NITHYA SAJEEV

 DEFINITION
 ANATOMY OF APICAL FORAMEN
 RADIOGRAPHIC LIMITATION
 LIMITATIONS OF RADIOGRAPHIC WORKING
LENGTH
 EMERGENCE OF ELECTRONIC APEX
LOCATORS
 MODE OF ACTION
 CLASSIFICATION AND GENERATIONS OF EAL
 OTHER USES OF APEX LOCATOR
 HOW TO USE EAL
 PRECAUTIONS TAKEN TO AVOID FALSE
READING
 CONCLUSION
 An electronic apex locator is an electronic
device used in endodontics to determine the
position of the apical constriction and thus
determine the length of the root canal space
 The minor apical foramen is a more consistent
anatomical feature that can be regarded as being
the narrowest portion of the canal system and thus
the preferred landmark for the apical end-point for
root canal treatment.
 The anatomy of the apical foramen changes with
age.
 The apical foramen is not always located at the
anatomical apex of the tooth. The foramen of the
root canal may be located to one side of the
anatomical apex, sometimes it is up to 2mm short
radiographic apex in 50%of roots.
 When the apical foramen exits to the side of the
root or in a buccal or lingual direction it becomes
difficult to view on the radiograph.

Dense bone and anatomical structures can make

the visualization of root canal files impossible by
obscuring the apex.

The superimposition of the zygomatic arch has been

shown to interfere radiographically with 20% of
maxillary first molar apices and 42% of second
molar apices.
The deposition of secondary dentine and cementum
can move the apical constriction further.
 Radiation exposure is always avoided in
pregnant women

 Its difficult to take radiograph in patients

having gag reflex.
 An electronic method for root length
determination was first investigated by
Custer(1918).
 The idea was revisited by Suzuki in 1942.
 Sunada in 1962 took these principles and
constructed a simple device that used direct
current to measure the canal length.
 In 1980s Kobayshi developed a third
generation EAL.
EALs functions by using the human body to
complete an electrical circuit. One side of the
apex locator’s circuit subsequently connected
to the oral mucosa through a lip clip and the
other side to a file. When the file is placed into
the root canal and advanced apically until its
tip touches periodontal tissue at the apex, the
electrical circuit is completed. The electrical
resistance of the EALs and the resistance
between the file and oral mucosa are now
equal, which results in the device indicating
that the apex has been reached.
When a circuit is complete (tissue is contacted by
the tip of the file), resistance decreases markedly
and current suddenly begins to flow.

Depending upon the devices, this sudden current

flow signalled by a beep, a buzzer, digital readout,
flashing light or pointer on screen display.

The electrical characteristic of the tooth structure

are measured and exact position of the instrument
in the tooth is determined.
Classification

The classification of apex locators was

given by Mc Donald (1992) based on

Type of current flow (operating

principle)

Opposition to the current flow and as

well as on number of current frequencies
involved.
 a. Depending upon type of current involved

Direct Original ohmmeters used by Suzuki and Sunada(1942)

current
Resistance Root canal meter(Onuki)
type  Sono explorer (Satelec)
Neosono-D, MC
Ultima EZ (Amadent)
Apex finder
Alternating Impedance Endocator uses 400 kHz
current type
Frequency Subtraction Endex/Apex(Osada) uses 1kHz and
type type 5kHz Neosono Ultima EZ(Amadent)
Ratio type 2 Root ZX uses 0.4kHz & 8
frequencies kHz
5 The AFA apex finder
frequencies (sybron) Elements
Diagnostic unit
b. Resistance type apex locators :
These apex locators has a built in resistance value of 6.5 kilo Ohms. The apex
locators are attached to the patient's lip on one side and the other side is
attached to the file. The file is then advanced into the canal until it touches the
periodontal tissue at the apex which then completes the circuit.

Apex locator Advantages Disadvantages

Resistance Easy to operate Requires a dry

type Uses K-type files environment
Digital readout There should be no caries
or defective restorations
Detects
Requires calibration
perforations Requires a lip clip with
Built in pulp tester good contact
Patient sensitivity
Perforations can give false
readings
Contraindicated in
patients with pacemakers
c. Impedance type apex locator : Operate on the principle that there is electrical
impedance across the walls of the root canal due to the presence of the
transparent dentin. The tooth exhibits increasing electrical impedance across
the walls of the root canal, which is greater apically than coronally. At the DCJ,
the level of impedance drops dramatically. The unit detects the sudden change
and indicates it on the analogue meter. To overcome the problem of a wet
environment, insulated probes are utilized.

Apex locator Advantages Disadvantages

Impedance type Operate in fluid Requires
environment calibration
Analogue Requires coated
meter probes
No patient No digital
sensitivity readout
Operated with Difficult to
RC Prep operat
No lip clip
Detect
bifurcated canals
Detect
peroration
d. Frequency dependant apex locators : it measures the impedance of tooth at two
different frequencies. In the coronal portion of the canal, the impedance difference
between the frequencies is constant. As the file advanced apically, the difference in the
impedance value begins to differ greatly with maximum differences at the apical area.

Apex locator Advantages Disadvantages

Frequency type Easy to operate Must calibrate
Operates in each canal
fluid Sensitive to
environment canal fluid level
Operates with Needs fully
RC prep charged battery
Low voltage
electrical output
Classification according to Generations of
EALs (Evolution of EALs) –

First Generation Electronic Apex Locators

 Measures opposition to the flow of direct

current or resistance.
 Found to be unreliable when compared with
radiographs.
Some of the apex locators were The Root Canal
Meter , the Dentometer and the Endo Radar.
Gave inaccurate readings in wet canals,
obstructed canals, in carious/ defective restorations,
in case of perforations and in patients with cardiac
pacemakers, metallic restorations.
Second Generation Electronic Apex Locators
(Impedance Type):
Operates on the principle that there is electrical impedance
across the wall of the root canal due to the presence of transparent
dentin.
Sono-Explorer, Sono-Explorer M-III, Endo Analyzer .
Disadvantages-
a) Electro-conductive materials gives inaccurate readings.
b) they required calibration and complicated calculations,
c) required coated probes instead of normal endodontic
instrument,
d) no digital readout was present and it was very difficult to
operate.
Third Generation Electronic Apex Locators (Frequency
dependent comparative impedance Type):
 multiple frequencies to determine the distance from the end of
the canal.
Apit or Endex/Apit –Endex . The device operates most
accurately when the canal is filled with electrolyte such as saline
or sodium hypochlorite. The disadvantage of this device needs
“reset” or “calibrated” for each canal.
The Root ZX - uses dual-frequency(8 kHz and 0.4 kHz) and
comparative impedance principle
4. Fourth Generation Electronic Apex Locators :
These are Ratio Type apex locators which determine the
impedance at five frequencies and have built in electronic pulp
tester.
These devices take the resistance and capacitance measurement
and compare them with a database to determine the distance to
the apex of the root canal.
Disadvantage
They need to perform in relatively dry or in partially dried
canals.
Fifth Generation Electronic Apex Locators (Dual Frequency
Ratio Type):
It measures the capacitance and resistance of the circuit
separately. It is supplied by diagnostic table that includes statistic
of the file. They have best accuracy in any root canal condition
(dry, wet, bleeding, saline, EDTA, NAOCL

The device provides with a digital read out, graphic illustration

and an audible signal. The built in pulp tester can be used to
access tooth vitality
6. Sixth Generation Electronic Apex Locators (Adaptive
Apex Locators):

The efficacy of 6th generation EALs in long term use yet

to be established.
Advantage
Eliminates the necessity of drying and moistening of
the canal.

Adaptive apex locators continuously define humidity of

the canal and immediately adapts to dry or wet canal.

This way it is possible to be used in dry or wet canals,

canals with blood or exudates.
Other uses of apex locators are-
To detect root perforations to clinically acceptable limits
Determine the location of root and pulpal floor perforations
To detect horizontal fractures
To confirm suspected periodontal or pulpal perforations
during pinhole preparation
Recognize any connection between the root canal &
periodontal membrane such as root fracture, cracks & internal or
external resorption.
Some have ability to detect vitality of the too.
HOW TO USE APEX LOCATORS

1. Analyze the root anatomy for curvature and

establish an estimated working length from the
pre operative radiograph.
2. The coronal aspect of the canal should be opened
or prepared to provide a straight line aspect or a
glide path to the apical aspect of the root canal.
3. Modern apex locators generally function well in
the presence of fluids and irrigants in the root
canal ,but prior to using the apex locator excess
irrigating fluids are removed from the access
cavity.
4. Once the lip hook and file holder are attached, in most cases a
size 15 or 20 file is advanced into the root canal unil the blue scale
on the apex locator reaches the “ apex and red triangle “ on the
screen of the root ZX. This indicates that the file is now at the
apical foramen.

5.A diagnostic radiograph is taken with the file at this length. If

the radiograph confirms the file to be at the apex this length is
effectively the “canal length”.

6. Since the apical constriction is on average 0.5mm from the

apical foramen, the working length is calculated by subtracting 0.5
mm from the canal length. The canal can now be prepared o the
working length.
Precautions taken in order to avoid
obtaining false reading.
1. The file of the locator should not contact metal crown
or filling.
2. There should not be any fluid contact between the
pulp chamber and the gingiva/periodontal tissues
either through leaky cervical filling or deep or
cervical caries , such an outside contact may cause
leakage of measuring current and inaccurate reading.
3. Generally the locator should be used in absence of
fluid in the canal .
4. Some newer models overcome this limitation eg.
ROOT ZX, ENDEX, PROPEX
5. As much of pulp tissue as possible should be removed prior to
using locator.

6. The largest file that will bind the apex should be used.

7. Too loose fitting instrument should be avoided.

8. Always except in unavoidable situation, the reading should be

confirmed in collaboration with radiographic findings.

9. EALs are ineffective in case of teeth with wide open apex as

obtaining correct reading is almost impossible.

10. EALs should be avoided in patients wearing pace makers.

Conclusion

No individual technique is truly satisfactory in determining

endodontic working length. Modern electronic apex locators
can determine this position with accuracies of greater than 90%
but still have some limitations. Knowledge of apical anatomy,
prudent use of radiographs and the correct use of an electronic
apex locators are user friendly, less time consuming and reliable
in most of the clinical situations. Though at this stage apex
locators cannot replace radiographs, but will definitely serve as
an effective adjuvant.