PDF(Pubmed)
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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
背景：成功的牙髓治疗需要准确确定工作长度（WL）。电子顶点定位器(EAL)被提出作为射线照相方法的替代方案；从那时起，他们已经进化并在WL的确定中获得了普及。然而,手术后疼痛的证据不足,充分性，和EAL在确定WL时的准确性。
目的：系统评价和荟萃分析旨在收集有关EAL对WL测定的有效性的证据，当与不同的成像技术以及与WL测定相关的术后疼痛进行比较时，手术过程中拍摄的X光片数量，花费的时间,以及不利影响。
方法：对于审查，在七个电子数据库中搜索了交叉和平行臂随机对照试验（RCTs）的临床研究，然后交叉引用选定的研究和相关的研究综合。使用Cochrane的RoB工具进行偏倚风险（RoB）评估，并使用随机效应模型。Meta分析采用RevMan软件5.4.1进行。
结果：11个符合条件的RCT纳入综述，8个RCT纳入荟萃分析，其中五个人的RoB较高，其余六个人的RoB不清楚。在荟萃分析之后，EAL组和X线片组术后疼痛无显著差异(SMD0.00,CI.29~.28,354名参与者;P值=0.98).射线照相组显示出更好的WL准确性（SMD0.55，CI.11至.99，254名参与者；P值=0.02），而EAL组的WL充分性提高了10％（RR1.10，CI1.03-1.18，573名参与者；P值=0.006）。
结论：我们发现非常低的确定性证据支持不同类型的EAL与X线照相术对测试结果的疗效。我们无法就任何类型的EAL的优越性得出任何结论。需要通过标准化结果和结果测量方法来进行计划良好的RCT。
目的：系统评价和荟萃分析旨在收集有关EAL对WL测定的有效性的证据，当与不同的成像技术以及与WL测定相关的术后疼痛进行比较时，手术过程中拍摄的X光片数量，花费的时间,以及不利影响。
方法：对于审查，在七个电子数据库中搜索了交叉和平行臂随机对照试验（RCTs）的临床研究，然后交叉引用选定的研究和相关的研究综合。使用Cochrane的RoB工具进行偏倚风险（RoB）评估，并使用随机效应模型。Meta分析采用RevMan软件5.4.1进行。
结果：11个符合条件的RCT纳入综述，8个RCT纳入荟萃分析，其中五个人的RoB较高，其余六个人的RoB不清楚。在荟萃分析之后，EAL组和X线片组术后疼痛无显著差异(SMD0.00,CI.29~.28,354名参与者;P值=0.98).射线照相组显示出更好的WL准确性（SMD0.55，CI.11至.99，254名参与者；P值=0.02），而EAL组的WL充分性提高了10％（RR1.10，CI1.03-1.18，573名参与者；P值=0.006）。
结论：我们发现非常低的确定性证据支持不同类型的EAL与X线照相术对测试结果的疗效。我们无法就任何类型的EAL的优越性得出任何结论。需要通过标准化结果和结果测量方法来进行计划良好的RCT。
