WORKING LENGTH

DETERMINATION
Prof. Promila Verma
Department Of Conservative Dentistry
&
Endodontics
 WORKING LENGTH
•Working length is defined as the
distance from a coronal reference
point to the point at which canal
preparation and obturation should
terminate
 ANATOMICAL CONSIDERATIONS

•Anatomic apex: it is defined as the tip or end of the

root determined morphologically.
•Radiographic apex: it is defined as the tip or end of the
root determined radiographicaly.
• Apical foramen (Major diameter): it is the main apical
opening of the root canal.it is frequently eccentrically
located away from the anatomic or radiographic apex.
•Apical constriction (Minor diameter):
• it is the apical portion of the root canal having the
narrowest diameter
• Cementodentinal Junction: it is the region where the
dentin and cementum are united. It is a histological
landmark and cannot be located clinically or
radiographically. The CDJ does not always coincide with
apical constriction and is located 0.5 -3mmshort of
anatomic apex
 METHODS OF WORKING LENGTH
DETERMINATION
RADIOGRAPHICAL METHOD NON RADIOGRAPHICAL METHOD
1.Grossman’s formula 1.Digital tactile sense
2. Ingles method 2.Apical periodontal sensitivity
3.Weine’s method 3.Paper point method
4.Radiovisiography 4.Electonic apex locator
5.Xeroradiography
 GROSSMAN’S METHOD
• CLT = KLI × ALT / ALI Where, CLT= correct length of the tooth
KLI= known length of the instrument in the tooth
ALT= apparent length of the tooth on radiograph
ALI= apparent length of the instrument on radiograph

A,The length of the tooth is measured on the diagnostic radiograph (schematic view).
B, This measurement is transferred to a diagnostic instrument prepared with a silicone stop, the instrument is placed in the root
canal, and a radiograph is made.
C and D, The root canal and working lengths are determined from the radiograph.
 INGLE’S METHOD
• Tooth length is measured in the pre operative radiograph

• 1 mm “safety allowance” is subtracted for possible image distortion

• the endodontic file is set at this tentative working length, and the instrument is inserted in
the canal
• on the radiograph the difference between the end of file and root end is measured and this
value is either subtracted or added to the initial working length measurement depending on
weather the file is shortof apex or extended beyond apex
• From this adjusted working length 1mm “ safety allowance” is subtracted again to confirm
with the apical termination of instrument
 WEINE’S MODIFICATION
A .If, radiographically, there is no resorption of the root end or bone, shorten the length by the
standard 1.0 mm.

B. If periapical bone resorption is apparent, shorten by 1.5 mm, and

C. if both root and bone resorption are apparent, shorten by 2.0 mm

 ELECTRONIC METHOD OF DETERMINING
WORKING LENGTH:
ELECTRONIC APEX LOCATORS

• With a apex locator the working length is determined by comparing the electrical resistance
of the periodontal membrane with that of gingiva surrounding the tooth, both of which should
be similar
• A probe , such as a file, is attached to an electronic instrument with an electric cord and is
inserted through the root canal until it contacts the surrounding PDL.
• When the probe touches the soft tissues of the PDL, the electrical resistance gauges for both
gingiva and PDL would have similar readings.
• By measuring the depth of insertion of the probe, one may determine the exact working
length of root canal
 CLASSIFICATION OF APEX LOCATORS

• First-generation apex locators – based on Resistance

• Second-generation apex locators – based on Impedance
• Third-generation apex locators – based on Frequency or comparative
impedence
• Fourth generation apex locator- measures resistance and capacitance
separately rather than the resulting
impedence
 FIRST GENERATION APEX LOCATOR

• First-generation apex locator devices, also known as resistance apex locators

• Measure opposition to the flow of direct current or resistance.
• When the tip of the reamer reaches the apex in the canal, the resistance value is
6.5 kilo-ohms (current 40 mA)
• often yield inaccurate results in presence of electrolytes, excessive moisture,
vital pulp tissue, exudates and blood
• Examples:
• Neosono apex locator
 SECOND GENERATION APEX LOCATOR

 Second-generation apex locators, also known as impedance apex locators

 measure opposition to the flow of alternating current or impedance

 Uses the electronic mechanism that the highest impedance is at the apical constriction where
impedance changes drastically

 Examples
 endocater,
 sono explorer,
 apex finder
 endoanalyzer
 THIRD GENERATION APEX LOCATOR

• Works on the principle of frequency or comparative impedence

• Examples: Endex,
• Root zx,
• Neosono
• Ultima Ez,
• Mark V plus,
 MULTIPLE FREQUENCYAPEX LOCATORS

• Uses two wavelength: one high (8kHz) and one

low(400Hz)
• They assess the apical terminus by the
simultaneous measurements of the impedence
of two different frequencies that are used to
calculate the quotient of the impedence
 NEW ADVANCEMENT ELECTRONIC APEX
LOCATORS
• Integration of the apex locators with the battery powered
endodontic slow speed hand piece.
• File start to automatically rotate the moment the
instruments is introduced in to the canal.
• If the preset torque level for the instruments is exceeded
then the hand piece automatically stops and reverse
rotation.
• The integrated apex locators stops the file rotation and
reverse the moment the file tip extends beyond the apical
 ADVANTAGES OF APEX LOCATOR

Devices are mobile, light weight and easy to use

Much less time required
Additional radiation to the patient can be reduced
(particularly useful in cases of pregnancy)
80 - 97 % accuracy observed
 DISADVANTAGES OF APEX LOCATORS

• Accuracy limited to mature root apices

• Extensive periapical lesion can give faulty readings

• Weak batteries can affect accuracy

• Can interfere with functioning of artificial cardiac

pacemakers – cuatious use in such patients
 XERORADIOGRAPHY
• Xeroradiography – an electrostatic imaging system that uses a uniformly charged x-ray
sensitive selenium alloy photoreceptor plate in a light-proof cassette.

Advantages:
1.Produces image of superior quality – edge enhancement property and sharper contrast
2.Radiation levels are reduced to only 1/3rd
3.Rapid – require only 20 sec to produce a permanent dry image

Disadvantages:
1.Large areas of bone > 2 cm are shown better with conventional intra
oral film technique than with xeroradiography
2.Greater degree of artefacts than in conventional technique
 DIGITAL TACTILE SENSE

Although it may appear to be very simple, its accuracy depends on sufficient

experience.

Confirmation may be done either by the radiographic or electronic method.

If the coronal portion of the canal is not constricted, an experienced clinician may
detect an increase in resistance as the file approaches the apical 2 to 3 mm.

Tactile sensation, although useful in experienced hands, has many limitations.

The anatomical variations in apical constriction, location of apical constriction, tooth

size, tooth type, age make working length assessment unreliable.
 APICAL PERIODONTAL SENSITIVITY

• Based on patient’s pain perception

• Any method of working length determination, based on the patient’s

response to pain, does not meet the ideal method of determining WL
 PAPER POINT METHOD

 In a root canal with an immature (wide open) apex, the most reliable means of determining
WL is to gently pass the blunt end of a paper point into the canal after profound anesthesia

 The moisture or blood on the portion of the paper point that passes beyond the apex - an
estimation of WL or the junction between the root apex and the bone.

This method, however, may give unreliable data

• If the pulp not completely removed
• If the tooth – pulpless but a periapical
lesion rich in blood supply present
• If paper point – left in canal for a long time
 REFERENCE POINT

•The reference point is the site on the occlusal

or incisal surface from which measurements
are made. This point is used throughout
canal preparation and obturation.
 SELECTION
• A reference point is chosen that is stable and
easily visualized during preparation. Usually
this is the highest point on the incisal edge on
anterior teeth and a buccal cusp tip on
posterior teeth. The same reference point is
best used for all canals in multirooted teeth.
The mesiobuccal cusp tip is preferred in
 STABILITY
• A reference point that will not change during or
between appointments is selected. If it is
necessary to use an undermined cusp, it should
be reduced considerably before access
preparation. Areas other than cusp tips, such as
marginal ridges or the floor of the chamber, are
unreliable or difficult to visualize.
• Do not use weakened enamel
walls or diagonal lines of
fracture as a reference site for
length-of-tooth measurement.

• B, Weakened cusps or incisal

edges are reduced to a well-
supported tooth structure.

• Diagonal surfaces should be

flattened to give an accurate
site of reference
 DETERMINATION OF WORKING LENGTH BY
RADIOGRAPHIC METHODS

1.Good, undistorted, preoperative radiographs showing the total length and all
roots of the involved tooth.
2.Adequate coronal access to all canals.
3.An endodontic millimeter ruler.
4. Working knowledge of the average length of all of the teeth.
5. A definite, repeatable plane of reference to an anatomic landmark on the tooth, a
fact that should be noted on the patient’s record.
 ESTIMATED WORKING LENGTH

• The diagnostic film,

which is made using a
paralleling technique, is
measured from the
reference point to the
apex with a millimeter
endodontic ruler.
• A, Initial measurement.
• The tooth is measured on a good preoperative
radiograph using the long cone technique.
• In this case, the tooth appears to be 23 mm
long on the radiograph.
• Subtract at least” 1.0 mm “safety allowance”
for possible image distortion or magnification.
. Set the endodontic ruler at this tentative
working length and adjust the stop on the
instrument at that level
• BTentative working length.
•
• As a safety factor, allowing for image
distortion or magnification,subtract at least 1
mm from the initial measurement for a
tentative working length of 22 mm.
• . Place the instrument in
the canal until the stop
is at the plane of
reference , the
instrument is left at that
level and the rubber
stop readjusted to this
new point of reference.

• 5. Expose, develop, and

clear the radiograph.
• C, Final working length.
• The instrument is inserted into the tooth to this length and
a radiograph is taken.

• RADIOGRAPH SHOWS
• That the image of the instrument appears to be 1.5 mm
from the radiographic end of the root. This is added to the
tentative working length,giving a total length of 23.5 mm.
• From this, subtract 1.0 mm as adjustment for apical
termination short of the cementodentinal junction. The
final working length is 22.5 mm.
• 6. On the radiograph, measure
the difference between the end
of the instrument and the end
of the root and add this
amount to the original
measured length the
instrument extended into the
tooth If, through some
oversight, the exploring
instrument has gone beyond
the apex, subtract this
difference.
• From this adjusted length of tooth, subtract a 1.0 mm
“safety factor” to conform with the apical termination
of the root canal at the apical constriction.
• If there is root resorption, the apical constriction is
probably destroyed—hence the shorter move back up
the canal.

• 8. Set the endodontic ruler at this new corrected

length and readjust the stop on the exploring
instrument
• D, Setting instruments.
• The final working length
• of 22.5 mm is used to set stops on instruments
used to enlarge the root canal.
• Because of the possibility of radiographic distortion,
sharply curving roots, and operator measuring error, a
confirmatory radiograph of the adjusted length is
highly desirable.

• 10. When the length of the tooth has been accurately

confirmed, reset the endodontic ruler at this
measurement.
 . Record this final working length and the coronal point
• 11

of reference on the patient’s record.

• 12. Once again, it is important to emphasize that the final

working length may shorten by as much as 1 mm as a curved
canal is straightened out by instrumentation. It is therefore
recommended that the “length of the tooth” in a curved
canal be reconfirmed after instrumentation is completed.
 SUMMARY AND CONCLUSION

• The cementodentinal junction or minor diameter is a practical and anatomic

termination point for the preparation and obturation of the root canal – and this
cannot be determined radiographicaly.

• Modern apex locators can determine this position with accuracies greater than 90%
but with some limitations.

• No individual method is truly satisfactory in determining endodontic working length.

• Therefore, combination of methods should be used to assess the accurate working

length determination
•

THANK YOU