Working Length Determination in Mandibular Primary Second Molars - A Retrospective Study
Godlin Jeneta J1, Mahesh Ramakrishnan2*
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
2 Professor, Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
*Corresponding Author
Mahesh Ramakrishnan,
Professor, Department of Pedodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, PH Road, Chennai 600077, Tamil
Nadu, India.
Tel: 9840322728
E-mail: mahesh@saveetha.com
Received: September 03, 2019; Accepted: September 29, 2019; Published: September 30, 2019
Citation: Godlin Jeneta J, Mahesh Ramakrishnan. Working Length Determination in Mandibular Primary Second Molars - A Retrospective Study. Int J Dentistry Oral Sci.
2019;S7:02:003:10-14. doi: dx.doi.org/10.19070/2377-8075-SI02-07003
Copyright: Mahesh Ramakrishnan© 2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Working length determination is an important step for a successful root canal therapy in deciduous or permanent teeth. The main
objective of this study is to evaluate the association between age, gender, tooth number, number of visits with working length of
mandibular second primary molar. This was a retrospective, institutional based study. Sample size was 298. Data about patients below
18 years who underwent root canal treatment in the mandibular second primar molar in a period of june 2019 to march 2020
were collected. Excel tabulation was done and data was transferred to SPSS software. T test and pearson correlation was done to
compare the age, gender, tooth number, number of visits with working length. p<0.05 was considered statistically significant. The
mean age of males was 5.59 ± 1.8 and females was 5.68 ± 2.2 . The mean working length of males was 12.04 ± 2.8 and females
was 12.34 ± 2.8. There was a statistical significant association found between the number of visits and working length. There was
no statistical association found between age and working length, gender and working length, tooth number and working length.
2.Introduction
3.Materials and Methods
4.Results and Discussion
5.Conclusion
6.References
Keywords
Mandibular Primary Second Molar; Radiography; Working Length.
Introduction
Successful endodontic treatment in a primary teeth plays an important
role in preservation of dentition until the completion of
physiologic exfoliation [1]. The primary objective of pulpectomy
in deciduous teeth is to retain the teeth in a symptom free state
and to maintain the arch form [2].
Determination of root canal working length is considered as one
of the most important steps in endodontic treatment [3]. Proper
detection working length is important prior to pulpectomy in primary
teeth. Working length should be measured from the coronal
pont to the site where the root canal ends. The working length
should be accurate because it influences the success of the root
canal treatment directly [4]. Errors in working length determination
may cause the instrument to go beyond the apical foramen
causing extravasation of irrigating solutions and restorative materials
leading to postoperative pain. In primary tooth, the instrumentation
beyond the apex may damage the permanent tooth
germ [5].
There are various methods for determining the working length of
primary teeth such as tactile sensation method, conventional radiography,
radio visiography and the electronic apex locator method
[6]. Radiography is the most common techniques followed and
widely use for determining the working length [7]. Conventional
radiography has been generally used to determine the working
length. There are some disadvantages in this method such as superposition
of anatomical structures, image distortion and processing
time [8]. In radiovisiography method, a sensor is used
instead of film which reduces the processing time,has less radiation
exposure and allows image editing making it easy to examine
the details [9]. The apex locators were developed to determine
working length without radiation exposure and has been used for
over 40 years [10]. There are various generations of apex locators.
Apex locators are gaining popularity nowadays and has been used
in permanent teeth in recent years to estimate the working length
of the root canal and increase the precision rate of endodontic
treatment [11]. Apex locators apart from reducing the unnecessary exposure to radiation has been shown to reduce clinical time.
Due to these, its use in primary teeth is recommended [12].
Our department is passionate about child care, we have published
numerous high quality articles in this domain over the past 3 years
[13-31]. With this inspiration we planned to pursue research on
the working length determination in mandibular primary second
molars.
The objective of this study is to determine the working length of
the mandibular primary second molars and associate it with age,
gender and tooth number.
Materials and Methods
The study was in a University setting. Study includes patients who
underwent crown lengthening in the anterior region (aesthetic
zone). Sample size is 243. The study was a retrospective unicentric
observational study. Ethical approval from university ethics
committee. Data was collected from DIAS where the dental and
medical history of the patients were recorded. The data tabulation
done in excel sheet and transferred to SPSS for data analysis. Chisquare
test was done.
Study Design
This was a retrospective study conducted in a private dental institution.
The patient case records were reviewed for the necessary
information by a trained examiner. The advantage of conducting
the study in an institutional set up provides easy access to patient
records. Among patients who have visited the dental clinic
of the institution, the information of 243 teeth was reviewed.
A age range of under 18 was selected for the study. The institutional
ethical committee provided approval for the study (SDC/
SIHEC/2020/DIASDATA/0619-0320).
Inclusion criteria
1. Patients who had undergone pulpectomy in mandibular primary second molars
2. Patients from below 18 years of age
Exclusion criteria
1. Incomplete patient data
2. Duplicate patient data
3. Pulpectomy in other primary teeth other than mandibular primary second molars.
Sampling
A total of 243 tooth sites of patients who underwent pulp therapy
were reviewed for the tooth number, age, working length and
gender. Convenient sampling method was used to select the patients
for the study. The data obtained from the case records were
cross verified with photographs.
Data collection
All the data after thorough checking for duplicates, incomplete
entries and cross verification with photographs were entered in Microsoft excel spread sheet in order to organise the data. The
variables obtained from the data included age, gender, arch, and
reason for crown lengthening. Here the age, gender, tooth number
are the independent variables and , working length is the dependent
variable.
Statistics
The statistical analysis of the obtained data was performed by the
SPSS software version 23.0. The data from the excel spreadsheet
was transferred to SPSS software for analysis. Chi square tests
were employed in order to find the association between different
variables. The p value less than 5% was considered statistically
significant. The final results are presented in the form of graphs
for further interpretation and discussion.
Results and Discussion
One of the most important steps for successful pulp therapy is to
determine the working length accurately. Working length determination
plays an important role to avoid possible damage to the underlying
permanent teeth bud, periradicular tissue injury or infection
due to over instrumentation [32]. There are not much studies
on the working length of primary mandibular second molars.
A total of 243 mandibular second primary molars were included
in this study. All these are root canal treated teeth. The mean age
of the boys and girls were 5.59 ± 1.8 and 5.68 ± 2.2 respectively.
The mean working length of boys and girls were 12.04 ± 2.8 and
12.34 ± 2.8 respectively. A study by Koruyucu stated that the
working length of primary teeth present in the lower jaw is 12.73
± 1.76 [7].
The distribution of age and the working length were studied in
that individuals below 5 years had 16.46% of teeth with working
length less than 10 and 37.45% of teeth with working length
between 11 to 20. Individuals of age group 5 to 10 had 12.35%
of teeth with working length less than 10, 32.10% of teeth with
working length between 11 to 20 and 0.41% of teeth above 21.
Individuals of age group above 11 had 0.41% of teeth with working
length less than 10, 0.82% of teeth with working length between
11 to 20. There was no statistically significant association
found (p=0.471). However, working length of 11 to 20 was more
prevalent below 5 years. (Figure 1)
Figure 1. Depicts the association between the age and the working length. X axis represents the age and Y axis represents the total number pulpectomy done in mandibular second molars. From the present graph it can be inferred that the association between the variables is statistically not significant (p value=0.471; p > 0.05). However, working length of 11 to 20 was more prevalent below 5 years and between 6 to 10 years.
The distribution of tooth number and the working length were studied in that the mandibular left second primary molar had 16.05% of teeth with working length below 10, 32.92% of teeth with working length between 11 and 20, 0.41% of teeth with working length above 21. Mandibular right second primary molar had 13.17% of teeth with working length below 10 and 37.45% of teeth with working length between 11 and 20. There was no statistically significant association found (p=0.307). However, working length of 11 to 20 was more prevalent in 85. (Figure 2)
Figure 2. Depicts the association between the tooth number and the working length. X axis represents the tooth number and Y axis represents the total number pulpectomy done in mandibular second molars. From the present graph it can be inferred that the association between the variables is statistically not significant (p value=0.307; p > 0.05). However, working length of 11 to 20 was more prevalent in 85.
The distribution of gender and the working length were studied in that males had 17.28% of teeth with working length below 10 and 39.51% of teeth with working length between 11 and 20. Females had 11.93% of teeth with working length below 10, 30.86% of teeth with working length between 11 and 20, 0.41% of teeth with working length above 21. There was no statistically significant association found (p=0.471). However, working length of 11 to 20 was more prevalent in males. (Figure 3)
Figure 3. Depicts the association between the gender and the working length. X axis represents the gender and Y axis represents the total number pulpectomy done in mandibular second molars. From the present graph it can be inferred that the association between the variables is statistically not significant (p value=0.471; p > 0.05). However, working length of 11 to 20 was more prevalent in males.
The distribution of number of visits and the working length were studied in that single visit had 25.51% of teeth with working length below 10 and 57.20% of teeth with working length between 11 and 20. Multi visits had 3.70% of teeth with working length below 10, 13.17% of teeth with working length between 11 and 20, 0.41% of teeth with working length above 21. Statistical significance was found between number of visits and working length (p=0.048). Working length of 11 to 20 was more prevalent in single visits. (Figure 4)
Figure 4. Depicts the association between the number of visits and the working length. X axis represents the number of visits and Y axis represents the total number pulpectomy done in mandibular second molars. From the present graph it can be inferred that the association between the variables is statistically significant (p value=0.048; p < 0.05).
Limitations of this study include small sample size and subjective bias. Future study should be conducted with a wide range of population.
Conclusion
Within the limitation of the study, we can conclude that there is a
significant difference between the number of visits and working
length. There was no statistical significance found between age
and working length, gender and working length, tooth number
and working length. Working length of 11 to 20 was more prevalent
than working length less than 10 or above 21.
References
- American Academy on Pediatric Dentistry Clinical Affairs Committee-Pulp Therapy subcommittee. American Academy on Pediatric Dentistry Council on Clinical Affairs: Guideline on pulp therapy for primary and young permanent teeth. Pediatr. Dent.. 2009;30(7):170-4.
- Rodd HD, Waterhouse PJ, Fuks AB, Fayle SA, Moffat MA, British Society of Paediatric Dentistry. Pulp therapy for primary molars. Int J Paediatr Dent. 2006 Sep;16Suppl 1:15–23.
- Özsezer E, İnan U, Aydın U. In vivo evaluation of ProPex electronic apex locator. J Endod. 2007 Aug 1;33(8):974-7.
- Pereira KF, Silva PG, Vicente FS, Arashiro FN, Coldebella CR, Ramos CA. An in vivo study of working length determination with a new apex locator. Braz Dent J. 2014 Jan-Feb;25(1):17-21.Pubmed PMID: 24789286.
- Basso MD, Jeremias F, Cordeiro RC, Santos-Pinto L. Digital radiography for determination of primary tooth length: in vivo and ex vivo studies. ScientificWorldJournal. 2015;2015:939045. doi: 10.1155/2015/939045. Epub 2015 Feb 23.Pubmed PMID: 25802894.
- Wankhade AD, Kumar R, Singh RK, Chandra A. Root canal length determination by different methods in primary teeth: an in vivo study. Pediatr Dent. 2013 Mar-Apr;35(2):E38-42.Pubmed PMID: 23635968.
- Koruyucu M, Bayram M, Kasımoğlu Y, Seymen F. Comparison of root canal length measurement methods in primary teeth. Dentistry 3000. 2018 Jul 13;6(1):8-16.
- Orosco FA, Bernardineli N, Garcia RB, Bramante CM, Duarte MA, Moraes IG. In vivo accuracy of conventional and digital radiographic methods in confirming root canal working length determination by Root ZX. J Appl Oral Sci. 2012 Sep-Oct;20(5):522-5.Pubmed PMID: 23138737.
- Ellingsen MA, Hollender LG, Harrington GW. Radiovisiography versus conventional radiography for detection of small instruments in endodontic length determination. II. In vivo evaluation. J Endod. 1995 Oct;21(10):516- 20.Pubmed PMID: 8596074.
- Sunada I. New method for measuring the length of the root canal. J Dent Res. 1962 Mar;41(2):375-87.
- ElAyouti A, Weiger R, Löst C. The ability of root ZX apex locator to reduce the frequency of overestimated radiographic working length. J Endod. 2002 Feb;28(2):116-9.Pubmed PMID: 11833683.
- Oznurhan F, Ünal M, Kapdan A, Ozturk C, Aksoy S. Clinical evaluation of apex locator and radiography in primary teeth. Int. J. Paediatr. Dent. 2015 May;25(3):199-203.
- Ravikumar D, N S, Ramakrishna M, Sharna N, Robindro W. Evaluation of McNamara's analysis in South Indian (Tamil Nadu) children between 8-12 years of age using lateral cephalograms. J Oral BiolCraniofac Res. 2019 Apr- Jun;9(2):193-197.Pubmed PMID: 31211035.
- Ravikumar D, Gurunathan D, Gayathri R, Priya VV, Geetha RV. DNA profiling of Streptococcus mutans in children with and without black tooth stains: A polymerase chain reaction analysis. Dent Res J. 2018 Sep- Oct;15(5):334-339.Pubmed PMID: 30233653.
- Ravikumar D, Jeevanandan G, Subramanian EM. Evaluation of knowledge among general dentists in treatment of traumatic injuries in primary teeth: A cross-sectional questionnaire study. Eur J Dent. 2017 Apr;11(2):232-7.
- Ravindra V, Rekha V, Annamalai S, Sharmin D, Norouzi-Baghkomeh P. A comparative evaluation between dermatoglyphic patterns and different terminal planes in primary dentition. J ClinExp Dent. 2018 Dec 1;10(12):e1149-e1154.Pubmed PMID: 30697372.
- Ravindra V, Rekha CV, Annamalai S, Sharmin DD, Norouzi-Baghkomeh P. A comparative evaluation between cheiloscopic patterns and the permanent molar relationships to predict the future malocclusions. J ClinExp Dent. 2019 Jun 1;11(6):e553-e557.Pubmed PMID: 31346376.
- Govindaraju L, Jeevanandan G, Subramanian EMG. Comparison of quality of obturation and instrumentation time using hand files and two rotary file systems in primary molars: A single-blinded randomized controlled trial. Eur J Dent. 2017 Jul-Sep;11(3):376-379.Pubmed PMID: 28932150.
- Govindaraju L, Jeevanandan G, Subramanian EM. Knowledge and practice of rotary instrumentation in primary teeth among Indian dentists: a questionnaire survey. J Int Oral Health. 2017 Mar 1;9(2):45.
- Nair M, Jeevanandan G, Vignesh R, Subramanian EM. Comparative evaluation of post-operative pain after pulpectomy with k-files, kedo-s files and mtwo files in deciduous molars-a randomized clinical trial BDS. 2018 Oct 24;21(4):411-7.
- Jeevanandan G, Ganesh S. Kedo file system for root canal preparation in primary teeth. Indian J Dent Res. 2019 Jul 1;30(4):622-4.
- Panchal V, Jeevanandan G, Subramanian E. Comparison of instrumentation time and obturation quality between hand K-file, H-files, and rotary Kedo- S in root canal treatment of primary teeth: A randomized controlled trial. J Indian SocPedodPrev Dent. 2019 Jan-Mar;37(1):75-79.Pubmed PMID: 30804311.
- Subramanyam D, Gurunathan D, Gaayathri R, Vishnu Priya V. Comparative evaluation of salivary malondialdehyde levels as a marker of lipid peroxidation in early childhood caries. Eur J Dent. 2018 Jan-Mar;12(1):67-70. Pubmed PMID: 29657527.
- Vignesh R, Sharmin D, Rekha CV, Annamalai S, Baghkomeh PN. Management of Complicated Crown-Root Fracture by Extra-Oral Fragment Reattachment and Intentional Reimplantation with 2 Years Review. ContempClin Dent. 2019 Apr-Jun;10(2):397-401.Pubmed PMID: 32308309.
- Ramadurai N, Gurunathan D, Samuel AV, Subramanian E, Rodrigues SJ. Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig. 2019 Sep 1;23(9):3543-50.
- Panchal V, Gurunathan D, Shanmugaavel AK. Smartphone application as an aid in determination of caries risk and prevention: A pilot study. Eur J Dent. 2017 Oct-Dec;11(4):469-474.Pubmed PMID: 29279672.
- Panchal V, Jeevanandan G, Subramanian EMG. Comparison of post-operative pain after root canal instrumentation with hand K-files, H-files and rotary Kedo-S files in primary teeth: a randomised clinical trial. Eur Arch Paediatr Dent. 2019 Oct;20(5):467-472.Pubmed PMID: 30864090.
- Jeevanandan G, Govindaraju L. Clinical comparison of Kedo-S paediatric rotary files vs manual instrumentation for root canal preparation in primary molars: a double blinded randomised clinical trial. Eur Arch Paediatr Dent. 2018 Aug;19(4):273-278.Pubmed PMID: 30003514.
- Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51-60.Pubmed PMID: 31710096.
- Ramakrishnan M, Dhanalakshmi R, Subramanian EMG. Survival rate of different fixed posterior space maintainers used in Paediatric Dentistry - A systematic review. Saudi Dent J. 2019 Apr;31(2):165-172.Pubmed PMID: 30983825.
- Vishnu Prasad S, Kumar M, Ramakrishnan M, Ravikumar D. Report on oral health status and treatment needs of 5-15 years old children with sensory deficits in Chennai, India. Spec Care Dentist. 2018 Jan;38(1):58-59. Pubmed PMID: 29333605.
- Silva EJ, Herrera DR, Souza-Júnior EJ, Rosa TP. Evaluation of the multifrequency electronic apex locator Joypex 5 in primary teeth. Eur Arch Paediatr Dent. 2014 Feb;15(1):51-4.Pubmed PMID: 23881737.
