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Systematic Review
A B S T R A C T
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
Ideal pulp treatment is defined as the removal of infected
pulp and cleaning, shaping, and disinfecting the root
canal system.[1] Subsequently, a three-dimensional
filling can be provided. To achieve this goal, an essential
stage is the assessment of the correct length of the root
canals.[1,2]
Working length is defined as the distance between the
coronal/incisal reference point and the area that has been
prepared and at which the filled canal should end.[1]
Access this article online
Quick Response Code:
Website:
www.dentalhypotheses.com
DOI:
10.4103/2155-8213.136744
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: razavian@dnt.mui.ac.ir
84
Dental Hypotheses
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Mosleh, et al.: Electronic apex locator
Data extraction
Extraction of data from studies and assessment of
validity was independently performed by two authors
(HM and AV) and checked by a third author (FZ).
In the case of disagreement between evaluators, it
reassessed by discussion between two reviewers and a
final consensus was agreed on (HR and SKh). Figure 1
provides information on the number of papers identified
through the search strategy. Information of the authors,
their institutions, and result of primary studies were
removed before assessment of the validity. Information
on the first author, year of publication, study design,
study population and sample size, and the outcome
measurements (main results) were extracted.
Results
Out of 402 articles, 183 studies were reviewed and 108
studies were selected for this part. The studies were
categorized as follows.
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
Jul-Sep 2014 / Vol 5 | Issue 3
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Mosleh, et al.: Electronic apex locator
Table 1: Different generations of electrical apex locator devices and their operation base[86]
Generation Operation base
First
Second
Third
Fourth
Fifth
Device samples
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Mosleh, et al.: Electronic apex locator
Table 2: Comparison of different electronic apex locators (EALs) in working length determination
Authors
Comin Chiaramonti
et al.[31]
Ex vivo
2012
40 teeth
Baginska et al.[32]
Ex vivo
2012
40 teeth
Somma et al.[89]
In vivo
2012
30 teeth
Paludo et al.[48]
In vivo
2012
100 root
Canals
Jung et al.[15]
In vitro
2011
104 teeth
In vivo
2011
40 root
canals
Stober et al.[87]
In vivo
2011
40 root
canals
Miletic et al.[91]
In vivo
2011
48 root
canals
In vivo
2011
23 teeth
deVasconcelos
et al. [28]
Ex vivo
2010
38 teeth
Guise et al.[17]
In vitro
2010
40 teeth
2010
31 teeth
In vivo
2009
831 root
canals
Higa et al.[13]
In vitro
2009
12 teeth
In vivo
2009
29 teeth
Pascon et al.[25]
Ex vivo
2009
60 teeth
Ebrahim et al.[16]
In vitro
2007
32 teeth
2007
40 teeth
Bernardes et al.[12]
2007
40 teeth
Invitro
Aim of study
Bingo 1020
Propex
Comparing operation
of different apex
locator devices
Raypex 5, Apex
Comparing operation
D.S.P and Locapex of different apex
Five
locator devices
Dentaport ZX,
Comparing operation
Raypex 5,
of different apex
ProPex II
locator devices
Apex and iPex
Comparing the
accuracy of EALs in
length measurement
Root ZX,
I-Root
Comparing operation
of different apex
locator devices
Raypex 5
Comparing operation
Mini Apex Locator
of different apex
locator devices
Root ZX and iPex
Comparing operation
of different apex
locator devices
Dentaport ZX,
Comparing operation
RomiApex A-15 and of different apex
Raypex 5
locator devices
Root ZX,
Comparing operation
Novapex
of different apex
locator devices
Root ZX, RomiApex Comparing operation
D-30, and Ipex
of different apex
locator devices
Comparing operation
Root ZX II,
of different apex
Elements AL,
locator devices
Precision AL
Root ZX-II, Novapex, Comparing operation
Mini AL
of different apex
locator devices
DentaPort ZX,
Comparing operation
Raypex 5
of different apex
locator devices
Justylll, Dentaport, Comparing operation
E-Magic Finder
of different apex
locator devices
Root ZX II, Apex
Comparing operation
NRG
of different apex
XFR, Mini Apex
locator devices
Locator
Dentaport ZX,
Comparing operation
Raypex 5 Elements of different apex
Diagnostic Unit and locator devices
AL
Dentaport ZX,
Comparing operation
ProPex,
of different apex
Foramatron D10,
locator devices
Apex NRG,
Apit 7
Mini AL, Root ZX II Comparing operation
of different apex
locator devices
Root ZX, Elements Comparing operation
Diagnostic Unit and of different apex
A L, RomiAPEX
locator devices
D-30
Type of
generation
No significant
difference
Fourth
No significant
difference
Fifth
No significant
difference
Third and
Fourth
There werent
significant
differences and
both devices were
accurate
No significant
difference
Fourth
No significant
difference
Fourth
No significant
difference
Third and
Fourth
No significant
difference
Third and
Fourth
No significant
difference
Third and
Fourth
Third and
Fourth
Third
Third and
Fourth
Third and
Fourth
No significant
difference
Third
Elements
Diagnostic Unit and
A L was not accurate
than others
Dentaport ZX,
ProPex,
Foramatron D10
were more accurate
Third and
Fourth
No significant
difference
Fourth
No significant
difference
Third and
Fourth
Third and
Fourth
(Continued)
Dental Hypotheses
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Mosleh, et al.: Electronic apex locator
Table 2: (Continued)
Authors
Aim of study
Type of
generation
Wrbas et al.[94]
In vivo
2007
20 teeth
Root ZX
Raypex5
No significant
difference
Third
Stavrianos et al.[24]
In vivo
2007
80 root
canals
Dentaport
ZX,RayPex 4
No significant
difference
Third and
Fourth
Venturi et al.[26]
Ex vivo
2007
60 root
canals
Third
Topuz et al.[19]
In vitro
2007
47 teeth
TCM Endo V
Root ZX
Comparing operation
of different apex
locator devices
Comparing operation
of different apex
locator devices
Comparing operation
of different apex
locator devices
evaluating the
accuracy of the
apex-locating function
of the TCM Endo V
and to compare the
results to these of
the Root ZX
Third and
Fourth
Ebrahim et al.[27]
Ex vivo
2006
36 teeth
Plotino et al.[30]
Ex vivo
2006
40 teeth
In vitro
2006
40 teeth
Hor et al.[29]
Ex vivo
2005
193 teeth
Justy II
Raypex4
Haffner et al.[95]
In vivo
2005
40 teeth
ElAyouti et al.[14]
Ex vivo
2005
182 root
canals
Root ZX
Endy
Justy II
EndoxLysis
Raypex 4, Apex
pointer, Root ZX
Venturi et al.[96]
Invivo
2005
64 teeth
Apex Finder,
Root ZX
Lucena-Martin
et al.[11]
In vitro
2004
20 teeth
Hoer et al.[46]
In vivo
2004
75 teeth
Justy II,
Root ZX,
NeosonoUltima EZ
Justy II, Endy 5000
In vivo
2003
32 teeth
Root ZX
Endo Analyzer
Model 8005
In vitro
1999
15 single
canal teeth
Apex Finder
AFAModel 7005,
Apex-Finder,
Neosono
Ultima EZ and
Apit 2
88
Dental Hypotheses
Comparing operation
of different apex
locator devices
Comparing operation
of different apex
locator devices
to compare the
accuracy of the RootZX and
Novapex electronic
apex locators (EALs)
in locating the apical
foramen
Comparing operation
of different apex
locator devices
Comparing operation
of different apex
locator devices
Third and
Fourth
Third and
Fourth
Root-ZX and
Third and
Novapex are
Fourth
useful and accurate
devices for the apical
foramen location
Third and
Fourth
No significant
difference
Third
Third and
Fourth
Third
Third
Third
Third
Third
(Continued)
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Mosleh, et al.: Electronic apex locator
Table 2: (Continued)
Authors
Weiger et al. [22]
Lauper et al.[97]
Ex vivo
1996
130 root
canals
Apit and
Odontometer
In vivo
1995
61 root
canals
1994
116 root
canals
Odontometer and
Endo Cater
1987
60 single
root teeth
Sono-Explorer,
C. L. Meter and
Neosono-D
In vitro
Aim of study
Type of
generation
Third
First and
Second
Second and
Third
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Table 3: Comparison of electronic apex locators (EALs) and different other techniques in working length
determination
Authors
Orosco et al.[60]
Type of
study
In vivo
Kishor[99]
In vitro
2012
2012
Zand et al.[100]
In vivo/
Exvivo
In vivo
2011
Parekh and
Taluja[101]
Janner et al.[63]
Ex vivo
2011
In vivo
2011
Neena et al.[54]
In vivo
2011
Singh et al.[57]
In vivo
2011
Real et al.[51]
In vitro
2011
Patino-Marin
et al.[45]
Kqiku et al.[7]
In vivo
2011
Ex vivo
2011
Vieyra et al.[38]
In vivo/In
vitro
2011
Mancini et al.[44]
Ex vivo
2011
Cianconi et al.[37]
Ex vivo
2010
Sharma and
Arora[102]
Vieyra et al.[46]
In vivo/
Exvivo
In vivo
2010
Javidi et al.[40]
In vitro
2009
Kim et al.[43]
In vivo
2008
Krajczar et al.[39]
In vitro
2008
2008
Jarad et al.[36]
2011
2010
Shanmugaraj
et al.[6]
In vivo/In
vitro
2007
Smadi et al.[51]
In vivo
2006
Subramaniam
et al.[62]
In vitro
2005
90
Dental Hypotheses
Types of
studied ELA
Root ZX
Aim of study
Foramatron-IV
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Mosleh, et al.: Electronic apex locator
Table 3: (Continued)
Authors
Type of
study
Types of
studied ELA
Aim of study
ElAyouti et al.[41]
In vitro
2002
30 teeth
Root ZX
Brunton et al.[42]
In vitro
2002
50 teeth
Martinez-Lozano
et al.[35]
In vitro
2001
70 teeth
Apit EM-S3
Saad et al.[103]
In vivo
2000
14 teeth
Root ZX
Ounsi et al.[61]
In vitro
1998
37 teeth
Endex
Himel et al.[55]
In vivo
1993
96 root canals
Formatron IV
Hembrough
et al.[49]
In vivo
1993
26 maxillary
molar teeth
Sono-Explorer
Mark III
Frank et al.[56]
In vivo
1993
185
root canal
Endex
Trope et al.[59]
In vivo
1985
2002
Stavrianos
et al.[105]
Ounsi et al.[106]
In vivo
2007
85 teeth
Raypex 5
In vitro
1999
39single root
teeth
Root ZX
Vajrabhaya
et al.[107]
Shabahang
et al.[108]
Wu et al.[109]
In vivo
1997
In vivo
1996
20
Root ZX
Single root teeth
26 root canals Root ZX
In vivo
1992
Ricard et al.[110]
In vivo
1991
20 single root
teeth
37 teeth
Sono-Explorer
type Y-III
RCM Mark II
1990
47 teeth
Endocater
Berman et al.[112]
In vivo
1984
Busch et al.[113]
In vitro
1976
24 mature
Neosono-D
and 5 immature
root canals
77 teeth (46 vital Sono-Explorer
and 26 necrotic)
Discussion
Different generations of EALs, with improved functions
and greater clinical applications, have entered the market
over these past few decades. Our results indicate that
there are no significant differences between different
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Mosleh, et al.: Electronic apex locator
Type of
study
In vitro
Types of studied
ELA
Root ZX and
ProPex
Stavrianos et al.[114]
In vitro
2008
40 teeth
Alves et al.[78]
Ex vivo
2005
62 teeth
Dentaport ZX,
RayPex 5, Endo
Master and
Bingo-1020
Tri Auto ZX
Goldberg et al.[115]
In vitro
2005
Uzun et al.[79]
Ex vivo
2008
Uzun et al.[81]
In vitro
2007
Fadel et al.[74]
In vivo
2012
Jakobson et al.[73]
In vivo
2008
Felippe et al.[72]
Ex vivo
2008
Campbell et al.[75]
In vitro
1998
Goldberg et al.[67]
In vitro
2008
Topuz et al.[66]
In vitro
2008
Ebrahim et al.[65]
In vitro
2006
al Kadi et al.[116]
In vitro
2006
Azabal et al.[64]
In vitro
2004
Hoer et al.[76]
In vitro/
In vivo
2004
Oishi et al.[77]
In vitro
2002
Pratten and Mc
Donald [117]
In vitro
1996
Aim of study
Apit
Evaluation apex locators
Device
ability in detremination apical can determine apical
constriction
constriction
(Continued)
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Mosleh, et al.: Electronic apex locator
Table 4: (Continued)
Authors
Types of studied
ELA
Endocater
Aim of study
Keller et al.[118]
Type of
study
In vivo
Zmener et al.[71]
In vitro
1999
40 teeth
Tri Auto ZX
Kaufman et al.[70]
In vitro
1997
Fuss et al.[68]
In vitro
1996
Hulsmann et al.[69]
In vivo
1989
30 teeth with
perforation in
middle third
32 teeth with
perforation in
midle third
21 teeth
Root ZX , Sono
Explorer Mark II
Junior and Apit III
Sono Explorer
Mark2 Junior
andApit 2
Exact-A-Pex
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Mosleh, et al.: Electronic apex locator
Conclusion
The results of the present study showed that EAL
is an appropriate technique for root canal length
measurements.
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