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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2025, vol. 31, issue4
Subject Area: Dental Medicine
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DOI: 10.5272/jimab.2025314.6516
Published online: 07 October 2025
Original article
J of IMAB. 2025 Oct-Dec;31(4):6516-6524
COMPARATIVE IN VIVO ASSESSMENT OF DIGITAL RADIOGRAPH SOFTWARE AND APEX LOCATOR FOR WORKING LENGTH DETERMINATION
Angela Gusiyska
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Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University Sofia, Bulgaria.
ABSTRACT:
Accurate determination of the working length (WL) is essential for the success of root canal treatment, ensuring proper cleaning, shaping, and obturation of the canal system while avoiding apical over-instrumentation or inadequate preparation. Usually, WL is determined using a combination of electrometric devices and periapical radiographs, yet the increasing availability of digital radiographic software offers new opportunities for more precise measurement. The aim of this study was to estimate the ability of the software Planmeca Romexis viewer (Planmeca Group, Helsinki, Finland) to measure WL on periapical digital radiographs, and to compare its performance with electrometric measurements obtained using an electronic apex locator. The WL was established under direct vision with a stereomicroscope. Periapical radiographs were taken under standardised conditions, and WL was measured digitally using the linear measurement tools of the Romexis software. Electrometric WL values were also recorded for each tooth. All values were statistically compared with the actual lengths to assess accuracy and consistency. The results demonstrated a strong correlation between electrometric measurements and the actual WL, with minimal deviations. The digital radiographic measurements using Planmeca Romexis also showed a high level of accuracy, though slightly less consistent than the electrometric method, particularly in cases with anatomical variations or radiographic superimposition.
Within the limitations of this in vitro study, electrometric and digital radiographic measurements proved reliable for WL determination. The Planmeca Romexis software can serve as a valuable adjunct in clinical practice, complementing electrometric methods in endodontic treatment.
Keywords: dental digital radiography, electromyography, endodontics, radiography, apical constriction, tooth apex,
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Please cite this article as: Gusiyska A. Comparative in vivo Assessment of Digital Radiograph Software and Apex Locator for Working Length Determination. J of IMAB. 2025 Oct-Dec;31(4):6516-6524. [Crossref - 10.5272/jimab.2025314.6516]
Correspondence to: Angela Gusiyska, Department of Conservative Dentistry, Medical University – Sofia; 1, Georgi Sofiyski Blvd., Sofia, Bulgaria; E-mail: gusiyska@yahoo.com
REFERENCES:
1. Bhagavatula P, Moore A, Rein L, Szabo A, Ibrahim M. Multi-state outcome analysis of treatment interventions after failure of non-surgical root canal treatment: a 13-year retrospective study. J Appl Oral Sci. 2021;29:e20201079.[PubMed]
2. Chang JW, Manigandan K, Samaranayake L, NandhaKumar C, AdhityaVasun P, Diji J, et al. Morphotypes of the apical constriction of maxillary molars: a micro-computed tomographic evaluation. Restor Dent Endod. 2022 Mar 24;47(2):e19. [PubMed]
3. Wu MK, Wesselink PR, Walton RE. Apical terminus location of root canal treatment procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(1):99-103. [PubMed]
4. Siqueira JF Jr. Microbial causes of endodontic flare-ups. Int Endod J. 2003;36(7):453-463.[PubMed]
5. Nogueira L, Amaral G, Silva E, Tinoco J, Alves F, Sassone LM. Bacterial Reduction in Oval-Shaped Root Canals After Different Irrigant Agitation Methods. Eur Endod J. 2021;6(1):110-116. [PubMed]
6. Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J. 2011;44(7):583-609. [PubMed]
7. Schäfer E, Diez C, Hoppe W, Tepel J. Roentgenographic investigation of frequency and degree of canal curvatures in human permanent teeth. J Endod. 2002;28(3):211-216. [PubMed]
8. Peters OA. Current challenges and concepts in the preparation of root canal systems: A review. J Endod. 2004;30(8):559-567.[PubMed]
9. Gordon MPJ, Chandler NP. Electronic apex locators. Int Endod J. 2004;37(7):425-437.[PubMed]
10. Ramezani M, Bolbolian M, Aliakbari M, Alizadeh A, Tofangchiha M, Faegh SM, et al. Accuracy of Three Types of Apex Locators versus Digital Periapical Radiography for Working Length Determination in Maxillary Premolars: An In Vitro Study. Clin Pract. 2022 Dec 12;12(6):1043-1053. – [PubMed]
11. Saha D, Mazumdar D, Biswas M, Chanani A, Das S. Comparative evaluation of efficacy in working length determination: Radiography versus Electronic apex locators using in vivo and ex vivo methods with stereomicroscope validation. J Conserv Dent Endod. 2024;27(8):790-794.[PubMed]
12. Kaur G, Thomas AR, Samson RS , Varghese E, Ponraj RR, Nagraj SK, et al. Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis. BMC Oral Health. 2024 May 4;24(1):532. [PubMed]
13. Bhagat E, Agnihotri Y, Das A, Das S, Panda S, Hota S. Accuracy of an Electronic Apex Locator (EAL) in Measuring the Working Length of Root Canals in Comparison With Radiographs: An In Vivo Study. Cureus. 2024;16(5):e60283. [PubMed]
14. Barakat RM, Almohareb RA, Alharbi AO, Alhazmi A, Alomar R. Comparative Accuracy and Reliability of Three Electronic Apex Locators in Determining the Apical Constriction of Molar Canals: A Micro-CT Evaluation. Journal of Clinical Medicine. 2024; 13(17):5199.[PubMed]
15. Vier FV, Figueiredo JAP. Internal apical resorption and its correlation with periapical lesion. Int Endod J. 2004;37(11):730-737.[PubMed]
16. Patel S, Kanagasingam S, Pitt Ford T. External cervical resorption: A review. J Endod. 2009; 35(5):616-625. [PubMed]
17. Vieyra JP, Casillas FC, Julieta AG. Comparison of Working Length Determination in Teeth with Vital Pulps with Digital Radiographs and Four Electronic Apex Locators. An In Vivo Study. On J Dent Oral Health. 2018 Dec;1(4):000516. [Crossref]
18. Eren I, Deniz Y. The usefulness of ultrasonography as a dynamic measurement system for visualizing root canal working length: an in vivo study. BMC Oral Health. 2024 Jul 16;24(1):801. [PubMed]
19. Çınar F, Üstün Y. Ex Vivo Evaluation of the Accuracy of 3 Electronic Apex Locators in Different Environments: A Micro-Computed Tomography Study. Eur Endod J. 2020;5(3):226-230. [PubMed]
20.Vianna ME, Horz HP, Gomes BPFA, Conrads G. In vivo evaluation of microbial reduction after chemo-mechanical preparation of human root canals containing necrotic pulp tissue. Int Endod J. 2006;39(6):484-492. [PubMed]
21. Donnermeyer D, Bürklein S, Dammaschke T, Schäfer E. Endodontic sealers based on calcium silicates: A systematic review. Odontology. 2019;107(4):421-436. [PubMed]
22. Dioguardi M, La Notte D, Sovereto D, et al. Exploring the Impact of Access Cavity Designs on Canal Orifice Localization and Debris Presence: A Scoping Review. Clin Exp Dent Res. 2024;10(6):e70013. [PubMed]
Received: 04 July 2025
Published online: 07 October 2025