Evaluation of the Effect of Different Irrigation Solutions on Electronic Apex Locator Working Length Measurement
Abstract
Objectives: This in vitro study aims to evaluate the accuracy of root canal working length measurements made by the Raypex 6 electronic apex locator in the presence of QMix, 40% citric acid, 5.25% NaOCl, 17% EDTA, and 2% CHX irrigation solutions, in comparison to the actual working length (AWL).
Materials and Methods: Eighty caries-free mandibular premolars were used in the study. The AWL for each tooth was determined under a microscope with a size 10/.02 K-type file. The teeth were placed in a simulated oral environment apparatus, and measurements were taken with the Raypex 6 using five different irrigation solutions. After the application of each solution, the canal was irrigated with 0.9% saline and dried with paper points. The measurements were compared using repeated measures ANOVA and the Bonferroni post-hoc test (p<0.05).
Results: A significant difference was found between the electronic apex locator (EAL) measurements obtained in the presence of irrigation solutions in the root canals and the AWL (p<0.001). Post-hoc comparisons revealed that the EAL measurements in the presence of QMix, citric acid, NaOCl, and EDTA irrigation solutions were statistically shorter than the AWL (p<0.001). In contrast, no significant difference was detected between the EAL measurements in the presence of the CHX irrigation solution and the AWL (p=0.996).
Conclusions: Irrigation solutions with potentially higher conductivity (QMix, citric acid, NaOCl, EDTA) led to the perception of a shorter working length with the Raypex 6, whereas CHX, which has a lower conductivity, yielded results closer to the actual working length. Clinicians should be mindful of the selected irrigation solution when interpreting EAL measurements, especially when using highly conductive solutions, to avoid determining a short working length.
Ethical Statement
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Kahramanmaraş Sütçü İmam University Medical Research Ethics Committee (Date: 21.04.2025, Session No: 2025/14, Decision No: 07).
References
- 1. Peters OA, Peters CI, Basrani B. Cleaning and shaping of the root canal system. In: Hargreaves KM, Berman LH, editors. Cohen's Pathways of the Pulp. 12th ed. St. Louis: Elsevier 2020:236-303.
- 2. Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment—a reframing of the principles. Int Endod J 2023;56(2):82-115.
- 3. White SN, Boehne DJ. Endodontic complications. In: Glick M, editor. Avoiding and treating dental complications: best practices in dentistry. Hoboken: Wiley Blackwell; 2016:50-72.
- 4. Alothmani OS, Friedlander LT, Chandler NP. Radiographic assessment of endodontic working length. Saudi Endod J 2013;3(2):57-64.
- 5. Karatas OH, Toy E. Three-dimensional imaging techniques: a literature review. Eur J Dent 2014;8(01):132-140.
- 6. Shirazi Z, Al-Jadaa A, Saleh AR. Electronic apex locators and their implications in contemporary clinical practice: a review. Open Dent J 2023;17(1):1874-2106.
- 7. Pisano M, Sangiovanni G, Frucci E, Scorziello M, De Benedetto G, Iandolo A. Evaluation of the accuracy of electronic apex locators in modern endodontics: an umbrella review. Medicina (Kaunas) 2024;60(10):1709.
- 8. Rifaat S, Aljami A, Alshehri T, Alameer ST, Aldossary A, Almutairi W, et al. The effect of coronal pre-flaring and type of root canal irrigation on working length accuracy using electronic apex locators. F1000Res 2023;12:533.
- 9. Kaur G, Reddy TVK, Venkatesh KV, Mahalakshmi K. Effects of chitosan oligosaccharide and calcium hypochlorite on E. Faecalis dentinal biofilm and smear layer removal-SEM analysis. Indian J Dent Res 2020;31(4):550-556.
- 10. Jha P, Nikhil V, Raj S, Ravinder R, Mishra P. Accuracy of electronic apex locator in the presence of different irrigating solutions. Endodontology 2021;33(4):232-236.
- 11. Rossi-Fedele G, Doğramacı EJ, Guastalli AR, Steier L, de Figueiredo JAP. Antagonistic interactions between sodium hypochlorite, chlorhexidine, EDTA, and citric acid. J Endod 2012;38(4):426-431.
- 12. Çelebi Keskin İS, Yalçın TY. Evaluation of heated sodium hypochlorite's effect on the accuracy of contemporary electronic apex locators: an in vitro study. BMC Oral Health 2025;25(1):634.
- 13. López-Maekawa A, Rupay CRG. Accuracy of four apex locators in premolars with root resorption: an in vitro study. Iran Endod J 2022;17(1):20.
- 14. Shekarchizade N, Farhad A, Khalifezade S. The accuracy of three apex locators in determining the location of strip root perforation in different environments. Iran Endod J 2021;16(3):184.
- 15. Mahmoud O, Awad Abdelmagied MH, Dandashi AH, Jasim BN, Tawfik Kayali HA, Al Shehadat S. Comparative evaluation of accuracy of different apex locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and periapical radiograph—in vitro study. Int J Dent 2021;2021(1):5563426.
- 16. Siddiqui AY. Influence of embedding medium on iPex electronic apex locator accuracy: an ex vivo comparative study using alginate, saline, and gelatin models. J Contemp Dent Pract 2023;24(10):733-738.
- 17. Cîmpean SI, Chisnoiu RM, Colceriu Burtea AL, Rotaru R, Bud MG, Delean AG, et al. In vitro evaluation of the accuracy of three electronic apex locators using different sodium hypochlorite concentrations. Medicina (Kaunas) 2023;59(5):918.
- 18. 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.
- 19. Fan W, Fan B, Gutmann J, Bian Z, Fan M. Evaluation of the accuracy of three electronic apex locators using glass tubules. Int Endod J 2006;39(2):127-135.
- 20. Marek E, Łagocka R, Kot K, Woźniak K, Lipski M. The influence of two forms of chlorhexidine on the accuracy of contemporary electronic apex locators. BMC Oral Health 2019;20(1):3.
- 21. Dumani A, Ates A, Ucan C, Yilmaz S, Unal I, Yoldas O. The influence of MTAD and QMix on the accuracy of electronic apex locator in locating simulated perforations. Niger J Clin Pract 2022;25(3):281-285.
- 22. Joshi C, Joshi S, Desai U, Thumar S, Patel A, Khunt A. Accuracy of the integrated electronic apex locator in locating simulated perforation under various irrigating solutions in an in vitro study. Braz J Oral Sci 2024;23:e241118.
- 23. Khursheed I, Bansal R, Bansal T, Singh HP, Yadav M, Reddy KJ. A comparative evaluation of working length with digital radiography and third generation apex locator (ProPex) in the presence of various intracanal irrigants: an in vivo/ex vivo study. Dent Res J (Isfahan) 2014;11(1):56.
- 24. Özsezer E, İnan U, Aydın U. In vivo evaluation of ProPex electronic apex locator. J Endod 2007;33(8):974-977.
- 25. La Rosa GRM, Angjelova A, Jovanova E, Apostolska S, Santos JM, Pedulla E. Integrated electronic apex locators for determining working length: a systematic review of in-vitro studies. Odontology 2025;113(3):918-929.
- 26. Diemer F, Plews E, Georgelin-Gurgel M, Mishra L, Kim H-C. Effect of sodium hypochlorite concentration on electronic apex locator reliability. Materials (Basel) 2022;15(3):863.
- 27. Topçuoğlu G, Solak Kolçakoğlu K. Evaluation of accuracy of an electronic apex locator in presence of sodium hypochlorite in primary teeth with and without resorption. J Clin Pediatr Dent 2023;47(6):150-154.
- 28. Kara Ö, Sübay RK. In vivo and in vitro accuracy and precision evaluations of mini electronic apex locators. Aust Endod J 2025; 51:329–335.
- 29. Pisano M, Sangiovanni G, Frucci E, Scorziello M, De Benedetto G, Iandolo A. Assessing the reliability of electronic apex locators in different apical foramen configurations. Asian J Periodontics Orthodontics 2023;3(1-2023):1-5.
- 30. Aydın ZU, Altunbaş D, Meşeci B. The effect of different irrigation solutions on the accuracy of two electronic apex locators in locating artificial root perforations. Meandros Med Dent J 2020;21(2):134-139.
Farklı İrrigasyon Solüsyonlarının Elektronik Apeks Bulucunun Çalışma Boyu Ölçümüne Etkisinin Değerlendirilmesi
Abstract
Amaç: Bu in vitro çalışmanın amacı, QMix, %40 sitrik asit, %5.25 NaOCl, %17 EDTA ve %2 CHX irrigasyon solüsyonlarının varlığında, Raypex 6 elektronik apeks bulucu ile yapılan kök kanalı çalışma boyu ölçümlerinin doğruluğunu, gerçek çalışma boyu (GÇB) ile karşılaştırarak değerlendirmektir.
Gereç ve Yöntem: Çalışmada seksen adet çürüksüz mandibular premolar diş kullanıldı. Her bir diş için GÇB, bir mikroskop altında 10/.02 numara K-tipi eğe ile belirlendi. Dişler simüle oral ortam düzeneğine yerleştirildi ve Raypex 6 ile beş farklı irrigasyon solüsyonu kullanılarak ölçümler alındı. Her bir solüsyon uygulamasından sonra kanal, %0.9 salin ile yıkandı ve kağıt konlar ile kurulandı. Ölçümler, tekrarlayan ölçümler ANOVA ve Bonferroni post-hoc testi (p<0.05) kullanılarak karşılaştırıldı.
Bulgular: Kök kanallarında irrigasyon solüsyonları varlığında elde edilen elektronik apeks bulucu (EAB) ölçümleri ile GÇB arasında anlamlı bir fark bulundu (p<0.001). Post-hoc karşılaştırmalar, QMix, sitrik asit, NaOCl ve EDTA irrigasyon solüsyonları varlığındaki EAB ölçümlerinin istatistiksel olarak GÇB'den daha kısa olduğunu ortaya koydu (p<0.001). Buna karşılık, CHX irrigasyon solüsyonu varlığında alınan EAB ölçümleri ile GÇB arasında anlamlı bir fark tespit edilmedi (p=0.996).
Sonuç: Potansiyel olarak daha yüksek iletkenliğe sahip irrigasyon solüsyonlarının (QMix, sitrik asit, NaOCl, EDTA) Raypex 6 ile daha kısa bir çalışma boyu algılanmasına yol açtığı; daha düşük iletkenliğe sahip olan CHX'in ise gerçek çalışma boyuna daha yakın sonuçlar verdiği görüldü. Klinisyenler, özellikle yüksek iletkenliğe sahip solüsyonlar kullanırken, kısa bir çalışma boyu belirlemekten kaçınmak için EAB ölçümlerini yorumlarken seçilen irrigasyon solüsyonunun etkisini göz önünde bulundurmalıdır.
Ethical Statement
Çalışma, Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüş olup Kahramanmaraş Sütçü İmam Üniversitesi Tıp Araştırmaları Etik Kurulu tarafından onaylanmıştır (Tarih: 21.04.2025, Oturum No: 2025/14, Karar No: 07).
References
- 1. Peters OA, Peters CI, Basrani B. Cleaning and shaping of the root canal system. In: Hargreaves KM, Berman LH, editors. Cohen's Pathways of the Pulp. 12th ed. St. Louis: Elsevier 2020:236-303.
- 2. Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment—a reframing of the principles. Int Endod J 2023;56(2):82-115.
- 3. White SN, Boehne DJ. Endodontic complications. In: Glick M, editor. Avoiding and treating dental complications: best practices in dentistry. Hoboken: Wiley Blackwell; 2016:50-72.
- 4. Alothmani OS, Friedlander LT, Chandler NP. Radiographic assessment of endodontic working length. Saudi Endod J 2013;3(2):57-64.
- 5. Karatas OH, Toy E. Three-dimensional imaging techniques: a literature review. Eur J Dent 2014;8(01):132-140.
- 6. Shirazi Z, Al-Jadaa A, Saleh AR. Electronic apex locators and their implications in contemporary clinical practice: a review. Open Dent J 2023;17(1):1874-2106.
- 7. Pisano M, Sangiovanni G, Frucci E, Scorziello M, De Benedetto G, Iandolo A. Evaluation of the accuracy of electronic apex locators in modern endodontics: an umbrella review. Medicina (Kaunas) 2024;60(10):1709.
- 8. Rifaat S, Aljami A, Alshehri T, Alameer ST, Aldossary A, Almutairi W, et al. The effect of coronal pre-flaring and type of root canal irrigation on working length accuracy using electronic apex locators. F1000Res 2023;12:533.
- 9. Kaur G, Reddy TVK, Venkatesh KV, Mahalakshmi K. Effects of chitosan oligosaccharide and calcium hypochlorite on E. Faecalis dentinal biofilm and smear layer removal-SEM analysis. Indian J Dent Res 2020;31(4):550-556.
- 10. Jha P, Nikhil V, Raj S, Ravinder R, Mishra P. Accuracy of electronic apex locator in the presence of different irrigating solutions. Endodontology 2021;33(4):232-236.
- 11. Rossi-Fedele G, Doğramacı EJ, Guastalli AR, Steier L, de Figueiredo JAP. Antagonistic interactions between sodium hypochlorite, chlorhexidine, EDTA, and citric acid. J Endod 2012;38(4):426-431.
- 12. Çelebi Keskin İS, Yalçın TY. Evaluation of heated sodium hypochlorite's effect on the accuracy of contemporary electronic apex locators: an in vitro study. BMC Oral Health 2025;25(1):634.
- 13. López-Maekawa A, Rupay CRG. Accuracy of four apex locators in premolars with root resorption: an in vitro study. Iran Endod J 2022;17(1):20.
- 14. Shekarchizade N, Farhad A, Khalifezade S. The accuracy of three apex locators in determining the location of strip root perforation in different environments. Iran Endod J 2021;16(3):184.
- 15. Mahmoud O, Awad Abdelmagied MH, Dandashi AH, Jasim BN, Tawfik Kayali HA, Al Shehadat S. Comparative evaluation of accuracy of different apex locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and periapical radiograph—in vitro study. Int J Dent 2021;2021(1):5563426.
- 16. Siddiqui AY. Influence of embedding medium on iPex electronic apex locator accuracy: an ex vivo comparative study using alginate, saline, and gelatin models. J Contemp Dent Pract 2023;24(10):733-738.
- 17. Cîmpean SI, Chisnoiu RM, Colceriu Burtea AL, Rotaru R, Bud MG, Delean AG, et al. In vitro evaluation of the accuracy of three electronic apex locators using different sodium hypochlorite concentrations. Medicina (Kaunas) 2023;59(5):918.
- 18. 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.
- 19. Fan W, Fan B, Gutmann J, Bian Z, Fan M. Evaluation of the accuracy of three electronic apex locators using glass tubules. Int Endod J 2006;39(2):127-135.
- 20. Marek E, Łagocka R, Kot K, Woźniak K, Lipski M. The influence of two forms of chlorhexidine on the accuracy of contemporary electronic apex locators. BMC Oral Health 2019;20(1):3.
- 21. Dumani A, Ates A, Ucan C, Yilmaz S, Unal I, Yoldas O. The influence of MTAD and QMix on the accuracy of electronic apex locator in locating simulated perforations. Niger J Clin Pract 2022;25(3):281-285.
- 22. Joshi C, Joshi S, Desai U, Thumar S, Patel A, Khunt A. Accuracy of the integrated electronic apex locator in locating simulated perforation under various irrigating solutions in an in vitro study. Braz J Oral Sci 2024;23:e241118.
- 23. Khursheed I, Bansal R, Bansal T, Singh HP, Yadav M, Reddy KJ. A comparative evaluation of working length with digital radiography and third generation apex locator (ProPex) in the presence of various intracanal irrigants: an in vivo/ex vivo study. Dent Res J (Isfahan) 2014;11(1):56.
- 24. Özsezer E, İnan U, Aydın U. In vivo evaluation of ProPex electronic apex locator. J Endod 2007;33(8):974-977.
- 25. La Rosa GRM, Angjelova A, Jovanova E, Apostolska S, Santos JM, Pedulla E. Integrated electronic apex locators for determining working length: a systematic review of in-vitro studies. Odontology 2025;113(3):918-929.
- 26. Diemer F, Plews E, Georgelin-Gurgel M, Mishra L, Kim H-C. Effect of sodium hypochlorite concentration on electronic apex locator reliability. Materials (Basel) 2022;15(3):863.
- 27. Topçuoğlu G, Solak Kolçakoğlu K. Evaluation of accuracy of an electronic apex locator in presence of sodium hypochlorite in primary teeth with and without resorption. J Clin Pediatr Dent 2023;47(6):150-154.
- 28. Kara Ö, Sübay RK. In vivo and in vitro accuracy and precision evaluations of mini electronic apex locators. Aust Endod J 2025; 51:329–335.
- 29. Pisano M, Sangiovanni G, Frucci E, Scorziello M, De Benedetto G, Iandolo A. Assessing the reliability of electronic apex locators in different apical foramen configurations. Asian J Periodontics Orthodontics 2023;3(1-2023):1-5.
- 30. Aydın ZU, Altunbaş D, Meşeci B. The effect of different irrigation solutions on the accuracy of two electronic apex locators in locating artificial root perforations. Meandros Med Dent J 2020;21(2):134-139.
Details
| Primary Language | English |
|---|---|
| Subjects | Endodontics |
| Journal Section | Research Article |
| Authors | |
| Submission Date | September 24, 2025 |
| Acceptance Date | December 28, 2025 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1789719 |
| IZ | https://izlik.org/JA88NJ69CL |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
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