A novel noninvasive radiographic working length determination method – A randomized controlled clinical trial
Abstract
This randomized controlled clinical trial compared a novel, noninvasive radiographic method with a fourth-generation electronic apex locator (EAL) for working length determination.
A geometric technique using the law of symmetric triangles was piloted on extracted teeth and applied clinically with a custom sensor holder and digital protractor to standardize angulation. The trial followed Consolidated Standards of Reporting Trials 2025 Guidelines (CTRI/2020/01/022629). A total of 208 root canals from 64 adult patients were randomly assigned into two groups: Digital radiographic (DR) method (
n
= 93 canals, 30 patients) and EAL (Root ZX Mini;
n
= 115 canals, 34 patients). The primary outcome was radiographic master cone fit within ± 2 mm of the apex. The secondary outcomes included obturation length, postoperative symptoms, and lesion healing using the Periapical Index at a 3-month follow-up. Analysis was performed using the SPSS v23.0 (
P
< 0.05).
Underestimation was significantly lower in the EAL group (1.7%) than in the DR group (15.1%) (
P
= 0.0001). Both showed adequate master cone and obturation lengths, with a single overestimation in the DR group (1.07%,
P
= 0.447). EAL had higher accuracy (61.7%,
P
= 0.0001), while DR achieved a greater mean lesion size reduction (77% vs. 23%,
P
= 0.04).
Digital radiography showed a similar tendency to underestimate working length as the EAL, with a comparable need for correction. However, it yielded accurate measurements in only…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 115 participants or records.
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