Accurate determination of the root canal apical termini is essential for a successful root canal treatment. 1 Failure to locate the working length precisely could compromise the clinical outcome of the root canal treatment. 1 Variations in root morphology and radiograph distortion might cause the radiographic apex to differ from the anatomic apex. 2,3 The exact termination point for root canal preparation has been a major subject of debate for decades; 4 in teeth with vital pulps and normal periapical tissues, a higher clinical success rate was achieved when canal preparation ended 1 mm from the radiographic apex, short of the apical foramen at the dentin-cemental junction. 4The drawbacks of employing a radiograph for the determination of working length include the image being only a 2-D representation of the root canal system, a paralleling technique is not always feasible with digital radiographic techniques, and there are concerns with radiation exposure. 5-7 These drawbacks have allowed the apex locators to be widely accepted and are the preferred method for working length determination. A systematic review on the clinical efficacy and accuracy of electronic apex locators reported that Abstract Aim: The aim of the present study was to assess the clinical accuracy APEX and 0.5 marks of three different apex locators -iPex II, Root ZX, and Apex ID -before and after canal preparation in the mandibular first molar.Methods: Sixty patients between the ages of 13-60 years participated in the study.After access gaining and canal preparation stages files were inserted with the apex locator clip attached until the electronic apex locators (EALs) shows readings of APEX and 0.5 marks and same is confirmed with periapical radiographs. Eighteen apex locator readings were recorded from each tooth, and 1080 readings were obtained from the 60 patients.
Results: Differences among readings from apex locators and radiographic readingswere assessed using paired t test. Only in two patients (1 male and 1 female) were the APEX mark readings different from the radiograph estimation. When the 0.5 mark readings of three different EALs were compared with each other, we could observe that the readings from Root ZX differed significantly (P < 0.05).
Conclusions:In the present study, we observed the negligible differences in readings between the EAL at the APEX mark readings, coinciding with the radiographic observation. Clinically, we recommend the apical foramen be located with the apex locators' APEX mark readings prior to identifying the apical constriction position.
K E Y W O R D Sapex locator, apical constriction, apical foramen, mandibular first molar, working length