CALCULATION of WORKING

LENGTH
The most important segment of endodontic
treatment is canal preparation.
&
The most important steps in canal
preparation is calculation of working length
 The significances of length
determination are:
1-Determination how far into the canal the
instruments are placed and worked.
..How deeply into the tooth the tissues,
debris, metabolites, end products, and
other are removed from the canal.
2-Limiting the depth to which the canal filling
may be placed.
3-Affecting the degree of pain and
discomfort that the patient will feel
following the appointment.
4- If Calculated within correct limits, it will
play an important role in success of the
treatment,& conversely, if incorrectly may
doom the treatment to failure.
 THEORETICALLY
The canal preparation and, thus, the canal
filling, should terminate at the
cementodentinal junction (CDJ).
HISTORICAL PERSPECTIVES
At the end of 19th century, WORKING
Length was calculated to the site where
the patient experienced feeling for an
instrument placed into the canal.
If vital tissue were left in the canal..Too short
If PA lesion were present the leng...Too long
That was befor 1899 when KELLS
Applied the X-ray to dentistry.
In 1900 the popular opinion was that
the tip of the root on the radiograph
the RADIOGRAPHIC APEX
IS the correct site to terminate canal
preparation and fill the canal.
In the 1920s GROVE concluded that pulp
tissue could not extend beyond the CDJ
There is no Odontoblast found past the CDJ
&
Advised that preparation beyond the CDJ
would result in injury to the PA tissues.
The filling short of the root tip gave the
best results.
In 1955s KUTTLER after microscopic study
of the root tip view that;
the canal or canals exit short of the
root tip in a very high percentage of cases.
 METHODS FOR CALCULATION
OF WORKING LENGTH
1-Radiographic apex_filing to the tip as seen
on the x-ray film.
2-A specific distance from the radiographic
apex_most often 1.0 mm is selected.
3-According to the studies of Kuttler_to
locate The major and miner diametr from
preoperative radiograph.
4-Electronic Apex locator_Difference in
electrical charge between the tissues
around the tooth and within the canal.
 Use of the radiographic Apex as
Termination point.
Who endorse this concept state that it is
impossible to locate the CDJ clinically, and
radiographic apex is the only site available
in this area.
Filing to the rad.apex can be only one thing--
--IT IS TOO LONG!
 Is the Radiographic apex
Reproducible
The position of the rad.apex depends on many
factors;
1-angulation of the tooth.
2-film psition.
3-holding agent(finger, holder).
4-length of the x-ray cone.
5-horizantal and vertical position.
6-the anguletion.
7-anatomic structure adjacent to the tooth.
 Advantages
1-Eliminating the unwanted, possibly
diseased materials.
in operative=caries must be removed.
in perio.treatment=all calculus must be removed
Similarly, in endo.treatment, all materials,
tissues, and debris from the canal must be
removed.
2-A small error in length calculation will not
lead to an undesirably short filling with an
apical segment of unprepared canal.
 Disadvantages
1-Decrease in success when filling materials
are passed into the PA tissues.
2-Increase postoperative pain.
3-Undesirable Shape which is very difficult
to seal by any technique (when the canal
exits short of the root).
EXIT deviation occurs toward the buccal or
lingual aspects of the tooth twice as often
as toward the mesial or distal aspect.
 Specific Distances Short of the
Radiographic Apex
The method was to locate the rad.apex and
then back of a specific measurement from
that length.
At first it was 0.5mm..then 1.0mm
when microscopic studies indicated that
the CDJ usually was more than 0.5mm
from the root tip.
Advantages;
No postoperative pain.
Disadvantages;
When the canal exist more than
1.0mm from the rad.apex. (the root tip)
 According to the studies of Kuttler
The narrowest diameter of the canal not at
the site of exiting of the canal from the
tooth but within the dentin, just prior to the
initial layers of cementum.(minor diameter)
The average distance between The minor and
major diameters were 0,5 (18-25year)
0,7(>55year)
 Advantages
1-The most scientific method for CWL.
2-Pain-free treatment.
3-If slight errors are made, les than 1mm(too
long, too short), RARELY causes
problems.
4-Allows development of a solid apical
dentin matrix.
5-Improves the opportunity for
demonstrating lateral canals.
 Disadvantages
1-The most Complicated techniques.
2-Takes the most time.
3-Requires radiographs of excellent quality.
Technique for Calculating Working
Length
Before starting RCT Dentist must identify;
C-L-E-W
1-CanaL Configuration.
2-The Estimated length.
3-The Site of Exiting of the canal (s).
4-The Estimated Width of the canal (s).
by analyzing
The Preoperative radiographs (straight & angled)
 Step-by-step technique
1-After evaluating the preoperative x-ray,
access cavity-excavation-locating the
orifices-pulp extirpation-removing pulp
tissue or debris.
2-Locate the Major or minor diameter on x-ray.
3-Estimate the Length of the root (s).
4-Estimate the width of the canal (s).
5-Place the file into the access and take initial x-
ray.
6)If the tip of the file appears too long or too
short more than 1mm from the miner
diameter (-4to+2)(from rad.apex) adjust
the file & retake x-ray.
7) If the tip of the file appears too long or too
short from the minor diameter by LESS
than 1mm accept the working length
 Additional Considerations
Short Exiting;
Exiting short may occur at levels
(0.2-2)mm
as far as 4mm at radiographic apex
Effect of PA Radiolucency with Resorption.
If apical root resorption is extensive, it necessary
to shorten the length as much as 2mm or more
to allow for the dentin matrix.
Symptoms of Overinstrumentation.
Post operative pain & tender to percussion.
By using paper point inside the canal will
pass easily past the working length
determinate.
.. When withdrawn, a reddish brown
discoloration indicates the seeping
inflamed tissue of the PA area.
 Use of the Apex Locator
The final result of the three previously
discussed methods for length
determination, had Subjective
information, which may or may not turn out
to be accurate.
Today of electronically calculators &
computers, developed an objective
Determination for information.
Electronic apex locator.
 HISTORY
SUZUKI before 1962 reported his study on
ionophoresis of ammoniated silver nitrate
and found that
the electrical resistance of the P Ligament,
was equal
to the electrical resistance of the oral
mucous membrane.
 Development of Differing Types of
Apex Locators
-The First generation based on the Electrical
resistance principle.
//Blood, pus, chelating agents, irrigants,
other materials used within the canal, and
contact with metallic restorations could
give False readings.//
--The second generation, based on the
principle of Impedance, such as the
Endocater.
The theory is ; The root canal, a long,
hollow tube, develops an electrical
impedance, caused by transparent dentin
deposition, which decrease at the CDJ.
this sudden drop measured electrically.
---The third generation is the frequency-
dependent machine. As (Root ZX, Endex).
In the canal give differences in impedance
between high (8kHz) and low (400Hz)
frequencies.
As the file goes deeper into the canal, the
difference in frequencies increases and is
the greatest at the CDJ.
This system needs liquid in the canal.
Technique for Calculating Working
Length Using the Resistance
locators
1-Turn on the device & attach the lip clip
near the arch being treated.
2-Place a file into the reamer/file holder.
3-Insert the tip of the file (o,5mm ) inside the
Sulcus & adjust the control knob.
4-From preoperative x-ray estimate working
length and width.
5- irrigate the canal with H2O2.
6-Insert the file slowly and adjust the file.
7-Keep insertion the file until you had alarm
bleeps sound.
8-Reset stop at the reference point.
9- take x-ray with the file at the L indicated &
examine the resulting film.
 Advantages
1-The apex locator had Objective
information with high accuracy.
2-the best use is where x-rays are difficult to
read.
3-Useful in verifying perforations of the root,
bifurcations of the root, & obstructions.
 Disadvantages
1- Overestimation was a problem with
locators.
2-Incorrect reading (low battery, tissue
remain in the canal, too wet canal, too dry
canal, too narrow canal, ).
3- when used rarely.
Apex locators versus Radiographs
Apex locators were not meant to replace
radiographs, but to add to the information
obtained by radiographs.
Apex locators cannot help determine canal
width, canal curvature, or number of
canals
only with good preop. X-ray.
 Combination Apex Locator and
Mechanical Filing
Tri Auto-ZX.
Combination of an apex locator and a
handpiece that is used for canal
enlargement.
..When the file reaches the length, the
filing automatically reverses and pushes
the file out.
Use of Reference Points.
Using the Buccal Objective Rule
and Determining Working Length
for Posterior Teeth