Comparative evaluation of efficacy in working length determination: Radiography versus Electronic apex locators using in vivo and ex vivo methods with stereomicroscope validation

Abstract

Background: Accurate determination of the working length (WL) is crucial for successful endodontic treatment. Various methods, including radiography and electronic apex locators (EALs), are employed for WL measurement, each with its advantages and limitations. Aim: This study aimed to compare the accuracy of WL determination using conventional radiography and the Root ZX Mini EAL against an ex vivo gold standard method. Materials and Methods: Fifty single-rooted teeth scheduled for extraction were included. WLs were determined using radiography (Grossman’s method) and the Root ZX Mini EAL. An ex vivo method served as the gold standard with WL carried out on extracted teeth under a stereomicroscope. Statistical analysis included Paired samples t-test, Chi-square test, and Bland–Altman plots. Results: The mean WL values were comparable among methods, with slight variations in precision. The Root ZX Mini EAL demonstrated significantly lower mean absolute error compared to radiography (P < 0.001). Accuracy within ± 0.5 mm and ± 1 mm tolerance ranges favored the EAL over radiography (P = 0.04 and P = 0.004, respectively). Conclusion: The Root ZX Mini EAL exhibited superior accuracy and lower error rates in WL determination compared to radiography. Integrating EALs alongside radiographic techniques is recommended to optimize WL precision in clinical practice.