Magnification devices for endodontic therapy

BackgroundAfter the introduction of microsurgical principles in endodontics, involving new techniques for root canaltreatment, there has been a continuous search for enhancing the visualisation of the surgical field. It would beinteresting to know if the technical advantages for the operator brought in by magnification devices like surgicalmicroscope, endoscope and magnifying loupes, are also associated with advantages for the patient, in terms ofimprovement of clinical and radiographic outcomes.ObjectivesThe purpose of this systematic review was to evaluate and compare the effects of endodontic treatmentperformed with the aid of magnification devices versus endodontic treatment without magnification devices. Wealso aimed at comparing among them the different magnification devices used in endodontics (microscope,endoscope, magnifying loupes).Search strategyThe Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE were searched with appropriatesearch strategies. Handsearching included nine dental journals. The bibliographies of relevant clinical trials andrelevant articles were checked for identifying studies outside the handsearched journals. Seven manufacturers ofinstruments in the field of endodontics and/or endodontic surgery, as well as the authors of the identifiedrandomised controlled trials (RCTs) were contacted in order to identify unpublished or ongoing RCTs. There wereno language restrictions. The last electronic search was conducted on 2nd April 2009, and the lasthandsearching was undertaken on 31st January 2009.Selection criteriaAll randomised and quasi-randomised trials comparing endodontic therapy performed with or without using oneor more types of magnification device, as well as randomised and quasi-randomised trials comparing two ormore magnification devices used as an adjunct to endodontic therapy were considered.Data collection and analysisScreening of studies and data extraction were conducted independently and in duplicate. The CochraneCollaboration statistical guidelines were to be followed for data synthesis.Main resultsNo trial could be included in the present review. All of the prospective trials that were identified, all dealing withendodontic surgery, had to be excluded for various reasons. Only one RCT was identified comparing threemagnificators (magnifying loupes, surgical microscope, endoscope) in endodontic surgery. No RCT was foundthat compared the outcome of endodontic therapy using or without using a given magnification device.Authors' conclusionsNo objective conclusion can be drawn from the results of this review as no article was identified in the currentliterature that satisfied the criteria for inclusion. It is unknown if and how the type of magnification device affectsthe treatment outcome, considering the high number of factors that may have a significant impact on the successof endodontic surgical procedure. This should be investigated by further long-term RCTs with large sample size.Technical advantages of magnificators have been widely reported in low evidence level studies, but they shouldbe systematically addressed to know if there can be the clinical indication for using a given magnification devicefor specific clinical situations, such as for molar teeth, or if they can all be used interchangeably.Well-designed RCTs should also be performed to determine the true difference in terms of treatment successrates between using or not using a magnification device in both conventional and surgical endodontic treatment,if any exist.