Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta‐analysis of clinical studies

Abstract

Background The lack of a well‐defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length. Objectives To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies. Methods Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta‐analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta‐analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS‐2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Twenty‐nine studies were included in the qualitative analysis and twenty‐three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta‐analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within −0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome. Discussion The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice. Conclusions Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth. Registration CRD42021277414 (PROSPERO).

Deciphering Pediatric Root Canal Practices in Turkey: A Comparative Study Bridging the Gap between Practice and Literature

“…The use of apex locators to determine the canal length of deciduous teeth is still a matter of debate. Although there are resources in the literature that do not recommend its use [ 59 ], resources that suggest its use but argue that there is not enough research on the subject [ 60 ], and resources that recommend its use [ 61 ] and references report that apex locators are much more acceptable by children than traditional radiography [ 62 ], no conclusive evidence has been provided as to which of the methods is the best.…”

Evaluation of accuracy of an electronic apex locator in presence of sodium hypochlorite in primary teeth with and without resorption

“…It is reported that the use of an electronic apex locator (EAL) eliminates these disadvantages [2]. It is stated that EALs can produce beneficial results, especially when radiographic imaging of the root apex is prevented by certain anatomical structures such as bone density, superposed tooth roots or zygomatic arch [3]. Unlike radiographic methods, by using the EAL the patient is not exposed to radiation, and the elimination of the time required to take a traditional film image are indicated as important advantages in the use of an EAL [4].…”