Removing inflamed pulp and sealing a tooth preserves its natural strength, making root canal treatment possible. This is nearly always preferrable to extracting the tooth. The apex of the tooth contains all the blood vessels and nerve fibres needed to keep the tooth alive. However, tooth decay, leaky fillings and dental trauma can damage the apex, opening it up for harmful bacteria to infect the root canal.
An open apex can prevent root canal treatment success as there is no natural barrier to contain the added filling. Because of this, closing the open tooth root is a crucial clinical challenge, one which is best aided by using a reliable electronic apex locator (EAL) to find the position of the apical foramen and work out the length of the root canal space.
The working length
Whilst radiographs are used by practitioners for diagnosis and determining the working length of the tooth root, an EAL can be more effective for the latter, with a 99.7 per cent accuracy versus the 98.1 per cent of a digital radiograph and 96.1 per cent for a conventional radiograph. The working length of a tooth must be reliably determined for the success of the operation as it keeps the preparation inside the restricted radicular area; apical extrusion is then avoided and good obturation is secured. Inaccuracy in locating the apex and defining the working length can lead to damage of the apices and periapical tissues, limiting the success of post-operative healing.
Moreover, accidental over-instrumentation can result in a root canal with no apical constriction. In these instances of treatment failure, the patient will be dissatisfied, with discomfort, pain and inconvenience, surmounting to a negative experience. The importance of determining working length therefore demands a device as effective as an EAL to ensure treatment success and create a satisfying experience for the patient.
Patient compliance
Childhood trauma is a common cause for an incompletely formed tooth root, with the highest frequency for dental trauma among children of 12 to 14 years. This is often attributed to the increase in participating in aggressive sports and other physical activities, whilst infants and preschool children are most likely to experience dental trauma caused by a fall at home. Paediatric dentists treating these injuries are likely to perform apexification and using an EAL can make the treatment easier. One of the major advantages of an EAL is its non-invasiveness, making it a preferrable option when delivering complex root canal therapy that requires patient compliance, especially among children.
Unlike the experience of a radiograph, in which having to bite down on the intraoral film causes discomfort and can trigger the gag reflex, an EAL is more agreeable. It connects the patient’s lip with the endodontic file in the root canal, turning the body into a minimally invasive electric circuit. A painful or uncomfortable treatment can both inhibit its success and lead to a negative experience for the young patient, with the potential to increase dental anxiety or fear. An EAL can provide greater clinical confidence whilst also being a satisfactory experience for the patient. Emetophobic adult patients may also prefer an EAL for treatment, whilst the reduction in radiation exposure compared to a radiograph makes it a more appealing alternative.
Moreover, an EAL streamlines the workflow, taking less time and providing results quickly, without the practitioner having to step out of the room. Combined with its non-invasiveness, the efficiency of an EAL makes it optimal for treatment success and patient satisfaction.
Best in the business
For a first-class apex locator, consider the CanalPro Jeni from Coltene, an innovative endomotor that features a digital assistance system designed for root canal preparation. The angled handpiece of the integrated apex locator allows for constant, precise measurement of the working length; afterwards the machine changes to the next file size until the required preparation size has been achieved. The CanalPro Jeni assistance system uses complex algorithms to control the variable file movements in millisecond intervals by receiving feedback of the current intensity, torque and file stress, preventing over-instrumentation.
A comfortable experience and a successful treatment can improve how patients engage with the dental practice. By harnessing the best technologies, practitioners can deliver excellent endodontic work for adults and children alike, preserving the natural teeth.
References available on request.