Comparative evaluation of three electronic apex locators in determining working length: An in-vitro study

Volume 13 , Issue 1 , April 2026 , Pages 20-27

Authors

Adil Othman Abdullah 1 ; Aso Muhamad Abdulkarem 2 ; Zana Adbulrahman Hamadameen 2

1 1. Department of Dental Assistant, Erbil Technical Medical Institute, Erbil Polytechnic University, Erbil 44001, Iraq , 2. Department of Endodontics, Faculty of Dentistry, Tishk International University, Erbil, 44001, Iraq

2 Department of Dental Assistant, Erbil Technical Medical Institute, Erbil Polytechnic University, Erbil 44001, Iraq.

DOI logo 10.17656/sdj.10218

Keywords

Abstract

Objective: The purpose of this in-vitro study was to determine the precision of three electronic apex locators (AppleDent AL, Eighteeth AL, and Coxo AL) in determining the working length (WL) of root canals using extracted human teeth. Although several new apex locator models have recently become commercially available, independent evidence regarding their measurement accuracy remains limited, underscoring the need for objective evaluation.

Methods: A total of 90 freshly extracted human permanent single-rooted teeth with mature apices were standardized. Access cavities were prepared and canal patency was controlled (with a 10 K file) and AWL (with size 15 K file at ×25 magnification) were detected by the stereomicroscope. After embedding them in alginate to recreate the periodontium, teeth were randomly divided into 3 groups (n = 30). The average of 3 repeated measurements was used for the calculation of the EWL in each group. The value of AWL and EWL have been calculated. The accuracy was measured under ±0.5 mm and ±1.0 mm. Data were statistically treated with Shapiro-Wilk test (to assess data normality), Levene´s test, one-way ANOVA and Tukey's post hoc testing (α = 0.05).

Results: In comparison with Eighteeth AL (0.41 ± 0.27 mm), the mean deviations of AppleDent AL and Coxo AL from AWL were by a lower level (by 0.24 ± 0.58 mm and by 0.24 ± 0.33 mm, respectively). Precision within ±0.5 mm was 50.0%, 86.7%, and 73.3% for AppleDent, Coxo, and Eighteeth models, respectively. All devices achieved a 90% or greater accuracy within ±1.0 mm. The ANOVA analysis confirmed that Eighteeth was different from AppleDent and Coxo (p = 0.012), which the Tukey's test also confirmed.

Conclusions: All 3 electronic foramen locators showed clinical accuracy. Coxo AL performed far better, while AppleDent AL showed similar mean scores, but had higher variability, and Eighteeth overestimated the working length.

پوختە

پوختە

ئامانجەکان: ئامانجی ئەم توێژینەوەیە بەراوردکردنی ئامێری پشکنینی درێژی ڕەگی ددانی هەمیشەیی بوو، بە بەکارهێنانی سێ جۆری جیاوازی ئەپێکس لۆکەیتەر بەناوەکانی:

 AppleDent AL)، Eighteeth AL، (Coxo  AL لە دیاریکردنی درێژی ڕەگی ددان (WL) بە بەکارهێنانی ددانی کێشراوی هەمیشەیی مرۆڤ. چەندین جۆری نوێی ئامێری بازرگانی دیاریکردنی درێژی ڕەگی ددان بەردەستن، بەڵام بەڵگەی تەواوی زانستی سەبارەت بە وردی پێوانەکانیان سنووردارە، ئەمەش جەخت لەسەر پێویستی هەڵسەنگاندنی بابەتیانە دەکاتەوە.

ڕێگاکان: سەرجەم ٩٠ ددانی تاک ڕەگی هەمیشەیی مرۆڤی تازە کێشراو کە سەرەڕەگی )لووتکەی ( پێگەیشتوویان هەبوو ستاندارد کران. بۆشایی ناو ڕەگی ددانەکان پاککرایەوە و دەرچەی کەناڵەکان ئامادەکرا بە فایلی جۆری 10 K و AWL بە فایلێکی قەبارەی 15 K بە گەورەکردنی ×25 بە بەکارهێنانی ستێریۆ مایکرۆسکۆپ دەستنیشانکرا. دوای جێگیرکردنیان لە ئەڵجینەیتدا بۆ دووبارە دروستکردنەوەی دەوروبەری ددان، ددانەکان بە شێوەیەکی هەڕەمەکی دابەشکران بۆ ٣ گروپ

، (n = 30) تێکڕای سێ جار پێوانەکردن بۆ هەژمارکردنی EWL لە هەر گروپێکدا بەکارهێنرا. بەهای AWL و EWL پێوانەی بۆکرا .وردییەکەی لە ژێر ±0.5 ملم و ±1.0 ملم پێوانە کرا. داتاکان شیکاریی ئاماری بۆ ئەنجام درابە تاقیکردنەوەی  Shapiro-Wilk Test )بۆهەڵسەنگاندنی ئاساییبوونی داتاکان( ، تاقیکردنەوەی Levene´s  test  و تاقیکردنەوەی One-way ANOVA  و Tukey's post-hoc testتێپەرین و ئاستی level of significant دیاریکرا لەسەر .(α = 0.05)

ئەنجامەکان   ئەنجامی خوێندنەوەی : Eighteeth AL    )  0.41    ± 0.27( ملم بەبەراورد لەگەڵ هەریەک لە ئامێرەکانی خوێندنەوەی دریژی ڕەگی ددان  AppleDent AL و Coxo AL بۆ  AWL  لادانی مامناوەندی هەبوو بە ئاستێکی نزمتر بۆ هەریەک لە دوو ئامێرەکانی پێشووتر بەدوای یەکدا ( 0.24 ± 0.58 ملم و  0.24 ± 0.33 ملم). وردیی ودققەت لە نێوان ±0.5 ملم بریتی بوو لە 50.0%، 86.7%، و 73.3%  بۆ مۆدێلەکانی Eighteeth AL، Coxo AL، AppleDent AL بەدوای یەکدا.  هەموو ئامێرەکان وردبینییەکی 90% یان زیاتریان هەبوو لە نێوان ±1.0 ملم. شیکارە زانستی یە ستاتیستیکی یەکان ANOVA و Tukey’s test پشتڕاستیان کردەوە کە Eighteeth AL جیاوازە لە AppleDent ALو  . (p=0.012) Coxo AL

دەرەئەنجامەکان:  هەر ٣ جۆری ئەلیکترۆنی ئەپێکس لۆکەیتەرەکان ووردی ودققەتی کلینیکییان نیشاندا لە دیاریکردنی درێژی ڕەگی ددان Coxo AL .  باشتر کارەکانی ئەنجامدا، لە کاتێکدا AppleDent AL  هەمان تێکرای ناوەندی نیشاندا، بەڵام گۆڕانکاری  لەخوێندنەوەی دریژی ڕەگی ددان زیاتر بەدیکرا. وە لە بەکارهێنانی جۆری Eighteeth AL دا زیاد خەمڵاندنی پێوانەکان بەدیکرا.

References

  1. Ricucci D, Langeland K. Apical limit of root canal instrumentation and obturation, part 2: A histological study. Int Endod J. 1998;31(6):394-409.
  2. Tsesis I, Blazer T, Ben-Izhack G, Taschieri S, Del Fabbro M, Corbella S, et al. The precision of electronic apex locators in working length determination: A systematic review and meta-analysis of the literature. J Endod. 2015;41(11):1818-23.
  3. Pirani C, Camilleri J. Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: A systematic review. Int Endod J. 2023;56 Suppl 3:436-54.
  4. Broon NJ, Palafox-Sánchez CA, Estrela C, Camarena DCS, Uribe M, Ceja I, et al. Analysis of electronic apex locators in human teeth diagnosed with apical periodontitis. Braz Dent J. 2019;30(6):550-4.
  5. Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in endodontics: A review. Int Endod J. 2015;48:3-15.
  6. Przesmycka A, Tomczyk J. Differentiation of root canal morphology: A review of the literature. Anthropol Rev. 2016;79(3):221-39.
  7. Mourão PS, Fernandes IB, Moreira LV, Machado GF, Falci SG, de Souza GM, et al. Conventional methods and electronic apical locator in determining working length in different primary teeth: Systematic review and meta-analysis of clinical studies. Evid Based Dent. 2025;26(2):116.
  8. Golkar S, Khademi A, Saatchi A, Ghorani A, Iranmanesh P. Factors influencing the accuracy of electronic apex locators: A scoping review. Dent Res J. 2025;22:26.
  9. Santhosh L, Raiththa P, Aswathanarayana S, Panchajanya S, Reddy JT, Susheela SR. Influence of root canal curvature on the accuracy of an electronic apex locator: An in vitro study. J Conserv Dent Endod. 2014;17(6):583-6.
  10. Jha P, Nikhil V, Raj S, Ravinder R, Mishra P. Accuracy of electronic apex locator in the presence of different irrigating solutions. Endodontology. 2021;33(4):232-6.
  11. Yolagiden M, Ersahan S, Suyun G, Bilgec E, Aydin C. Comparison of four electronic apex locators in detecting working length: An ex vivo study. J Contemp Dent Pract. 2018;19(12):1427-33.
  12. Mahmoud O, Awad Abdelmagied MH, Dandashi AH, Jasim BN, Tawfik Kayali HA, Al Shehadat S. Comparative evaluation of accuracy of different apex locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and periapical radiograph-In vitro study. Int J Dent. 2021;2021:5563426.
  13. Baruah Q, Sinha N, Singh B, Reddy PN, Baruah K, Augustine V. Comparative evaluation of accuracy of two electronic apex locators in the presence of contemporary irrigants: an in vitro study. J Int Soc Prev Community Dent. 2018;8(4):349-53.
  14. Monteiro Czornobay LF, de Oliveira Rocha A, Leite CC, Menezes Dos Anjos L, Ribeiro JS, Pacheco de Castro Henriques BA, et al. A global overview on electronic apex locator use from 1968 to 2023: a bibliometric analysis. J Endod. 2024;50(7):925-33.
  15. Abdullah AO. A survey of root canal treatment in Kurdish community: A pilot study. Polytech J. 2024;14(2):8.
  16. Mosleh H, Khazaei S, Razavian H, Vali A, Ziaei F. Electronic apex locator: A comprehensive literature review, part I: Different generations, comparison with other techniques and different usages. Dent Hypotheses. 2014;5(3):84-97.
  17. Dutlu D, Yilmaz A. Apex locators and apical resorption. Int Dent J. 2024;74:S310.
  18. Venturi M, Breschi L. A comparison between two electronic apex locators: an in vivo investigation. Int Endod J. 2005;38(1):36-45.
  19. Shirazi ZA, Saleh AR. Electronic apex locators and their implications in contemporary clinical practice: A review. Open Dent J. 2023;17(1):1-10.
  20. Mancini M, Palopoli P, Iorio L, Conte G, Cianconi L. Accuracy of an electronic apex locator in the retreatment of teeth obturated with plastic or cross-linked gutta-percha carrier-based materials: an ex vivo study. J Endod. 2014;40(12):2061-5.
  21. Chogle S, Zuaitar M, Sarkis R, Saadoun M, Mecham A, Zhao Y. The Recommendation of cone-beam computed tomography and its effect on endodontic diagnosis and treatment planning. J Endod. 2020;46(2):162-8.
  22. D'Assunção FL, Silva JR, Arnaud KC, Leite TB, dos Santos JP, de Almeida AC. Evaluation of the effect of irrigants on the accuracy and repeatability of three electronic apex locators: An ex vivo study. Res Soc Dev. 2021;10(3):1-8.
  23. de Morais AL, de Alencar AH, Estrela CR, Decurcio DA, Estrela C. Working length determination using cone-beam computed tomography, periapical radiography and electronic apex locator in teeth with apical periodontitis: A clinical study. Iran Endod J. 2016;11(3):164-8.
  24. Ahmad IA, Pani SC. Accuracy of electronic apex locators in primary teeth: a meta-analysis. Int Endod J. 2015;48(3):298-307.
  25. Khandewal D, Ballal NV, Saraswathi MV. Comparative evaluation of the accuracy of 2 electronic Apex locators with conventional radiography: An ex vivo study. J Endod. 2015;41(2):201-4.
  26. ElAyouti A, Dima E, Ohmer J, Sperl K, von Ohle C, Löst C. Consistency of apex locator function: a clinical study. J Endod. 2009;35(2):179-81.
  27. Çalışkan MK, Kaval ME, Tekin U. Clinical accuracy of two electronic apex locators in teeth with large periapical lesions. Int Endod J. 2014;47(10):920-5.
  28. D'Assunção FL, Silva JR, Arnaud KC, Leite TB, dos Santos JP, de Almeida AC. Comparative evaluation of the accuracy of electronic apex locator and digital radiography for working length determination in primary teeth: A systematic review. J Dent (Shiraz). 2024;25(13):203-14.
Statistics
  • Article view765
  • Downloads12
  • First online1 April 2026
  • Published at1 April 2026

  • RIS
  • BibTeX
  • EndNote
  • Mendeley
  • APA (7th edition)
  • MLA (9th edition)
  • Chicago
  • Harvard
  • IEEE
  • Vancouver