FROM the ARCHIVES

Independent Evaluation of 3 All-Fluids Apex Locators

from Dentaltown Magazine

by Martin B. Goldstein, DMD, Wollcott, CT

If you dont routinely use an all-fluid apex locator.

READ THIS!

Fig. 1

Fig. 2

Fig. 3

An independent dental publication recently asked a dentist/author

to compare the Root ZX, the Analytic All Fluid and the
Foramatron D-10, and tell dentists how to comfortably
incorporate this technology into their endodontic technique.
A slightly modified version of this article first appeared in
DentalTown magazine (August, 2001). It is with the kind
permission of that publication that it appears here.

How to select a device and

become comfortable using
the latest generation of
foramen-locating devices.
If you regularly perform endodontics
and have yet to incorporate a quality
electronic apical foramen locating device
(ALD) into your routine, you are passing
up a genuine opportunity to increase the
accuracy and consistency of your fills
and save
precious time.
The time spent taking working length
and multiple check films along with
development times can add as much as
fifteen minutes to any endodontic visit.
This is often enough to prevent a single
visit completion. Dividing an endodontic
fee over two visits, when the second visit
involves nothing more than gaining
access, irrigating and obturating, may
negate the profitability associated with
endodontic treatment.

And there are other benefits to

electronic apex location ...

Nothing is so comforting during a procedure as to have a confirmation of your instrumentation efforts just moments away.
With the ALD probe resting comfortably
near your rubber dam (perhaps perched
on your patients bib), you need only pick
it up, touch your seated file, wait for a
quick reading and think Ahhhh, Im still
there; just where I want to be! And it
didnt take you five minutes to find out.
This rapid reassurance and peace of mind
are a great psychological boon. Even in a
weepy canal, you know youre not overinstrumenting the apex.

Determining the working length. Here are all three devices

showing the point for obturation. The Root-ZX (left) and Analytic
All Fluid (center) use liquid-crystal scales. The Foramatron D-10
(right) uses colored tracking lights.

By the same token, when straightening a

very curved canal, youre alerted if you
alter the working length.
If suddenly your readings become
unstable, you may suspect that youve
packed some sludge apically and are in
danger of losing canal patency. Time to
stop, irrigate and recapitulate.
And all this information was available
without anyone de-gloving or having to
get up from their chairs. Talk about saving time (and gloves!!!)
Your patients will be exposed to far
fewer RADs and will spend less time in
your chair. A study a few years ago at the
University of Tennessee concluded that
routine use of an apex locator can reduce
Xray exposure by up to 66%, even when
it is used very conservatively. They used
it only to position the file before taking
an initial radiograph.1
Once youve learned to speak its language, the ALD provides a constant
monitor of your canal-shaping progress.
ALD Speak varies from unit to unit,
but once youve learned to trust and
understand its readings, your results will
reach a level of consistency that you
never thought possible.
The competency of todays devices far
surpasses what was possible only a few
years ago. You can now locate an apex
in any fluid youre likely to encounter
with incredible accuracy. Be advised,
however, there still are devices available
that havent embraced the newer concepts
Ill discuss below. When trying a device,
check with the manufacturer to see if
their electronics work in all fluids, and

2011 Parkell, Inc. Toll Free: 1-800-243-7446 Visit www.parkell.com Email: info@parkell.com

make sure that the device is returnable if

you are dissatisfied.

How electronic foramen

locators work

The purpose of this article is not to make

you an expert on the scientific principles
of an ALD. In the event a patient asks
you how they work, however, (Hey, you
never know) here are a few tidbits that
will most likely satisfy their curiosity and
hopefully yours as well.
Dentin, enamel and cementum are electrical insulators. Soft tissue (including the
periodontal membrane) is a conductor.
All ALDs establish a circuit in the
mouth that originates in the device, runs
through your file via its attached probe,
extends down the canal, out the apex
and into the periodontal membrane. The
circuit continues through your patients
mucosa and eventually completes the
loop by hopping onto the supplied lip clip
that is connected to the ALD through a
return wire.
As your instrument descends the canal
and approaches the soft tissue at the apex,
the strength of the signal arriving back at
the instrument gets stronger and stronger.
When the file reaches the highly conductive periodontal membrane at the apex,
there is a huge jump in the strength of
the signal.
Early electronic apex locators monitored
either the resistance or impedance of a
single frequency.
Some required calibration while others
didnt. Such ALDs were easily confused
by conductive fluids such as sodium
hypochlorite or local anesthetic. If your
1

Fig. 4

Fig. 5

Fig. 6

Taking a reading.
I find it easier to
use a touch-probe
than the more
common instrument clip (Fig.
4). The Analytic
probe (Fig. 5) is
narrower than the
one that comes
with the D-10 (Fig.
6). This can be a
plus if the tooth is
almost as long as
the instrument and
there isnt much
file left to touch.

technique involved either of these, you

had to flush them out thoroughly using
water and paper points before you could
take a reading. In many instances, preparing the canal to allow an accurate reading
became a science unto itself and totally
eliminated the convenience factor.
When gizmos are inconvenient, were apt
to leave them sitting on the shelf.
Japanese dental researchers discovered
that when two different frequencies were
sent down a canal contaminated with conductive fluid, each signal would be distorted to a different degree, but the amount of
distortion was proportional. This allowed
them to develop an algorithm that used
the relative strengths at these frequencies
to compensate for the distortion. For the
first time, it was possible to electronically
locate the apex when the canal contained
conductive fluid.
Though the mechanism of operation varies
somewhat from instrument to instrument,
the new All-fluid devices use signals
consisting of two or more frequencies.
They compensate for any shift of the
test signal caused by conductive fluid
using the other signal as a reference.
The bottom line is that the latest
generation of ALDs work very well,
and if you do endodontics, you shouldnt
be without one.
When your file/probe combo zeros in
on the apical foramen, the modern ALD
really struts its stuff by allowing the
dentist well versed in ALD-speak to
discern very fine positional changes in
the location of the file tip relative to the
apical foramen. And yes, it does this in the
2

presence of bleach, anesthetic, RC Prep,

blood, suppuration or plain old water.
To be sure, certain rules still need to be
adhered to, but they are simple, easy to
abide by and will be discussed in brief
very shortly.
As an interesting aside, studies have
shown that both generations of ALDs
share equivalent levels of accuracy when
canal conditions are just right for the
device in use. The big dif between the
newer and older devices is that the just
right conditions for the later models are
infinitely more forgiving than the previous
units. Thus, the time needed to measure a
canal length has been condensed from as
much as five minutes or more to just a
few seconds.2,3

Selecting a device

Now that Ive convinced you that you

need one, lets take a look at three of the
better-known ALDs available to you.
(Incidentally, I own all three and use them
routinely in my practice.)
Though they work similarly, there are
differences in features and cost that you
should be aware of before making a purchase decision. An interesting side note:
cost used to be a major determining factor
when deciding whether to try an ALD or
not. The big two, as I refer to the Morita
and Analytic ALDs each cost approximately $1000. For most of us, that places
them in the major purchase category.
(Lets see, do I replace that beat up curing light that I use ten times a day or do I
purchase an ALD that I might use three to
five times a week.)
One manufacturer, Parkell, has broken
new ground with the Foramatron D-10 (I
know, the name is too long.) Ive tested
it side by side with my Root ZX and
Analytic All Fluid, and have some good
news. Not only does it live up to Parkells
claims of accuracy, but it costs about half
what the other two devices sell for. To be
sure, there are differences in the overall
presentation and functionality of the three
units, but the apical foramen location
(what were really interested in, after all)
appears to be very similar in all three
devices. Lets look more closely at each.
The Morita Root ZX (street price in the
vicinity of $900)
Not counting a tryst with what will remain
an unnamed ALD in the early 70s, a

sordid affair that resulted in early termination due to its erratic performance, my
first serious foray into working with an
ALD began three years ago with the sexy
ROOT ZX from Morita.
The RZX is short in stature and is significantly wider at the base, so its difficult to
accidentally knock over. It offers a spiffy
LCD three-color display. Canal negotiation is tracked by a descending, rainbow
shaped readout composed of horizontal,
parallel LCD bars that widen as the apex
is approached. File placement beyond the
apex is signaled by a flashing icon that is
accompanied by a disconcerting alarm.
Apical placement that pleases the RZX
is indicated by a more pleasing cadence,
in effect rewarding us for getting it right.
The RZX also allows the operator to
select one of three alarm sounds and has
a volume control as well as an ear phone
plug should you wish to spare your patient
the sound effects.
The Root ZX is powered by conventional
Alkali AA batteries, as is the Analytic
device to be discussed shortly. RZXs
wire-work consists of a lip clip that
looks much like a fish hook (debarbed
of course) which turns out to be reasonably effective at engaging your patients
lip and staying put, and a spring-loaded
clip that latches onto your file via a quick
press of the thumb. The RZX needs to be
turned on via a conveniently placed on-off
depressible pad on the top upper right of
the unit. It is self-calibrating. If you fail
to use it for five minutes or so, it will turn
itself off to conserve battery power.
As alluded to before, when the rules are
followed, the RZX is dead-on accurate.
The rules are simple (In fact, they are
similar for all three of these ALDs.)
Dont touch amalgam or gold with your
probe file when taking a reading and
avoid a flooded pulp chamber when
treating multi-rooted teeth. That is, limit
your conductive fluids to the canal you
are measuring. This appears to be more
important with conductive irrigants such
as bleach and local anesthetics. Viscous,
non-conductive irrigants such as RC Prep
or Glide can be measured through with
reckless abandon, and in fact Ive found
my most accurate canal assessments to occur in pulp chambers that are completely
filled with RC Prep or Glide and relieved
of any nearby alloy.
You can use the smallest of files, (I

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typically start with a #6 K file in posterior

teeth) and obtain just as accurate a reading as could be had with a more robust
instrument, so long as the canal isnt overly
large resulting in an unstable instrument.
In such cases, youll find a larger instrument creates a more stable reading. Finally,
make sure your lip clip is secure and dont
neglect to read the devices manual for
routine operation recommendations.
One more aside, an experienced dentist
can usually look at his diagnostic film
and know within a narrow range what his
working length will be provided the original landmarks are still intact. The ALD
is used in conjunction with this knowledge and thus assists the practitioner in
fine-tuning what he already knows. It is a
convenient means of piecing together the
evidence necessary to finalize a working length. It is especially valuable in
those not so uncommon situations where
a maxillary root is difficult to visualize
on radiograph owing to dense bone or a
palatal root that is excessively divergent.
Summary: The Root ZX is a nifty unit that
will get the job done but may create a dent
in your technology budget.
The Analytic All Fluid (now owned by
Kerr; street price approximates $1000)
My second love affair began shortly after
taking a Steve Buchanan course. At this
time he professed to use the Analytic
device, and wanting very much to emulate
the master, I purchased one.
The AF is boxy, also short in stature like
the ZX and is characterized by a dual
LCD display that is at times difficult to
read if the unit is not angled properly
towards you. It tends to reflect
overhead lighting.
It sports a monochrome display, has a
staid, professional look to it and could be
described as the least-sexy-looking of the
units discussed. Its control panel is of the
touch pad variety which allow for the AF
to be tweaked to your personal preferFig. 8

Fig. 9

The Analytic AF features

a separate readout that
indicates the wetness of
the canal.

ences. That is, one can alter the readout to

correspond with where you typically like
to work your canal lengths, in essence creating your own apical landmark. Its not a
bad feature to have, but I never found the
need to use it. The factory settings were
just fine.
The AF visually tracks canal length by a
broad LCD bar that extends to the right as
you progress down the canal. This display
is accompanied by markings in half-mm
increments. When you penetrate the
forbidden zone, the bar begins blinking on
and off.
An additional but narrower bar is found
atop the canal read-out and is intended
to inform the user of the relative wetness of the canal. The AF wants that bar
to rest in the center of the display, which
indicates a moist, but not flooded canal. It
is said to have greater accuracy when this
is the case, a claim with which I concur.
(Fig. 9)
The Analytic AF, when ordered can come
with a spring-loaded clip or a forked
probe that requires only that you touch
the file with the notched part of the fork.
I much prefer this method of probing, as
it allows more freedom of file placement.
The user becomes less apt to dislodge the
file by merely touching it as opposed to
grabbing onto it with a spring-loaded clip
(Figs. 4-6.)
Its lip clip is a broad, flat affair thats effective at staying in place, but is difficult
to clean owing to a narrow curvature
where the lip is engaged.
The AF turns on automatically when a
circuit is completed, which is a nice convenience. One neednt remember to turn
it on, it does it all by itself and will turn
off independently when you havent used
it for several minutes. Ive found the ALL
FLUID to be very accurate and obtain my
best obturation results when I settle upon
a working length that finds the LCD bar .5
mm short of the indicated apex.
Summary: Like the RZX, the AT is a
worthy piece of equipment that accomplishes what it sets out to do. It also can
be purchased as a combination unit that
incorporates an electronic pulp tester as
well. The Analytic All Fluid is currently
marketed by the Kerr Corporation.

2011 Parkell, Inc. Toll Free: 1-800-243-7446 Visit www.parkell.com Email: info@parkell.com

Fig. 7

The Parkell Formamatron D-10.

($495)
Parkell has been offering an ALD for
years, but prior to its new D-10, it had
fallen to a lower rung on the ladder,
because their older model (the Foramatron
4) was a single frequency device that was
confused by conductive fluids. It worked.
It just was less convenient to use and had
more rules and regulations to follow.
Parkell has enjoyed a reputation for
marketing electronic dental devices that
though they sometimes possess fewer
do-dads, perform well at a very attractive
price. Witness their wildly successful
ultrasonic scaler and their very competent
electrosurge unit. I have owned and operated both for many years and have never
been disappointed.
Enter the D-10. Finding it difficult to
resist a new ALD (and actually needing a
third one in our group practice) I chose to
see if Parkell had turned the corner with
this newcomer. I knew full well that they
would take it back if I found it unable
to measure up to the establishment. (I
couldnt resist the pun. Sorry.)
The D-10 has a funky look to it, but the
innards are all business. While I encountered some slight inconveniences in its
design, I found it to be a very competent
device and was fascinated by the fact that
such accuracy could be had for half of the
cost of its competitors.
The D-10 does not feature an LCD
read-out (cost-containment factor) but
is instead adorned by a string of colored
lights that descend on the schematic of a
stylized root. When you are far short of
the foramen, the tracking lights are green.
They switch to a cautionary yellow when
the file tip approaches close to the foramen. A large red light identifies the apical
foramen. As your file descends, the lights
turn on and the device beeps at you. As
with the ZX, apical perforation is signaled
3

by an alarm, as well as an illumination of

lights that indicate youre out of the root.
These lights are orange.
The display is more dramatic than the ZX
or AF, and is effective at cuing the
operator when hes hit pay dirt. Working
length can also be monitored by sound
only. That is, you neednt look at the
display once youve learned what the
indicator beeps mean.
The D-10 comes with both a clip probe
and a forked touch probe as well as a
slightly cumbersome lip clip. The cabling
is light weight, at first appearing fragile.
This first impression turns out to be false
as the cables can endure considerable handling and stretching while remaining intact. The lip clip works but is not as stable
as those with the other units described. I
found myself holding it steady with a free
digit on several occasions.
The D-10 also has a dial on-off-volume
wheel, much like a transistor radio that allows the user to reduce the tonal volume.
When the unit self-turns off after 20 minutes of inactivity, the operator must turn
the dial to the off position and then back
to the on position to re-enable it. This is
a minor inconvenience, but sometimes
awkward for the gloved hand.
The forked probe is useful but will probably be thinned in a future design that will
enable easier file engagement in canals
that are nearly as long as the files used to
measure them (Fig. 6).
The D-10 is light in weight, something
my assistant loves. It features a rear
bracket upon which the units cabling
can be wrapped when the unit is put
away (another feature appreciated by my
assistant.) Beware, however: the lightness
of the unit and its angled stance makes it
somewhat less resistant to being accidentally knocked over.
On the other hand, the snack-pack, cerealbox sized case allows easy storage.
I found greatest success when I determined my working length using the
yellow light that precedes the large red
APEX light. In fact, I had the impression
that when the red light was steadily lit, my
instruments appeared on the confirmation
film to be just out of the canal.
This is where ALD-speak comes in.
Each one of the units has certain performance quirks that become apparent with
4

repeated use. In time the user begins to

know what they mean and can discern the
difference between a stable, accurate reading that can be trusted, and one that may
require film verification or further canal
shaping before the reading becomes rock
solid. Once the user is comfortable with
a device, theres no mistaking the look
of reliable readout indicating that the file
terminates just short of the apex.
Without hesitation, I trust all three of
these apex locators for final fills, sans
film. This trust develops over time, but
once established, it renders the ALD a
tremendous time saver.
Summary: The Parkell Foramatron D-10
represents a trust-worthy, reasonably well
designed ALD that has broken a price
barrier for instruments that feature such
versatility and accuracy. I have no trouble
using it interchangeably with the other
two instruments described.
Learning the language- Adjusting to a
new apex locator
Learning the language comes from taking working length films during the first
few months of use and observing where
the file is relative to the instrument reading. (Figs. 10-13).

the hassle involved, GET BACK ON THE

HORSE! You wont be able to appreciate
the strides taken until youve experienced
it. In fact, its more important to begin
using the newer generation of ALDs than
which brand you buy ... so long as it is the
next generation.
So which one is right for you?
Ill go out on a limb and attempt a match.
If you are an endodontist (who by some
miracle doesnt already own an ALD),
get the Analytic. Your everyday usage
will justify the cost. If you are a GP doing
lots and lots of endo (or you just like sexy
hi-tech hardware), the Root ZX might fill
the bill. If, however, youre a GP averaging three to five root canal cases per week,
the Parkell D-10 is a wonderful match. Its
accuracy rivals the more expensive units
while the small inconveniences mentioned
wont be significant enough to discourage
its use. And heck, youll have enough
money left over to help replace that beat
up, outdated curing light. What are you
waiting for? Start learning ALD-speak.
Its time!!!
Fig. 10

Fig. 11

Fig. 12

Fig. 13

After several months of learning the

language, youll trust its measurement
more than the radiograph.
Think about it: Who hasnt held an
extracted tooth in hand for an up close
and personal look at its anatomy. The
apical foramen often has very little to do
with the physical root tip. The technology
for ascertaining true root canal working
lengths is now both reliable and affordable. It neednt be estimated, as was once
regularly taught.
Granted, there will be times when a reliable reading will not be had and a film
will be necessary, but in my experience,
these incidences are few and far between.
A foramen locating device is no longer a
novelty. The time you save and accuracy
you gain will cover the cost of the device
many times over. As mentioned, I complete many cases with only a diagnostic
film and a final film, depending entirely
on one of my ALDs to quickly determine
working length.
If you own an older generation device,
REPLACE IT! If you owned one and
ceased using it due to unstable readouts or

References:

1 Himmel VT, Cain C. An evaluation of two electronic apex locators in a dental student clinic. Ouint
Int. 25:11, p803-805, 1993
2 Barthel CR, et al. Length-measurement of root
canals with ApexFinder and RootZX in vivo. Jour
Dent Res. 76:Spec, Abstr #2319. p303 Mar 97
3 Austin BP et al. Clinical evaluation of five apex
locators. Jour Dent Res. 76:Spec. Abstr #2321, p304,
Mar 97

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