Apical termination of root canal procedures—ambiguity or disambiguation?

Abstract

Abstract The issues of working length determination, its apical extent, and the position of the final root canal filling have been controversial, as differing points of view have existed between the biologically based and clinically based endodontic gurus regarding this concept for decades. Coupled with the following issues, it has become somewhat of an empirical bastion for clinicians, especially those in the limelight or who use social media to augment their clinical prowess: (1) the variable anatomy of the root apex; (2) where to terminate canal enlarging and shaping apically; (3) status of the accessory communications apically; (4) size of the apical preparation; (5) ability to debride the apical extent of the root canal and remove both bacteria and biofilm; (6) response of the periapical tissues, when both vital and necrotic, to the intracanal filling materials and techniques that may impinge on these tissues; and (7) long-term outcomes and assessments of the procedures rendered. For purposes of succinctness, the concept of working length, the apical position of instrument termination, and the position of the final filling will be addressed simultaneously in this paper.