DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY
Date of admission to course
TITLE OF THE TOPIC
“WORKING LENGTH DETERMINATION IN PRIMARY MOLARS BY ELECTRONIC APEX LOCATOR AND COMPUTERISED RADIOGRAPHIC METHOD – A COMPARATIVE IN VIVO STUDY.”
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY:
One of the most challenging pediatric endodontic procedures is pulpectomy. Pulpectomy of primary teeth generally involves access opening, working length determination, biomechanical preparation and obturation. Endodontic anatomy of primary teeth, in particular of molars is difficult to predict because of the balance of resorption and hard tissue deposition ..
Radiographic method described by Ingle is one of the most common and reliable methods used in determining the working length by paralleling technique. Computerized radiographic images (PSP system) by Durr vista scan plus using DBSWIN 5.3 imaging software allows substantial reduction in the duration of endodontic procedure, because it effectively eliminates the film processing time.
Electronic apex locators are the non-radiographic method of working length determination and safest without radiation exposure. Ipex locator of NSK Company is the fourth generation apex locator, which is based on multi frequency principle, which works both in the wet and dry canals.
There are studies on these two methods,takingthe biological aspects and technical considerations with different parameters we will compare computerized radiograph and electronic apex locator to determine the working length in primary teeth .The null hypothesis of this study is that working length determined by both these methods will show no difference.
6.2 REVIEW OF LITERATURE:
A study conducted to assess the working length in primary teeth using intra oral digital RVG and apex locator and compared the results with conventional radiograph for accuracy.A total of 30 primary teeth which were indicated for pulpectomy were taken and the results showed not significant difference in mean working length .The mean of working length with apex locator is 11.79mm, RVG is 11.98mm and with conventional method is 11.76mm.It was concluded that apex locator is comparable to conventional radiograph in determining working length without radiation in primary teeth 1.
An ex vivo study done to compare the accuracy of radiographic and electronic root canal length determination methods with actual root canal length obtained with stereomicroscope.30 extracted single rooted permanent teeth were used and access preparation was done. Working length was determined by digital radiography and electronic measurement of all teeth were embedded in an alginate model to test apex locator in vitro. The results showed no significant difference was found and concluded that the present ex vivo study showed that electronic root canal working length determined is not superior to radiographic methods.Both methods provided a good performance in determining the root canal working length2.
A study done to evaluate the radiographic and electronic root canal length determination in primary molar.128 canals from 66 primary molars were selected.The root of each tooth was cut open and real tooth length was measured and gold standard working length was determined by subtracting 1mm from this measurement.Electronic measurement using a Root ZX apex locator and radiographic determination of working length was done.The results showed statistically significant difference between each tested method and the gold standard.It is concluded that Root ZX apex locator is a reliable method to determine the working length of primary teeth,since it showed greater accuracy than the radiographic method 3.
A study conducted to assess the accuracy of working length determination using 3 electronic apex locators and direct digital radiography.Twenty extracted maxillary premolars were selected: 17 two rooted and 3 single rooted (total of 37 canals). Working length was measured using electronic apex locators Elements Diagnostic,RootZX, Just 11 and with digital radiography.Results showed statistical difference and concluded that Root ZX and Elements Diagnostic are more accurate in determining working length when compared with Just 11 and Schick direct digital radiography 4.
An in vitro study was done to compare the accuracy of root canal length in primary teeth .The study sample consisted of 20 extracted, single rooted primary teeth and working lengthmeasurements are obtained by tactile sensation, electronic apex locator, conventional film and digital radiography. Real canal length was obtained using stereo microscopic measurements.It was concluded that no statistically significant difference were seen between the techniques 5.
6.3 AIM & OBJECTIVES OF THE STUDY:
The aim of this study is to compare the working length in primary molars using computerized radiography and electronic apex locator.
To determine the working length in primary molars using electronic apex locator(Ipex) and computerized radiography(Vista Scan) during endodontic procedures
To compare the mean working length using both methods.
7 MATERIALS AND METHODS
7.1SOURCE OF DATA
The study will be conducted in children of age group 5-9 years attending Department of Pedodontics, M S Ramaiah dental College indicated for pulpectomy on primary molars from January 2013 to November 2014.
A comparative study to compare the working length using electronic apex locator and computerized radiography.
From literature review in a study by Neena IE et al it has been observed that the working length determination using digital radiography was 11.79 +1.7mm and using apex locator it was 11.98 +1.7mm.In the present study to get similar values for working length determination using the same methods,with 95% confidence,80% power and expecting the difference of 1.1mm between the two methods as clinically significant ,a sample size of minimum 38 canal measurements will be used for both the methods .
7.2METHOD OF DATA COLLECTION:
Step 1:ORAL EXAMINATION AND DIAGNOSIS
The first appointment will include intra oral examination, diagnosis and behavioural modification of the patient. A diagnostic intra oral periapical radiograph of the tooth will be taken using computerized radiography.Children will be selected according to the inclusion criteria after obtaining informed consentfrom the parents.
Children of age group of 5-9 yrs indicated for pulpectomy.
Teeth having adequate tooth structure and radiographically visible canals.
Children with special health care needs.
Primary molarsshowing signs of apical resorption.
Patients who are medically compromised.
The standard procedure for pulp therapy will be carried out in the consecutive appointment which will include local anesthesia administration, rubber dam isolation, caries excavation and access cavity preparation will be done using round bur under abundant water spray and pulp tissue will be removed and irrigated with sodium hypochlorite solution.
Step 3:USE OF APEX LOCATOR
The root canal length will be clinically determined with the help of electronic apex locator(Ipex).The file will be attached to the file holder and the lip holder will be attached to patient's lip.The file will advance till the device indicates that the apical constriction is reached and the working length will be estimated.
Step 4: RADIOGRAPHIC EXAMINATION
Measurement from preoperative radiographs will be taken using ISO15-20 number K- files with rubber markers, keeping them 0.5mm short of the root apex as in Ingle's method.Withthese measurements, files are inserted into canal and intra oral computerized radiograph will be taken and root canal length will be measured.
Step 5: STATISTICAL ANALYSIS:
The data obtained from step 3-4 will be tabulated on a master chart and subjected to statistical analysis. Descriptive statistics of working length determination could be analyzed and expressed in terms of mean and standard deviation.Independent t test could be used to compare the working length between computerized radiography and apex locator.
Does the study require any investigation or intervention to be conducted on patients or other human or animal? If so, specify briefly.
Yes, Informed consent will be obtained from the parent as a part for routine treatment plan. Consent to participate in the study will be separately obtained.
Has the ethical clearance been obtained from your institution in case of the above?
LIST OF REFERENCES:
Neena IE,Ananthraj A,Praveen P,Karthik V,Rani P. Comparision of digital radiography and apex locator with the conventional method in root length determination of primary teeth.J Indian Soc Pedod Prev Dent 2011;29:300-4.
Kqiku L,Stadtler P.Radiographic verses electronic rootcanal working length determination.Indian J Dent res 2011;22:777-80.
Lucineide de Melo Santos,Jose lvo Limeira dos Reis.Comparitive analysis of the electronic and radiographic determination of root canal length of primary molars-an ex vivo study.Braz J Oral Sci2009;8(4):189-92.
Goncalves Real et al.Accuracy of working length determination using 3 electronic apex locators an direct digital radography.Oral surg OralMed Oral Pathol Oral radiol Endod2011;111:e44-e49.
Subramaniam P,Konde S,Mandanna DK.An in vitro comparison of root canal measurement in primary teeth.J Indian Soc Pedod prev Dent 2005;23:124-5.
INFORMED CONSENT FORM
Title of the Topic:
WORKING LENGTH DETERMINATION IN PRIMARY MOLARS BY ELECTRONIC APEX LOCATOR AND COMPUTER RADIOGRAPHIC METHOD – A COMPARATIVE IN VIVO STUDY.
I ________________________ parent/guardian of ______________________ have been informed in detail about the proposed study by Dr ________________. I understand that information provided regarding the prescribed Endodontic procedure (Working length determination) is a part of the treatment of my child. Also, the information gathered will be kept confidential and used for academic purposes only. I have understood that I have the right to refuse my consent or withdraw it any time during the study without adversely affecting my treatment. I have been provided ample time to ask questions and I have clarified to my satisfaction
I, ____________________________ the undersigned, hereby give my consent to be a participant of this study.
Signature / thumb impression Signature of the doctor