title: In vivo assessment of the impedance ratio method used in electronic foramen locators.
abstract: BACKGROUND
  The results of an in vivo study on the "ratio method" used in electronic foramen locators (EFL) are presented. EFLs are becoming widely used in the determination of the working length (WL) during the root canal treatment. The WL is the distance from a coronal reference point to the point at which canal preparation and filling should terminate. The "ratio method" was assessed by many clinicians with the aim of determining its ability to locate the apical foramen (AF). Nevertheless, in vivo studies to assess the method itself and to explain why the "ratio method" is able to locate the apical foramen and is unable to determine intermediate distances were not published so far.
  
  
  METHODS
  A developed apparatus applies an electrical current signal with constant amplitude of 10 μARMS through the endodontic file within the root canal. The applied current signal is composed by summing six sine waves, from 250 Hz to 8 kHz. Data were acquired with the endodontic file tip at 7 different positions within root canals. In the frequency domain the quotients between the amplitude of a reference frequency and the amplitudes of the other frequencies components were calculated. Twenty one root canals were analyzed in vivo, during the endodontic treatment of twelve teeth of different patients, with age between 20 to 55 years.
  
  
  RESULTS
  For the range of frequencies used in the commercial EFLs and for distances ranging from -3 mm to -1 mm of the AF, the impedance of the root canal is mainly resistive. However, when the file tip gets closer to AF, the root canal electrical impedance starts to change from a mainly resistive to a complex impedance. This change in the measured root canal impedance starts when the file tip is near -1.0 mm from the AF, getting stronger as the file tip gets closer to the AF. This change in the impedance behavior affects the ratio (quotient) of the impedance measured at different frequencies. Through graphic analysis it is demonstrated why EFLs based on the ratio method are unable to accurately measure any distances between - 3.0 and -0.5 mm from the apical foramen. The only reliable measurement is the 0 mm distance, which is when the file tip is at the AF.
  
  
  CONCLUSIONS
  The electrical impedance values of 21 root canals were in vivo studied. The results confirm the ability of EFLs that are based on the ratio method to accurately locate the AF position and explain why they are unable to determine the file tip position along the root canal.
authors.affiliation: Federal University of Technology - Paraná/CPGEI, Curitiba/PR, Brazil.
authors.forename: Marcos V H
authors.initials: MV
authors.lastname: Rambo
authors.forename: Humberto R
authors.initials: HR
authors.lastname: Gamba
authors.forename: Gustavo B
authors.initials: GB
authors.lastname: Borba
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Maia
authors.forename: Carlos A S
authors.initials: CA
authors.lastname: Ramos
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003786:Dental Pulp Cavity / Q000601:surgery; D017097:Electric Impedance; D055615:Electrical Equipment and Supplies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D019227:Tooth Apex / Q000601:surgery*
references.citation: J Endod. 2001 Jan;27(1):49-52
references.pmid: 11487165
references.citation: Annu Int Conf IEEE Eng Med Biol Soc. 2007;2007:570-3
references.pmid: 18002020
references.citation: IEEE Trans Biomed Eng. 2002 Jul;49(7):746-8
references.pmid: 12083312
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Apr;105(4):e79-83
references.pmid: 18329572
references.citation: Med Biol Eng Comput. 2002 Mar;40(2):200-4
references.pmid: 12043801
references.citation: J Endod. 1996 Nov;22(11):616-8
references.pmid: 9198419
references.citation: J Endod. 2003 Aug;29(8):497-500
references.pmid: 12929694
references.citation: Int Endod J. 2009 Sep;42(9):819-26
references.pmid: 19549150
references.citation: Int Endod J. 1984 Oct;17(4):192-8
references.pmid: 6593303
references.citation: Int Endod J. 2006 Aug;39(8):595-609
references.pmid: 16872454
references.citation: Oral Surg Oral Med Oral Pathol. 1991 Aug;72(2):238-42
references.pmid: 1923402
references.citation: Oral Surg Oral Med Oral Pathol. 1992 Dec;74(6):796-800
references.pmid: 1488238
references.citation: J Endod. 2002 Feb;28(2):116-9
references.pmid: 11833683
references.citation: Endod Dent Traumatol. 1997 Jun;13(3):126-31
references.pmid: 9550026
references.citation: Dent Clin North Am. 1992 Apr;36(2):293-307
references.pmid: 1572500
references.citation: J Endod. 2001 Mar;27(3):209-11
references.pmid: 11487154
references.citation: Int Endod J. 1998 Nov;31(6):394-409
references.pmid: 15551607
references.citation: Int Endod J. 2004 Feb;37(2):125-31
references.pmid: 14871179
references.citation: Int Endod J. 2008 Apr;41(4):317-21
references.pmid: 18217990
references.citation: J Endod. 1994 Mar;20(3):111-4
references.pmid: 7996080
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Feb;79(2):226-31
references.pmid: 7614187
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Oct;104(4):e91-4
references.pmid: 17703968