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Abstract：
OBJECTIVE: To conduct a systematic review and meta-analysis according to the following PICO question: in extracted human permanent teeth, does preflaring, compared with unflared canals, influence the accuracy of WL determination with EAL?
METHODS: A systematic review was conducted according to the PRISMA checklist, using the following databases: PubMed, Science Direct, Scopus, and Web of Science. Studies related to WL determination using EAL both in preflared and unflared root canals of extracted human teeth were included. The outcome of interest was the accuracy of the electronic WL determination. A quality assessment of the included studies was performed, determining the risk of bias. The meta-analyses were calculated with the 5.4 RevMan software using the inverse variance method with random effects. PROSPERO registration: CRD42021243412.
RESULTS: Ten experimental studies fulfilled the inclusion criteria, and most of them found that preflaring increases the accuracy of the EALs in WL determination. The calculated OR was 1.98 (95% CI = 1.65-2.37; p < 0.00001; I2 = 10%), indicating that the determination of WL by EALs is almost twice as accurate in preflared canals. The accuracy of Root ZX in WL determination increases more than three times (OR = 3.25; p < 0.00001). Preflaring with Protaper files significantly increases the accuracy of EALs (OR = 1.76; p < 0.00001). The total risk of bias of the included studies was low. No obvious publication bias was observed.
CONCLUSIONS: The results indicate a significant increase in the accuracy of WL determination with EAL after preflaring, doubling the percentage of exact measurements. Preflaring should be recommended as an important step during mechanical enlargement of the root canal, not only because it improves the access of the files to the canal, but also because it allows one to obtain more accurate electronic determinations of WL.
METHODS: A systematic review was conducted according to the PRISMA checklist, using the following databases: PubMed, Science Direct, Scopus, and Web of Science. Studies related to WL determination using EAL both in preflared and unflared root canals of extracted human teeth were included. The outcome of interest was the accuracy of the electronic WL determination. A quality assessment of the included studies was performed, determining the risk of bias. The meta-analyses were calculated with the 5.4 RevMan software using the inverse variance method with random effects. PROSPERO registration: CRD42021243412.
RESULTS: Ten experimental studies fulfilled the inclusion criteria, and most of them found that preflaring increases the accuracy of the EALs in WL determination. The calculated OR was 1.98 (95% CI = 1.65-2.37; p < 0.00001; I2 = 10%), indicating that the determination of WL by EALs is almost twice as accurate in preflared canals. The accuracy of Root ZX in WL determination increases more than three times (OR = 3.25; p < 0.00001). Preflaring with Protaper files significantly increases the accuracy of EALs (OR = 1.76; p < 0.00001). The total risk of bias of the included studies was low. No obvious publication bias was observed.
CONCLUSIONS: The results indicate a significant increase in the accuracy of WL determination with EAL after preflaring, doubling the percentage of exact measurements. Preflaring should be recommended as an important step during mechanical enlargement of the root canal, not only because it improves the access of the files to the canal, but also because it allows one to obtain more accurate electronic determinations of WL.
摘要：
目的：根据以下PICO问题进行系统评价和荟萃分析：在提取的人恒牙中，确实令人发指，与未张开的运河相比，
方法：根据PRISMA检查表进行系统评价，使用以下数据库:PubMed,科学直接，Scopus,和WebofScience。包括使用EAL在拔除的人牙的前扩张和未扩张根管中进行WL测定的相关研究。感兴趣的结果是电子WL测定的准确性。对纳入的研究进行了质量评估，确定偏差的风险。meta分析使用5.4RevMan软件使用具有随机效应的逆方差方法进行计算。PROSPERO注册：CRD42021243412。
结果：10项实验研究符合纳入标准，并且他们中的大多数人发现预扩张增加了WL确定中EAL的准确性。计算的OR为1.98（95％CI=1.65-2.37；p<0.00001；I2=10％），表明EALs对WL的测定几乎是扩口运河的两倍。根ZX在WL测定中的准确度提高了三倍以上(OR=3.25;p<0.00001)。使用Protaper文件进行预反射显着提高了EAL的准确性（OR=1.76；p<0.00001）。纳入研究的总偏倚风险较低。未观察到明显的发表偏倚。
结论：结果表明，预燃烧后，用EAL测定WL的准确性显着提高，将精确测量的百分比加倍。在根管机械扩大过程中，应建议将反射作为重要步骤，不仅因为它改善了文件对运河的访问，还因为它允许人们获得更准确的WL电子测定。
方法：根据PRISMA检查表进行系统评价，使用以下数据库:PubMed,科学直接，Scopus,和WebofScience。包括使用EAL在拔除的人牙的前扩张和未扩张根管中进行WL测定的相关研究。感兴趣的结果是电子WL测定的准确性。对纳入的研究进行了质量评估，确定偏差的风险。meta分析使用5.4RevMan软件使用具有随机效应的逆方差方法进行计算。PROSPERO注册：CRD42021243412。
结果：10项实验研究符合纳入标准，并且他们中的大多数人发现预扩张增加了WL确定中EAL的准确性。计算的OR为1.98（95％CI=1.65-2.37；p<0.00001；I2=10％），表明EALs对WL的测定几乎是扩口运河的两倍。根ZX在WL测定中的准确度提高了三倍以上(OR=3.25;p<0.00001)。使用Protaper文件进行预反射显着提高了EAL的准确性（OR=1.76；p<0.00001）。纳入研究的总偏倚风险较低。未观察到明显的发表偏倚。
结论：结果表明，预燃烧后，用EAL测定WL的准确性显着提高，将精确测量的百分比加倍。在根管机械扩大过程中，应建议将反射作为重要步骤，不仅因为它改善了文件对运河的访问，还因为它允许人们获得更准确的WL电子测定。
