Apex Locator

[Downloadedfreefromhttp://www.dentalhypotheses.comonSaturday,September20,2014,IP:112.196.14.
6]||ClickheretodownloadfreeAndroidapplicationfor
journal
SYSTEMATIC REVIEW
Electronic apex locator: A comprehensive

literature review Part II: Effect of different
clinical and technical conditions on electronic
apex locators accuracy
Hamid Razavian, Hamid Mosleh1, Saber Khazaei2, Armita Vali
Department of Endodontics and Torabinejad Dental Research Center, 1Dental Students Research Center, School of Dentistry, Isfahan University of
Medical Sciences, Isfahan, 2Department of Research, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran.
A B S T R A C T
Introduction: To investigate the effects of different clinical and technical conditions on the accuracy of electronic apex locators (EALs).
Materials and Methods: Tooth apex, dental instrument, odontometry, electronic medical, and electronic apex locator were
searched as primary identifiers via Medline/PubMed, Cochrane library, and Scopus data base up to 30 July 2013. Original articles that
fulfilled the inclusion criteria were selected and reviewed. Results: Out of 402 relevant studies, 183 were selected based on the inclusion
criteria. In this part, 75 studies are presented. Pulp vitality conditions and root resorption, types of files and irrigating materials do not affect
an EALs accuracy; however, the file size and foramen diameter can affect its accuracy. Conclusions: Various clinical conditions such as the
file size and foramen diameter may affect EALs accuracy. However, more randomized clinical trials are needed for definitive conclusion.
Key words: Dental instrument, electronic apex locator, electronic medical, odontometry, tooth apex
Introduction
Materials and Methods
Exact determination of the canal length is a

necessary factor for the long-term success of root
treatment.[1] The use of the electronic apex locators
(EALs) as an aid to measure canal length has increased
recently.[2]
Search strategy
In the first part, different generations, comparison with

other techniques and different usages of EALs have
been reviewed and discussed. The aim of this part is to
evaluate the effects of different clinical and technical
conditions on the accuracy of EALs.
Access this article online
Quick Response Code:
Website:
www.dentalhypotheses.com
DOI:
10.4103/2155-8213.140588
Electronic searches were performed, using tooth

apex, dental instrument, odontometry, electronic
medical, and electronic apex locator as keywords.
The searching protocol used in this literature review
was identical to that used for Part I of the review.[2]
Inclusion and exclusion criteria

The inclusion and exclusion criteria for this review were set
as Part I of the review.[2] In this part, 75 studies were selected.
Data extraction
Extraction of data from studies, assessment of validity,
and designed check list was based on the first part.[2]
Result
Out of 402 articles, 183 studies were reviewed, and 75
studies were selected for this part. The studies were
categorized as follows.
Corresponding Author: Dr. Saber Khazaei, Department of Research, School of Denstry, Kermanshah University of Medical Sciences, Kermanshah, Iran.
E-mail: skhazaei@kums.ac.ir
Oct-Dec 2014 / Vol 5 | Issue 4
Dental Hypotheses
133
[Downloadedfreefromhttp://www.dentalhypotheses.comonSaturday,September20,2014,IP:112.196.14.6]||ClickheretodownloadfreeAndroidapplicationfor
journal
Razavian, et al.: Electronic apex locator
The effect of different tooth preparation techniques

on electronic EALs accuracy
In all 15 studies assessed the effects of irrigating
materials on EAL accuracy,[1-16] of which 10 of them
reported that EAL, regardless of the presence of different
irrigation materials, was accurate, although the other 5
studies found differences between various devices and
materials.[1,9,13,15,16] [Table 1]. Lee et al.[17] evaluated the
accuracy of the endodontic meter SII apex locator device
in the detection of the cemento-dentinal junction and
major apical .They showed that the apex locator was
more accurate in detecting major apical foramen than
the cemento-dentinal junction. Guerreiro-Tanomaru
et al.,[19] evaluated the effects of dental embedding
materials, concluding that type of embedding materials
were affected the accuracy of EALs, but Baldi et al.[20]s
study presented that regardless of the presence of
embibing materials, EALs were accurate. Ebrahim
et al.[14] reported that in the presence of blood, canal
length was only underestimated with small file sizes,
although each canal should be worked with a file
size similar to its prepared diameter; however, in the
presence of NaOCl, even with small file sizes, the results
were accurate [Table 1].
De Camnargo et al. [21] investigated the effect of
preflaring on the accuracy of determining canal
length with four different EALs. They reported that
preflaring increased the efficiency of the Root ZX and
Mini apex locator devices, but for some other devices,
it did not increase the efficiency. Also, the results
of Morgental et al.s[22] study recommended that for
greater accuracy, canal length should be determined
after coronal flaring. Altenburger et al.[23] evaluated
the accuracy of length control through root canal
therapy with three types of file (Mtwo, ProTaper,
Flexmaster) with the Tri Auto ZX and Raypex 5
attached to handpiece devices. The results of their
study showed that the distance between the file tip
and the major foramen did not change with different
systems and files, but the distance between the file
tip and the minor foramen with the Flexmaster was
significantly different from that measured with the
Mtwo and ProTaper [Table 1].
Barthelemy et al.[24] compared the exactitude of central
lead handpieces for apex locators. It has been assumed
that same length is achieved with EALs of both manual
and motor-driven types. X Smarts dual-estimated
length showed significantly shorter length, and the
motor-driven length measured by the X Smart Dual was
significantly longer than measured by the Dentaport
134
Dental Hypotheses
ZX. The authors concluded that measuring working

length with a motor-driver EAL was safe in clinical
practice, but it was not the same as using a manual
EAL. Grimberg et al.,[25] evaluated the accuracy of an
apex locator device, along with rotary files, in root
canal length measurement with the Tri Auto ZX, and
they concluded that the clinically acceptable range
was accurate. Carneiro et al.,[26] investigated Tri Auto
ZX devices in root canals that they had prepared with
ProTaper instruments. They evaluated 20 distobuccal
canals of maxillary molars and showed that working
length in canals prepared with ProTaper instruments
was shorter than the length worked with routine
methods, although this length was acceptable for
clinical purposes [Table 1]. Genc et al.,[27] studied the
accuracy of the Tri Auto ZX apex locator device in root
canals that had been prepared with rotary files, using
the light speed and S-apex technique, and they also
studied the ability of these devices to create apical
stops in root-end re-sected teeth in comparison with
manual techniques. According to this study, there were
no significant differences between Light speed and
the other techniques. Thomas et al.,[28] investigated
the effects of the sizes and types (SS and NiTi files) of
files on EALs accuracy, and they showed that, based
on the manufacturers instructions, both files were
accurate in different sizes. Also, Briseno-Marroquin
et al.,[29] evaluated the file size effect on the accuracy
of EALs in 146 teeth and concluded that there were
no significant differences between EALs and different
file sizes [Table 1]. Nekoofar et al.,[30] and Sadeghi
et al.,[31] investigated effect of file type (NiTi, SS) on
the accuracy of an apex locator and showed that no
significant differences existed between different files.
The effects of root anatomy and tooth type on the

accuracy of EALs
Several studies assessed how apex locator devices
would work in deciduous teeth.[32-47] Various studies
evaluated EALs operation in presented root resorption.
But Kielbassa et al.[33] evaluated the accuracy of EALs in
deciduous sound teeth. All 11 studies concluded that
root resorption of deciduous teeth did not affect EALs
accuracy [Table 2].
Tang et al.,[48] evaluated the effects of root canal anatomy,
tooth type (tooth location), root curvature, and canal
calcification on the accuracy of the Root ZX apex
locator. The results indicated that tooth anatomy
obviously affected the accuracy of EALs and made canal
preparation difficult. Ding et al.,[49] showed that apical
anatomic features significantly affected the accuracy
journal
Table 1: The effect of different tooth preparation techniques on EALs accuracy

Authors
Gomes
et al.[13]
Type of Publication Sample Types of studied

study
year
(n)
ELA
2012
34 single Rapex 5
In vivo
root
teeth
Carvalho
et al.[4]
In vitro
2010
Kang
et al.[5]
In vitro
2008
Erdemir
et al.[6]
In vivo
2007
Elements
Diagnostic, Root
ZX and Apex DSP
40 teeth Apex Finder 7005,
Apit, Bingo-1020,
e-Magic Finder,
ProPex, Root ZX,
and SmarPex
76 teeth Tri Auto ZX
Ozsezer
et al[1]
In vivo
2007
27 teeth
Prepex
Ebrahim
et al.[9]
In vitro
2007
45 teeth
Root ZX
Ebrahim
et al.[14]
In vitro
2007
45 single Dentaport ZX
root
teeth
Muthu
et al.[10]
In vitro
2006
30 teeth
Neo-Sono Copilot
Goel
et al.[11]
In vitro
2006
30 teeth
Root ZX
Kaufman
et al.[3]
In vitro
2002
120
teeth
Bingo 1020
Root ZX
Tinaz
et al.[7]
In vitro
2002
50 teeth
Root ZX
Meares
et al.[12]
In vitro
2002
40 teeth
Root ZX
Nam
et al.[15]
In vivo
2002
31 root
canals
Root ZX
Jenkins
et al.[8]
In vitro
2001
30 teeth
Root ZX
Fouad
et al.[16]
In vitro
1993
60 teeth
Fouad
et al.[17]
In vitro
1989
20 teeth
Exact-apex,
Endocater,
Neosono-D, Apex
finder, and SonoExplorer
Exact apex,
Endocater,
Neosono-D, Apex
finder, and Sono
Explorer
GuerreiroTanomaru
et al.[19]
In vitro
2012
20 teeth
20 teeth
Root ZX II
Aim of study
Main study result
Evaluative of the performance of the Raypex

5 electronic apex locator in the presence
of different irrigate solutions: 2.5% sodium
hypochlorite (NaOCl), 2% CHX, and 17%
Ethylenediaminetetraacetic acid (EDTA)
Effect of irrigating materials on apex locator
device accuracy (Saline 0.9% and sodium
hypochlorite 1%)
device accuracy
(NaOCl 5.25%, saline, chlorhexidine 0.1%,
EDTA 15%, and dry canal)
The Raypex 5 performed

equally well irrespective of
the irrigate used

device accuracy
(9%, Nacl 2.5%, H2O2 3%, chlorhexidine
6.2%, EDTA 17%)
Effect of irrigating materials on apex
locator device accuracy (NaOCl 0.9%,
chlorhexidine gluconate 2%)
device accuracy (NaOCl 0.5%, EDTA 15%,
NaOCl 2.5%, Nacl 2.5%, chlorhexidine 8%,
and RC Prep)
device accuracy (0.5% NaOCl, 2.5%
NaOCl, 15% EDTA, 0.8% chlorhexidine
(CHX), and RC Prep) in large canals
device accuracy (Saliva, H2O2 5%, sodium
hypochlorite 3.25%)
device accuracy (normal saline, 0.2%
chlorhexidine and 2.5% of sodium hypochlorite)
device accuracy (dry root canals, 3% NaOCl,
saline, 0.2% chlorhexidine, 17% EDTA, Xylol)
device accuracy (Different concentration of
NaOCl (5.25%, 2.65%, 1%, and 0.5%))
device accuracy (sodium hypochlorite
5.25%, 2.125%)
device accuracy in different apical size
(NaOCl 2.5% and H202)
device accuracy (Lidocain 2% with 1/100000
epinephrine, sodium hypochlorite 5.25%, RC
Prep, EDTA solution, H2O2 3%, and Peridex)
Evaluated the reliability of EALs in present
different irrigants (ethanol, hydrogen
peroxide, saline, Xylocaine, sodium
hypochlorite, and blood )
EAL regardless of the

different irrigation materials
were accurate except saline
EALs regardless of the

were accurate
were accurate
Most accurate length was in

dry canals
EAL in presence of NaOCl
2.5%, NaOCl 5% and EDTA
was more accurate
In the presence of CHX and
RC Prep only large file size
(#40, #60 and #80) was
accurate
were accurate
irrigation materials were
accurate
irrigation materials were
accurate
were accurate
different sodium hypochlorite
concentration was accurate
EAL did not affected by
different canal contents and
apical sizes
were accurate
In dry canals, there were
not significant differences
between EALs.
Evaluated the reliability of EALs in present

different irrigants (ethanol, hydrogen
peroxide, saline, Xylocaine, sodium
hypochlorite, and blood)
The reliability of the EALs

depended on the electrical
conductivity of the fluid and
poorest results in presence
of sodium hypochlorite,
blood was given
Effect of dental embedding materials on
Alginate provide greater
apex locator accuracy ( alginate, saline, and accuracy than others
floral foam or gauze soaked in saline)
(Continued)
Dental Hypotheses
135
journal
Table 1: (Continued)
Authors
Baldi
et al.[20]
Type of Publication Sample

study
year
(n)
2007
30 teeth
In vitro
Types of studied
ELA
Root ZX, Elements
Diagnostic Unit and
Apex Locator, and
RomiAPEX D-30.
24
Root ZX and
extracted Novapex
maxillary
molars
40 teeth Root ZX, Elements
Diagnostic Unit and
Apex Locator, Mini
Apex Locator, and
Apex DSP
30 teeth Novapex, Mini
Apex Locator and
Propex II
32
Root ZX
canals
Brito-Junior Ex vivo
et al.[63]
2012
de
Camargo
et al.[21]
In vitro
2009
Morgental
et al.[22]
In vitro
2011
Ibarrola
et al.[64]
In vitro
1999
Rivera and In vitro

Seraji[65]
Genc
In vitro
et al.[27]
1993
30 teeth
Neosono D
2011
85 teeth
Tri Auto ZX apex
Kocak
et al.[66]
In vitro
2013
51 teeth
VDW Gold , Tri

Auto ZX
Barthelemy In vitro
et al.[24]
2008
45 teeth
Carneiro
et al.[26]
In vitro
2006
20 root
canals
Dentaport ZX,
Endomaster,
XSmart Dual
Tri Auto ZX
Grimberg
et al.[25]
In vivo
2002
25 teeth
Tri Auto ZX
Steffen
et al.[67]
In vitro
1999
50 teeth
ROOT ZX, and

Justy
Sadeghi
et al.[31]
In vitro
2010
BrisenoMarroquin
et al.[29]
Nguyen
et al.[68]
In vitro
2008
In vitro
1996
Lee et al.[18] In vitro
2002
20 single Raypex 5
canal
teeth
146
Elements AL,Justy
Teeth
II, Raypex 5,
ProPex II
21 single Root ZX
root
teeth
31 root
Endodontic Meter
canals
SII
Thomas
et al.[28]
2003
In vitro
20 teeth
Root ZX
Aim of study
Main study result
Effect of dental embedding materials on

apex locator accuracy (1% agar, gelatin,
alginate, saline, and flower sponge soaked
in saline)
Evaluating the effect of preflaring and file
size on the EAL accuracy

embibing materials were
accurate
Preflaring increased EAL
accuracy
Effect of preflaring on apex locator accuracy In Root ZX and Mini apex

locator accuracy was
significantly increased
Effect of coronal flaring on apex locator
accuracy
After coronal flaring,

apex locators were more
accaurate
To determine if preflaring of canals would
Preflaring of canals will
facilitate the passage of files to the apical
increase the efficacy of the
foramen by eliminating cervical interferences Root ZX apex locator.
and to see what effect this would have on the
performance of the Root ZX apex locator.
Effect of recapitulation on apex locator
Recapitulation is necessary
accuracy
for accurate reading.
Evaluation of the accuracy of apex locator
No significant difference
device along with rotary files in root canal
between light speed
length measurement by using difference
and S-Apex and manual
technique
technique
Both manual and
device with handpieces in root canal length handpieces methods were
measurement
accurate and safe
Manual kind was more
device with handpieces in root canal length accuracy and safety
measurement
In clinical acceptable range
is accurate
length measurement
Evaluation the accuracy of apex locator
In clinical acceptable range
is accurate
length measurement
Comparison of measurements obtained with Under the conditions of
hand files or the Canal Leader attached
this study the working
to electronic apex locators
length of canals obtained
with electronically assisted
hand files were similar to
those obtained with the
electronically assisted
mechanical handpiece canal
leader.
Evaluated the effect of file type on EALs
There were no significant
accuracy (SS file and M two NiTI file)
differences between both
groups
Effect of file characteristic on accuracy of
apex locator (#8,#10,#15)
between EALs and different
file size
Evaluated the effect of different file size
In both file size EAL was
(#10 and #60) in EALs accuracy large canal accurate
Comparison of the accuracy of apex locator
in detecting apical foramen and cementdentinal junction using automatic circuit
change
Effect of file characteristic on accuracy of
apex locator
Apex locator was more

accurate in detecting
major apical foramen than
cement-dentinal junction
Both SS and NiTi files
files in different size were
accurate
(Continued)
136
Dental Hypotheses
journal
Authors

study
year
(n)
2002
54 root
Nekoofar
In vitro
canals
et al.[30]
Altenburger Ex vivo
2009
60 teeth
et al.[23]
Types of studied
Aim of study
ELA
Neosono Ultima EZ Effect of file characteristic on accuracy of
apex locator(different alloy:NiTi, SS)
Tri Auto ZX
Evaluation of apex locator ability in
determining apical foramen with different
rotary files
Versiani
et al.[69]
Ex vivo
2009
70 teeth
Root ZX II
DuranSindreu
et al.[70]
Beltrame
et al.[71]
In vivo/
In vitro
2012
46 root
canals
Root ZX
In vivo/
In vitro
2011
15 teeth
Root ZX
Williams
et al.[72]
In vivo
26
canals
Root ZX
2006
between different files
No significant l difference
between different rotary files
in detecting major apical
foramen
Comparison of the accuracy of apex locator 1 mm index of minor apical
in detecting apical constriction using
foramen was more accurate
different meters reading
Comparison of in vitro and in vivo
between both conditions
application of apex locator device
Comparison of in vitro and in vivo

application of apex locator device in
deciduous teeth
Comparison of the difference between
the in vivo working length established by
viewing a peri-apical radiograph and the
in vitro measurement from the file tip to the
apical foramen of the extracted tooth
of measurement, and Uzun et al.,[50] also demonstrated

that an EALs accuracy was not affected by the presence
of lateral canals [Table 2].
Herrera et al.,[51] studied the effects of apical foramen
diameter and file size on the accuracy of the Root
ZX. The results of their study showed that with a 0.6
mm diameter, all length measurements were accurate,
without considering the file size. With 0.7 and 0.8 mm
diameters, the file size needed to match the apical
foramen diameter for exact length measurements, and
with diameter greater than 0.9 mm, the accuracy was
low [Table 2]. Also, Herrera et al.,[52] and Vasconcelos
et al.,[53] evaluated the effect of apical constriction
size on EALs accuracy and concluded that the file
size must be approximately the same as the apical
constriction diameter. Goldberg et al.,[54] studied the
effects of simulated root resorption on the accuracy of
the Root ZX and showed that root resorption did not
affect the accuracy of the Root ZX. Chevalier et al.,[55]
evaluated the effects of patients ages and types of
teeth on the accuracy of the Justy II EAL in apical
foramen determination, and they reported that patients
ages and types of teeth did not affect the accuracy of
EALs. Elayouti et al.,[56] studied the effects of different
conditions (vitality, type of teeth, presence of metallic
resorption, and tooth obliteration) on the accuracy of
the Root ZX and the Raypex 5 in 507 teeth. The results
indicated that except for obliteration of root canals,
other factors did not have significant effects on the
EALs accuracy [Table 2].
Main study result
between both conditions
When the file is short and
it is closer to the apical
foramen than it appears
radiographically; when it is
long and it is longer than it
appears radiographically
Effect of pulp conditions on EALs accuracy

Pommer et al.,[57] concluded that EALs were more
accurate in vital teeth than in necrotic ones. However,
Aksiue et al., [58] reported that pulp condition did not
affect the accuracy of EALs [Table 2]. Also, Renner
et al.,[59] investigated the accuracy of the Novapex
apex locator in posterior teeth. Thirty-five vital teeth
(68 canals) and 42 necrotic teeth (76 canals) were
studied. It was demonstrated that pulp condition did not
affect the accuracy of EALs. Serry et al.,[60] investigated
that EAL in necrotic pulp with apical lesion, was less
accurate than vital pulp [Table 2].
Effect of peri-apical conditions on EALs accuracy

Piasecki et al.,[61] evaluated the ability of the Root ZX
II to detect the apical foramen in teeth with apical
periodontitis. Based on this study, the presence of
defects in the pre-apical area did not affect the accuracy
of the Root ZX II or its reliability, but Kuzminski[62]
claimed that apical lesions negatively affected EALs
accuracy [Table 2].
Discussion
It should be noted that there is no difference between
different generations of EALs. The EALs are accurate
for canal length measurement, within a clinically
acceptable range of 0.5.[2] However, various clinical
conditions may affect EALs accuracy.
There was no significant difference in the accuracy of EALs
when used manually or with handpieces.[24] To reduce
Dental Hypotheses
137
journal
Table 2: The effect of tooth conditions and kinds on the accuracy of EALs
Authors
Silva et al.[44]
Wankhade
et al.[45]
Saritha et al.[40]

study
year
(n)
2013
25 root
Ex vivo
canals
2012
70 tetth
In vitro
In vivo
2012
Odabas et al.[34]
In vivo
2011
Nelson-Filho
et al.[37]
Nelson-Filho
et al.[46]
Ex vivo
2011
In vitro
2010
Angwaravong
et al.[35]
Leonardo
et al.[38]
In vitro
2009
Ex vivo
2009
Chevalier
et al.[55]
In vitro
2009
Leonardo
et al.[32]
Ex vivo
2008
Bodur et al.[41]
In vitro
2008
Ghaemmaghami In vivo
et al.[36]
Tosun et al.[42]
In vitro
2008
Kielbassa
et al.[33]
Mente et al.[39]
In vivo
2003
In vitro
2002
Goldberg
et al.[54]
Katz et al.[47]
In vitro
2002
In vitro
1996
ElAyouti et al.[56]
In vivo
2009
Uzun et al.[50]
In vitro
2012
Pagavino
et al.[73]
In vivo
1998
Tang et al.[48]
In vivo
2011
Vasconcelos
et al.[53]
Ex vivo
2012
Ding et al.[49]
In vitro
2010
Stein et al.[74]
Ex vivo
1990
2008
Types of
Aim of study
studied ELA
Joypex 5
Evaluation apex locator device
operation in deciduous teeth
Joypex 5
40 teeth Root ZX II
28 teeth Root ZX
20 teeth iPex
34 root
Digital Signal Evaluation apex locator device
canals
Processing
andProPex
60 teeth Root ZX
15teeth Root ZX II,
Mini Apex
Locator
209 root ApexPointer Evaluation effect of tooth type and
canals
and Novapex patients age on accuracy of apex
locator
57 root
Root ZX II
To evaluate accuracy of EALs
canals
and Mini
inPrimary resorption teeth
Apex Locator
90 teeth Root ZX
Endex
150
Root ZX
teeth
34 teeth Root ZX Tri
Auto ZX
71 teeth Root ZX
24 teeth Tri Auto ZX
50 teeth Root ZX
Effect of apical root resorption on
EALs accuracy
20 teeth Root ZX
507
Root ZX,
Evaluation effect of different
teeth
Raypex 5
condition, on apex locator
accuracy(vitality, type of teeth,
presence of metallic resorption
and tooth obliteration)
42 teeth Justy II
Effect of lateral canals on apex
locator accuracy
27 vital Root ZX
Evaluated the accuracy of EAL
teeth
in length measurement in normal
apical foramen (along the root
main axis) and lateral foramen
(deviating from the root main axis)
1005
Root ZX
Effect of root canal anatomy on
root
apex locator accuracy
canals
40
Root ZX,
Evaluated the accuracy of EALs
single
Novapex,
in canal length measurement with
root
and Justy II
different apical size
Teeth
356
Root ZX
Effect of apical foramen diameter
teeth
Elements
on apex locator accuracy
apex locator
Raypex 5
47 teeth Neosono-D
Effect of apical foramen diameter
on apex locator accuracy
Main study result

Device is accurate and sufficient in
deciduous teeth
deciduous teeth
deciduous teeth
deciduous teeth
deciduous teeth
Both devices were accurate
deciduous teeth
Devices are accurate and sufficient in
deciduous teeth
Type of teeth not affected on
accuracy of EALs
Both devices were accurate
Devices are accurate and sufficient in
deciduous teeth
deciduous teeth
Root resorption of deciduous teeth
does not affect Root Zx accuracy
deciduous teeth
deciduous teeth
Root resorption didnt affect accuracy
on device
deciduous teeth
Except obliteration of root canals,
other factors were not significant
effect
EAL accuracy was not affected by
presence lateral canals
In both groups, EAL was accurate,
but in normal apical foramen, it was
significantly more accurate
Root curvature, canal calcification
and tooth type affect on the accuracy
of EAL
Justy II and Novapex were more
accurate regardless of the file
adjustment and Root ZX was more
accurate when fit apical file was used
Minor apical foramen diameter
significantly affect the accuracy of
EALs particularly in elements apex
locator
Major apical foramen diameter
significantly affect the accuracy of
EALs particularly in Elements Apex
(Continued)
138
Dental Hypotheses
journal
Authors
Herrera et al.[51]

study
year
(n)
2011
10 teeth
In vitro
Herrera et al.[52]
In vitro
2007
10 teeth
Renner et al.[59]
In vivo
2012
Serry et al.[60]
In vivo
2012
Akisue et al.[58]
In vitro
2007
77 teeth
(144
root
canals)
50
patients
134
teeth
Pommer et al.[57] In vitro
2002
Mayeda et al.[75]
In vivo
1993
Dunlap et al.[76]
In vivo
1998
Piasecki et al.[61] In vivo
2011
Kuzmimski[62]
2006
In vitro
Types of
Aim of study
studied ELA
Root ZX
Effects of apical foramen
diameter and file size on apex
locator accuracy
Root ZX
Effect of root canal anatomy on
apex locator accuracy
Novapex
Effect of pulp condition on apex
locator accuracy
i-Root

locator accuracy
locator accuracy
Elements
Diagnostic
Unit and
Apex Locator
171 root AFA Apex
canals
Finder
locator accuracy
33 teeth Endex
locator accuracy
34 teeth Root ZX
To compare the canal length
determined by an apex locator to
the apical constriction in both vital
and necrotic canals.
27 teeth Root ZX II
Effect of peri-apical defects on
accuracy of apex locator devices
18 teeth Root ZX
Effect of peri-apical defects on
accuracy of apex locator devices
the risk of canal plugging with debris, recapitulation

with a small-diameter hand file should be considered
when a complete series of NiTi files are driven. The
results of the present review showed that the files alloys
did not affect EALs accuracy. The apical measurements
are the same whether NiTi files or stainless steel files
are used.[31] Apical measurement with manual apex
locators and motor-driven apex locators appears not to
be equivalent. Previous study has demonstrated that
larger file sizes can negatively affect EALs accuracy,
but to our knowledge, larger files are not used for length
determination.[14]
The results of several studies reported positive effects
of preflaring on the accuracy of EALs,[22,62,63] but it
was noted that preflaring could only result in better
accuracy in some types of EALs.[21] It appears that after
preflaring, EALs should be used more cautiously for
length measurement.
The results of this study showed that different types of
canal-irrigating materials did not affect the accuracy of
the new generation of EALs.[4,5] Several studies reported
that, within a high electro-conductive irrigate, as canal
diameter increases, the EALs accuracy is decreased.[9,14]
The accuracy of EALs depends on the types of EALs and
the irrigation materials and root canal anatomy.
Main study result

File size must be approximately the
same as apical foramen diameter
File size must be approximately the
same as apical constriction diameter
Pulp condition did not affect on the
accuracy of device
In necrotic pulp with apical lesion,
EAL was less accurate than vital pulp
accuracy of devices
This device is more accurate in vital
teeth than necrotic ones
accuracy of device
There was no significant difference
between the ability of the Root ZX to
determine the apical constriction in
vital canals versus necrotic canals.
Pre-apical lesion did not affect the
accuracy of Root ZX ll
Pre-apical lesion negatively affected
the accuracy of Root ZX
The results showed that root resorption does not

affect EALs accuracy, and these devices can be used
for determining the root canal length of deciduous
teeth.[32-36] Thus, the application of EALs in children is
recommended.
Root canal infection can involve progressive stages
of inflammation, which cause root resorption of the
hard tissues of the tooth. Peri-apical may cause some
enlargement of the apical canal diameter, deviation of
the foramen, and distortion of the apical constriction.[61]
Piasecki et al.,[61] showed that pre-apical condition did not
affect the accuracy of the Root ZX II. However, due to lack
of the clinical studies on this situation, more randomized
clinical trials are required for definite results.
The present review has some limitations. First, only
relevant articles were searched in Medline/PubMed,
Cochrane library, and Scopus data base up to 30 July
2013, which might have restricted the results. More
prospective, randomized clinical trials are needed to
provide more evidences for clinical usage of EALs.
Conclusion
Pulp vitality conditions, root resorption, and different
types of files and irrigating materials do not affect EALs
Dental Hypotheses
139
journal
accuracy. However, the file size and foramen diameter

affect EALs accuracy.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
140
Ozsezer E, Inan U, Aydin U. In vivo evaluation of ProPex

electronic apex locator. J Endod 2007;33:974-7.
Mosleh H, Khazaei S, Razavian H, Vali A, Ziaei F. Electronic apex
locator: A comprehensive literature review- part I: Different
generations, comparison with other techniques and different
usages. Dent Hypotheses 2014;5:84-97.
Kaufman AY, Keila S, Yoshpe M. Accuracy of a new apex
locator: An in vitro study. Int Endod J 2002;35:186-92.
Carvalho AL, Moura-Netto C, Moura AA, Marques MM,
Davidowicz H. Accuracy of three electronic apex locators in
the presence of different irrigating solutions. Braz Oral Res
2010;24:394-8.
Kang JA, Kim SK. Accuracies of seven different apex locators
under various conditions. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2008;106:e57-62.
Erdemir A, Eldeniz AU, Ari H, Belli S, Esener T. The influence of
irrigating solutions on the accuracy of the electronic apex locator
facility in the Tri Auto ZX handpiece. Int Endod J 2007;40:391-7.
Tinaz AC, Sevimli LS, Gorgul G, Turkoz EG. The effects of
sodium hypochlorite concentrations on the accuracy of an
apex locating device. J Endod 2002;28:160-2.
Jenkins JA, Walker WA 3rd, Schindler WG, Flores CM. An
in vitro evaluation of the accuracy of the root ZX in the presence
of various irrigants. J Endod 2001;27:209-11.
Ebrahim AK, Yoshioka T, Kobayashi C, Suda H. The effects of
file size, sodium hypochlorite and blood on the accuracy of
Root ZX apex locator in enlarged root canals: An in vitro study.
Aust Dent J 2006;51:153-7.
Muthu MS, Sivakumar N. Accuracy of electronic apex locator
in length determination in the presence of different irrigants:
An in vitro study. J Indian Soc Pedod Prev Dent 2006;24:182-5.
Goel Y, Acharya S, Kundabala M, Ballal V. A comparative
evaluation of the accuracy of third generation electonic apex
locator (Root ZX) in presence of various intracanal irrigants.
J Endodontol 2006;18:28-33.
Meares WA, Steiman HR. The influence of sodium hypochlorite
irrigation on the accuracy of the Root ZX electronic apex locator.
J Endod 2002;28:595-8.
Gomes S, Oliver R, Macouzet C, Mercade M, Roig M, DuranSindreu F. In vivo evaluation of the Raypex 5 by using different
irrigants. J Endod 2012;38:1075-7.
Ebrahim AK, Wadachi R, Suda H. An in vitro evaluation of the
accuracy of Dentaport ZX apex locator in enlarged root canals.
Aust Dent J 2007;52:193-7.
Nam KC, Kim SC, Lee SJ, Kim YJ, Kim NG, Kim DW. Root canal
length measurement in teeth with electrolyte compensation.
Med Biol Eng Comput 2002;40:200-4.
Fouad AF, Rivera EM, Krell KV. Accuracy of the endex with
variations in canal irrigants and foramen size. J Endod
1993;19:63-7.
Fouad AF, Krell KV. An in vitro comparison of five root canal
length measuring instruments. J Endod 1989;15:573-7.
Lee SJ, Nam KC, Kim YJ, Kim DW. Clinical accuracy of a new
apex locator with an automatic compensation circuit. J Endod
2002;28:706-9.
Guerreiro-Tanomaru JM, Croti HR, Silva GF, Faria G, TanomaruFilho M. Tooth embedding medium influences the accuracy of
electronic apex locator. Acta Odontol Latinoam 2012;25:214-7.
Dental Hypotheses
20. Baldi JV, Victorino FR, Bernardes RA, de Moraes IG, Bramante CM,
Garcia RB, et al. Influence of embedding media on the
assessment of electronic apex locators. J Endod 2007;33:476-9.
21. de Camargo EJ, Zapata RO, Medeiros PL, Bramante CM,
Bernardineli N, Garcia RB, et al. Influence of preflaring on the
accuracy of length determination with four electronic apex
locators. J Endod 2009;35:1300-2.
22. Morgental RD, Vier-Pelisser FV, Luisi SB, Cogo DM, Kopper PMP.
Preflaring effects on the accuracy of three electronic apex
locators. Revista Odonto Ciencia 2011; 26: 331-335.
23. Altenburger MJ, Cenik Y, Schirrmeister JF, Wrbas KT,
Hellwig E. Combination of apex locator and endodontic motor
for continuous length control during root canal treatment. Int
Endod J 2009;42:368-74.
24. Barthelemy J, Gregor L, Krejci I, Wataha J, Bouillaguet S.
Accuracy of electronic apex locater-controlled handpieces. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:437-41.
25. Grimberg F, Banegas G, Chiacchio L, Zmener O. In vivo
determination of root canal length: A preliminary report
using the Tri Auto ZX apex-locating handpiece. Int Endod
J 2002;35:590-3.
26. Carneiro E, Bramante CM, Picoli F, Letra A, da Silva Neto UX,
Menezes R. Accuracy of root length determination using Tri
Auto ZX and ProTaper instruments: an in vitro study. J Endod
2006;32:142-4.
27. Genc O, Alacam T, Kayaoglu G. Evaluation of three
instrumentation techniques at the precision of apical stop and
apical sealing of obturation. J Appl Oral Sci 2011;19:350-4.
28. Thomas AS, Hartwell GR, Moon PC. The accuracy of the Root ZX
electronic apex locator using stainless-steel and nickel-titanium
files. J Endod 2003;29:662-3.
29. Briseno-Marroquin B, Frajlich S, Goldberg F, Willershausen B.
Influence of instrument size on the accuracy of different apex
locators: An in vitro study. J Endod 2008;34:698-702.
30. Nekoofar MH, Sadeghi K, Sadighi Akha E, Namazikhah MS.
The accuracy of the Neosono Ultima EZ apex locator using
files of different alloys: An in vitro study. J Calif Dent Assoc
2002;30:681-4.
31. Sadeghi S, Abolghasemi M. The accuracy of the Raypex5
electronic apex locator using stainless-steel hand K-file versus
nickel-titanium rotary Mtwo file. Med Oral Patol Oral Cir Bucal
2010;15:e788-90.
32. Leonardo MR, da Silva LA, Nelson-Filho P, da Silva RA, Lucisano
MP. Ex vivo accuracy of an apex locator using digital signal
processing in primary teeth. Pediatr Dent 2009;31:320-2.
33. Kielbassa AM, Muller U, Munz I, Monting JS. Clinical evaluation
of the measuring accuracy of ROOT ZX in primary teeth. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:94-100.
34. Odabas ME, Bodur H, Tulunoglu O, Alacam A. Accuracy of an
electronic apex locator: A clinical evaluation in primary molars
with and without resorption. J Clin Pediatr Dent 2011;35:255-8.
35. Angwaravong O, Panitvisai P. Accuracy of an electronic
apex locator in primary teeth with root resorption. Int Endod
J 2009;42:115-21.
36. Ghaemmaghami S, Eberle J, Duperon D. Evaluation of the Root
ZX apex locator in primary teeth. Pediatr Dent 2008;30:496-8.
37. Nelson-Filho P, Romualdo PC, Bonifacio KC, Leonardo MR,
Silva RA, Silva LA. Accuracy of the iPex multi-frequency
electronic apex locator in primary molars: An ex vivo study.
Int Endod J 2011;44:303-6.
38. Leonardo MR, Silva LA, Nelson-Filho P, Silva RA, Raffaini
MS. Ex vivo evaluation of the accuracy of two electronic apex
locators during root canal length determination in primary teeth.
Int Endod J 2008;41:317-21.
journal
39. Mente J, Seidel J, Buchalla W, Koch MJ. Electronic
determination of root canal length in primary teeth with and
without root resorption. Int Endod J 2002;35:447-52.
40. Saritha S, Uloopi KS, Vinay C, Chandra Sekhar R, Rao VV.
Clinical evaluation of Root ZX II electronic apex locator in
primary teeth. Eur Arch Paediatr Dent 2012;13:32-5.
41. Bodur H, Odabas M, Tulunoglu O, Tinaz AC. Accuracy of two
different apex locators in primary teeth with and without root
resorption. Clin Oral Investig 2008;12:137-41.
42. Tosun G, Erdemir A, Eldeniz AU, Sermet U, Sener Y. Accuracy
of two electronic apex locators in primary teeth with and without
apical resorption: A laboratory study. Int Endod J 2008;41:436-41.
43. Subramaniam P, Konde S, Mandanna D. An in vitro comparison
of root canal measurement in primary teeth. J Indian Soc Pedod
Prev Dent 2005;23:124-5.
44. Silva EJ, Herrera DR, Souza-Junior EJ, Rosa TP. Evaluation of
the multifrequency electronic apex locator Joypex 5 in primary
teeth. Eur Arch Paediatr Dent 2014;15:51-4.
45. Wankhade AD, Kumar R, Singh RK, Chandra A. Root canal
length determination by different methods in primary teeth:
An in vivo study. Pediatr Dent 2013;35:E38-42.
46. Nelson-Filho P, Lucisano MP, Leonardo MR, da Silva RA, da
Silva LA. Electronic working length determination in primary
teeth by ProPex and Digital Signal Processing. Aust Endod
J 2010;36:105-8.
47. Katz A, Mass E, Kaufman AY. Electronic apex locator: A useful
tool for root canal treatment in the primary dentition. ASDC
J Dent Child 1996;63:414-7.
48. Tang L, Sun TQ, Gao XJ, Zhou XD, Huang DM. Tooth anatomy
risk factors influencing root canal working length accessibility.
Int J Oral Sci 2011;3:135-40.
49. Ding J, Gutmann JL, Fan B, Lu Y, Chen H. Investigation of
apex locators and related morphological factors. J Endod
2010;36:1399-403.
50. Uzun O, Topuz O, Aslan S, Tinaz AC. Effects of simulated lateral
canals on the accuracy of measurements by an electronic apex
locator. J Can Dent Assoc 2012;78:c65.
51. Herrera M, Abalos C, Lucena C, Jimenez-Planas A, Llamas R.
Critical diameter of apical foramen and of file size using the Root
ZX apex locator: An in vitro study. J Endod 2011;37:1306-9.
52. Herrera M, Abalos C, Planas AJ, Llamas R. Influence of apical
constriction diameter on Root ZX apex locator precision.
J Endod 2007;33:995-8.
53. Vasconcelos BC, Matos Lde A, Pinheiro-Junior EC, Menezes AS,
Vivacqua-Gomes N. Ex vivo accuracy of three electronic
apex locators using different apical file sizes. Braz Dent
J 2012;23:199-204.
54. Goldberg F, De Silvio AC, Manfre S, Nastri N. In vitro
measurement accuracy of an electronic apex locator in teeth
with simulated apical root resorption. J Endod 2002;28:461-3.
55. Chevalier V, Arbab-Chirani R, Nicolas M, Morin V. Occurrence
of no-function of two electronic apex locators: An in vivo
study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2009;108:e61-5.
56. ElAyouti A, Dima E, Ohmer J, Sperl K, von Ohle C, Lost C.
Consistency of apex locator function: A clinical study. J Endod
2009;35:179-81.
57. Pommer O, Stamm O, Attin T. Influence of the canal contents
on the electrical assisted determination of the length of root
canals. J Endod 2002;28:83-5.
58. Akisue E, Gavini G, de Figueiredo JA. Influence of pulp vitality
on length determination by using the Elements Diagnostic Unit
and Apex Locator. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2007;104:e129-32.
59. Renner D, Grazziotin-Soares R, Gavini G, Barletta FB. Influence of

pulp condition on the accuracy of an electronic foramen locator
in posterior teeth: An in vivo study. Braz Oral Res 2012;26:106-11.
60. Serry A, Adel M, Elden EM. Accuracy of electronic apex locator
in relation to the condition of human dental pulp: Histological
and histochemical study. J Am Sci 2012;8.
61. Piasecki L, Carneiro E, Fariniuk LF, Westphalen VP, Fiorentin MA,
da Silva Neto UX. Accuracy of Root ZX II in locating foramen
in teeth with apical periodontitis: An in vivo study. J Endod
2011;37:1213-6.
62. Kuzmimski M. The influence of apical lesions on electronic
tooth-length measurements- an in vitro study. Adv Clin Exp
Med 2006;15:607-11.
63. Brito-Junior M, Camilo CC, Moreira-Junior G, Pecora JD, SousaNeto MD. Effect of pre-flaring and file size on the accuracy of
two electronic apex locators. J Appl Oral Sci 2012:538-43.
64. Ibarrola JL, Chapman BL, Howard JH, Knowles KI, Ludlow
MO. Effect of preflaring on Root ZX apex locators. J Endod
1999;25:625-6.
65. Rivera EM, Seraji MK. Effect of recapitulation on accuracy of
electronically determined canal length. Oral Surg Oral Med Oral
Pathol 1993;76:225-30.
66. Kocak MM, Kocak S, Helvaciodlu Kivanc B, Alacam T. An in vitro
comparison of working length determination by two motor-driven
electronic apex locators. Minerva Stomatol 2013;62:57-61.
67. Steffen H, Splieth CH, Behr K. Comparison of measurements
obtained with hand files or the Canal Leader attached
to electronic apex locators: An in vitro study. Int Endod
J 1999;32:103-7.
68. Nguyen HQ, Kaufman AY, Komorowski RC, Friedman S.
Electronic length measurement using small and large files in
enlarged canals. Int Endod J 1996;29:359-64.
69. Versiani MA, Santana BP, Caram CM, Pascon EA, de Souza CJ,
Biffi JC. Ex vivo comparison of the accuracy of Root ZX II in
detecting apical constriction using different meters reading. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2009l;108:e41-5.
70. Duran-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;38:236-9.
71. Beltrame AP, Triches TC, Sartori N, Bolan M. Electronic
determination of root canal working length in primary molar
teeth: An in vivo and ex vivo study. Int Endod J 2011;44:402-6.
72. Williams CB, Joyce AP, Roberts S. A comparison between
in vivo radiographic working length determination and
measurement after extraction. J Endod 2006;32:624-7.
73. Pagavino G, Pace R, Baccetti T. A SEM study of in vivo accuracy
of the Root ZX electronic apex locator. J Endod 1998;24:438-41.
74. Stein TJ, Corcoran JF, Zillich RM. Influence of the major
and minor foramen diameters on apical alectronic probe
measurments. J Endod 1990;16:520-2.
75. Mayeda DL, Simon JH, Aimar DF, Finley K. In vivo measurement
accuracy in vital and necrotic canals with the Endex apex
locator. J Endod 1993;19:545-8.
76. Dunlap CA, Remeikis NA, BeGole EA, Rauschenberger CR. An
in vivo evaluation of an electronic apex locator that uses the ratio
method in vital and necrotic canals. J Endod 1998;24:48-50.
Cite this article as: Razavian H, Mosleh H, Khazaei S, Vali A. Electronic

apex locator: A comprehensive literature review: Part II: Effect of different
clinical and technical conditions on electronic apex locators accuracy. Dent
Hypotheses 2014;5:133-41.
Source of Support: Nil, Conflict of Interest: None.
Dental Hypotheses
141
Copyright of Dental Hypotheses is the property of Dental Hypotheses and its content may not
be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for
individual use.

Apex Locator

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Apex Locator

Diunggah oleh

Hak Cipta:

Format Tersedia

[Downloadedfreefromhttp://www.dentalhypotheses.comonSaturday,September20,2014,IP:112.196.14.

Electronic apex locator: A comprehensive

Materials and Methods

Exact determination of the canal length is a

In the first part, different generations, comparison with

Electronic searches were performed, using tooth

Inclusion and exclusion criteria

The effect of different tooth preparation techniques

ZX. The authors concluded that measuring working

The effects of root anatomy and tooth type on the

Table 1: The effect of different tooth preparation techniques on EALs accuracy

Type of Publication Sample Types of studied

Main study result

Evaluative of the performance of the Raypex

The Raypex 5 performed

Effect of irrigating materials on apex locator

EAL regardless of the

EALs regardless of the

Most accurate length was in

Evaluated the reliability of EALs in present

The reliability of the EALs

Type of Publication Sample

Rivera and In vitro

Tri Auto ZX apex

VDW Gold , Tri

ROOT ZX, and

Lee et al.[18] In vitro

Main study result

Effect of dental embedding materials on

EALs regardless of the

Effect of preflaring on apex locator accuracy In Root ZX and Mini apex

After coronal flaring,

Apex locator was more

Oct-Dec 2014 / Vol 5 | Issue 4

Type of Publication Sample

Comparison of in vitro and in vivo

of measurement, and Uzun et al.,[50] also demonstrated

Main study result

Effect of pulp conditions on EALs accuracy

Effect of peri-apical conditions on EALs accuracy

Type of Publication Sample

Main study result

Oct-Dec 2014 / Vol 5 | Issue 4

Type of Publication Sample

Pommer et al.[57] In vitro

Piasecki et al.[61] In vivo

Effect of pulp condition on apex

the risk of canal plugging with debris, recapitulation

Main study result

The results showed that root resorption does not

accuracy. However, the file size and foramen diameter

Ozsezer E, Inan U, Aydin U. In vivo evaluation of ProPex

Oct-Dec 2014 / Vol 5 | Issue 4

59. Renner D, Grazziotin-Soares R, Gavini G, Barletta FB. Influence of

Cite this article as: Razavian H, Mosleh H, Khazaei S, Vali A. Electronic

Anda mungkin juga menyukai