Accuracy of the Electronic Apex Locator in Relation to Patient’s Cooperative Behavior

Hafiz, Zain

doi:10.21608/edj.2018.76922

Cited by 1 publication

(10 citation statements)

References 5 publications

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“…Considering the number of examiners who performed the measurements, one study used four examiners (Patino‐Marin et al, 2011), five studies used three examiners (Alafandy, 2018; Chougule et al, 2012; de Alencar et al, 2019; Kumar et al, 2016; Sivadas et al, 2013), six studies used two examiners (Caliskan et al, 2021; Davalbhakta et al, 2021; Ghaemmaghami et al, 2008; Kielbassa et al, 2003; Koruyucu et al, 2018; Odabaş et al, 2011), and 17 studies used a single examiner (Abdullah et al, 2016; Awasthi et al, 2017; Balaji & Pravallika, 2019; Beltrame et al, 2011; Bhat et al, 2017; Dandempally et al, 2013; Hafiz, 2018a; Neena et al, 2011; Nellamakkada et al, 2020; Nogorani et al, 2014; Oznurhan et al, 2015; Rathore et al, 2020; Sankar & Jeevanandan, 2021; Saritha et al, 2012; Senthil et al, 2016; Soruri et al, 2013; Wankhade et al, 2013). Inter‐ and intra‐examiner agreement was assessed only in 11 studies, in which values were considered excellent for all analyses used: Kappa (0.87 to 0.98) (Davalbhakta et al, 2021; Koruyucu et al, 2018; Kumar et al, 2016; Odabaş et al, 2011), ICC (0.80 to 0.99) (Alafandy, 2018; Hafiz, 2018a; Patino‐Marin et al, 2011; Wankhade et al, 2013), Cronbach's alpha (0.95 to 0.99) (Alafandy, 2018; de Alencar et al, 2019), and Altmann & Bland (0.98) (Kielbassa et al, 2003).…”

Section: Resultsmentioning

confidence: 99%

“…Inter-and intra-examiner agreement was assessed only in 11 studies, in which values were considered excellent for all analyses used: Kappa (0.87 to 0.98) (Davalbhakta et al, 2021;Koruyucu et al, 2018;Kumar et al, 2016;Odabaş et al, 2011), ICC (0.80 to 0.99) (Alafandy, 2018;Hafiz, 2018a;Patino-Marin et al, 2011;Wankhade et al, 2013), Cronbach's alpha (0.95 to 0.99) (Alafandy, 2018;de Alencar et al, 2019), and Altmann & Bland (0.98) (Kielbassa et al, 2003).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…During the risk of bias assessment, inappropriate exclusions, not reporting the exclusion F I G U R E 2 Meta-analysis comparing the mean lengths between the measurements obtained by the electronic method and the comparative methods: radiography, radiovisiography, SEM, and visual direct. criteria and failure in reporting sample randomization in the randomized trials, rated the domain patient selection as 'high risk of bias' (Alafandy, 2018;Caliskan et al, 2021;Dandempally et al, 2013;Davalbhakta et al, 2021;Hafiz, 2018a;Kumar et al, 2016;Neena et al, 2011;Rathore et al, 2020;Soruri et al, 2013). For the index test and reference standard domains, the non-blinding of the examiners or the knowledge of the comparison measure before the electronic measurement attributed the concept of 'high risk of bias' (Abdullah et al, 2016;Dandempally et al, 2013;Neena et al, 2011;Nellamakkada et al, 2020;Sankar & Jeevanandan, 2021;Saritha et al, 2012).…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…A previous systematic review (Ahmad & Pani, 2015) was carried out; however, some limitations in this study need to be overcome to increase the certainty of the evidence, as most of the included studies were in vitro investigations. The most reliable evidence is obtained from well-conducted clinical studies and, since 2013 (the search date of the previous systematic review), several clinical studies have been performed to assess the accuracy of different EALs used for working length determination in primary teeth (Abdullah et al, 2016;Alafandy, 2018;Awasthi et al, 2017;Balaji & Pravallika, 2019;Bhat et al, 2017;Caliskan et al, 2021;Dandempally et al, 2013;Davalbhakta et al, 2021;de Alencar et al, 2019;Hafiz, 2018a;Koruyucu et al, 2018;Kumar et al, 2016;Nellamakkada et al, 2020;Nogorani et al, 2014;Oznurhan et al, 2015;Rathore et al, 2020;Sankar & Jeevanandan, 2021;Senthil et al, 2016;Sivadas et al, 2013;Soruri et al, 2013;Wankhade et al, 2013). However, the results of these studies have not been are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…T A B L E 1Considering the number of examiners who performed the measurements, one study used four examiners(Patino-Marin et al, 2011), five studies used three examiners(Alafandy, 2018;Chougule et al, 2012;de Alencar et al, 2019;Kumar et al, 2016;Sivadas et al, 2013), six studies used two examiners (Caliskan Abbreviations: ICC, interclass correlation coefficient; N/I, not informed; non-RCT, non-randomized clinical trial; RCT, randomized clinical trial; RVG, radiovisiography; SD, standard deviation; SEM, scanning electron microscopy; y, years old.T A B L E 1 ContinudeDavalbhakta et al, 2021;Ghaemmaghami et al, 2008;Kielbassa et al, 2003;Koruyucu et al, 2018;Odabaş et al, 2011), and 17 studies used a single examiner(Abdullah et al, 2016;Awasthi et al, 2017;Balaji & Pravallika, 2019;Beltrame et al, 2011;Bhat et al, 2017;Dandempally et al, 2013;Hafiz, 2018a;Neena et al, 2011;Nellamakkada et al, 2020;Nogorani et al, 2014;Oznurhan et al, 2015;Rathore et al, 2020; …”

mentioning

confidence: 99%

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

et al. 2022

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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).

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