Original Article

Comparison of third generation versus fourth

generation electronic apex locators in detecting
apical constriction: An in vivo study
DV Swapna, Akash Krishna1, Anand C Patil2, Rashmi K, Veena S Pai, Ranjini MA
Department of Conservative Dentistry and Endodontics, Dayanandasagar College of Dental Sciences, Bengaluru, 1Department of
Endodontics and Cosmetic Dentistry, AL Rahba - (John Hopkins) SEHA - Hospital, Abu Dhabi, UAE, 2Department of Conservative Dentistry
and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India

Abstract
Aim: The aim of this in vivo study was to compare the accuracy of Root ZX and Raypex 5 in detecting minor diameter in human
permanent single-rooted teeth.
Materials and Methods: Thirty-one patients with completely formed single-rooted permanent teeth indicated for extraction
were selected for the study. Crown was flattened for stable reference point and access cavity prepared. Working length was
determined with both apex locators. A 15 K file adjusted to that reading was placed in the root canal and stabilized with
cement. The tooth was then extracted atraumatically. Following extraction apical 4 mm of root was shaved. The position
of the minor diameter in relation to the anatomic apex was recorded for each tooth under stereomicroscope at 10. The
efficiency of two electronic apex locators to determine the minor diameter was statistically analyzed using paired sample
t-test.
Results: The minor diameter was located within the limits of 0.5 mm in 96.6% of the samples with the Root ZX and 93.2% of
the samples with Raypex 5. The paired sample t-test showed no significant difference.
Conclusion: On analyzing the results of our study it can be concluded that Raypex 5 was as effective as Root ZX in determining
the minor diameter.
Keywords: Minor diameter; Raypex 5; Root Z X

INTRODUCTION
The exact location of the physiological root apex is a
prerequisite for the successful endodontic therapy. It is
imperative to completely clean and shape the canal in order
to prevent irritation to the periapical tissues.[1] Failure to
determine the proper working length can result in short
working length with tissue being left in the canal or a long
Address for correspondence:

Dr. D V Swapna, Department of Conservative Dentistry and

Endodontics, Dayanandasagar College of Dental Sciences,
Bengaluru - 560 078, Karnataka, India.
E-mail: drsapnadv@gmail.com
Date of submission : 26.03.2015
Review completed : 07.05.2015
Date of acceptance : 02.06.2015
Access this article online

working length, with possible sequelae of damage to the

periradicular tissues. This can result in patient discomfort,
reinfection and/or extrusion of irrigating solution beyond
the confines of the canal.[2,3]
Traditionally, the point of termination of endodontic
instrumentation and obturation has been determined by
digital tactile sense, apical periodontal sensitivity, paper
point measurement, and radiographic technique.[1]
However, among all these methods, none of them was singly
able to accurately determine the apical constriction. To
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DOI:
10.4103/0972-0707.159726

288

How to cite this article: Swapna DV, Krishna A, Patil AC,

Rashmi K, Pai VS, Ranjini MA. Comparison of third
generation versus fourth generation electronic apex locators in
detecting apical constriction: An in vivo study. J Conserv Dent
2015;18:288-91.

2015 Journal of Conservative Dentistry | Published by Wolters Kluwer - Medknow

Swapna, et al.: Comparative study on apex locators

date, radiographs are the most commonly used technique,

but they are subjected to distortion, magnification, lack
of three-dimensional representation, increased radiation
exposure to the patient, interpretation variability among
the different clinicians and is time-consuming.[4]
Apart from the above mentioned, radiograph has inherent
drawbacks when the apical portion of the canal is obscured
by anatomic structures, such as impacted teeth, tori,
zygomatic arch, excessive bone density, overlapping roots,
or shallow palatal vault. Electronic apex locator (EAL)
currently are being used to determine the working length
and is an important adjunct to radiographs which has
overcome its drawbacks.[5]
Since the introduction of first electronic apex locater by
Sunada, it has undergone lot of improvements. This has
led to a greater precision, fewer procedural errors, less
discomfort to the patient and faster case completion.[6]
Although many generations of EALs are available for use
in clinical practice, Root ZX has become the benchmark to
which other apex locators are compared. Root ZX has been
exhaustively tested for accuracy in vivo and in vitro. Root
ZX has shown 90-100% accuracy in determining the minor
apical foramen.[4]
As there are not enough clinical studies reported in the
literature regarding the accuracy of Raypex 5 in determining
the location of minor diameter, there arises a need to
compare the efficacy of newer EALs to the older ones.
The purpose of this study was to evaluate in vivo accuracy
of Raypex 5 and compare it with Root ZX in detecting the
minor apical foramen.

MATERIALS AND METHODS

Thirty-one patients with completely formed singlerooted permanent teeth indicated for extraction due to
orthodontic, prosthodontic and periodontal reasons were
selected for the study. Before initiation of treatment,
informed consent was obtained from each patient.
Two percent 1:80,000 lignocaine (Lignox, Warren)
anesthetic was administered; the tooth was isolated
under rubber dam (Hygenic Corp., Coltene Whaledent).
The occlusal surface was flattened using number 201 flat
end tapered fissure diamond point (Shofu, Kyoto, Japan)
in a high-speed handpiece and water spray. This was to
allow for easy access to pulp chamber and to create a
flat reference point for working length. Endodontic
access was prepared with Endo Access Bur (dentsply.
co.uk) pulp extirpated using barbed broach (Dentsply
Maillifer). Root canal orifice was flared using Orifice
Shapers 1 and 2 (Dentsply Tulsa Dental, USA). 2.6%

Sodium hypochlorite solution (Vensons India) was used

for irrigation. Fifteen size K-file (Kendo, Europe) was
used to obtain the working length of each tooth from
both the apex locators-Root ZX (J. Morita Corporation,
Tokyo, Japan) and Raypex 5 (VDM, Munich, Germany).
The file was withdrawn from the canal each time, and
WL recorded using digital caliper.
The working length reading from the apex locator that
was used last was taken and 15 K file adjusted to that
reading was placed in the canal and cemented with TypeII GIC (FUJI II, GC Corporation, Japan). The estimated
working length was reconfirmed by adapting the
electrode to the cemented file, to make sure that GIC
placement did not disturb the recording. The handle of
the instrument was sheared off using orthodontic wire
cutter. The tooth was then extracted as atraumatically
as possible with the cemented file in the root canal.
The extracted tooth was then placed in 5.25% of sodium
hypochlorite for 15 min, to remove organic debris. The
samples were then placed in 0.2% thymol saline solution
till examined.
The same procedure was repeated for all the teeth,
but the sequence of use of Raypex 5 and Root ZX
were alternated to avoid bias. The working length
determination was done with both the apex locators,
following manufactures instructions. The position of
the minor diameter in relation to the anatomic apex
and presence of resorption was recorded for each tooth
under stereomicroscope at 10.
The apical 4 mm of root was shaved using a 12 fluted bur,
size ET6 with 1.4 mm diameter (E.T. Carbide, USA) along
the long axis of the tooth in a plane that was determined
to show the best representation of the minor diameter in
relation to the file. Shaving with bur was performed under
an operating microscope (Alltion, Germany) at 12.5 such
that the file could be seen through a thin layer of dentin.
This last layer was then removed using a number 15 Bard
Parker blade.
A double-blind examination was performed with regard to
the use of two EALs. Two investigators, blinded at which
EALs was used, recorded the distance from the end of the
file to minor diameter (narrowest part of canal as given
by Kuttlers) under stereomicroscope (Labomed) at 10
(negative value indicates short or coronal to minor diameter)
[Table 1]. The data were statistically analyzed using paired
sample t-test to know the statistical significance of the two
EALs.
During the histomorphometric analysis in one of the teeth
included in the study was found to have apical defect
(fracture) and hence was excluded and another case was
taken to compensate the sample size of 30.

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289

Swapna, et al.: Comparative study on apex locators

Table 1: Two investigators, blinded at which electronic apex locator was used, recorded the distance from the end of
the file to minor diameter under stereomicroscope (labomed) at 10 magnification. (negative value indicates short [or
coronal] to minor diameter)
No of teeth
Root ZX (mm)
Raypex 5 (mm)
No of teeth
Root ZX (mm)
Raypex 5 (mm)

1
-0.5
0.5
16
-0.1
0.3

2
0.5
0.6
17
0.3
0.2

3
0.0
0.0
18
0.0
0.0

4
0.0
0.0
19
0.0
0.0

5
-0.3
0.0
20
0.2
-0.3

6
-0.3
0.0
21
-0.2
-0.2

Figure 1: Extracted tooth under stereomicroscope

The minor diameter was determined in all the teeth.

Figures 1 and 2 showed the distances of the file tips for the
EALs in relation to the minor diameter. The mean distance
between the instrument tip and the minor diameter was
+0.00 0.21 mm for the Root ZX and +0.05 0.23 mm
for the Raypex 5 [Table 2].
The minor diameter was coinciding with the tip of the
instrument in 10 cases when Root ZX was used and in 12
cases when Raypex was used. In 96.6% of cases tested with
Root ZX the minor diameter was within the limit of 0.5
mm. In 93.2% of cases, minor diameter was within a limit of
0.5 mm with Raypex 5 [Table 3].
An exact agreement between the results of the two EALs
was not found in any of the cases. The paired sample t-test
showed that there was no significant difference between
the results of Root ZX and Raypex 5 in determining the
minor diameter (P < 0.362271) [Table 2].

DISCUSSION
In clinical practice, the apical constriction is the
narrowest and more consistent anatomical feature in the
root canal system.[7] Thus, preferred apical end point for
instrumentation and obturation in endodontic therapy.
Posttreatment discomfort is greater when this area is
violated by instrumentation or filling materials and the
healing process may be compromised. Kuttler in 1955
gave the most comprehensive anatomic microscopic

290

7
-0.1
-0.1
22
0.1
0.0

8
0.3
0.0
23
-0.2
0.0

9
0.0
0.4
24
-0.1
-0.2

10
-0.3
0.4
25
0.1
-0.1

11
0.3
0.0
26
-0.1
-0.3

12
0.3
0.4
27
0.2
0.0

13
0.0
0.1
28
0.0
-0.1

14
-0.1
0.0
29
0.0
0.2

15
0.0
-0.3
30
0.1
0.1

Figure 2: Extracted tooth after sectioning under operating

microscope

study of the root tip. Minor foramen is often thought

to coincide with the apical constriction and regarded
as being at or near the cemento-dentinal junction (CDJ)
(Kuttler 1958). The minor diameter represents the
transition between the pulpal and the periodontal tissue,
located in the range of 0.5-1.0 mm from the external
foramen or major diameter on the root surface.[7] Kuttler
concluded that the average distance between the minor
and major diameters was 0.524-0.659 mm.[2] Modern apex
locators help to determine the apical end point of root
canal instrumentation. Hence, they are recommended to
complement conventional radiographic working length
determination techniques.[5]
Although many generations of EALs are available for use
in clinical practice, since the introduction of Root ZX, it
has become a benchmark to which other apex locators are
compared.[4] Root ZX uses two different frequencies (8 KHz
and 400 Hz) simultaneously to measure the impedances in
the canal. The device then determines a quotient value by
dividing the 8 KHz impedance value by 400 Hz impedance
value. The minor diameter is located when a quotient
equals 0.67. Root ZX can be used in canals filled with all
types of fluids because the quotient (0.67) is always the
same.[8-10]
Raypex 5 is a newly introduced apex locator that uses two
separate frequencies (400 Hz and 800 Hz). It is claimed
that the combination of using only one frequency at a time
and basing the measurements on the root mean square

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Swapna, et al.: Comparative study on apex locators

Table 2: Distances from the tip of file relative to the
minor diameter (mm) a paired sample t-test: There
was no statistically significant difference between the
accuracy of the two electronic apex locators in locating
the minor diameter (P < 0.362271)
EALs
Root ZX (n=30)
Raypex 5 (n=30)

Mean

SD

0.0000
0.0533

0.2166
0.2330

Table 3: Distance-instrument to minor diameter.

Distances of the instruments tip for Root ZX and
Raypex 5 in relation to the minor diameter
Distance from file tip
to minor diameter

Root Zx
(n=30)

Raypex 5
(n=30)

had gone beyond the major foramen.[20] During working

length determination, the file should only be advanced
until the display indicates the apex. This is to avoid the files
passing through the major foramen and overestimating the
working length.[20-21]
In the present study, both the Root ZX and Raypex 5 showed
the accuracy of the results to the extent of 96.6% and 93.2%
accurate in detecting the minor diameter to the strictest
acceptable range of 0.5 mm. Hence, from these results, it
can be concluded that Raypex 5 is as effective as Root ZX in
determining the minor diameter.

Financial support and sponsorship

Nil.

-1.0 to -0.5
-0.5 to 0.0
0.0 to 0.5

0
11
18

36.6
60

0
8
20

26.6
66.6

Conflicts of interest

0.5 to 1.0

3.3

6.6

There are no conflicts of interest.

>1.0

REFERENCES

values of the signal frequency increases the measurement

accuracy and the reliability of the device.[4,11]
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and Raypex 5 as apex locators. In another study, the file

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