Electronic apex locaters detailing in Endodontics

detailing on apex locators, usage, advantages, generations

1. 12/20/2015 uday kumar p 1 GOOD MORNING

2. WORKING LENGTH DETERMINATION PART-2 ELECTRONIC METHODS 12/20/2015 uday kumar p 2

3. In 1918, CUSTER was the first to report the use of electric current to determine working length In 1942 , SUZUKI, reported his study on iontophoresis of ammoniated silver nitrate in the teeth of dogs  the electrical resistance between the root canal instrument inserted into a root canal and an electrode applied to the oral mucous membrane registered a consistent value of approximately 6.5 kilo ohms (kW). 12/20/2015 uday kumar p 3 HISTORY

4. In 1960 GORDON , was the second to report the use of a clinical device for electrical measurement of root canals. In 1962 SUNADA , adopted the principle of Suzuki and was the first to describe the detail of a simple device to measure working length with a constant resistance of 6.5 ( kw ) In 1987 , HUANG , reported that this principle is not a biologic characteristic, but rather a physical principles of electricity alone. 12/20/2015 uday kumar p 4

5. It has 4 parts: The lip clip The file clip The instrument itself A cord which connects the three parts A display screen exhibits the advancement of the file towards the apex 12/20/2015 uday kumar p 5 PARTS OF AN APEX LOCATORS

6. INDICATIONS When apical portion is obstructed. In pregnant patients Disabled or heavily sedated patients Patients with gag reflex In children CONTRA INDICATIONS In patients with cardiac pacemakers 12/20/2015 uday kumar p 6

7. CLASSIFICATION OF ELECTRONIC APEX LOCATORS 12/20/2015 uday kumar p 7

8. Evolution of apex locaters 1st generation : D irect current-RESISTANCE 2 ND generation :Alternating current-impedence with single frequency. I n simple impedence=resistance + capacitance. It is AC equivalent of resistance. 3 RD generation : Similar to 2 nd generation using M ulti frequency. 12/21/2015 uday kumar p 8

9. 4th generation : Dual frequency. 5th generation : capacitance and resistance calculated separately. 6th generation : Adaptive apex locaters. 12/22/2015 uday kumar p 9

10. FIRST GENERATION:(RESISTANCE TYPE) It detects the point where the file displaces from within the canal to the periodontal ligament, they used direct current. Principle: Electrical resistance between the periodontal ligament and the oral mucosa is constant value 6.5 kilo omega. 12/20/2015 uday kumar p 10

11. The root canal meter (1969) – 150 HZ current is used. Pain was often due to high current. Endodontic meter and Endodontic meter S II which used a current of less than 5μA. Dentometer and Endo Radar 12/20/2015 uday kumar p 11

12. Advantages Easily operated Has digital read out Audible indication Operated with RC prep Disadvantages The resistance type EAL’S yield inaccurate results -electrolytes, -excessive moisture, -vital pulp tissue, -exudates -excessive hemorrhage Can not estimate beyond 2 mm Sensitivity Calibration is required Lip clip with good contact required 12/20/2015 uday kumar p 12

13. SECOND GENERATION(IMPEDENCE TYPE) : They used alternating current and low frequency. Impedence is maximum at the apical constriction Ex: endocater, foramatron IV PRINCIPLE : Tooth is considered to be a long hallow tube with one of its end closed . T he tooth exhibits increasing electrical impedence across the walls of the root canal, which is greater apically than coronally . T his is due to presence of transparent dentin which begins to form at 17 years of age. 12/20/2015 uday kumar p 13

14. The Apex Finder:- Has a visual digital LED indicator and pulp tester. The Endo Analyzer: combined apex locator and pulp tester. Digipex :- Has a visual LED digital indicator and an audible indicator. It requires calibration . Digipex II: -Is a combination of apex locator and pulp tester 12/20/2015 uday kumar p 14

15. Exact – A – Pex : - - Has an LED bar graph display and audio indicator. Formatron:- - Has a flashing LED light and a digital LED display . - does not require calibration. - This device is small, light weight and inexpensive . The Pio: - -Apex locator having an analog meter display and an audioindicator. -It has an adjusting knob for calibration. 12/20/2015 uday kumar p 15

16. Advantages Operates in presence of fluid Analog method No sensitivity Operates with RC prep. Disadvantages Difficult to operate No digital read out Requires coated probes Inaccurate in cases with open apices. Root canal has to be reasonably free of electro conductive materials Not all apex locators incorporated the same degree of sophistication in electronic circuitry 12/20/2015 uday kumar p 16

17. Principle : Third generation apex locators are similar to the second generation except that they use multiple frequencies to determine the distance from the end of the canal . These units have more powerful microprocessors and are able to process the mathematical quotient and algorithm calculations required to give accurate readings . 12/22/2015 uday kumar p 17 THE THIRD GENERATION (OR) FREQUENCY DEPENDENT

18. The Endex / Apit : The relative values of frequency response method detects the apical constriction by calculating the difference between two direct potentials picked up by filters when a 1 kHz rectilinear wave is applied to the canal. This was described by Saito & Yamashita (1990 ). DRAWBACKS: N eeds to be calibrated in each canal . A pex locators erroneous readings with electrolytes. . 12/22/2015 uday kumar p 18

19. ROOT ZX: I ntroduction of the ratio method and the subsequent development of the self-calibrating Root ZX. The ratio method works on the principle that two electric currents with different sine wave frequencies will have measurable impedances that can be measured and compared as a ratio regardless of the type of electrolyte in the canal. 12/22/2015 uday kumar p 19

20. the ratio of different frequencies have definitive values, and that the ratio rate of change did not change with different electrolytes in the canal. The change in electrical capacitance at the apical constriction is the basis for the operation of the Root ZX and its reported accuracy . It has become the benchmark to which other apex locators are compared , and maintains a 95% world market share for apex locators in use today. 12/22/2015 uday kumar p 20

21. ROOT ZX:- A third generation apex locator that uses dual frequency and comparative impedance principles ( Kobayashi) . The ratio method (or) division method . The Root ZX measures the two impedances at two frequencies (8 and 0.4 KHZ) inside the canal The root zx simultaneously uses two waveform of a high(8KHz) and low(400Hz) frequency. The impedances are measured at these two frequencies & compared as ratio regardless of the electrolyte. 12/20/2015 uday kumar p 21

22. A micro processor in the device calculates the ratio of the two frequencies. The quotient of the impedance is displayed on an LCD (Liquid Crystal Display) meter panel and represents the position of the Instrument inside the canal. The Root ZX is mainly based on detecting the change in electrical capacitance that occurs near the apical constriction. 12/20/2015 uday kumar p 22

23. Advantages It requires no adjustment (or) calibration Can be used when the canal is filled with strong electrolyte (or) when the canal is “empty” and moist The meter is easy to read LCD 12/20/2015 uday kumar p 23

24. The APEX FINDER. A.F.A (All fluids allowed). frequency dependent EAL, which uses five different frequencies (0.5, 1,2,4,8 KHZ) & to read four amplitude ratio’s. The unit is self – calibrating and can measure with electrolyte present in the canal. 12/20/2015 uday kumar p 24

25. MARK V PLUS JUSTWO (or) JUSTY II 12/22/2015 uday kumar p 25

26. PROPEX :- Is a modern apex locator based on multi frequency Enables to locate apical foramen with great precision in any canal condition. Propex screen facilitates the access to the exact file position. Propex audio signals combined with the screen information helps about 2-3mm before the apex is reached. Propex warns when the file approaching the apical zone by emitting 2 beeps . 12/20/2015 uday kumar p 26

27. FORMATRON D-10. ( Parkell company ) Monitors the impedance between the lip clip and the file, being sensitive to both the voltage applied and the current circuit with current of multiple frequencies. The D-10 does not feature an LCD Adorned by a string of colored lights When for short of foramen,  Green. Cautionary yellow  approaches close to the foramen. Red light  apical foramen. Orange light beyond apex and device starts beeping. 12/20/2015 uday kumar p 27

28. 3 RD GENERATION Advantages Easy to operate. Operates in presence of fluid Uses k type file. Audible indication Disadvantages Require lip clip May be short circuited 12/20/2015 uday kumar p 28

29. The BINGO 1020 / RAY – PEX 4. (Forum engineering technologies Israel). T wo separate frequencies 400 HZ and 8 KHZ similar to the 3rd generation units. C laim that the combination of using only one frequency at a time and basing measurements on the root mean square Values of the signals increases the measurement accuracy and the reliability of the device . 12/20/2015 uday kumar p 29 FOURTH GENERATION

30. 12/20/2015 uday kumar p 30 Bingo 1020

31. THE FIFTH GENERATION Developed in 2003 . It measures the capacitance and resistance of the circuit separately . It is supplied by diagnostic table that includes the statistics of the values at different positions to diagnose the position of the file. 12/22/2015 uday kumar p 31

32. DRAWBACKS: Devices employing this method experience considerable difficulties while operating in dry canals. he accuracy of electronic root canal length measurement varies with the pulp and periapical condition . So, pulp condition and periapical diseases should be considered to evaluate the relation between the pulp state and accuracy of electronic apex locators. 12/22/2015 uday kumar p 32

33. WOOD PEX 3 12/22/2015 uday kumar p 33

34. I ROOT APEX LOCATER 12/22/2015 uday kumar p 34

35. JOY PEX 5 12/22/2015 uday kumar p 35

36. THE SIXTH GENERATION Adaptive Apex Locator overcomes as the disadvantages of the popular apex locators 4th generation low accuracy on working in wet canals, as well the disadvantages of devices V th generation difficulty on working in dry canals. Adaptive Apex locaters immediately adapts to dry or wet canal. Possible to be used in dry and in additional wetted canals as well, canals with blood or exudates, canals with still not extirpated pulp . 12/22/2015 uday kumar p 36

37. APEX LOCATOR & ENDONTIC HANDPIECE Tri Auto ZX : Root ZX apex locator+ hand piece uses NI-TI rotary instruments that rotates at 280 ± 50rpm. rotary instrument is monitored on the LED control panel of the handpiece during the shaping and cleaning of the canal. Tri auto ZX has three automatic safety mechanisms . -Auto start-stop mechanism -Auto torque reverse mechanism - Auto – apical – reverse mechanism 12/20/2015 uday kumar p 37

38. X –SMART DUAL 12/22/2015 uday kumar p 38

39. ELEMENT DIAGNOSTIC UNIT & APEX LOCATOR Device does not process the impedance information as a mathematical algorithm,  takes the resistance and capacitance measurements and compares  database to determine the working length. Uses a composite waveform of two signals0.5 and 4 KHZ. 12/20/2015 uday kumar p 39

40. COMMON PROBLEM SOLVING WITH EAL Unstable electronic signal with rapid wandering signs – Most frequent problem. Occurs when file touches metallic restorations or in presence of cervical leakage. Remove the metallic restoration. 12/20/2015 uday kumar p 40

41. Sharp drop of the signal at the apical foramen- occurs in dry canal: Gently irrigate the canal Apex signs from the beginning Presence of too much of electrolyte Canals with extreme bleeding & active pus discharge: Gently dry the canal 12/20/2015 uday kumar p 41

42. Inaccurate readings due to a ) Low battery b) Too much tissue in the canal c) Canal may be too wet or dry d) Blockage in the canal e) Displaced lip clip 12/20/2015 uday kumar p 42

43. Studies done in our department A comparative evaluation of the accuracies of recent dual functional apex locaters in locating the apical constriction: A H istomorphometric study. by Dr.SWARUPA under the guidence of Dr.GIRIJA S. SAJJAN Conclusion : There was no statistical significant difference in the accuracies of ROOT ZX ,Elements and N ouvag apex locaters in locating the apical constriction. T he apical constriction and CDJ are not same ,while the constriction found coronal to CDJ. 12/22/2015 uday kumar p 43

44. LIBRARY DISSERTATION A comparative evaluation of combination of apex locater and endodontic motor with an integrated endodontic motor: An invitro stereomicroscopic study. Conclusion: The assembly of propex –NSK Endomate DT and the apex locating –TCM Endo V Nouvag are clinically acceptable with neither of them superior over the other. By Dr.SWARUPA under the guidence of Dr.GIRIJA S. SAJJAN 12/22/2015 uday kumar p 44

45. APEX LOCATOR IN OUR DEPARTMENT 12/20/2015 uday kumar p 45

46. WOODPEX 1 12/20/2015 uday kumar p 46

47. WOODPEX III 12/22/2015 uday kumar p 47

48. ROOT ZX 12/20/2015 uday kumar p 48

49. PROPEX 12/20/2015 uday kumar p 49

50. TCM ENDO V –ENDOMOTOR WITH APEX LOCATOR 12/20/2015 uday kumar p 50

51. ELEMENTS DIAGNOSTIC UNIT AND APEX LOCATOR 12/20/2015 uday kumar p 51

52. CONCLUSION No individual technique is truly satisfactory in determining endodontic working length. The CDJ is a practical and anatomic termination point for the preparation and obturation of the root canal and this cannot be determined radio graphically . Understanding morphology of apical one third and prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results Have a stable coronal reference point. 12/20/2015 uday kumar p 52

53. REFERENCES 1.ENDODONTIC PRACTICE , 11th edition , LOUISGROSSMAN 2.ENDODONTICS , 5th&6th edition JOHN I. INGLE , LEIF K. BAKLAND , J. CRAIG BAUMGARTNER . 3.PATHWAYS OF THE PULP , 9th edition , STEPHEN COHEN . 4. TEXT BOOK OF ENDODONTICS , 1ST edition , NISHA GARG 5. Sonal S, Mohan S, Vineeth V.Electronics apex locaters.journal of dental sciences and oral rehabilitation 2013;24-7. 6. M. P. J. Gordon & N. P. Chandler.Review of Electronic apex locators. International Endodontic Journal 2004;37:425–37. 12/21/2015 uday kumar p 53

54. Hamid M, Saber K, Hamid R, Armita V, Farzad Z.Electronic apex locator: A comprehensive literature review — : Different generations, comparison with other techniques and different usages. Dental Hypotheses 2014 ; 5(3):84-97. Internet for images. 12/22/2015 uday kumar p 54

55. 12/20/2015 uday kumar p 55 THANK YOU