765+2024 Evalua&on of the Accuracy of Different Apex Locaters with 45° Apical Root Resorp&on Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.765 h#p://den*stry3000.pi#.edu Evaluation of the Accuracy of Different Apex Locaters with 45° Apical Root Resorption Ahmed I Al-Jobory 1, Mohammed Ayad Taha 1, Mohammed Jabbar Atyiah 2 1 College of Dentistry, Tikrit University, Tikrit, Iraq 2 Ministry of Health, Iraq Abstract Aim: This study was aimed to calculate the working length (WL) of permanent teeth with simulated 45° resorp>on of the apical part of the root using four electric apex locaters (EALs): NSK, Woodpecker III, Woodpecker V, and Eighteeth. Methods: Twenty maxillary anterior single-rooted teeth were removed. Following tooth prepara>on to offer access to the root canal and replicate the 45° apical root resorp>on, each tooth underwent a microscope-assisted working length determina>on process. The four apex locaters measured each individual tooth and calculated electronic working lengths. Results: No discernible change existed between all four apex locater devices. Conclusion: NSK, Woodpecker III, Woodpecker V, and Eighteeth provide virtually the same measurement for 45° apical root resorp>on in single rooted teeth. Keywords: Apex Locater Devices, Working Length, Electronic Working Length Test, 45° Root Resorp>on. Cita;on: Al-Jobory AI, et al. (2024) Evalua;on of the accuracy of different apex locaters with 45° apical root resorp;on. Den;stry 3000. 2:a001 doi:10.5195/d3000.2024.765 Received: November 1, 2024 Accepted: November 7, 2024 Published: November 22, 2024 Copyright: ©2024 Al-Jobory, et al. This is an open access ar;cle licensed under a Crea;ve Commons AXribu;on Work 4.0 United States License. Email: Mohammedayad@tu.edu.iq Introduction For endodontic therapy to be successful, the root canal length must be accurately determined, particularly in situations of recurrent infection or re-infection. In these situations, non-surgical methods are frequently used to solve the problem. Removing the old filling from the root canal is the first step in the conservative non- surgical retreatment. In order to appropriately cleanse and disinfect the root canal system, access must be granted. To guarantee that all filling materials, debris, diseased pulp tissue, and necrotic material are completely removed, further root canal preparation could be necessary. The root canal must be adequately enlarged and cleaned at the precisely measured length in order to successfully repair the periradicular tissues. The physician can guarantee that all afflicted or diseased regions are completely cleansed and treated by precisely measuring the root canal length [1–15]. Establishing the working length is crucial for root canal preparation and 3D obturation in primary endodontic treatments and retreatments [16]. Numerous radiographic pictures are acquired throughout the root canal retreatment, which exposes the patient to excessive radiation and makes it hard to establish the working length only by radiography [17]. The aim of this examination was to assess how well four EALs determined working length during root canal rehabilitation. Material and Methods Twenty maxillary anterior single- rooted teeth that had been removed were utilized. Prior research found that these teeth had been taken due to serious illness or orthodontic treatment [10,18]. After the blood was removed from the teeth, they were preserved in 5.25% sodium hypochlorite for two Evalua&on of the Accuracy of Different Apex Locaters with 45° Apical Root Resorp&on Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.765 h#p://den*stry3000.pi#.edu hours and then placed in sterile 0.9% saline solution until the next step (Figure 1). A diamond disc was used to de- coronate teeth at the cementoenamel junction, making it easier to access the root canal and create fixed occlusal landmark (Figure 2) [11,19]. A 45° oblique incision was performed at the root apex using a disc to mimic apical root resorption. Nickel titanium endo K file sizes of 8, 10, 15, and 20 were used for instrumentation, and 2.5% sodium hypochlorite was used for irrigation (Figures 3 and 4) [12]. Working length was determine under microscope and visual [13,20]. Resorption at 45° oblique cut was made because only a few studies have studied accuracy of apex-locator with root resorption [21]. To maintain the root canal wet, 0.5 ml of saline was inserted within the canal prior to the electronic working length (EWL) measurement [22]. Salt and water were utilized to create an electric circuit. Figure 1. Samples used. Figure 2. Cutting the crown with aa diamond disk. Figure 3. Oblique cut to simulate apical resorption. Figure 4. Simulated resorption at apex. Four distinct apex locators were used to measure the electronic working length (EWL) values: 1. Woodpecker III 2. Eighteeth 3. Woodpecker V 4. NSK (i pex II) These devices were used in this study because they are the most common uses in dentistry. To maintain the root canal wet, 0.5 ml of saline was inserted within the canal prior to the electronic working length (EWL) measurement (Figure 5) [14]. To generate the current, the mounted roots were submerged in containers with 0.9% saline, ensuring that the apical and middle sections of the roots were completely submerged. One of the conductors was saline. The labial clip of the apex finder was also Evalua&on of the Accuracy of Different Apex Locaters with 45° Apical Root Resorp&on Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.765 h#p://den*stry3000.pi#.edu submerged in saline. A #15 K-file was used for each measurement twice, and the mean value was computed (Figures 6 through 14). [15]. Figure 5. Measuring procedure. Figure 6. Container of water and salt. Figure 7. Bottle containing water and salt. Figure 8. Method of measurement by endo ruler. Figure 9. Measurement by Woodpecker III Apex Locator. Figure 10. Measurement by Eighteeth Apex Locator. Evalua&on of the Accuracy of Different Apex Locaters with 45° Apical Root Resorp&on Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.765 h#p://den*stry3000.pi#.edu Figure 11. Measurement by NSK Apex Locator. Figure 12. Measurement by Woodpecker V Apex Locator. Figure 13. Measurement procedure. Figure 14. Resorption at 45° on the apex. Evalua&on of the Accuracy of Different Apex Locaters with 45° Apical Root Resorp&on Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.765 h#p://den*stry3000.pi#.edu Results Table1. Comparison Between Actual Working Length and the Four Devices. N Actual working length under microscope (mm) NSK (mm) Woodpecker lll (mm) Woodpecker V (mm) Eighteeth (mm) 1 17 17 / Yes 16.5 / No 16 / No 18 / No 2 16 17 / No 17.5 / No 16.5 / No 17.5 / No 3 11.5 11.5 / Yes 11 / No 11.5 / Yes 12 / No 4 13 13 / Yes 14 / No 13 / Yes 13.5 / No 5 16 16.5 / No 17 / No 17 / No 17.5 / No 6 10 10 / Yes 12 / No 10 / Yes 12.5 / No 7 20 20 / Yes 19 / No 20 / Yes 20.5 / No 8 12.5 11 / No 13.5 / No 13 / No 13 / No 9 13.5 13 / No 14 / No 13 / No 14.5 / No 10 14 13 / No 13.5 / No 14.5 /No 12.5 / No 11 11 11 / Yes 11 / Yes 11 / Yes 11.5 / No 12 9 9 / Yes 9.5 / No 9 / Yes 9 / Yes 13 10.5 11.5 / No 12 / No 11.5 / No 12 / No 14 13 13 / Yes 13 / Yes 12.5 / No 13.5 / No 15 11.5 11.5 / Yes 11.5 / Yes 11.5 / Yes 10.5 / No 16 13 13 / Yes 14 / No 13 / Yes 13 / Yes 17 14.5 13.5 / no 13 / No 14 / No 13 / No 18 14 14 / Yes 15 / No 14.5 / No 14 / Yes 19 10.5 10.5 / Yes 11 / No 10 / No 11 / No 20 14.5 13.5 / No 15 / No 13 / No 14 / No Evalua&on of the Accuracy of Different Apex Locaters with 45° Apical Root Resorp&on Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.765 h#p://den*stry3000.pi#.edu The collected data revealed no significant differences between all test groups using a one-way ANOVA analysis (p=0.945). Discussion and Conclusion The precision of calculating the root canal length has a substantial impact on the success rate of root canal retreatment. Over-filling the root canals resulted in a success rate as low as 36%, suggesting that the infection was not adequately treated. Nevertheless, the effectiveness rate rose to 62% when the working duration was precisely ascertained during retreatment [23]. We selected the most commonly apex locators used in dentistry. Woodpecker V came as a replacement of Woodpecker III to improve determination of working length. Woodpecker III required a dry environment and fully charged battery for best results. Eighteeth apex locator is sensitive to canal fluids and requires fully charged battery. It does not work well in cases of excessive exudates or blood. NSK is less studied. That relative error of NSK was (13.125%), Woodpecker V was (13.225%), Eighteeth was (13.65%), and Woodpecker III was (13.675%). 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