ACCEPTANCE AND PRACTICALITY OF DIFFERENT WORKING LENGTH DETERMINATION METHODS IN PRIMARY TEETH: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Pulpectomy has been the most common treatment modality in pediatric patients and is also associated with dental anxiety and fear. Determining the working length (WL) is one of the crucial steps for a successful pulpectomy. A technique for determining working length must yield exact and reproducible results. The behaviour of children can influence the outcome of pulpectomy. Most of the methods used for working length determination can cause anxiety and are time-consuming. Aim: To compare the acceptance, anxiety, behaviour, and time efficiency of different working length determination methods—tactile sensation, radiographic method, and electronic apex locator—in primary teeth for most effective clinical practices. Materials and Methods: This randomized clinical study included 150 children aged 4–7 years requiring pulpectomy in primary molars. The children were randomly allocated into three groups (n = 50 each). Working length was determined using the tactile sensation method in Group 1, digital radiographic method in Group 2, and electronic apex locator (EAL) in Group 3. Children’s anxiety and behaviour were assessed using the Venham Picture Test (VPT) and Frankl Behaviour Rating Scale (FBRS), respectively, at three stages: before treatment, during working length determination, and after treatment. The time required for working length determination was recorded. Data were statistically analyzed using appropriate nonparametric and parametric tests with a significance level set at p < 0.05. Results: A significant difference was observed in VPT scores within and between groups, with higher anxiety levels noted during working length determination in the EAL group (p < 0.05). FBRS scores showed significant differences in distribution between groups but did not significantly influence the time required for working length determination. The mean time required was shortest for the tactile method (1.30 ± 0.13 minutes) and longest for the EAL method (3.00 ± 0.38 minutes), with statistically significant differences between all groups (p < 0.05). Conclusion: In summary, while group type and VPT scores in different stages significantly influence the time taken in WL estimation, the results of FBRS do not have a noticeable effect. Clinical Significance: Choosing time-efficient and comfortable working length determination methods may reduce anxiety and the need for behaviour guidance techniques in pediatric endodontic practice.