Accuracy of various apex locators in detecting root canal perforation in single rooted teeth-an in vitro study

Abstract

Introduction: In Spite of the advancements made in endodontic techniques, few mishaps are bound to occur. The most common endodontic mishap is root perforation.A root perforation is defined as an artificial opening in the tooth crown or root area creating a communication between the root canal system with the periodontal tissues or oral cavity. Root perforations often compromise the success of root canal therapy. They pose a challenge to the clinician with the fact that they are mostly difficult to diagnose radiographically and also challenge the clinician in determining the location and size of the perforation. Ever since an electronic device to determine the working length has been introduced by Sunada, various reports have advocated the use of these devices to determine the perforation. EALs are touted to be reliable for detecting root perforations. There are six generations of electronic apex locators with specific functions. Aim: The aim of this study is to comparatively evaluate the accuracy of three different apex locators in detecting the root perforation. Materials and Methods: Ten extracted, single-rooted human teeth were perforated artificially in the middle section. The actual canal lengths (ALs) up to the perforation site were determined, and then the teeth were embedded in an alginate mold. A 10k file was inserted into the canal through the access cavity and then determination of perforation with the three apex locators (ROOT ZX, APEX ID, PROPEX PIXI) was made. The electronic measurements of the perforations were obtained using a size 10 K-file by each EAL in various conditions. For each tooth, the AL was subtracted from the electronic length of the perforation. Results: The mean values of Root ZX and Apex ID are lower compared to propex pixi implying that Root ZX and Apex ID detected perforation better compared to Propex pixi.The mean values of Root ZX(0.95+/-0.8) and Apex ID(0.96+/-0.5) are lower compared to propex pixi(1.67+/-0.7) implying that Root ZX and Apex ID detected perforation better compared to Propex pixi. Conclusion: Under the given conditions and with the electronic devices employed in this study, we were able to determine a root canal perforation in all cases. In the present study, Root ZX and Apex ID were able to give better results compared to Propex pixi.