groups were distinguished: one without perforation (Group 1) and the other with an apical third perforation (Group 2). Retreatment included filling removal, apical preparation, and irrigation. Actual working lengths (AWL) were determined using a stereomicroscope. CBCT images were used to measure CBCT working length (CWL), with adjustments for optimal views. Propex II and Dentaport ZX were used to measure electronic working length (EWL). Differences between EWL and AWL, as well as CWL, were analyzed to gauge accuracy. Data underwent Two-way ANOVA analysis. Measurements within ± 0.5 and ± 1 mm tolerance ranges were deemed successful for each device, followed by applying the Pearson Chi-square test. Results The study reveals no significant inter-group variations in device performance ( p  > .05). Dentaport ZX missed detecting perforation in two Group 2 (apical perforation) cases. For ± 1 mm tolerance, Propex II displayed the highest success in Group 2 (apical perforation). Conclusion This study demonstrates the comparable performance of Propex II, Dentaport ZX, and CBCT in endodontic retreatment, providing insights into diagnostic reliability.

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.

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.

Objective Although apex locators are generally effective tools for determining root canal working length, they may produce inaccurate results in some cases. The present study aimed to evaluate the efficacy of ultrasonography as an alternative method for measuring root canal length. Materials and methods Forty-seven anterior teeth with apical lesions were selected for the study. Initially, an electronic apex locator was used to measure the working length. Subsequently, ultrasonography was employed to visualize the root apex and determine the working length. During ultrasound imaging, a K-file No. 15 was inserted into the root canal until its tip was visible on the ultrasound monitor. Measurements obtained from both methods were compared using an independent sample t-test. Correlations were assessed with the Pearson correlation coefficient, and agreement was determined using the Bland‒Altman plot. Results The mean working canal length was 19.9 mm for the apex locator and 20.6 mm for the ultrasonography-guided method. No significant differences were observed between the data obtained using the apex locator method and the data obtained using the ultrasonography guidance method. Furthermore, a high level of agreement was identified between the two techniques. Conclusion Ultrasonography can be used to visualize the apex effectively and determine canal length, especially when canal length determination is uncertain for various reasons.