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Comparative Accuracy of Electronic Apex Locators and Conventional Radiography for Working Length Determination in
Naser A Alarifi1, Abdulrahman M Alqahtani2, Abrar Z Alharbi3
1Dental Department, Albaha University, Albaha, SAU.
Cureus
|November 10, 2025
Summary
Electronic apex locators (EALs) offer superior accuracy for root canal treatment working length determination compared to radiographs. This systematic review found EALs provide more reliable measurements, reducing overextensions and improving treatment outcomes.
Area of Science:
- Endodontics
- Dental Diagnostics
- Radiology
Background:
- Accurate working length determination is crucial for successful root canal therapy.
- Radiographs are traditional tools, but electronic apex locators (EALs) offer an alternative diagnostic method.
Purpose of the Study:
- To systematically review and meta-analyze the accuracy of EALs versus conventional and digital radiographs for working length determination.
- To compare in vivo and ex vivo study results.
Main Methods:
- Comprehensive literature search across major databases (PubMed, Cochrane Library, LILACS, EBSCO, Google Scholar).
- Inclusion of 16 eligible studies, including randomized controlled trials.
- Risk-of-bias assessment using QUADAS-2.
Main Results:
- EALs demonstrated higher acceptable working length determination rates (87.0%–92.1%) compared to radiographs (74.0%–83.1%).
- EAL groups showed a significantly lower incidence of overextended root canal treatments.
- Both in vivo and ex vivo studies confirmed EALs' superior or comparable accuracy within ±0.5-1.0 mm tolerance.
Conclusions:
- EALs are more accurate and reliable than radiographs for determining root canal working length.
- Integration of EALs into endodontic practice is supported by current evidence.
- Further standardized, multicenter studies are recommended to solidify clinical guidelines.
