Accuracy of electronic apex locators to detect root canal perforations with inserted metallic posts: an ex vivo study
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HEAD & FACE MEDICINE
RESEARCH
Open Access
Accuracy of electronic apex locators to detect root canal perforations with inserted metallic posts: an ex vivo study Benjamín Briseño Marroquín1,5*, Claudia Cortazar Fernández3, Irene Schmidtmann4, Brita Willershausen1 and Fernando Goldberg2
Abstract Introduction: The detection of possible root canal perforations caused during a metal post placement is frequently difficult to diagnose. The aim of this study was to investigate the accuracy of apex locators to diagnose such perforations. Materials and methods: Thirty mesiolingual root canals of extracted mandibular molars were instrumented (30/.04) and a post space was prepared. A root canal perforation was intentionally made at the bi-furcation (n = 15). Metal posts were cemented in 15 perforated and 15 non-perforated root canals. The teeth roots were embedded in an agar-agar solution. The resulting measurements (“short” or “beyond” the apex) disclosed if a perforation could be identified with five different apex locators (ProPex II, Elements Apex Locator, Apex NRG, Raypex 5 and Raypex 6). The sensitivity and specificity (95% interval confidence) were calculated. Results: All devices excluded the absence of perforations (100% with 95% confidence interval [78%; 100%] specificity). The Apex NRG and Raypex 6 detected all perforations (100% with 95% confidence interval [78%; 100%] sensitivity). The ProPex II, Elements Apex Locator, and Raypex 5 detected 14 out of 15 perforations (93% with 95% confidence interval [68%; 100%] sensitivity). Conclusions: All devices determined root canal perforations, due to metallic posts, within clinical acceptable ranges. Keywords: Root perforation, Metal post, Diagnosis, Apex locators
Introduction Despite technological advancements in endodontic techniques, endodontic mishaps such as root perforations during access preparation, root canal instrumentation, or preparation for post space are not unusual [1,2]. Root perforations compromise the success of endodontic therapy and have been regarded as, and probably are still, one of the most unpleasant accidents to deal with during re-treatment [3,4]. Occasionally, a clinician will be challenged with the fact that a radiological diagnose of patient with non-acute clinical symptomatology shows that * Correspondence: [email protected] 1 Department of Operative Dentistry, Johannes Gutenberg University Medical Center, Mainz, Germany 5 Poliklinik für Zahnerhaltung, Langenbeckstr. 1, Mainz 55131, Germany Full list of author information is available at the end of the article
the tooth has been previously endodontically treated, a post has been placed and the crown restored without evidence of a root perforation caused during the post insertion. A root perforation is defined as an artificial opening in the tooth crown or root area creating a communication between the root canal system with the periodontal tissues or oral cavity [5]. Iatrogenic root perforations are frequently caused by inappropriate post space preparation and have been classified as o
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