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ABSTRACT

OBJECTIVE: To compare the accuracy of digital radiography method for root canal working length determination compared with actual root canal length in patients presenting at Isra University Hospital Hyderabad.STUDY DESIGN: A Cross sectional comparative study

thPLACE AND DURATION: At Operative Department/College of Dentistry Isra University, Hyderabad. Study duration was from 13 thAugust 2012 to 13 August 2013.

METHODOLOGY: A total fifty patients of either gender who were advised extractions of teeth for orthodontics or any other reasons were selected. The access opening was performed, after which a stainless steel wire was inserted in the canal. The Digora system and aid of a device were used and all digital radiographs were taken by the paralleling technique. The radiographic images were sent and saved in a computer and working length was calibrated according to the Bregman's formula. The included teeth were extracted. The root canal endodontic file was inserted into the root canal and visibility of tip of the file was checked at the apical foramen and actual working length was determined.RESULTS: Among total of fifty patients, the mean difference between the calibrated working length and actual length was measured for each tooth. The mean difference was .030 mm with the standard deviation of ±1.29524. There was an insignificant difference between the two groups (p=.871) with the confidence level of 95%. CONCLUSION: There is an insignificant difference between digital radiographic working length by Bregman's method and actual working length of root canal of teeth. KEY WORDS: Root canal treatment, digital radiographic working length, actual working length, Digora system, parallelism technique

HOW TO CITE THIS:Iqbal Z, Zaighum M, Comparision of Digital Radiographic Method in Determination of working length in Vivo to the actual working Length Ex Vivo after Extraction. Isra Med J. 2017;9(2):71-74

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 9 - Issue 2 | Mar - Apr 2017

INTRODUCTION

The success of root canal therapy depends upon the proper 1execution of the steps involved in the treatment. From the

removal of all the affected pulp tissue and microorganisms, thorough mechanical instrumentation and irrigation of the root

2 canal is mandatory to achieve the desired results mentioned.These objectives are achieved when the termination of root

3canal is determined accurately.Researcher suggested that on average, the pulp periodontium

4junction is 0.50 to 0.75 mm coronal to the apical foramen. Short instrumentation and obturation of the root canal system from the cementodentinal junction doesn't remove bacteria in this complex and critical space that leads to failure of

endodontic treatment subsequently. In contrast, overinstrumentation and obturation due to long working length measurement beyond the cementodentinal junction will damage the anatomy of the root end. So it is difficult to obtain an apical seal and keep and limit the root canal filling material

5within the tooth. Therefore it is important to accurately 6determine this point for the success of endodontic therapy.

Radiographic method for canal length determination has been there for decades. Radiographic method is one of the most reliable and common method used for working length

7determination. Direct digital radiography (DDR) is the recent development that made it possible to make additive multiple

8point (click) measurements of onscreen images. By using DDR the hazards and problems related to conventional radiography

9can be avoided.Previously study was conducted to compare the difference in interpretation of the position of endodontic file tips between two radiographic imaging systems and found that difference was present between tip of the file and root apex with digital radiograph so digital radiographic method is more perfect and

10accurate to determine length of trial file. The practitioner may get benefit by using digital imaging system for determining positions of file during root canal procedures. All these studies mentioned above provide the evidence that to overcome the limitations that are associated with conventional radiography

Comparision of Digital Radiographic Method in Determination of WorkingLength in Vivo to the Actual Working Length ex Vivo after Extraction

1 2Zahid Iqbal , Madiha Zaighum

1. Associate Professor of Operative Dentistry2. Lecturer of Operative Dentistry College of Dentistry, Isra University Hyderabad

Correspondence to:Zahid IqbalAssociate Professor of Operative DentistryCollege of Dentistry, Isra University HyderabadEmail.zahidig@hotmail.com

Received for Publication: 18-08-16Accepted for Publication: 30-04-17

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radiographic methods were compared with the AWL. Bregman's formula CLT = KLI × ALT/ ALIThis states that ALT and ALI are, respectively, the apparent lengths of the tooth and instrument in the radiograph, KLI is the known length of the actual instrument and CLT is the correct length of the tooth. Statistical package for social sciences (SPSS 20) was used to calculate the mean age, frequency of teeth and gender distribution. Mean of radiographic and actual working length with standard deviation was calculated. Paired t-test was applied to calculate the mean difference between the radiographic working length and actual working with 0.05 level of significance at 95% of confidence interval.

RESULTS

Total of fifty patients took part in the study, twenty four patients (48%) were female and twenty six (52%) were male. (Fig - 1)

The mean of the age of the patients was 42 years with standard deviation of ± 8.80.Out of 50 teeth, 29 were incisors, 11 were canines and 10 were pre-molars. Teeth with completely formed mature roots were included in this study. • The mean value for calibrated working length was 21.06 ±

2.29 while that of actual working length was 21.09 ± 2.217.(Table - I)

• The mean difference between the calibrated working length and actual length was .030 mm respectively. This difference was statistically insignificant (p=.871).(Table - I)

the need of digital radiography is increasing therefore studies in vivo are required to support the accuracy and reliability of digital radiography in working length determination. We conducted this study to compare the accuracy of digital radiography method for root canal working length determination compared with actual root canal length in patients presenting at Isra University Hospital Hyderabad.

METHODOLOGY

The cross sectional comparative study was conducted at the Department of Operative Dentistry/College of Dentistry Isra

th thUniversity, Hyderabad Pakistan from 13 August 2012 to 13 August 2013. The objective was to observe the accuracy of digital radiographic method for root canal working length determination compared with actual root canal length. The patients who were advised extraction of mature teeth for orthodontics or any other reasons were selected.The ethical review committee granted ethical consent prior to initiation of the study. The fifty patients were selected as follows. All the patients of both gender and age 16 to 65 years were included. The patients that presented with immature open apices, calcified root canal system and apical root resorption were not included in the study. An informed consent was taken from every patient. Pre-operative intra oral peri-apical radiograph was obtained. Endodontic access was made and canals were identified with endodontic explorer. After identifying the canals, a stainless steel wire of 0.6 mm diameter with the length of 10 mm was placed in the root canal.The digital images were obtained by the paralleling technique with the aid of a XCP rinn positioning device and using Digora system (Orion Corporation Soredex, Helsinki, Finland).. The digital images were calibrated for working length

11determination according to the Bregman's formula with the help of "Pro Image" software, and then the measurements were recorded. The teeth were extracted and all organic tissue remnants were removed by placing teeth in 5.25% sodium hypochlorite solution for 10 minutes. After which the teeth were viewed for actual working length by inserting a file (ISO 15# K) up to the point where it is visible through the apical foramen. The reference point was established by placing a stopper. The root canal length was measured and the working length was determined by reducing 0.5 mm from the root canal length. These measurements were recorded as actual working length (AWL).The radiographic working lengths obtained by

FIGURE - 1: GENDER DISTRIBUTION OF PATIENTS (N=50)

TABLE- I: DESCRIPTIVE STATISTICS MEAN AND STANDARD DEVIATION FOR CALIBRATED AND ACTUAL WORKING LENGTHDETERMINATION AND MEAN DIFFERENCE BETWEEN CALIBRATED AND ACTUAL WORKING LENGTH. (N = 50)

Paired t-test applied t-value = .164 p >0.05

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DISCUSSION

The biomechanical preparation and resultant obturation of the root canal system upto the accurate working length of root canal

12is very important in endodontic procedures. In this in vivo and ex vivo study we evaluated the accuracy of the radiographic method in working length determination with the actual length of the tooth. In this study we evaluated 50 teeth for working length in vivo by using digital radiography and the calibrated the recorded images and compared it with that of the actual working length in vitro. An insignificant difference .030 mm (p =.871) was found between the calibrated radiographic working length and the actual working length of the teeth.These findings were in accordance with studies of Javidi's in 2006 who compared digital and conventional radiography for working length determination and found it to be reliable

13method of working length determination. Mentes in 2002 used direct digital radiography for working length determination and compared it to the actual length and

14reported favorable outcome in curved canals. MohtaviPour reported similar results in his study on the working length determination in curve canals with digital radiography and also found that there is an insignificant difference (p˃0.05) between

15radiographic and actual working length.In the present study software was used to calibrate the radiographic image for working length according to Bregmans method to increase the accuracy of the radiographic working length determination. Schmitd, et al in 2008 compared conventional radiographic working length measurements with indirect digital imaging working length method during root canal treatment and concluded that digital imaging has high

16accuracy in determining the working length. Sanabe et al in 2009 studied the conventional versus digital radiography and found that the digital measurements with calibrations are more accurate measurements than uncalibrated measurements and

17result of study is consistent with the present study.The higher resolution of images can be obtained due to recent

18 19advances in sensor technology. In the present study PSP sensor was used to record the image which is proved to have higher image resolution then other sensor systems. The reliable endodontic working length measurements in relation to the visibility of endodontic root canal files and root apices at different exposures even at very low exposures can be obtained

20by the Digora intraoral image plate system (Soredex) because PSP sensors have increased dynamic range. Previously two PSP systems and radiographic film were compared in order to find out difference between file tip and root apex and they found a smaller difference between root canal file tip and root apex with digital radiographic technique, so it can be suggest that digital radiographic method is more accurate to assess length of trial file. The practitioner may get benefit for determining positions of root canal file during root canal procedures by using this

21digital imaging system.As any other previous study, this present study has some limitations. This study was a clinical study and the ideal patient positioning during working length radiographs was not always

possible and it was limited to get absolute reproducibility. The study does not have histological examinations so comparison with actual anatomical structures cannot be made. The quality of image has variations from one patient to another. Therefore, it is difficult to achieve the proper image because radiograph is a two dimensional, the radiographic working length determination should be combined with other methods of working length determination rather using it alone.

CONCLUSION

With all the limitations of this study, it can be concluded that combination of digital radiograph and Bregman's method may be a reliable method for working length determination. There is an insignificant difference between digital radiographic working length and actual working length.

Contributions of authors:Iqbal Z: Conceived Idea, Designed Methodology, Manuscript Writing.Zaighum M: Data Collection, Literature Review, Data Interpretation.

Disclaimer: None.Conflict of Interest: None.Source of Funding: None.

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