Int J. Odontostomat, 8 (2)..

: 177-183,
2014.

Determination of the working length in Endodontics. Clinical

implications Anatomy Root and Root Canal System

Working Length Determination in Endodontics. Clinical Issues

of Dental Root Canal and Root Systems Morphology

Cynthia Rodriguez-Niklitschek *, ** V & Gonzalo H. Oporto. ***, ****

RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Determination of the working length in endodontics. Clinical implications of root anatomy and root canal
system. Int J. Odontostomat, 8 (2)..: 177-183, 2014.

SUMMARY: Endodontics studies the morphology and physiology of the canal system of a tooth. Its main objective is to prevent pulp and periodontal injuries and treating already installed.

Determining the working length is one of the most important stages of endodontic treatment. Inaccuracies in this process may favor the occurrence of accidents and postoperative complications. This
literature review describes the importance of dental anatomy applied to endodontics and study in each population, as well as presenting the main techniques to determine the working length. The working
length limits the preparation and obturation of the root canal. This limit should be the apical constriction. Various determination methods have been used, where apex locators use turns out to be the most
reliable method. However, it is necessary to know the morphology of the channel system in this process. Benchmark root lengths worldwide were published by Ingle & Bakland. There are no studies to
determine the working length for each tooth in American population; Nor must determine the working length in patients with apical locators. Study and understand the root anatomy is a fundamental
requirement for successful endodontic treatment. It is expected that there are differences between classical anatomical descriptions teeth and dental anatomy of specific populations. The need arises to
determine parameters of normality in each population worldwide. It requires knowledge of the morphology of the channel system in this process. Benchmark root lengths worldwide were published by
Ingle & Bakland. There are no studies to determine the working length for each tooth in American population; Nor must determine the working length in patients with apical locators. Study and understand
the root anatomy is a fundamental requirement for successful endodontic treatment. It is expected that there are differences between classical anatomical descriptions teeth and dental anatomy of specific
populations. The need arises to determine parameters of normality in each population worldwide. It requires knowledge of the morphology of the channel system in this process. Benchmark root lengths
worldwide were published by Ingle & Bakland. There are no studies to determine the working length for each tooth in American population; Nor must determine the working length in patients with apical
locators. Study and understand the root anatomy is a fundamental requirement for successful endodontic treatment. It is expected that there are differences between classical anatomical descriptions
teeth and dental anatomy of specific populations. The need arises to determine parameters of normality in each population worldwide. Bakland. There are no studies to determine the working length for each tooth in American po

KEYWORDS: endodontic dental root canal treatment, pulp cavity dentine, tooth apex.

INTRODUCTION

Endodontics is a specialty of dentistry (recognized as such
by the American Dental Association in 1963) that studies the
structure, morphology and physiology of root dental cavities
coronal and containing the dental pulp and in turn, tries pathology
complex dentine-pulp and periapical region (Sources et al., 2012).
The aim is to prevent the root canal and pulpal lesions and treat
periodontal already installed, providing the dental substrate to
restore lost function and form through oral rehabilitation (Fuen-
tes et al.). For this it is necessary to perform a thorough mechanical
and chemical cleaning of the pulp chamber and root canal
complete system (Al-Qudah & Awawdeh, 2009; Chandra et al., 2011;
De Moor et al., 2004; Huang et al., 2010a; Jarad et al., 2011;
McDonald & Hovland, 1990) which, as prepared and disinfected,
they must be completely sealed with a material inert and
biocompatible filler. Then, the tooth must be properly sealed to
ensure coronal and prevent bacterial filtration (De Moor et al.).

*
Master's program in Dentistry, Faculty of Dentistry, University of La Frontera, Temuco, Chile
**
School of Dentistry, Department of Endodontics, Universidad Mayor in Temuco, Temuco, Chile.
***
Department of Comprehensive Dentistry Adults, Faculty of Dentistry, University of La Frontera, Temuco, Chile.
***
Center for Molecular Biology and Pharmacogenetics, Department of Basic Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile.

177
 RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Determination of the working length in endodontics. Clinical implications of anatomy and root system
root canals. Int J. Odontostomat, 8 (2)..: 177-183, 2014.
Endodontic therapy as such is the removal of the pulp
present in the tooth cavity cameral and root canals, disinfect and
forming said channels and then filling them with a biocompatible
material, in order to keep the tooth in the oral cavity (Fuentes et
al.). The endodontic procedure includes several steps: diagnosis,
trepanning and access to dental cavities pulp crown and roots,
determining the working length of the root canals (radiograph),
biomechanical instrumentation or chemi (IBM or IQM), conometry
and sealing radicular. Determining the working length is one of the
most important stages of endodontic treatment and is also one of
the preponderant steps in the successful therapy.
Study and understand fully the root anatomy is a
fundamental requirement for a successful endodontic treatment
(Abella et al., 2012). There are several authors who have studied
the root length of the different teeth (Ingle & Bakland, 2004;
Martinez, 1998). From these measurements was defined as the
ideal limit of sealing root canal should be 1 mm root tip (from
coronal to apical) (Fuentes et al.). The measurements obtained from
the aforementioned investigations are currently used as reference
measurements for performing endodontic treatment in many
countries; Most of these studies were developed in extracted teeth
and none of them American population. Moreover, there is no
research to determine the working length of root canals for
different teeth, but set only an anatomical measure root length and
the total length of each tooth.
Based on the above, the importance of knowing the clinical
implications that may have morphology and root canal system in
clinical practice of endodontics, especially in determining the
working length and shutter limit arises.
This research presents a review of the literature regarding
the clinical implications of tooth anatomy and root canal system in
the success of endodontic treatments.
178
Determination of the working length. One of the most important
stages and criticism of endodontic therapy is the Conductometry.
This procedure is intended to obtain a measure of length,
corresponding to "the distance from a coronal reference point to
the point where it ends the preparation and obturation of the root
canal" (Martinez). Determining a precise working length is one of
the most important procedures endodontic therapy, and is a key
factor for successful treatment (Özsezer et al.,
2007). Cleaning, shaping and filling root canal system can not be
achieved unless accurately determined accurately measure.
Establish a suitable length work is essential to carry out a
successful treatment; not initially obtained correctly, all subsequent
efforts in achieving treatment success may be unsuccessful
(Martinez). The erroneous determination of the working length
could result in too long a measurement and lead the preparation
beyond the apical constriction, causing about instrumentation and
on sealing. In turn, it could also lead to the formation to a point
before the apical constriction, resulting in insufficient cleaning and
root canal filling (Özsezer et al.). For its narrow shape, the apical
constriction provides a natural resistance to packaging the sealant
material and must be respected (McDonald & Hovland).
The Conductometry establishes the apical extent of
instrumentation and the last apical level of root canal obturation.
The preparation and root canal filling level must end the
cemento-enamel junction, confined within the root canal system
(Jarad et al .;
McDonald & Hovland). The cement-enamel junction is defined as
"the most apical dental pulp" (Martinez), and corresponds to the
point where there is no longer dentin and channel continues with
cement walls. The objective of determining a working length is to
prepare and obturate the nearest root canals this point, ideally at
the level of the apical constriction, area of the root canal having the
smaller diameter and is the point of attachment between the fabric
pulp and periodontal tissue (Jarad et al.). Cement- dentin bond may
or may not coincide with the apical constriction; the latter should be
the limit of the preparation and root filling. The location of the
apical constriction varies considerably and re-
 RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Determination of the working length in endodontics. Clinical implications of anatomy and root system
root canals. Int J. Odontostomat, 8 (2)..: 177-183, 2014.
tion with the cemento-enamel is also variable and may be up to 3
mm higher on one side of the channel, compared to the other.
Moreover, the cemento-enamel can not be identified clinically
(Somma et al., 2012). The apical constriction generally lies between
0.5 to 2 mm radiographic tooth apex (Jarad et al.), and studies
relate the position of the cemento-enamel and the apical
constriction, the latter showing coronal always the first (Somma et
al.).
Consequence of an erroneous determination of working
length. Inaccurate determination of the working length may favor
the occurrence of endodontic accidents such as drilling and on
apical sealing, which are usually accompanied by postoperative
pain. Moreover, the start of the periapical repair can be extended
over time, increasing the number of failures due to incomplete
regeneration of the periapical tissues. Another risk present in front
of a length of incorrect work is incomplete instrumentation and
poor root canal filling with all the problems it brings (exacerbation
of infection and symptoms, reinfection of the root canal, the
appearance of apical lesions, pain due to persistent inflammation
of pulp tissue not eliminated). Furthermore, a step may be formed
before the apex, which could preclude a successful retreat, if
necessary in the future. The bone, cementum and periodontal
ligament may become active elements with large spare capacity,
which makes them particularly suitable for the restoration of normal
level periapex anatomo-physiologic conditions (Martinez). This is
one reason why it is not advisable to invade beyond the apical
constriction to implement or seal root canals in order to keep this
intact with all its potential repair area. A finished root canal filling in
the apical constriction provides optimal conditions for repair with
minimal contact between the filler and the apical tissue, thereby
reducing tissue destruction, et al.).
Methods for determining the working length. Over the years, the
most common techniques to determine the length of work have
been the radiographic technique and tactile sensation
(McDonald & Hovland; Shanmugaraj et al., 2007), however, none
of the two techniques can determine the location of the apical
constriction (Özsezer et al .; Shanmugaraj et al.). The tactile
sensation is highly unspecific, even more root canals with
immature apex, with excessive curvature or that taper along its
entire length (Shanmugaraj et al.). Moreover, the only sure
information offered by the x is the location of the radiographic
apex, defined as the apical portion of the tooth on a radiograph
(Jarad et al.), which it is also determined by the interpretation that
gives the clinician (McDonald & Hovland; Shanmugaraj et al.). The
anatomical apex may or may not coincide with the apical foramen,
which is the area where the channel opens to the root surface
contacting the periodontal igamento l. Since the apical foramen
often not located in the radiographic apex but laterally to this, the
location of the file at this length would produce many times over
and over shutter instrumentation.
Often seen in radiographic conductometry the place where
the file out of the root when the apical foramen is tilted mesially or
distally, or when matches the anatomical apex. However, when the
foramen is in buccal or lingual direction, an overlap of the image
occurs with the apex, which can cause an error of radiographic
interpretation (Martinez). A study with extracted teeth determined
by measuring the root canals with limes placed to a given length by
the location of the radiographic apex, only 82% coincided with the
actual apical foramen (Olson et al.,
1991).
Currently, there are tools to obtain a measurement of the
length of more reliable work; One is the apex locator. The concept
of measuring the working length of root canals using a device
apical localization emerged in 1942, and was described by Suzuki
(Kqiku et al., 2011), whereas the electrical resistance between the
periodontal ligament and the oral mucosa was described by
Sunada 1962 (Jarad
et al .; Kqiku et al.).
The basic concept for all measuring devices electronic
length is based on human tissues have certain characteristics that
can be modeled by a combination of com-
179
 RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Determination of the working length in endodontics. Clinical implications of anatomy and root system
root canals. Int J. Odontostomat, 8 (2)..: 177-183, 2014.
electrical components. Therefore, by measuring the electrical,
such as resistance and impedance properties it may be possible to
detect the end of the root canal (Nekoofar et al.,
2006). The root canal system is surrounded by dentine and
cement, which are insulators of electric current. In the lower apical
foramen (where the apical constriction starts), the conductive
substances are within the cavity of the root canal (tissue fluid) are
electrically connected to the periodontal ligament which is itself a
conductor of electric current. Therefore, dentin, along with the
tissue and the fluid within the channel forms a resistance, whose
value depends on its size and its inherent strength.
When an endodontic file penetrates inside the channel and
approaches the lower apical foramen, the resistance between the
endodontic file and foramen decreases because the effective
length of the resistive material (dentine tissue fluid) decreases
(Nekoofar et al.). Thus, we have developed several electronic
media using a variety of other principles for detecting the end of
the root canal. Sunada determined that the electrical resistance
between an instrument playing the periodontal membrane (part)
and the oral mucosa (the other) was a constant value regardless of
the age of the patient, the diameter of the channel or form of the
teeth (McDonald & Hovland). Since this discovery, several
electronic apex locators have been introduced into the market.
While the simplest device used to measure resistance, other
devices can measure impedance using high frequency, two
frequencies, or several frequencies. In addition, some systems use
low oscillation frequency or a voltage (gradient method) to detect
the end of the channel. et al;
Kqiku et al.). Many of these locators proved extremely accurate in
dry canals, but its use was limited due to their lack of precision in
wet channels or presence of pulp tissue, blood or remains of
irrigants (Özsezer et al.). In these situations, such that the apex
locators recorded had been reached, when in fact the file tip
touched the solution which completed the electrical circuit
(McDonald & Hovland). Former apex locators emitted a mild
electrical current and measuring the resistance of fabrics to step
180
she. Current also emit a slight current, but alternate type and measure impedance
between the apical and buccal mucosa tissue. Resistance and impedance measure the
difficulty that electricity to pass through a material. In general, when power is continuous,
one speaks of resistance; If the current is AC, it speaks impedance. Soft tissue conduct
electricity with relative ease, however hard tissues tend to resist the passage of electric
current acting as insulation. Thus, if on the one hand we have an electrode placed on the
lip, ie, buccal mucosa, and secondly an electrode in the tooth to be examined, to activate
the locator system, we will pass a very small AC between the two electrodes. At the start,
touching with a file enamel and then the dentin, the impedance values are very high, but
when entering into the root canal and cross it (cervical third, middle third and apical
third), the impedance values will decreasing progressively. Finally, when the file through
the channel tap periodontal tissue, the values fall sharply as it will have closed the circuit
between the oral mucosa and periodontium. Thus, through the use of alternating current
and determining the impedance, you can determine the area where the root canal ends
and begin periapical tissues. middle third and apical third), the impedance values will
gradually diminish. Finally, when the file through the channel tap periodontal tissue, the
values fall sharply as it will have closed the circuit between the oral mucosa and
periodontium. Thus, through the use of alternating current and determining the
impedance, you can determine the area where the root canal ends and begin periapical
tissues. middle third and apical third), the impedance values will gradually diminish.
Finally, when the file through the channel tap periodontal tissue, the values fall sharply as
it will have closed the circuit between the oral mucosa and periodontium. Thus, through
the use of alternating current and determining the impedance, you can determine the
area where the root canal ends and begin periapical tissues.
Use apex locator has become commoditized in recent
years, especially with the introduction of locators third and fourth
generation. The third generation apex locators have more powerful
microprocessors and are able to process mathematical algorithms
calculating quotients and necessary to give accurate readings. The
fourth generation process information no impedance as a
mathematical algorithm, but taking the resistance and capacitance
separately and compared with a database to determine the
distance to the root apex (Özsezer et al.).
The apex locators based on multiple frequencies have
been developed to further increase the accuracy. They are based
on the concept of measuring the impedance characteristics with
more than two frequencies. Modern locators operate using
different frequencies, determining the ratio between the different
electrical potentials proportional to each impedance (Özsezer et
al.). They also have the advantage of not
 RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Determination of the working length in endodontics. Clinical implications of anatomy and root system
root canals. Int J. Odontostomat, 8 (2)..: 177-183, 2014.
need root canal dry before use, because they work in the presence
of electrolytes. An example of this generation is ProPex® apex
locators (Dentsply, Maillefer, Ballaigues, Switzerland). This
apparatus allows the measurement of the root canal in all
conditions (presence of sodium hypochlorite in the channel,
channel dry, wet channel, etc.), as a result of multifrequency
technology.
ProPex® operation is based on the same principle of the
other modern devices using multiple frequencies to determine the
length of the root canal; an important feature of ProPex® is that
the calculation is based on the signal energy, while the other apex
locators using the signal amplitude (Özsezer et al.).
Electronic apical locator eliminates many of the problems
associated with radiographic methods (Shanmugaraj et al.). Its
main advantage is that it can measure the length of the root canal
until the end of the cement-enamel junction. The development of
electronic devices for measuring root canal length has helped
make the evaluation of the working length more accurate and
predictable (Somma et al.). It is considered to be a quick and easy
method without exposure requirements x rays (except when the
radiograph is used to supplement, to confirm the extent of length
indicated by the apex locator). However, we must not forget that its
accuracy is influenced by electrical channel conditions and
inaccurate in very open apex teeth and calcified canals
(Shanmugaraj et al.). Moreover, the apex locators do not locate
precisely the apical constriction, but rather detect an area between
the lower apical foramen (apical constriction) and most apical
foramen (apical foramen) in clinical conditions (Somma et al.).
Radicular anatomy. Against all risks involved implementing a root
canal without a precise measurement of the working length of this,
it is important that the dentist knows fully tooth anatomy to be
treated and the possible anatomical variations (Al-Qudah &
Awawdeh; Huang et al., 2010b; Martinez).
Thus, understanding the root anatomy will help improve
treatment outcomes and is key to achieving successful endodontic
treatment (Abella et al.). In this regard, they are
Several authors have studied the length of the individual teeth;
Weine in 1991, conducted a study to determine the length of the
teeth in nine thousand cases. The average length was determined
from the cusp tip to the root apex. In 1987, Ingle and Taintor
conducted a study to determine the average, maximum and
minimum lengths of all the groups of teeth (Martinez). Ingle
subsequently published the root lengths of all human teeth, based
on the results of studies of various authors (Ingle & Bakland).
Currently, the average root length used as a reference for
endodontic treatment in Chile and other countries in the world, is
determined by the results obtained from these studies, most
developed extracted teeth and none of them made in South
American population. In turn, there are no studies to determine the
working length for each root canal, but the studies define the
length of each root, each tooth from a coronal end to the root apex.
Based on these measurements available, was set as consensus
working length for each root canal and root canal filling are limited
to a distant point of 1 mm to root apex (from coronal to apical)
(Fuentes et al.). It seems relevant to analyze this background,
especially considear that today, increasingly determining the
working length is performed using apex locators; It is paradoxical
that this consensus remain as accepted reference for a clinical
procedure and not reformulate these references are based on
studies of measurements on teeth requiring endodontic treatment,
where the working length is obtained with apex locators.
Projections. The proper determination of the working length is a
fundamental process in obtaining a favorable prognosis of
endodontic therapy. To achieve success in this procedure, you
must have a thorough knowledge of root morphology and canal
system on each tooth, and to describe the methods of obtaining
this measure and manage background as to what method reaches
a length of work relates to a clinically successful treatment.
It is known that dental anatomy, and
181
 RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Determination of the working length in endodontics. Clinical implications of anatomy and root system
root canals. Int J. Odontostomat, 8 (2)..: 177-183, 2014.

specifically root anatomy, it can change with according to the
population tested. To date, a number of studies have reported that
the root systems vary by ethnicity of the individual, and these
variations may be genetically determined (Al-Qudah et al .; Zhang et
al., 2011). Then, it is expected that there are differences between
classical anatomical descriptions teeth and dental anatomy of
specific populations around the world. Therefore, the need arises
to determine parameters atingentes normal to each population in
order to establish normal ranges in them and not presume the
Rhea-from studies
Lysates specific groups of people (Ingle &
Bakland) not necessarily be extrapolated to all individuals
worldwide.
Based on the statement, and any differences in tooth
anatomy and the system of channels that exist in the various
groups of people around the world, it seems necessary to open the
research field of dental morphology apl ICADA to clinical practice
of endodontics in American population, so as to provide new data
and increase success rates of these dental procedures, as well as
laying the groundwork for future research

RODRIGUEZ-Niklitschek, C. & OPORTO, VGH Working length determination in endodontics. Clinical issues of dental root systems and root canal morphology. Int J.
Odontostomat, 8 (2)..: 177-183, 2014.

ABSTRACT: Endodontics is a specialty dentistry concerned With the study of root canal morphology and physiology, pathologies Besides tr eating root canal system and Affecting periapical region. Determining

working length is one of the Most Important stages of endodontic therapy. In This process inaccuracies May Contribute to occurrence of accidents and postoperative pain. This literature review Develops The Importance of

studying dental anatomy applied to endodontics, as well as The Importance of performing research in field in Diverse Populations esta worldwide, and discuss the main techniques to determine working length. Limits of ro ot canal

obturation preparation and are working length by Given. This limit is the apical constriction. Several methods used to det ermine Have Been This, apex locators Where are the MOST reliable tool, it is however, Necessary to know

root canal system morphology in esta process. Referential teeth root lengths used nowadays in endodontics Were published by I ngle & Bakland. There are no studies Determining if teeth length in South American population, are

in agreement With Ingle's data, nor is there any research Determining working length apex locators With. In order to Achieve a successful endodontic therapy it is Necessary to know teeth root morphology as well as root canals

anatomy systems. It is expected to discover Differences Between Dental classical anatomical descriptions and dental morphology of specific Populations. There is a need to determine root canal system parameters of normality in

Populations worldwide. Referential teeth root lengths used nowadays in endodontics Were published by Ingle & Bakland. There are no studies Determining if teeth length in South American population, are in agreement With

Ingle's data, nor is there any research Determining working length apex locators With. In order to Achieve a successful endodontic therapy it i s Necessary to know teeth root morphology as well as root canals anatomy systems. It

is expected to discover Differences Between Dental classical anatomical descriptions and dental morphology of specific Populations. There is a need to determine root can al system parameters of normality in Populations

worldwide. Referential teeth root lengths used nowadays in endodontics Were published by Ingle & Bakland. There are no studies Determining if teeth length in South American population, are in agreement With Ingle's data, nor

is there any research Determining working length apex locators With. In order to Achieve a successful endodontic therapy it is Necessary to know teeth root morphology as well as root canals anatomy systems. It is expected to

discover Differences Between Dental classical anatomical descriptions and dental morphology of specific Populations. There is a need to determine root canal system parameters of normality in Populations worldwide. In order to Achieve a successful endodontic t

KEY WORDS: endodontics, root canal therapy, dental pulp cavity, tooth root, tooth apex.

in this area in various latitudes.

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CHILE

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