An in-vitro comparison of working length determination between a digital system and conventional film when source-film/sensor distance and exposure time are modified

Abstract

Accurate determination of working length during endodontic therapy is a crucial step in achieving a predictable outcome. This is determined by the use of electronic apex locators, tactile perception, and knowledge of average tooth lengths and/or dental radiography whether digital or conventional is utilized. It is the aim of this study to determine if there is a difference between Schick digital radiography and Kodak Insight conventional film in accurately determining working lengths when modifying exposure time and source-film/sensor distance. Twelve teeth with size 15 K-flex files at varying known lengths from the anatomical apex were mounted in a resin-plaster mix to simulate bone density. Each tooth was radiographed while varying the source-film/sensor distance and exposure 122 time. Four dental professionals examined the images and films independently. Ten images and 10 films were selected at random and re-examined to determine each examiner?s repeatability. The error in working length was calculated as the observed value minus the known working length for each tooth type. A mixed-effects, full-factorial analysis of variance (ANOVA) model was used to model the error in working length. Included in the ANOVA model were fixed effects for type of image, distance, exposure time, and all two-way and three-way interactions. The repeatability of each examiner for each film type was assessed by estimating the intra-class correlation coefficient (ICC). The repeatability of each examiner on digital film was good with ICCs ranging from 0.67 to 1.0. Repeatability on the conventional film was poor with ICCs varying from -0.29 to 0.55.We found there was an overall difference between the conventional and digital films (p < 0.001). After adjusting for the effects of distance and exposure time, the error in the working length from the digital image was 0.1 mm shorter (95% CI: 0.06, 0.14) than the error in the working length from the film image. There was no difference among distances (p = 0.999) nor exposure time (p = 0.158) for film or images. Based on the results of our study we conclude that although there is a statistically significant difference, there is no clinically significant difference between digital radiography and conventional film when exposure time and source-film/sensor distance are adjusted.