Variations in the morphology of apical constriction affecting electronic readings: An in vitro investigation using 3D-printed tooth models
Juhee Nam DDS
Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Search for more papers by this authorLucila Piasecki Ms, PhD
Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, New York, USA
Search for more papers by this authorDoun Kwak DDS, MSD
Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Search for more papers by this authorJung Hwa Hong MSD
Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Search for more papers by this authorIl-Young Jung DDS, MSD, PhD
Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
Search for more papers by this authorSung-Ho Park DDS, MSD, PhD
Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
Search for more papers by this authorCorresponding Author
Sin-Yeon Cho DDS, PhD
Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Correspondence
Sin-Yeon Cho, Faculty, Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, 100, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea.
Email: [email protected]
Search for more papers by this authorJuhee Nam DDS
Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Search for more papers by this authorLucila Piasecki Ms, PhD
Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, New York, USA
Search for more papers by this authorDoun Kwak DDS, MSD
Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Search for more papers by this authorJung Hwa Hong MSD
Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Search for more papers by this authorIl-Young Jung DDS, MSD, PhD
Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
Search for more papers by this authorSung-Ho Park DDS, MSD, PhD
Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
Search for more papers by this authorCorresponding Author
Sin-Yeon Cho DDS, PhD
Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Kyeonggi-do, South Korea
Correspondence
Sin-Yeon Cho, Faculty, Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, 100, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, South Korea.
Email: [email protected]
Search for more papers by this authorJuhee Nam and Lucila Piasecki are co-first authors who contributed equally to this article.
All authors listed on the title page have contributed significantly to the work and are in agreement with the manuscript.
Abstract
We investigated the interference of apical constriction position and diameter on the accuracy of electronic apex locators using 3D-printed tooth models. Single-rooted tooth models with the same length, canal taper and major foramen, but variation in apical constriction position or size, were designed and 3D-printed. A mounting model was custom-made for precise measurement of both marks (0.5 and APEX/0.0) of two electronic apex locators. The electronic measurements of both devices were correlated significantly to the major foramen rather than apical constriction. The mean measurements of the group with 0.45 mm in apical constriction width were significantly shorter than those of the other groups for both marks of the two devices (p < 0.05). The variations in apical constriction position and width negatively affected the precision of the 0.5 mark of the tested devices. The 0.0 or APEX mark was consistently located the major foramen.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interests.
REFERENCES
- 1Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990; 16(10): 498–504.
- 2Gutierrez JH, Aguayo P. Apical foraminal openings in human teeth. Number and location. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 79(6): 769–77.
- 3ElAyouti A, Hulber JM, Judenhofer MS, Connert T, Mannheim JG, Lost C, et al. Apical constriction: location and dimensions in molars-a micro-computed tomography study. J Endod. 2014; 40(8): 1095–9.
- 4Schell S, Judenhofer MS, Mannheim JG, Hulber JM, Lost C, Pichler BJ, et al. Validity of longitudinal sections for determining the apical constriction. Int Endod J. 2017; 50(7): 706–12.
- 5Ricucci D. Apical limit of root canal instrumentation and obturation, part 1. Literature Rev Int Endod J. 1998; 31(6): 384–93.
- 6Piasecki L, Carneiro E, da Silva Neto UX, Westphalen VP, Brandao CG, Gambarini G, et al. The use of micro-computed tomography to determine the accuracy of 2 electronic apex locators and anatomic variations affecting their precision. J Endod. 2016; 42(8): 1263–7.
- 7ElAyouti A, Dima E, Ohmer J, Sperl K, von Ohle C, Lost C. Consistency of apex locator function: a clinical study. J Endod. 2009; 35(2): 179–81.
- 8Nekoofar MH, Ghandi MM, Hayes SJ, Dummer PM. The fundamental operating principles of electronic root canal length measurement devices. Int Endod J. 2006; 39(8): 595–609.
- 9Shabahang S, Goon WW, Gluskin AH. An in vivo evaluation of root ZX electronic apex locator. J Endod. 1996; 22(11): 616–8.
- 10Connert T, Judenhofer MS, Hulber JM, Schell S, Mannheim JG, Pichler BJ, et al. Evaluation of the accuracy of nine electronic apex locators by using micro-CT. Int Endod J. 2018; 51(2): 223–32.
- 11Pagavino G, Pace R, Baccetti T. A SEM study of in vivo accuracy of the root ZX electronic apex locator. J Endod. 1998; 24(6): 438–41.
- 12Martins JN, Marques D, Mata A, Carames J. Clinical efficacy of electronic apex locators: systematic review. J Endod. 2014; 40(6): 759–77.
- 13Herrera M, Abalos C, Planas AJ, Llamas R. Influence of apical constriction diameter on root ZX apex locator precision. J Endod. 2007; 33(8): 995–8.
- 14Tsesis I, Blazer T, Ben-Izhack G, Taschieri S, Del Fabbro M, Corbella S, et al. The precision of electronic apex locators in working length determination: a systematic review and meta-analysis of the literature. J Endod. 2015; 41(11): 1818–23.
- 15Hassanien EE, Hashem A, Chalfin H. Histomorphometric study of the root apex of mandibular premolar teeth: an attempt to correlate working length measured with electronic and radiograph methods to various anatomic positions in the apical portion of the canal. J Endod. 2008; 34(4): 408–12.
- 16Hwang G-Y, Roh B-D, Kim E-S, Lee S-J. In vitro evaluation of the consistency of two electronic apex locators. J Korean Acad Conserv Dent. 2008; 33(1): 20–7.
10.5395/JKACD.2008.33.1.020 Google Scholar
- 17Ding J, Gutmann JL, Fan B, Lu Y, Chen H. Investigation of apex locators and related morphological factors. J Endod. 2010; 36(8): 1399–403.
- 18Huang L. An experimental study of the principle of electronic root canal measurement. J Endod. 1987; 13(2): 60–4.
- 19Reymus M, Fotiadou C, Kessler A, Heck K, Hickel R, Diegritz C. 3D printed replicas for endodontic education. Int Endod J. 2019; 52(1): 123–30.
- 20Ordinola-Zapata R, Bramante CM, Duarte MA, Cavenago BC, Jaramillo D, Versiani MA. Shaping ability of reciproc and TF adaptive systems in severely curved canals of rapid microCT-based prototyping molar replicas. J Appl Oral Sci. 2014; 22(6): 509–15.
- 21ElAyouti A, Kimionis I, Chu AL, Lost C. Determining the apical terminus of root-end resected teeth using three modern apex locators: a comparative ex vivo study. Int Endod J. 2005; 38(11): 827–33.
- 22Piasecki L, Jose Dos Reis P, Jussiani EI, Andrello AC. A micro-computed tomographic evaluation of the accuracy of 3 electronic apex locators in curved canals of mandibular molars. J Endod. 2018; 44(12): 1872–7.
- 23Akisue E, Gratieri SD, Barletta FB, Caldeira CL, Grazziotin-Soares R, Gavini G. Not all electronic foramen locators are accurate in teeth with enlarged apical foramina: an in vitro comparison of 5 brands. J Endod. 2014; 40(1): 109–12.
- 24Duran-Sindreu F, Stober E, Mercade M, Vera J, Garcia M, Bueno R, et al. Comparison of in vivo and in vitro readings when testing the accuracy of the root ZX apex locator. J Endod. 2012; 38(2): 236–9.
- 25Soares RM, Silva EJ, Herrera DR, Krebs RL, Coutinho-Filho TS. Evaluation of the Joypex 5 and root ZX II: an in vivo and ex vivo study. Int Endod J. 2013; 46(10): 904–9.
- 26Jung IY, Yoon BH, Lee SJ, Lee SJ. Comparison of the reliability of "0.5" and "APEX" mark measurements in two frequency-based electronic apex locators. J Endod. 2011; 37(1): 49–52.
- 27Ebrahim AK, Wadachi R, Suda H. Ex vivo evaluation of the ability of four different electronic apex locators to determine the working length in teeth with various foramen diameters. Aust Dent J. 2006; 51(3): 258–62.
- 28Aguiar BA, Reinaldo RS, Frota LM, do Vale MS, de Vasconcelos BC. Root ZX electronic foramen locator: an ex vivo study of its three Models' precision and reproducibility. Int J Dent. 2017; 2017: 5893790–4.
- 29Serna-Pena G, Gomes-Azevedo S, Flores-Trevino J, Madla-Cruz E, Rodriguez-Delgado I, Martinez-Gonzalez G. In vivo evaluation of 3 electronic apex locators: root ZX mini, apex ID, and Propex Pixi. J Endod. 2020; 46(2): 158–61.
- 30Kolanu SK, Bolla N, Varri S, Thummu J, Vemuri S, Mandava P. Evaluation of correlation between apical diameter and file size using Propex Pixi apex locator. J Clin Diagn Res. 2014; 8(12): ZC18–20.
