Electronic Apex Locator: a Comprehensive Literature Review — Part I: Different Generations, Comparison with Other Techniques and Different Usages

[Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Systematic Review

Electronic apex locator: A comprehensive literature review — Part I: Different generations, comparison with other techniques and different usages

Hamid Mosleh, Saber Khazaei1, Hamid Razavian2, Armita Vali, Farzad Ziaei Dental Students’ Research Center, 2Department of Endodontics, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, 1Department of Research, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran

ABSTRACT

Introduction: To compare electronic apex locators (EAL) with others root canal determination techniques and evaluate other usage of this devices. 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, 108 studies are presented. Under the same conditions, no significant differences could be seen between different EALs of one generation. The application of EALs can result in lower patient radiation exposure, exact diagnosing of fractures, less perforation, and better retreatment. Conclusions: EALs were more accurate than other techniques in root canal length determination.

Key words: Dental instrument, electronic apex locator, electronic medical, odontometry, tooth apex

Introduction Commonly, the minor apical foramen or apical isthmus is considered the end of the area for canal preparation Ideal pulp treatment is defined as the removal of infected and filling. The minor apical foramen is the border line pulp and cleaning, shaping, and disinfecting the root between the dental pulp and periodontal area, which canal system.[1] Subsequently, a three-dimensional is approximately 0.5-1 mm from the anatomic apex.[1,3] filling can be provided. To achieve this goal, an essential Failure to determine the root canal length can result in stage is the assessment of the correct length of the root both over- and underestimation of the root canal length. canals.[1,2] Overestimated working length can result in preparation beyond the apical isthmus, which can damage the Working length is defined as the distance between the peri-apical region.[4] Underestimated working length coronal/incisal reference point and the area that has been and inadequate debridement can cause unsuccessful prepared and at which the filled canal should end.[1] treatment and dissatisfaction of both the patient and dentist.[5] Due to the pivotal role of working length Access this article online determinations in root canal therapy, several methods Quick Response Code: have been introduced as follows. Website: www.dentalhypotheses.com A: Tactile sensation and using the mean canal length

DOI: and the application of paper cones are examples of 10.4103/2155-8213.136744 experimental methods that are used by some clinicians due to their simplicity and relative efficiency.[6] These

Corresponding Author: Dr. Hamid Razavian, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Hezar Jerib St, Isfahan-81746-73461, Iran. E-mail: [email protected]

84 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

techniques can be inaccurate in some patients, however, English language only. Systematic reviews, case reports, due to open apex teeth and apical curvature.[6] letter to editors, editorials, and congress abstracts were excluded. The title and abstract of each article were B: Radiography is a common method for determining reviewed by three of the authors (HM, AV, and FZ), and the apical isthmus, which is 0.5-1 mm shorter than articles that fulfilled the inclusion criteria were selected. radiographic apex.[2] The radiographic method has its advantages, such as direct observation of the root canal Data extraction system and the canal curvature and of the existence Extraction of data from studies and assessment of of peri-apical lesions,[2] but radiography cannot validity was independently performed by two authors determine the apical isthmus, because it provides a two- (HM and AV) and checked by a third author (FZ). dimensional picture of a three-dimensional object.[2,7] In the case of disagreement between evaluators, it In addition, a disadvantage of radiation is that it can be reassessed by discussion between two reviewers and a dangerous to both patients and dental staff. final consensus was agreed on (HR and SKh). Figure 1 provides information on the number of papers identified C: Owing to the advantages of electronic apex locators through the search strategy. Information of the authors, (EAL), such as the elimination of radiographic obstacles their institutions, and result of primary studies were and EAL’s accuracy and convenience, the application removed before assessment of the validity. Information of EAL has developed.[3,8] The principal design and on the first author, year of publication, study design, development of the early apex locators dates back study population and sample size, and the outcome to Suzuki (1942)[9] whom investigated on dogs and measurements (main results) were extracted. found out that the electrical resistance between the periodontal membrane and the oral mucosa was a Results constant value. This point was introduced into clinical practice by Sunada[10] (1962) which almost measured Out of 402 articles, 183 studies were reviewed and 108 the electrical resistance between oral mucosa and studies were selected for this part. The studies were periodontal ligament. categorized as follows.

Over the last decade, different versions of EAL have Comparison of different EALs been released. Table 1 shows and compares the different In this part of the present study, 38 articles, consisting of [11-24] [25-33] [34-48] versions of these devices, based on the functions of 14 in vitro, 9 ex vivo, and 15 in vivo studies each generation. The aim of the present study was were reviewed. Of the in vitro studies, four articles to investigate and compare the accuracy of EALs in did not report significant differences between various devices[12,13,16,19] [Table 2]. All of the ex vivo studies determining the working length through root canal showed significant differences between different therapy. devices, except for the study by Comin Chiaramonti Materials and Methods et al.[31] and Baginska et al.[32][Table 2]. Among the

Search strategy Electronic searches were performed using “tooth apex,” “dental instrument,” “odontometry,” “electronic medical,” and “electronic apex locator” as keywords. Moreover, cross-references were screened to identify further study that probably missed through the search strategy.

Electronic databases Electronic searches were performed in Medline/PubMed, Cochrane library, and Scopus data base up to 30 July 2013. Four hundred and two articles were found.

Inclusion criteria The inclusion criteria were articles, clinical trials in humans and cohort and case-control studies in the Figure 1: Flow chart of selected articles

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 85 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 1: Different generations of electrical apex locator devices and their operation base[86] Generation Operation base Device samples First Measurement of electrical resistance Root canal meter (Onuki medical Co.tokyo, Japan) Endodontic meter(Onuki medical Co.tokyo, Japan) Dentometer (Dahlin ectromedicine, Copenhagen, Denmark) Endo Radar (Electronica liarre, Imola, Italy) Second Measurements of electrical impedance Sono-Explorer (Hayashi Dental Supply, Tokyo, Japan) Endo Cater (Yamaura Seisokushu, Tokyo, Japan) Digipex (Mada Equipment Co.Carlstadt, NJ, USA) Exact-A-Pex (Ellman International Hewlett, NY, USA) Formatron IV (Parkell Dental, Farmingdale, NY, USA) Endodontic Meter S II (Onuki Medical Co., Tokyo, Japan) Sono-Explorer Mark II (Hayashi Dental Supply, Tokyo, Japan). Sono-Explorer Mark II Junior (Hayashi Dental Supply, Tokyo, Japan) Third Using two different frequencies at the same Endex/Apit (Osada Electrica Co. Tokyo, Japan) time in order to measure the difference or ratio Root ZX (J.Morita, Tokyo, Japan) between two currents Neosono Ultima EZ (Satelec Inc, Mount Lourel, Nj, USA) TCM Endo V (Nouvag Ag, Goldach, Switzerland) Apex Pointer (MicroMega, Besanc¸on, France) Dat Apex (Dentsply Maillerfer, Ballaiques, Switzerland) Just or Justy II (Yoshida Co.Yokyo, Japan) Mark V Plus (Moyco/Union Broach, Bethpage, NY, USA) Apex pointer Endy 5000 (Loser, Leverkusen, Germany) Mini Apex Locator (Sybron Endo, Anaheim, CA, USA) Dentaport ZX (J. Morita MFG Corp., Osaka, Japan) Endo Analyzer Model 8005 (Analytic/Endo, Orange, CA, USA) Apex Finder AFA (Analytic Technologies, Redmond, WA) Mark V Plus (Moyco/Union Broach, Bethpage, New York, USA) Endox (Co. Lysis, Milan, Italy). Endy (Loser, Leverkusen, Germany) Apex Finder (Endo Analyzer 8001; Analytic Technology, Redmond, WA, USA) Foramatron D10 (Parkell Electronic Division, Farmingdale, New York, USA). Fourth Using two or more non-simultaneous Bingo1020/Raypex4 (Foroum Engineering Technologies Rishon Lezion, Israel) continuous frequencies in order to measure Raypex4 (VDW, Munich, Germany) the difference or ratio between two currents Element Dianostic Unit & Apex Locator (Sybron Endo, Anaheim, CA, USA) Neosono MC (Amadent Medical and Dental, Co., Cherry Hill, New Jersey, USA). Propex (Dentsply Maillerfer, Ballaiques, Switzerland) Novapex (Foroum Engineering Technologies Rishon Lezion, Israel) Apex NRG XFR (Medic NRG Ltd, Tel Aviv, Israel) Apex DSP (Septodont, Saint-Maur des Fosse´s, Cedex, France) AFA Apex Finder, Model 7005 (Ana-lytic Endodontics, Orange, CA) iPex (NSK Ltd, Tokyo, Japan) Romi Apex D-30 (Romidan LTD, Kiryat-ono, Israel) Fifth Measures the capacitance and resistance Propex II (Dentsply Maillerfer, Ballaiques, Switzerland) of the circuit separately Top of Form Bottom of Form Apex Locator Joypex 5 (Henan, CBD Neihuan Road, Zhengzhou, China) I-ROOT (E-Magic Finder)(S-Denti SEoul, South Korea) Raypex 5 (VDW, Munich, Germany)

in vivo studies, Welk et al.[34] and Arora et al.[47] found did not report any significant differences, [7,35,36,43,53,54] a significant difference between EALs [Table 2]. three studies concluded that radiography method was more accurate,[49,55,59] and the remainder reported greater Comparison of EALs with different working length accuracy with the EAL [Table 3]. Three studies that determination methods compared digital radiography to EAL showed that EAL Thirty-one studies evaluated different methods of [37,54,60] [6] working length determination. Among these studies, was more accurate [Table 3]. Shanmugaraj et al. eleven compared different EALs and conventional and compared three methods of measuring root canal length digital radiography as three different methods of working (apex locator, radiography, tactile sense) and reported length determination.[7,35-46,49-59] Among the studies that that EAL was the most reliable method, but Ounsi compared EALs to radiographic method, six studies et al.[61] showed that EAL and radiography method have

86 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 2: Comparison of different electronic apex locators (EALs) in working length determination Authors Type of Publication Sample (n) Types of studied Aim of study Main study result Type of study year ELA generation Comin Chiaramonti Ex vivo 2012 40 teeth Bingo 1020 Comparing operation No significant Fourth et al.[31] Propex of different apex difference locator devices Baginska et al.[32] Ex vivo 2012 40 teeth Raypex 5, Apex Comparing operation No significant Fifth D.S.P and Locapex of different apex difference Five locator devices Somma et al.[89] In vivo 2012 30 teeth Dentaport ZX, Comparing operation No significant Third and Raypex 5, of different apex difference Fourth ProPex II locator devices Paludo et al.[48] In vivo 2012 100 root Apex and iPex Comparing the There weren’t Fourth Canals accuracy of EALs in significant length measurement differences and both devices were accurate Jung et al.[15] In vitro 2011 104 teeth Root ZX, Comparing operation No significant Third I-Root of different apex difference locator devices Stober et al. [90] In vivo 2011 40 root Raypex 5 Comparing operation No significant Fourth canals Mini Apex Locator of different apex difference locator devices Stober et al.[87] In vivo 2011 40 root Root ZX and iPex Comparing operation No significant Third and canals of different apex difference Fourth locator devices Miletic et al.[91] In vivo 2011 48 root Dentaport ZX, Comparing operation No significant Third and canals RomiApex A-15 and of different apex difference Fourth Raypex 5 locator devices Silveira et al. [88] In vivo 2011 23 teeth Root ZX, Comparing operation No significant Third and Novapex of different apex difference Fourth locator devices deVasconcelos Ex vivo 2010 38 teeth Root ZX, RomiApex Comparing operation Root ZX was more Third and et al. [28] D-30, and Ipex of different apex accurate Fourth locator devices Guise et al.[17] In vitro 2010 40 teeth Root ZX II, Comparing operation Root ZX II was more Fourth Elements AL, of different apex accurate Precision AL locator devices D’Assuncao et al. [33] Ex vivo 2010 31 teeth Root ZX-II, Novapex, Comparing operation Root ZX II was more Fourth Mini AL of different apex accurate locator devices Pascon et al. [92] In vivo 2009 831 root DentaPort ZX, Comparing operation No significant Third and canals Raypex 5 of different apex difference Fourth locator devices Higa et al.[13] In vitro 2009 12 teeth Justylll, Dentaport, Comparing operation Justylll was more Third and E-Magic Finder of different apex accurate Fourth locator devices Siu et al. [93] In vivo 2009 29 teeth Root ZX II, Apex Comparing operation No significant Third NRG of different apex difference XFR, Mini Apex locator devices Locator Pascon et al.[25] Ex vivo 2009 60 teeth Dentaport ZX, Comparing operation Elements Third and Raypex 5 Elements of different apex Diagnostic Unit and Fourth Diagnostic Unit and locator devices A L was not accurate A L than others Ebrahim et al.[16] In vitro 2007 32 teeth Dentaport ZX, Comparing operation Dentaport ZX, Third and ProPex, of different apex ProPex, Fourth Foramatron D10, locator devices Foramatron D10 Apex NRG, were more accurate Apit 7 D’Assuncao et al.[18] Invitro 2007 40 teeth Mini AL, Root ZX II Comparing operation No significant Fourth of different apex difference locator devices Bernardes et al.[12] Invitro 2007 40 teeth Root ZX, Elements Comparing operation No significant Third and Diagnostic Unit and of different apex difference Fourth A L, RomiAPEX locator devices D-30 (Continued )

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 87 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 2: (Continued) Authors Type of Publication Sample (n) Types of studied Aim of study Main study result Type of study year ELA generation Wrbas et al.[94] In vivo 2007 20 teeth Root ZX Comparing operation No significant Third Raypex5 of different apex difference locator devices Stavrianos et al.[24] In vivo 2007 80 root Dentaport Comparing operation No significant Third and canals ZX,RayPex 4 of different apex difference Fourth locator devices Venturi et al.[26] Ex vivo 2007 60 root Root ZX, Apex Comparing operation Root ZX was more Third canals Finder of different apex accurate locator devices Topuz et al.[19] In vitro 2007 47 teeth TCM Endo V evaluating the TCM Endo V proved Third and Root ZX accuracy of the to be as reliable as Fourth apex-locating function Root ZX but the use of the TCM Endo V of the and to compare the device to determine results to these of the working length the Root ZX was not easy as Root ZX Ebrahim et al.[27] Ex vivo 2006 36 teeth Root ZX, Foramatron Comparing operation Root ZX and Third and D10, Apex NRG and of different apex Foramatron D10 Fourth Apit 7 locator devices were more Plotino et al.[30] Ex vivo 2006 40 teeth Root ZX, Elements Comparing operation ProPex was not Third and Diagnostic Unit and of different apex accurate than others Fourth A L, locator devices ProPex D’Assunco et al. [20] In vitro 2006 40 teeth Novapex to compare the Root-ZX and Third and Root-ZX accuracy of the Root- Novapex are Fourth ZX and useful and accurate Novapex electronic devices for the apical apex locators (EALs) foramen location in locating the apical foramen Hor et al.[29] Ex vivo 2005 193 teeth Justy II Comparing operation Raypex4 was more Third and Raypex4 of different apex accurate Fourth locator devices Haffner et al.[95] In vivo 2005 40 teeth Root ZX Comparing operation No significant Third Endy of different apex difference Justy II locator devices EndoxLysis ElAyouti et al.[14] Ex vivo 2005 182 root Raypex 4, Apex Comparing operation Root ZX was more Third and canals pointer, Root ZX of different apex accurate Fourth locator devices Venturi et al.[96] Invivo 2005 64 teeth Apex Finder, Comparing operation No significant Third Root ZX of different apex difference locator devices Lucena-Martin In vitro 2004 20 teeth Justy II, Comparing operation No significant Third et al.[11] Root ZX, of different apex difference NeosonoUltima EZ locator devices Hoer et al.[46] In vivo 2004 75 teeth Justy II, Endy 5000 Comparing operation No significant Third of different apex difference locator devices Welk et al. [34] In vivo 2003 32 teeth Root ZX Comparing Root ZX was more Third Endo Analyzer operation of accurate Model 8005 different apex locator devices De Moor et al. [21] In vitro 1999 15 single Apex Finder The accuracy Apex Finder AFA Third canal teeth AFA Model 7005, and operator Model 7005 was the Apex-Finder, dependency of four most Neosono electronic accurate Ultima EZ and canal length measuring Apit 2 devices were compared under a set of specified conditions (Continued )

88 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 2: (Continued) Authors Type of Publication Sample (n) Types of studied Aim of study Main study result Type of study year ELA generation Weiger et al. [22] In vitro 1999 41 teeth Root ZX Two apex locators In the presence of Third Apit were compared NaOCl, Root ZX regarding their ability to provides the most accurately locate the accurate apical constriction in EWL measurements the presence of various canal fluids at different meter readings. Lauper et al.[97] Ex vivo 1996 130 root Apit and Evaluated the accuracy Apit was more First and Third canals Odontometer of EAL in length Accurate measurement Arora et al. [47] In vivo 1995 61 root ENDEX and RCM Comparison the ENDEX was higher Third canals Mark II accuracy of EALs accuracy than the in canal length RCM Mark II measurement in present of different contents(vital pulp, necrotic pulp, pus/ exudates, sodium hypochlorite, and water) Pallares and Faus [98] Ex vivo 1994 116 root Odontometer and Compared the Endo Cater was First and canals Endo Cater accuracy of EAL in higher accuracy than Second length measurement the Odontometer Nahmias et al. [23] In vitro 1987 60 single Sono-Explorer, Compared the All EALs were Second and root teeth C. L. Meter and accuracy of EAL in accurate Third Neosono-D length measurement

same accuracy and significantly were more accurate determining the canal length of 79 teeth (93 canals). than tactile method. In the study by Subramaniam They showed that these devices can specify the sites of et al.[62], there were no significant differences among the minor and major apical foramen, but they cannot conventional radiography, digital radiography, and determine apical constriction with sufficient accuracy. tactile sense in primary teeth. Janner et al.[63] compared Also, Oishi et al.[77] investigated the accuracy of EALs in cone beam computed tomography to EAL in root canal determining apical constriction, and they were accurate length determination and concluded that both two [Table 4]. methods were comparable [Table 3]. Use of EAL in root canal retreatment Use of EAL in root perforations, fractures, and Six articles were published on this topic.[78-81] Two of apical foramen widening them evaluated the accuracy of EALs before and after Ten studies reported other uses of EALs, such as canal filling and showed that, in most cases, EALs identification of root perforation sites and the location were accurate in root canal retreatment.[78,80] In the of horizontal and vertical fractures. EALs were only study by Aggarwal et al.[80], the accuracy of Root ZX accurate in horizontal fracture diagnosis[64,65] although and Protaper devices was evaluated in the retreatment Topez et al.[66] reported that EALs were accurate in both of filled canals with: 1) gutta-percha+ zinc oxide vertical and horizontal root fractures. Furthermore, ogenol sealer; 2) gutta-percha+ AH plus sealer; and 3) Goldberg et al.[67] studied the consistency of EALs in Resilon+ Epiphany sealer. Both devices showed high teeth with simulated horizontal root fractures, and accuracy in the first and second treatments, and no they showed that EALs were accurate and consistent. significant differences were reported in the presence Several studies showed that EALs were able to detect of different filling materials. Uzun et al.[79] studied the perforation sites [Table 4].[68-71] There were five studies precision of two apex locators (tri auto ZX TCM, locating that evaluated EALs’ ability to control apical foramen handpieces endo apex) in root canal retreatment with widening with rotary files, and they both concluded root-end-cured teeth evaluated. They demonstrated that use of EALs in root canals that were prepared with that both devices could be used for determining apical rotary instruments was not sufficiently accurate to area, but for root canal retreatment, accuracy of 0.0 mm control apical extensions.[72-75] Hoer et al.[76] evaluated is required, which these devices could not accomplish the ability of the Justy II and Endy 5000 devices in [Table 4].

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 89 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 3: Comparison of electronic apex locators (EALs) and different other techniques in working length determination Authors Type of Publication Sample (n) Types of Aim of study Main study result study year studied ELA Orosco et al.[60] In vivo 2012 25 teeth Root ZX Comparison of EAL and radiography Conventional and EAL in determination of working length were comparable and better than digital Kishor[99] In vitro 2012 35 teeth Foramatron D10 Comparison of EAL and radiography, EAL are more accurate radiovisography in determination of working length Chougule et al.[58] In vivo 2012 13 primary teeth Dentaport ZX Comparison of EAL and radiography EAL are more accurate in determination of working length Zand et al.[100] In vivo/ 2011 75 teeth Root ZX Comparison of EAL and radiography No significant difference Ex vivo in determination of working length Jarad et al.[36] In vivo 2011 46 teeth Raypex 5 Comparison of EAL and radiography No significant difference in determination of working length Parekh and Ex vivo 2011 20 patients Root ZX Comparison of EAL and radiography Radiography and EAL Taluja[101] in determination of working length can be used together Janner et al.[63] In vivo 2011 3 patients Root ZX Compared CBCT method to EAL Two methods were comparable Neena et al.[54] In vivo 2011 30 teeth — Comparison of EAL and No significant difference radiography in determination of working length Singh et al.[57] In vivo 2011 20 teeth Propex II Comparison of EAL and radiography EALs are more accurate in determination of working length Real et al.[51] In vitro 2011 37 root canals Root ZX Comparison of EAL and radiography EALs are more accurate Just II in determination of working length Elements Diagnostic Patino-Marin In vivo 2011 61 root canals of Root ZX and Comparison of EAL and radiography EALs are more accurate et al.[45] primary teeth ProPex in determination of working length Kqiku et al.[7] Ex vivo 2011 30 teeth Root ZX Comparison of EAL and radiography No significant difference in determination of working length Vieyra et al.[38] In vivo/In 2011 245 teeth (693 Root ZX, Comparison of EAL and other EALs are more accurate vitro root canals) Elements- methods in determination of working Diagnostic, length Precision AL and Raypex 5 Mancini et al.[44] Ex vivo 2011 120 teeth Endex, Propexll Comparison of EAL and other EALs are more accurate and Root ZX methods in determination of working length Cianconi et al.[37] Ex vivo 2010 101 teeth Endex Comparison of EAL and radiography EALs are more accurate ProPex II in determination of working length Root ZX Sharma and In vivo/ 2010 100 teeth Root ZX Comparison of EAL and radiography EALs are more accurate Arora[102] Ex vivo in determination of working length Vieyra et al.[46] In vivo 2010 160 teeth Root ZX and Comparison of EAL and radiography EALs are more accurate Elements- in determination of working length Diagnostic Javidi et al.[40] In vitro 2009 30 teeth Root ZX Comparison of EAL and radiography Radiography and EAL in determination of working length can be used together Kim et al.[43] In vivo 2008 25 teeth Root ZX Evaluating EAL with or without No significant difference radiography in determination of working length Krajczar et al.[39] In vitro 2008 70 teeth ProPex Comparison of EAL and radiography EAL are more accurate in determination of working length Hassanien et al.[50] In vivo 2008 20 patients Root ZX Comparison of EAL and radiography EAL are more accurate in determination of working

Shanmugaraj In vivo/In 2007 30 teeth Foramatron-IV Comparison of EAL and other EAL are more accurate et al.[6] vitro methods in determination of working length Smadi et al.[51] In vivo 2006 151 root canals Tri Auto ZX Comparison of EAL and radiography Use of EAL could reduce in determination of working length need for additional radiography Subramaniam In vitro 2005 20 teeth Formatron D10 Comparison of EAL and other No significant difference et al.[62] methods in determination of working length (Continued )

90 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 3: (Continued) Authors Type of Publication Sample (n) Types of Aim of study Main study result study year studied ELA

ElAyouti et al.[41] In vitro 2002 30 teeth Root ZX Comparison of EAL and radiography EAL are more accurate in determination of working length Brunton et al.[42] In vitro 2002 50 teeth - Effect of apex locator on reduction Use of EAL reduced X-ray exposure patients X-ray exposure Martinez-Lozano In vitro 2001 70 teeth Apit EM-S3 Comparison of EAL and No significant difference et al.[35] radiography in determination of working length Saad et al.[103] In vivo 2000 14 teeth Root ZX Effect of apex locator combining This technique was Root ZX and a digital imaging useful system (RadioVisioGraphy]on reduction X-ray exposure Ounsi et al.[61] In vitro 1998 37 teeth Endex Comparison of EAL and Tactile sense method radiography, tactile sense method in was inaccurate, but other determination of working length two methods were same accurate Himel et al.[55] In vivo 1993 96 root canals Formatron IV Comparing the accuracy of EALs EALs weren’t accurate and radiography method in length measurement Hembrough In vivo 1993 26 maxillary Sono-Explorer Compared the accuracy of EAL EAL is useful only et al.[49] molar teeth Mark III and radiography method in length combined with measurement radiography and couldn’t replace it Frank et al.[56] In vivo 1993 185 Endex Compared EAL with radiography EAL was comparable root canal method in length measurement with radiography method

Trope et al.[59] In vivo 1985 127 root canals Sono-Explorer Comparison of EAL and radiography EAL wasn’t accuracy Mark III in determination of working length same as radiography Murakami et al.[104] In vivo 2002 66 infected Sono-Explorer To retrospectively assess the Use of the Sono- canals success of endodontic treatment Explorer that had been guided by audiometric aided successful (electronic) measurement. treatment of infected root canals Stavrianos In vivo 2007 85 teeth Raypex 5 Evaluated the accuracy of EAL in EAL was accurate et al.[105] length measurement Ounsi et al.[106] In vitro 1999 39single root Root ZX Evaluated the accuracy of EAL in Root ZX couldn’t detect teeth length measurement apical constriction and should only use to detecting major foramen Vajrabhaya In vivo 1997 20 Root ZX Evaluated the accuracy of EAL in In clinical acceptable et al.[107] Single root teeth length measurement range its accurate Shabahang In vivo 1996 26 root canals Root ZX Evaluated the accuracy of EAL in In clinical acceptable et al.[108] length measurement range its accurate Wu et al.[109] In vivo 1992 20 single root Sono-Explorer Evaluated the accuracy of EAL in In clinical acceptable teeth type Y-III length measurement range its accurate Ricard et al.[110] In vivo 1991 37 teeth RCM Mark II Evaluated the accuracy of EAL in In clinical acceptable length measurement range its accurate McDonald et al.[111] In vivo 1990 47 teeth Endocater Evaluated the accuracy of EAL in It was accurate detecting apical constriction Berman et al.[112] In vivo 1984 24 mature Neosono-D Evaluated the accuracy of EAL in EAL only in mature canal and 5 immature length measurement was accurate root canals Busch et al.[113] In vitro 1976 77 teeth (46 vital Sono-Explorer Evaluated the accuracy of EAL in EAL was accurate in and 26 necrotic) length measurement both groups

Use of EAL in patients with pacemakers Discussion Wilson et al.[82] investigated the operation of the Endo Analyzer Model 8005 in patients with pacemakers and Different generations of EALs, with improved functions cardioverter/defibrillator devices. They demonstrated and greater clinical applications, have entered the market that there was no interference between the apex locator over these past few decades. Our results indicate that and pacemaker function. there are no significant differences between different

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 91 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 4: Other usage of electronic apex locators (EALs) Authors Type of Publication Sample (n) Types of studied Aim of study Main study result study year ELA Aggarwal et al.[80] In vitro 2010 60 teeth Root ZX and Application of apex locator Both devices had high ProPex devices in root canal accuracy in retreatment retreatment Stavrianos et al.[114] In vitro 2008 40 teeth Dentaport ZX, Application of apex locator All device were reliable, RayPex 5, Endo devices in root canal but Dentaport ZX and Master and retreatment Endo Master were more Bingo-1020 accurate Alves et al.[78] Ex vivo 2005 62 teeth Tri Auto ZX Application of apex locator In most cases EAL was devices in root canal accurate in retreatment retreatment Goldberg et al.[115] In vitro 2005 20 teeth ProPex, NovApex, Application of apex locator Third devices had high and Root ZX devices in root canal accuracy in retreatment retreatment Uzun et al.[79] Ex vivo 2008 40 teeth TCM Endo V and Evaluation the accuracy of Devices should be used Tri Auto ZX apex locator device along with caution with rotary files in root canal length measurement in retreatment Uzun et al.[81] In vitro 2007 40 root TCM Endo V and Evaluation the accuracy of These devices are resected teeth Tri Auto ZX apex locator device along with not appropriate for rotary files in root canal length retreating. measurement in retreatment Fadel et al.[74] In vivo 2012 30 single root Root ZX II Use of apex locator in Not appropriate premolar controlled canal widening Jakobson et al.[73] In vivo 2008 24 teeth Root ZX II Evaluation of apex locator EAL with rotary ability control apical fromen instruments was not widening with rotary files accurate to controlling apical extension Felippe et al.[72] Ex vivo 2008 67 single root Root ZX II Use of apex locator in Not appropriate teeth controlled canal widening Campbell et al.[75] In vitro 1998 60 teeth Tri Auto ZX to examine the apical Instrumentation with extent of rotary canal the automatic apical instrumentation and the ability reverse feature set to maintain apical constriction at 1 consistently with the Tri Auto ZX at approximated the apical different automated settings constriction; however, the constriction was frequently enlarged Goldberg et al.[67] In vitro 2008 20 teeth ProPex Evaluation apex locatordevice All devices are reliable NovApex operation in diagnosis root Root ZX fractures Elements AL Topuz et al.[66] In vitro 2008 40 teeth TCM Endo V Evaluation apex locator Both devices identified and Tri Auto ZX device operation in diagnosis different root fracture in root fractures an acceptable range Ebrahim et al.[65] In vitro 2006 90 teeth Root ZX, Evaluation apex locatordevice Device works accurately Foramatron D10, operation in diagnosis root in teeth with horizontal Apex NRG fractures root fractures al Kadi et al.[116] In vitro 2006 100 teeeth Propex and Evaluation apex locatordevice Device works accurately Raypex-4 operation in diagnosis root in teeth with horizontal fractures and vertical root fractures Azabal et al.[64] In vitro 2004 64 teeth Justy II Evaluation apex locatordevice Device works accurately operation in diagnosis root in teeth with horizontal fractures root fractures Hoer et al.[76] In vitro/ 2004 93 root canals Justy II, Endy 5000 Evaluation apex locators Devices cannot In vivo ability in determination apical determine apical constriction constriction Oishi et al.[77] In vitro 2002 771 teeth ROOT ZX Evaluation apex locators Device ability in detremination apical can determine apical constriction constriction Pratten and Mc In vitro 1996 — Apit Evaluation apex locators Device Donald [117] ability in detremination apical can determine apical constriction constriction (Continued )

92 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

Table 4: (Continued) Authors Type of Publication Sample (n) Types of studied Aim of study Main study result study year ELA Keller et al.[118] In vivo 1991 99 canals Endocater Evaluated the ability of EAL in Device was not accurate detecting apical constriction and cemento dentinal junction Zmener et al.[71] In vitro 1999 40 teeth Tri Auto ZX Detection and measurement The Tri Auto ZX of endodontic root detected and measured perforations using a newly endodontic root designed perforations within apex-locating handpiece a range of clinically acceptable variations Kaufman et al.[70] In vitro 1997 30 teeth with Root ZX , Sono Evaluated the ability of EALs Regardless of the perforation in Explorer Mark II in locatin perforation perforation size all EALs middle third Junior and Apit III were accurate Fuss et al.[68] In vitro 1996 32 teeth with Sono Explorer Evaluated the ability of EALs Both device were perforation in Mark 2 Junior in locatin perforation accurate midle third and Apit 2 Hulsmann et al.[69] In vivo 1989 21 teeth Exact-A-Pex Evaluated the ability of EAL in Was accurate control apical bridge formation in the treatment of teeth with incomplete root formation

EALs of the same generation. The first generation Although most of the previous studies reported that apex locator was supplied by single frequency of EALs were more accurate, compared to radiography, direct current in order to measurement of electrical some of the studies noted no significant differences resistance. Pain and discomfort were often felt with between the two methods due to small sample sizes. using this type of apex locator.[83] The second generation However, a recent randomized, controlled clinical apex locator known as impedance apex locators was trial study showed no significant differences between measured opposition to the flow of alternating current these two methods.[2] To consider the advantages of or impedance.[84] The disadvantage of this generation conventional radiography, such as the ability to observe is that electro-conductive materials in canal affect the root canal system and the canal curvature directly on its accuracy.[83] The third generation apex locator and to determine the existence of peri-apical lesions, the (frequency dependent apex locators) was supplied decision of which method to use should be different in by two frequencies to measure the impedance in the each case. It should be noted that EALs could decrease [42,51] canal. The disadvantage of this generation sensitivity the patient’s radiation exposure. to canal fluid and the machine needs a fully charged There is controversy in the diagnosis of the horizontal battery.[85] The fourth generation apex locator measures and vertical root fractures by EALs. Some studies the impedance characteristics using more than two have reported that EALs have the capacity to diagnose frequencies.[3] The disadvantage includes needing to horizontal and lateral root fractures,[66,67] and others perform in relatively dry or in partially dried canals.[84] studies have indicated that horizontal fractures and The fifth generation apex locator was developed in 2003 perforation sites can be better diagnosed by EALs than which measure the capacitance and resistance of the vertical fractures.[64,65] Few studies have investigated [86] circuit separately. the ability of apex locators to detect root fractures and perforations. Due to limited information on this Many studies compared the ability of various generations subject, a general conclusion could not be achieved. of EALs in determining root canal length. Most of these More studies are required on this subject. studies showed that EALs were accurate for canal length measurement, within a clinically acceptable range of The present review has some limitations. First, only ± 0.5. Some studies indicated that the most recent relevant articles were searched in Medline/PubMed, generation of these devices had enhanced accuracy, Cochrane library, and Scopus, which might have better patient acceptance and greater ease of use for restricted the results. Second, our keywords were limited dentists.[31,87,88] but other studies mentioned that some to “Tooth apex,” “Dental instrument,” “Odontometry,” EALs of the third generation were more accurate than “Electronic medical,” and “Electronic apex locator” to those of the fourth generation.[20,27,28] focus on EALs. More prospective, randomized clinical

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 93 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

trials are needed to determine various conditions that 16. Ebrahim AK, Wadachi R, Suda H. In vitro evaluation of affect EALs’ accuracy. the accuracy of five different electronic apex locators for determining the working length of endodontically retreated teeth. Aust Endod J 2007;33:7-12. Conclusion 17. Guise GM, Goodell GG, Imamura GM. In vitro comparison of three electronic apex locators. J Endod 2010;36:279-81. The results of the present study showed that EAL 18. D’Assuncao FL, de Albuquerque DS, Salazar-Silva JR, de is an appropriate technique for root canal length Queiroz Ferreira LC, Bezerra PM. The accuracy of root canal measurements using the Mini Apex Locator and Root ZX-II: An measurements. evaluation in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e50-3. References 19. Topuz O, Uzun O, Tinaz AC, Sadik B. Accuracy of the apex locating function of TCM Endo V in simulated conditions: A 1. Renner D, Grazziotin-Soares R, Gavini G, Barletta FB. Influence of comparison study. Oral Surg Oral Med Oral Pathol Oral Radiol pulp condition on the accuracy of an electronic foramen locator Endod 2007;103:e73-6. in posterior teeth: An in vivo study. Braz Oral Res 2012;26:106-11. 20. D’Assuncao FL, de Albuquerque DS, de Queiroz Ferreira LC. 2. Ravanshad S, Adl A, Anvar J. Effect of working length The ability of two apex locators to locate the apical foramen: measurement by electronic apex locator or radiography on the An in vitro study. J Endod 2006;32:560-2. adequacy of final working length: A randomized clinical trial. 21. De Moor RJ, Hommez GM, Martens LC, De Boever JG. Accuracy J Endod 2010;36:1753-6. of four electronic apex locators: An in vitro evaluation. Endod 3. Duran-Sindreu F, Stober E, Mercade M, Vera J, Garcia M, Dent Traumatol 1999;15:77-82. Bueno R, et al. Comparison of in vivo and in vitro readings 22. Weiger R, John C, Geigle H, Lost C. An in vitro comparison of when testing the accuracy of the Root ZX apex locator. J Endod two modern apex locators. J Endod 1999;25:765-8. 2012;38:236-9. 23. Nahmias Y, Aurelio JA, Gerstein H. An in vitro model for 4. Stoll R, Urban-Klein B, Roggendorf MJ, Jablonski-Momeni A, evaluation of electronic root canal length measuring devices. Strauch K, Frankenberger R. Effectiveness of four electronic J Endod 1987;13:209-14. apex locators to determine distance from the apical foramen. 24. Stavrianos C, Vladimirov SB, Vangelov LS, Papadopoulos Int Endod J 2010;43:808-17. C, Bouzala A. Evaluation of the accuracy of electronic apex 5. Ozsezer E, Inan U, Aydin U. In vivo evaluation of ProPex locators Dentaport ZX and Ray Pex 4 under clinical conditions. electronic apex locator. J Endod 2007;33:974-7. Folia Med (Plovdiv) 2007;49:75-9. 6. Shanmugaraj M, Nivedha R, Mathan R, Balagopal S. Evaluation 25. Pascon EA, Marrelli M, Congi O, Ciancio R, Miceli F, Versiani MA. of working length determination methods: An in vivo / ex vivo An ex vivo comparison of working length determination by 3 study. Indian J Dent Res 2007;18:60-2. electronic apex locators. Oral Surg Oral Med Oral Pathol Oral 7. Kqiku L, Stadtler P. Radiographic versus electronic root Radiol Endod 2009;108:e147-51. canal working length determination. Indian J Dent Res 26. Venturi M, Breschi L. A comparison between two electronic apex 2011;22:777-80. locators: An ex vivo investigation. Int Endod J 2007;40:362-73. 8. Mello-Moura AC, Moura-Netto C, Araki AT, Guedes-Pinto AC, 27. Ebrahim AK, Wadachi R, Suda H. Ex vivo evaluation of the Mendes FM. Ex vivo performance of five methods for root ability of four different electronic apex locators to determine canal length determination in primary anterior teeth. Int Endod the working length in teeth with various foramen diameters. J 2010;43:142-7. Aust Dent J 2006;51:258-62. 9. Suzuki K. Experimental study on iontophoresis. J Jap Stomatol 28. de Vasconcelos BC, do Vale TM, de Menezes AS, Pinheiro- 1942;16:411. Junior EC, Vivacqua-Gomes N, Bernardes RA, et al. An 10. Sunada I. New method for measuring the length of the root ex vivo comparison of root canal length determination by canal. J Dent Res 1962;41:375-87. three electronic apex locators at positions short of the apical 11. Lucena-Martin C, Robles-Gijon V, Ferrer-Luque CM, de foramen. Oral Surg Oral Med Oral Pathol Oral Radiol Endod Mondelo JM. In vitro evaluation of the accuracy of three 2010;110:e57-61. electronic apex locators. J Endod 2004;30:231-3. 29. Hor D, Krusy S, Attin T. Ex vivo comparison of two electronic 12. Bernardes RA, Duarte MA, Vasconcelos BC, Moraes IG, apex locators with different scales and frequencies. Int Endod Bernardineli N, Garcia RB, et al. Evaluation of precision of J 2005;38:855-9. length determination with 3 electronic apex locators: Root ZX, 30. Plotino G, Grande NM, Brigante L, Lesti B, Somma F. Ex vivo Elements Diagnostic Unit and Apex Locator, and RomiAPEX accuracy of three electronic apex locators: Root ZX, Elements D-30. Oral Surg Oral Med Oral Pathol Oral Radiol Endod Diagnostic Unit and Apex Locator and ProPex. Int Endod J 2007;104:e91-4. 2006;39:408-14. 13. Higa RA, Adorno CG, Ebrahim AK, Suda H. Distance from 31. Comin Chiaramonti L, Menini M, Cavalleri G. A comparison file tip to the major apical foramen in relation to the numeric between two fourth generation apex locators. Minerva Stomatol meter reading on the display of three different electronic apex 2012;61:183-96. locators. Int Endod J 2009;42:1065-70. 32. Baginska J, Ewa L, Bartlomiej B, Anna K. An ex vivo 14. ElAyouti A, Kimionis I, Chu AL, Lost C. Determining the apical comparison of three electronic apex locators. Health Med BA terminus of root-end resected teeth using three modern 2012;10:3275-80. apex locators: A comparative ex vivo study. Int Endod J 33. D’Assuncao FL, Albuquerque DS, Salazar-Silva JR, Dos 2005;38:827-33. Santos VC, Sousa JC. Ex vivo evaluation of the accuracy and 15. Jung IY, Yoon BH, Lee SJ, Lee SJ. Comparison of the reliability coefficient of repeatability of three electronic apex locators of “0.5” and “APEX” mark measurements in two frequency- using a simple mounting model: A preliminary report. Int Endod based electronic apex locators. J Endod 2011;37:49-52. J 2010;43:269-74.

94 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

34. Welk AR, Baumgartner JC, Marshall JG. An in vivo comparison filling: A clinical study [ISRCTN71486641]. BMC Oral Health of two frequency-based electronic apex locators. J Endod 2006;6:4. 2003;29:497-500. 52. Fouad AF, Reid LC. Effect of using electronic apex locators 35. Martinez-Lozano MA, Forner-Navarro L, Sanchez-Cortes JL, on selected endodontic treatment parameters. J Endod Llena-Puy C. Methodological considerations in the determination 2000;26:364-7. of working length. Int Endod J 2001;34:371-6. 53. Real DG, Davidowicz H, Moura-Netto C, Zenkner Cde L, Pagliarin 36. Jarad FD, Albadri S, Gamble C, Burnside G, Fox K, Ashley JR, CM, Barletta FB, et al. Accuracy of working length determination et al. Working length determination in general dental practice: using 3 electronic apex locators and direct digital radiography. Oral A randomised controlled trial. Br Dent J 2011;211:595-8. Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:e44-9. 37. Cianconi L, Angotti V, Felici R, Conte G, Mancini M. Accuracy 54. Neena I, Ananthraj A, Praveen P, Karthik V, Rani P. Comparison of three electronic apex locators compared with digital of digital radiography and apex locator with the conventional radiography: An ex vivo study. J Endod 2010;36:2003-7. method in root length determination of primary teeth. J Indian 38. Vieyra JP, Acosta J. Comparison of working length determination Soc Pedod Prev Dent 2011;29:300-4. with radiographs and four electronic apex locators. Int Endod 55. Himel VT, Cain C. An evaluation of two electronic apex locators J 2011;44:510-8. in a dental student clinic. Quintessence Int 1993;24:803-6. 39. Krajczar K, Marada G, Gyulai G, Toth V. Comparison of 56. Frank AL, Torabinejad M. An in vivo evaluation of Endex radiographic and electronical working length determination electronic apex locator. J Endod 1993;19:177-9. on palatal and mesio-buccal root canals of extracted upper 57. Singh SV, Nikhil V, Singh AV, Yadav S. An in vivo comparative molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod evaluation to determine the accuracy of working length 2008;106:90-3. between radiographic and electronic apex locators. Indian J 40. Javidi M, Moradi S, Rashed R, Raziee L. In vitro comparative Dent Res 2012;23:359-62. study of conventional radiography and Root ZX apex locator 58. Chougule RB, Padmanabhan MY, Mandal MS. A comparative in determining root canal working length. N Y State Dent J evaluation of root canal length measurement techniques in 2009;75:48-51. primary teeth. Pediatr Dent 2012;34:53-6. 41. ElAyouti A, Weiger R, Lost C. The ability of root ZX apex locator 59. Trope M, Rabie G, Tronstad L. Accuracy of an electronic to reduce the frequency of overestimated radiographic working apex locator under controlled clinical conditions. Endod Dent length. J Endod 2002;28:116-9. Traumatol 1985;1:142-5. 42. Brunton PA, Abdeen D, MacFarlane TV. The effect of an apex 60. Orosco FA, Bernardineli N, Garcia RB, Bramante CM, locator on exposure to radiation during endodontic therapy. J Duarte MA, Moraes IG. In vivo accuracy of conventional and Endod 2002;28:524-6. digital radiographic methods in confirming root canal working 43. Kim E, Marmo M, Lee CY, Oh NS, Kim IK. An in vivo length determination by Root ZX. J Appl Oral Sci 2012;20:522-5. comparison of working length determination by only root- 61. Ounsi HF, Haddad G. In vitro evaluation of the reliability of the ZX apex locator versus combining root-ZX apex locator Endex electronic apex locator. J Endod 1998;24:120-1. with radiographs using a new impression technique. 62. Subramaniam P, Konde S, Mandanna DK. An in vitro Oral Surg Oral Med Oral Pathol Oral Radiol Endod comparison of root canal measurement in primary teeth. 2008;105:e79-83. J Indian Soc Pedod Prev Dent 2005;23:124-5. 44. Mancini M, Felici R, Conte G, Costantini M, Cianconi L. Accuracy 63. Janner SF, Jeger FB, Lussi A, Bornstein MM. Precision of of three electronic apex locators in anterior and posterior teeth: endodontic working length measurements: A pilot investigation An ex vivo study. J Endod 2011;37:684-7. comparing cone-beam computed tomography scanning with 45. Patino-Marin N, Zavala-Alonso NV, Martinez-Castanon standard measurement techniques. J Endod 2011;37:1046-51. GA, Sanchez-Benavides N, Villanueva-Gordillo M, Loyola- 64. Azabal M, Garcia-Otero D, de la Macorra JC. Accuracy of the Rodriguez JP, et al. Clinical evaluation of the accuracy of Justy II Apex locator in determining working length in simulated conventional radiography and apex locators in primary teeth. horizontal and vertical fractures. Int Endod J 2004;37:174-7. Pediatr Dent 2011;33:19-22. 65. Ebrahim AK, Wadachi R, Suda H. Accuracy of three different 46. Vieyra JP, Acosta J, Mondaca JM. Comparison of working electronic apex locators in detecting simulated horizontal and length determination with radiographs and two electronic apex vertical root fractures. Aust Endod J 2006;32:64-9. locators. Int Endod J 2010;43:16-20. 66. Topuz O, Uzun O, Tinaz AC, Bodrumlu E, Gorgul G. Accuracy 47. Arora RK, Gulabivala K. An in vivo evaluation of the ENDEX of two apex-locating handpieces in detecting simulated vertical and RCM Mark II electronic apex locators in root canals with and horizontal root fractures. J Endod 2008;34:310-3. different contents. Oral Surg Oral Med Oral Pathol Oral Radiol 67. Goldberg F, Frajlich S, Kuttler S, Manzur E, Briseno- Endod 1995;79:497-503. Marroquin B. The evaluation of four electronic apex locators in 48. Paludo L, Souza SL, So MV, Rosa RA, Vier-Pelisser FV, Duarte teeth with simulated horizontal oblique root fractures. J Endod MA. An in vivo radiographic evaluation of the accuracy of Apex 2008;34:1497-9. and iPex electronic Apex locators. Braz Dent J 2012;23:54-8. 68. Fuss Z, Assooline LS, Kaufman AY. Determination of location 49. Hembrough JH, Weine FS, Pisano JV, Eskoz N. Accuracy of of root perforations by electronic apex locators. Oral Surg Oral an electronic apex locator: A clinical evaluation in maxillary Med Oral Pathol Oral Radiol Endod 1996;82:324-9. molars. J Endod 1993;19:242-6. 69. Hulsmann M, Pieper K. Use of an electronic apex locator in the 50. Hassanien EE, Hashem A, Chalfin H. Histomorphometric study treatment of teeth with incomplete root formation. Endod Dent of the root apex of mandibular premolar teeth: An attempt Traumatol 1989;5:238-41. to correlate working length measured with electronic and 70. Kaufman AY, Fuss Z, Keila S, Waxenberg S. Reliability of radiograph methods to various anatomic positions in the apical different electronic apex locators to detect root perforations portion of the canal. J Endod 2008;34:408-12. in vitro. Int Endod J 1997;30:403-7. 51. Smadi L. Comparison between two methods of working length 71. Zmener O, Grimberg F, Banegas G, Chiacchio L. Detection and determination and its effect on radiographic extent of root canal measurement of endodontic root perforations using a newly

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 95 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

designed apex-locating handpiece. Endod Dent Traumatol 91. Miletic V, Beljic-Ivanovic K, Ivanovic V. Clinical 1999;15:182-5. reproducibility of three electronic apex locators. Int Endod 72. Felippe WT, Felippe MC, Reyes Carmona J, Crozoe FC, J 2011;44:769-76. Alvisi BB. Ex vivo evaluation of the ability of the ROOT ZX II to 92. Pascon EA, Marrelli M, Congi O, Ciancio R, Miceli F, Versiani MA. locate the apical foramen and to control the apical extent of An in vivo comparison of working length determination of rotary canal instrumentation. Int Endod J 2008;41:502-7. two frequency-based electronic apex locators. Int Endod J 73. Jakobson SJ, Westphalen VP, da Silva Neto UX, Fariniuk LF, 2009;42:1026-31. Picoli F, Carneiro E. The accuracy in the control of the 93. Siu C, Marshall JG, Baumgartner JC. An in vivo comparison of apical extent of rotary canal instrumentation using Root the Root ZX II, the Apex NRG XFR, and Mini Apex Locator by ZX II and ProTaper instruments: An in vivo study. J Endod using rotary nickel-titanium files. J Endod 2009;35:962-5. 2008;34:1342-5. 94. Wrbas KT, Ziegler AA, Altenburger MJ, Schirrmeister JF. 74. Fadel G, Piasecki L, Westphalen VP, Silva Neto UX, Fariniuk LF, In vivo comparison of working length determination with two Carneiro E. An in vivo evaluation of the auto apical reverse electronic apex locators. Int Endod J 2007;40:133-8. function of the Root ZX II. Int Endod J 2012;45:950-4. 95. Haffner C, Folwaczny M, Galler K, Hickel R. Accuracy of 75. Campbell D, Friedman S, Nguyen HQ, Kaufman A, Keila S. electronic apex locators in comparison to actual length — an Apical extent of rotary canal instrumentation with an apex- in vivo study. J Dent 2005;33:619-25. locating handpiece in vitro. Oral Surg Oral Med Oral Pathol 96. Venturi M, Breschi L. A comparison between two electronic apex Oral Radiol Endod 1998;85:319-24. locators: An in vivo investigation. Int Endod J 2005;38:36-45. 76. Hoer D, Attin T. The accuracy of electronic working length 97. Lauper R, Lutz F, Barbakow F. An in vivo comparison of gradient determination. Int Endod J 2004;37:125-31. and absolute impedance electronic apex locators, J Endod 77. Oishi A, Yoshioka T, Kobayashi C, Suda H. Electronic detection 1996;22:260-3. of root canal constrictions. J Endod 2002;28:361-4. 98. Pallares A, Faus V. An in vivo comparative study of two apex 78. Alves AM, Felippe MC, Felippe WT, Rocha MJ. Ex vivo evaluation locators. J Endod 1994;20:576-9. of the capacity of the Tri Auto ZX to locate the apical foramen 99. Kishor KM. Comparison of working length determination using during root canal retreatment. Int Endod J 2005;38:718-24. apex locator, conventional radiography and radiovisiography: 79. Uzun O, Topuz O, Tinaz C, Nekoofar MH, Dummer PM. Accuracy An in vitro study. J Contemp Dent Pract 2012;13:550-3. of two root canal length measurement devices integrated into 100. Zand V, Mokhtari H, Lotfi M, Reyhani MF, Sohrab A, Tehranchi rotary endodontic motors when removing gutta-percha from P, et al. Accuracy of working length determination with root ZX root-filled teeth. Int Endod J 2008;41:725-32. apex locator and radiography: An in vivo and ex vivo study. 80. Aggarwal V, Singla M, Kabi D. An in vitro evaluation of Afr J Biotechnol 2013;10:7088-91. performance of two electronic root canal length measurement 101. Parekh V, Taluja C. Comparative study of periapical radiographic devices during retreatment of different obturating materials. J techniques with apex locator for endodontic working length Endod 2010;36:1526-30. estimation: An ex vivo study. J Contemp Dent Pract 2011;12:131-4. 81. Uzun O, Topuz O, Tinaz AC, Alacam T. Apical accuracy of two 102. Sharma MC, Arora V. Determination of working length of root apex-locating handpieces in root canal retreatments of root-end canal. Med J Armed Forces India 2010;66: 231-4. resected teeth. J Endod 2007;33:1444-6. 103. Saad AY, al-Nazhan S. Radiation dose reduction during 82. Wilson BL, Broberg C, Baumgartner JC, Harris C, Kron J. Safety endodontic therapy: A new technique combining an of electronic apex locators and pulp testers in patients with apex locator (Root ZX) and a digital imaging system implanted cardiac pacemakers or cardioverter/defibrillators. J (RadioVisioGraphy). J Endod 2000;26:144-7. Endod 2006;32:847-52. 104. Murakami M, Inoue S, Inoue N. Clinical evaluation of 83. Suchde RV, Talim ST. Electronic ohmmeter. An electronic audiometric control root canal treatment: A retrospective case device for the determination of the root canal length. Oral Surg study. Quintessence Int 2002;33:465-74. Oral Med Oral Pathol 1977;43:141-50. 105. Stavrianos C, Vasiliadis L, Stavrianou I, Kafas P. Clinical 84. Muthu MS, Sivakumar N. Accuracy of electronic apex evaluation of the accuracy of an electronic tooth apex locator. locator in length determination in the presence of different J Med Sci 2007;7:1369-71. irrigants: An in vitro study. J Indian Soc Pedod Prev Dent 106. Ounsi HF, Naaman A. In vitro evaluation of the reliability of the 2006;24:182-5. Root ZX electronic apex locator. Int Endod J 1999;32:120-3. 85. Kobayashi C, Suda H. New electronic canal measuring device 107. Vajrabhaya L, Tepmongkol P. Accuracy of apex locator. Endod based on the ratio method. J Endod 1994;20:111-4. Dent Traumatol 1997;13:180-2. 86. Gordon MP, Chandler NP. Electronic apex locators. Int Endod 108. Shabahang S, Goon WW, Gluskin AH. An in vivo evaluation of J 2004;37:425-37. Root ZX electronic apex locator. J Endod 1996;22:616-8. 87. Stober EK, Duran-Sindreu F, Mercade M, Vera J, Bueno R, 109. Wu YN, Shi JN, Huang LZ, Xu YY. Variables affecting electronic Roig M. An evaluation of root ZX and iPex apex locators: An root canal measurement. Int Endod J 1992;25:88-92. in vivo study. J Endod 2011;37:608-10. 110. Ricard O, Roux D, Bourdeau L, Woda A. Clinical evaluation of 88. Silveira LF, Petry FV, Martos J, Neto JB. In vivo comparison the accuracy of the Evident RCM Mark II Apex Locator. J Endod of the accuracy of two electronic apex locators. Aust Endod J 1991;17:567-9. 2011;37:70-2. 111. McDonald NJ, Hovland EJ. An evaluation of the Apex Locator 89. Somma F, Castagnola R, Lajolo C, Paterno Holtzman L, Endocater. J Endod 1990;16:5-8. Marigo L. In vivo accuracy of three electronic root canal length 112. Berman LH, Fleischman SB. Evaluation of the accuracy of the measurement devices: Dentaport ZX, Raypex 5 and ProPex II. Neosono-D electronic apex locator. J Endod 1984;10:164-7. Int Endod J 2012;45:552-6. 113. Busch LR, Chiat LR, Goldstein LG, Held SA, Rosenberg PA. 90. Stober EK, de Ribot J, Mercade M, Vera J, Bueno R, Roig M, Determination of the accuracy of the Sono-Explorer for et al. Evaluation of the Raypex 5 and the Mini Apex Locator: establishing endodontic measurement control. J Endod An in vivo study. J Endod 2011;37:1349-52. 1976;2:295-7.

96 Dental Hypotheses Jul-Sep 2014 / Vol 5 | Issue 3 [Downloaded free from http://www.dentalhypotheses.com on Monday, August 11, 2014, IP: 218.241.189.21] || Click here to download free Android application for this journal

Mosleh, et al.: Electronic apex locator

114. Stavrianos CH, Vladimirov ST, Vasiliadis L, Stavrianou I, 2006;61:244-7. Panayotov I, Pamporakis P. In vitro evaluation of the precision 117. Pratten DH, McDonald NJ. Comparison of radiographic and of four different electronic apex locators in determining the electronic working lengths. J Endod 1996;22:173-6. working length of teeth after removing root canal obturation 118. Keller ME, Brown CE Jr, Newton CW. A clinical evaluation of the materials. Res J Med Sci 2008;2:282-6. Endocater an electronic apex locator. J Endod 1991;17:271-4. 115. Goldberg F, Marroquín BB, Frajlich S, Dreyer C. In vitro evaluation of the ability of three apex locators to determine the working length during retreatment. J Endod 2005; Cite this article as: Mosleh H, Khazaei S, Razavian H, Vali A, Ziaei F. 31:676-8. Electronic apex locator: A comprehensive literature review - Part I: Different 116. al Kadi H, Sykes LM, Vally Z. Accuracy of the Raypex-4 generations, comparison with other techniques and different usages. Dent Hypotheses 2014;5:84-97. and Propex apex locators in detecting horizontal and vertical root fractures: An in vitro study. SADJ Source of Support: Nil. Conflict of Interest: None declared.

Jul-Sep 2014 / Vol 5 | Issue 3 Dental Hypotheses 97