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BMC Oral Health
Published in: BMC Oral Health 1/2024

Open Access 01-12-2024 | Root Canal Debridement | Systematic Review

Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis

Authors: Gurveen Kaur, Anchu Rachel Thomas, Renu Sarah Samson, Eby Varghese, Ratna Rachel Ponraj, Sumanth Kumbargere Nagraj, Deepti Shrivastava, Hmoud Ali Algarni, Amna Yusuf Siddiqui, Osama S. Alothmani, Kumar Chandan Srivastava

Published in: BMC Oral Health | Issue 1/2024

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Abstract

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.
Appendix
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Metadata
Title
Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis
Authors
Gurveen Kaur
Anchu Rachel Thomas
Renu Sarah Samson
Eby Varghese
Ratna Rachel Ponraj
Sumanth Kumbargere Nagraj
Deepti Shrivastava
Hmoud Ali Algarni
Amna Yusuf Siddiqui
Osama S. Alothmani
Kumar Chandan Srivastava
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2024
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-024-04259-w

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