Comparative Evaluation of Using Cone Beam Computerized Tomography (CBCT) and Conventional Radiography Confirmed with Apex Locator for Working Length Determination in Curved Root Canals (Clinical Study)

Amal Hassan Mohamed¹*, Geraldine Mohamed Ahmed², Ghada Borhan Abou Hussein³ and Hamdy Adly Youssef²

¹Master Degree in Endodontics, Faculty of Dentistry, Cairo University, Egypt
²Professor of Endodontics, Faculty of Dentistry, Cairo University, Egypt
³Lecturer of Radiology, Faculty of Dentistry, Cairo University, Egypt

*Corresponding Author: Amal Hassan Mohamed, Master Degree in Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt.

Received: December 01, 2021; Published: December 30, 2021

Abstract

Purpose: The following case report is about the surgical management of a case of inflammatory gingival hyperplasia with a proportionate design of the anterior teeth to achieve an aesthetic appearance.

Material and Methods: A treatment was planned for smile designing using Chu’s Esthetic Gauge to contour the gingiva followed by simple gingivectomy and gingivoplasty using a 15 BP blade.

Conclusion: The use of Chu’s Aesthetic Gauge gave an easy and accurate measurement for esthetic designing of the anterior crowns producing a good esthetic result. This instrument is used to accurately design the gingival contours of the crowns, thus allowing an aesthetic outcome of such a surgery.

Introduction: For a successful endodontic treatment, removal of all pulp tissue and bacteria from the root canal is crucial. This cannot be performed without the proper determination of the working length of the canal. The working length of a tooth is between the coronal reference point and the end of the canal where preparation and obturation should stop. Several methods have been used for working length determination; tactile method, radiographic method, electronic method and 3D imaging.

Aim of the Study: to compare between CBCT and conventional radiography with apex locator in determination of working length in curved root canals.

Methods: 18 canals were included in this study. Working length in each root canal was determined by two methods; CBCT scan and conventional radiography confirmed with electronic apex locator (Root ZX).

Results: There was no statistically significant difference between the two methods (p value = 0.7). Conventional radiography confirmed with electronic apex locator (mean value = 21.05) CBCT scan method (mean value= 20.9).

Conclusion: No difference was found between using CBCT and conventional radiography with apex locator for working length determination. In curved root canals, it is recommended to use electronic apex locator in combination with conventional radiography without the need for CBCT.

Keywords: Working Length; Root Canal Length; Apex Locator; Electronic Method; Radiographic Method; CBCT;Cone Beam Computerized Tomography; 3D Imaging

References

1. Adarsh K., et al. “Accuracy and reliability of tooth length measurements on conventional and CBCT images: An in vitro comparative study”. The journal of Orthodontic Science 7 (2018): 17.
2. “American Dental Association Council on Scientific Affairs”. The Journal of the American Dental Association 8 (2012): 899-902.
3. Bhat KV., et al. “A Comparative Evaluation of Accuracy of Newgeneration Electronic Apex Locator with Conventional Radiography to determine Working Length in Primary Teeth: An in vivo Study”. International Journal of Clinical Pediatric Dentistry 1 (2017): 34-36.
4. Clayton B Williams. “A Comparison between In vivo Radiographic Working Length Determination and Measurement after Extraction”. Journal of Endodontics 7 (2006): 624-627.
5. De Morais ALG., et al. “Working Length Determination Using Cone-Beam Computed Tomography, Periapical Radiography and Electronic Apex Locator in Teeth with Apical Periodontitis: A Clinical Study”. International Endodontic Journal 3 (2016): 164-168.
6. Dutta K., et al. “Comparative evaluation of three methods to measure working length - Manual tactile sensation, digital radiograph, and multidetector computed tomography: An in vitro study”. Journal of Conservative Dentisty 20 (2017): 76-80.
7. ElAyouti A., et al. “The ability of root ZX apex locator to reduce the frequency of overestimated radiographic working length”. Journal of Endodontics2 (2002): 116-119.
8. Faraj, B. M. “Preoperative Estimation of Endodontic Working Length with Cone-Beam Computed Tomography and Standardized Paralleling Technique in comparison to Its Real Length”. BioMed Research International (2020): 2020.
9. Faraj BM. “Root canal curvature as a prognostic factor influencing the diagnostic accuracy of radiographic working length determination and postoperative canal axis modification: an in vitro comparative study”. BMC Oral Health1 (2021).
10. Jarad FD., et al. “Working length determination in general dental practice: a randomised controlled trial”. British Dental Journal 211 (2011): 595-598.
11. Flores-Mir C., et al. “Measurement accuracy and reliability of tooth length on conventional and CBCT reconstructed panoramic radiographs”. Dental Press Journal of Orthodontics 5 (2014): 45-53.
12. Gambarini G., et al. “A preliminary assessment of a new dedicated endodontic software for use with CBCT images to evaluate the canal complexity of mandibular molars”. International Endodontic Journal (2017): 1-10.
13. Ghule KD and Naik S. “Comparing the accuracy of cone-beam computed tomography and electronic apex locator for root canal length determination in primary teeth”. Journal of Indian Society of Pedodontics and Preventive Dentistry 37 (2019): 157-161.
14. Chandler NP., et al. “Electronic apex locators”. International Endodontic Journal 7 (2004): 425-437.
15. Jafarzadeh H., et al. “Evaluation of Conventional Radiography and an Electronic Apex Locator in Determining the Working Length in C-shaped Canals”. International Endodontic Journal 1 (2017): 60-63.
16. James Mah., et al. “The Genesis and Development of CBCT for Dentistry”. A Peer-reviewed publication at Dental Academy of Continuing Education www.ineedce.com (2017).
17. Janner SFM., et al. “Precision of endodontic working length measurements: A pilot investigation comparing cone-beam computed tomography scanning with standard measurement techniques”. Journal of Endodontics 8 (2011): 1046-1051.
18. Jeger, F. B., et al. “Endodontic working length measurement with preexisting cone-beam computed tomography scanning: A prospective, controlled clinical study”. Journal of Endodontics 7 (2012): 884-888.
19. Kobayashi C. “Electronic canal length measurement”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 79 (1995): 226-231.
20. Lucena, C., et al. “Accuracy of working length measurement: Electronic apex locator versus cone-beam computed tomography”. International Endodontic Journal 3 (2014): 246-256.
21. Mandlik J., et al. “An in vivo Evaluation of Different Methods of Working Length Determination”. The Journal of Contemporary Dental Practice 4 (2013): 644-648.
22. Martins JN., et al. “Clinical efficacy of electronic apex locators: systematic review”. Journal of Endodontics 40 (2014): 759-777.
23. Mittal R., et al. “Comparative evaluation of working length determination by using conventional radiography, digital radiography and electronic apex locator”. Journal of Dental Research 3 (2015): 70-75.
24. Nekoofar MH. “Electronic apex locators”. International Endodontic Journal 38 (2005) 418-472.
25. Nicholas P Chandler and Lara T Friedlander. “The anatomy of the root apex: A review and clinical considerations in endodontics”. Saudi Endodontic Journal (2013).
26. Obeid MF., et al. “Accuracy of CBCT in tooth length measurements: a comparative in vivo study”. Endo Practice Today 3 (2018): 169-174.
27. Patel S., et al. “Cone beam computed tomography in Endodontics - a review”. International Endodontic Journal (2015).
28. Pauwels R. “Cone beam CT for dental and maxillofacial imaging: dose matters”. OUP 165.1-4 (2015): 156-161.
29. Rathore K., et al. “Comparison of Accuracy of Apex Locator with Tactile and Conventional Radiographic Method for Working Length Determination in Primary and Permanent Teeth”. International Journal of Clinical Pediatric Dentistry 3 (2020): 235-239.
30. Ravanshad S., et al. “Effect of working length measurement by electronic apex locator or radiography on the adequacy of final working length: a randomized clinical trial”. The Journal of Endodontics 11 (2010): 1753-1756.
31. Saatchi M., et al. “Influence of Root Canal Curvature on the Accuracy of Root ZX Electronic Foramen Locator: An In vitro Study”. International Endodontic Journal 2 (2017): 173-178.
32. Sadaf D and Ahmad MZ. “Accurate Measurement of Canal Length during Root Canal Treatment: An In vivo Study”. International Journal of Biomedical Science 1 (2015): 42-47.
33. Santhosh L., et al. “Influence of root canal curvature on the accuracy of an electronic apex locator: An in vitro study”. The Journal of Conservative Dentistry 17 (2014): 583-586.
34. Scarfe WC and Farman AG. “What is cone-beam CT and how does it work?”. Dental Clinics of North America 4 (2008): 707.
35. Sherrard JF., et al. “Accuracy and reliability of tooth and root lengths measured on cone-beam computed tomographs”. The American Journal of Medicine 137 (4 SUPPL.) (2010): S100-S108.
36. Singh H and Kapoor P. “Generations of apex locators: which generation are we in?”. Stomatological Disease and Science4 (2019).
37. Tampelini FG., et al. “In vivo assessment of accuracy of Propex II, Root ZX II, and radiographic measurements for location of the major foramen”. Restorative Dentistry and Endodontics 3 (2017): 200-205.
38. Tchorz, JP., et al. “Accuracy of software based three-dimensional root canal length measurements using cone-beam computed tomography”. European Endodontic Journal 1 (2019): 28-32.
39. U stu n Y., et al. “Evaluation of the Reliability of Cone-beam Computed Tomography Scanning and Electronic Apex Locator Measurements in Working Length Determination of Teeth with Large Periapical Lesions”. The Journal of Endodontics 9 (2016): 1334-1337.
40. Vieyra, JP and Acosta J. “Comparison of working length determination with radiographs and four electronic apex locators”. International Endodontic Journal 6 (2011): 510-518.
41. Yadav RK., et al. “A Comparative Evaluation of Four Different Techniques for Determining the Accuracy of Root Canal Working Length: An In vitro Study”. Dental Hypotheses 11 (2020): 33-39.
42. Yildirim, C., et al. “Performance of the working length determination using cone beam computed tomography, radiography and electronic apex locator, in comparisons to actual length”. Iranian Journal of Radiology (2017).
43. Yilmaz F., et al. “Endodontic Working Length Measurement Using Cone-beam Computed Tomographic Images Obtained at Different Voxel Sizes and Field of Views, Periapical Radiography, and Apex Locator: A Comparative Ex??Vivo Study”. The Journal of Endodontics 1 (2017): 152-156.
44. Youssef HA. “A Radiographic technique for Determination of the Apical extent of root canal filling”. DJ 11 (1995).

Citation

Citation: Amal Hassan Mohamed., et al. “Comparative Evaluation of Using Cone Beam Computerized Tomography (CBCT) and Conventional Radiography Confirmed with Apex Locator for Working Length Determination in Curved Root Canals (Clinical Study)”. Acta Scientific Dental Sciences 6.1 (2022): 121-129.

Copyright

Copyright: © 2022 K Amal Hassan Mohamed., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.