TY - JOUR
T1 - Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis
AU - Kaur, Gurveen
AU - Thomas, Anchu Rachel
AU - Samson, Renu Sarah
AU - Varghese, Eby
AU - Ponraj, Ratna Rachel
AU - Nagraj, Sumanth Kumbargere
AU - Shrivastava, Deepti
AU - Algarni, Hmoud Ali
AU - Siddiqui, Amna Yusuf
AU - Alothmani, Osama S.
AU - Srivastava, Kumar Chandan
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/5/4
Y1 - 2024/5/4
N2 - Background: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. Objective: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. Methods: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. Results: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI.29 to.28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI.11 to.99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03–1.18, 573 participants; P value = 0.006). Conclusion: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.
AB - Background: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. Objective: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. Methods: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. Results: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI.29 to.28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI.11 to.99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03–1.18, 573 participants; P value = 0.006). Conclusion: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.
KW - Apex locator
KW - Endodontic
KW - Radiographs
KW - Root canal treatment
KW - Working lengt
KW - Odontometry/methods
KW - Humans
KW - Tooth Apex/diagnostic imaging
KW - Radiography, Dental/methods
KW - Dental Pulp Cavity/diagnostic imaging
UR - http://www.scopus.com/inward/record.url?scp=85192099565&partnerID=8YFLogxK
UR - https://pearl.plymouth.ac.uk/context/pds-research/article/1220/viewcontent/Efficacy_of_electronic_apex_locators_in_comparison_with_intraoral_radiographs_in_working_length_determination__a_systematic_.pdf
U2 - 10.1186/s12903-024-04259-w
DO - 10.1186/s12903-024-04259-w
M3 - Review article
C2 - 38704529
AN - SCOPUS:85192099565
SN - 1472-6831
VL - 24
JO - BMC Oral Health
JF - BMC Oral Health
IS - 1
M1 - 532
ER -