Endodontic therapy is a very common procedure in dental clinics performed by every dentist. The key method for an effective root canal operation is the determination of working length. The distance from the coronal reference point to the apical constriction in the radicular portion is the working length. To determine the working length, various methods are used e.g.
1 – Radiographic Method – A K-File is placed inside the canal & an IOPA (Intra Oral Peri Apical) X-Ray is taken of the affected tooth, then the working length is measured manually using a scale. This method shows numerous errors as X-Ray is a 2D image, where Apex is not visible accurately.
2 – Handling Method – The dentist calculates if the K file hits the apex with a minimum accuracy of just 42% based on hand sensation and patient pain.
Why Dental Apex Locator is Required?
- It provides a more accurate reading.
- No or Minimum errors
- No chance of over instrumentation that may lead to damage of periapical tissues.
- No chance of under instrumentation that leads to an insufficient apical section debridement eventually resulting in the failure of endodontic therapy.
- Reduced risk of perforations or zipping in case of curved canals
- Less chairside time
- Easy to use a portable device
- Decreased patient exposure to X-Ray
- Increased patient comfort & cooperation.
Generations of Apex Locators:
- 1st Generation: It is resistance. It measures which oppose direct current or resistance flow. In the presence of pulp, it does not give a precise reading.
- 2nd Generation: It is Impedance. It measures that are opposed to alternating current or impedance flow. It shows that at the apical constriction, there is the highest impedance.
- 3rd Generation: This works on the theory of impedance & frequency. It measures an impedance ratio of two different wave frequencies of electric currents.
- 4th Generation: To access the distance between the K file and the apical constriction. It consolidates resistance and capacitance measurement. It separately uses each frequency so that the precision can increase. E.g. NSK Ipex II Apex Locator
- 5th Generation: Modern apex locator with digital readout, graphic illustrations, and audible signal that works accurately with conductive fluids. This generation was created in 2003. It separately analyses the circuit’s resistance and capacitance. Adding a diagnostic table with importance statistics at various positions allows the diagnosis of the file’s location. E.g. Woodpecker DTE Dpex III Gold
- 6th Generation: Most advanced type of apex locator. This resolves the drawbacks of 4th & 5th generation, which while dealing with wet & dry canals respectively showed low precision. They continuously identify the humidity in the canal and can be used in both dry, wet canals, or canals with pulp residues and bleeding. E.g. Woodpecker DTE Dpex V
How does NSK & Woodpecker Apex Locator work?
The root apex has a specific resistance that it offers to the electrical current. This is measured using two terminals, one attached to the lip & the other attached to the K file. The principle behind the locator’s functioning is that once the circuit is done (the file is in contact with the tissue), there is a decrease in current resistance and flow. This event is indicated to warn the operator by a beep, different color code, digital read-out or pointer on the screen.
Points to Achieve Precision Using The Best Apex Locator:
- To prevent any conducting material between the lip hook & K file, cover the K file with EDTA before entering the isolated canal is important.
- It is recommended to avoid file contact with metallic restorations.
- Using very loose files in the canal may display swaying results.
- It is important to prevent salivary contamination
- Using the best apex locators after complete sodium hypochlorite irrigation & pulp extirpation to increase accuracy as dry canals mays how inappropriate results.
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