Determination of an accurate working

length(WL)is one of the most critical steps

of endodontic therapy.the cleaning,
shaping and obturation of root canal
system cannot be acomplished accurately
unless WL is determined precisely.
@ccording to endodontic glossary :
à
is defined asµ the distance from a
coronal reference point to a point at
which canal preparation obturation should
terminate.µ
m —eference point : is that site on occlusal
or the incisal surface from which
measurements are made .
@ reference point is chosen which is stable
and easily visualized during preparation.

m @natomic apex: is tip or end of root

determined morphologically .
m —adiographic apex: is tip or end of root
determined radiographically.
m @pical foramen: is main apical opening
of root canal which may be located
away from anatomic or radiographic
apex.
m @pical constriction: is apical portion of
root canal having narrowest diameter .
m It is usually 0.5-1mm short of apical
foramen.
m The Cementdentinal junction:is the
region where cementum and dentine
are united ,the point at which cemental
surface terminate at or near the apex.
m @verage root length from anatomic
studies
m —adiographic
m Mathematics method
m Tactile sensation
m Bleeding on paper point
m @pical periodontal sensitivity
m Electronic apex locator
1. Measure the estimated WL from preoperative
periapical radiograph
2. @djust stopper of instrument to this estimated WL
and place it in the canal up to the adjusted
stopper
3. Take the radiograph
4. On the radiograph measure the difference
between the tip of the instrument and the root
apex add or subtract this length to the estimated
WL to get the new WL.

5. correct WL is finally calculated by subtracting 1

mm from this new length .
1. No resorption -subtract 1mm
2. Periapical bone lesion - subtract 1.5 mm
3. Periapical bone +root apex resorption
-subtract 2 mm
m it is based on simple mathematical
formulation to calculate the WL.
m In this an instrument is inserted into the
canal ,stopper is fixed to the reference
point and radiograph is taken.
m The formula to calculate actual length of the
tooth ia as follow:
@ctual length of tooth apperent length of tooth in x-ray
-------------------------------- --- = ------------------------------------------------
@ctual length of instrument apperent length of instrument
in radiograph
So,

actual length of instrument X

apperent length of tooth in radiograph
@ctual length of tooth= ------------------------------------------------------------
apperent length of instrument in radiograph
Wrong readings can occur because of :
@. Variation in angles of radiograph
B. Curved root
C. S-shaped ,double curvature roots.
m Other methods of WL determination
including:
Ñ tactile sensation
Ñ @pical periodontal sensitivity
Ñ Paper point measurement
These methods don·t always provide the
accurate readings for example :
In case of narrow canals instrument may feel
increased resistance as file approaches apical
2-3mm and in case tooth with immature apex
instrument can go beyond apex.
So these methods should not used alone
should be used as supplement to radiographs
apex locators.
m The electronic method calculates the working length by
comparing the electrical resistance of the periodontal
membrane with that of the gingival surrounding the tooth,
both of which should be similar. The processors of these both
of these machines basically work on four mechanisms.
º ÷og readings
º Subtract method
º Taking averages
º Taking ratios
m These mechanisms are more important as compared to the
number of frequencies used to collect data, as these signify
essentially how the device interprets the data. All apex
locators function by using human body to complete a circuit.
The apex locators are also classified based on the principle
they work on.
m Suzuki conducted research in 1942 and this was used by
Sunanda
m The apex locators are base on three
principles:

º —esistance method
º Impedance method
º Frequency ratio method
—

  

 
  
 



m The apex locator has a built in resistant value
of 6.5 kilo Ohms. The apex locator is attached
to the patients lip on one side and the other
side is attached to the file. The file is then
advanced into the canal until it touches the
periodontal tissue at the apex which then
completes the circuit.
m Operates on the principle that there is electrical
impedance across the walls of the root canal due
to the presence of the transparent dentin. The
tooth exhibits an increasing electrical impedance
across the walls of the root canal, which is
greater apically than coronally. At the DCJ, the
level of impedance drops dramatically. The unit
detects the sudden change and indicates it on the
analogue meter. To overcome the problem of a
wet environment, insulated are utilized.
m Operates very similarly to the Impedance-type
because it measures the impedance of the
tooth at two different frequencies. In the
coronal portion of the canal, the impedance
difference between the frequencies is
constant. As the file is advanced apically, the
difference in the impedance value begins to
differ greatly with maximum difference at the
apical area.
rfourth-generationµ apex locators are
marketed by Sybron Endo and
included the @ @ @pex inder and the
Elements Diagnostic Unit. Both are ratio
type apex locators that determine the
impedance at 5 frequencies and both
have built-in electronic pulp testers.
 ifth generation of apex locater :
this type of apex locater contain rotary
endo system (built in)
m E@P are used for determining WL as an
adjunct to radiography.
They are basically used to locate the
apical constrictions or cementodentinal
junction or apical foramen and not the
radiographic apex.
1. Provide high degree of accuracy
2. Useful in conditions where apical portion is
obstructed.
3. Useful in patient with gag reflex
4. Pregnant patient
5. —oot perforation ,resorption ,root fracture .
6. Pulp vitality
7. —CT of teeth with incomplete root formation.
m @ccurate
m Objective measurement
m Easy and fast
m —eduction of exposure to radiation
m Perforation can be detected
m Can measure pulp space exactly to
constriction
m Can detect resorption and root fracture
m Canal should be free from debris
m Canal should be relatively dry
m No cervical leakage
m Proper contact of file with canal walls
and periapex
m No blockages or calcification in canal
m In patient who have cardiac pace
maker,electrical stimulation to such
patient can interfere with pace maker
function
m In teeth with periapical radiolucency
and necrotic pulp associated with root
resorption the use of apex locator is not
much beneficial.
m The most important to understand when
determining WL is morphology of apical
one third of the canal.
m The consideration should given to adopt
the parameter 0.5-0.0mm(from apical
constriction)as most ideal terminating
point in canal.
m We should use many of these techniques
as possible during the course of
treatment.