Comparison of Musculoskeletal Strain in Endodontists Using Magnification Versus the Naked Eye: A Systematic Review

Abstract

Objective: Work-related musculoskeletal disorders (WMSDs) are highly prevalent among dental professionals, particularly endodontists, due to prolonged static postures, sustained neck flexion, and high visual demands during precision-based procedures (Mansoor et al., 2022; Kumar et al., 2014). Dental magnification devices, including loupes and operating microscopes, have been proposed as ergonomic interventions capable of improving posture and reducing musculoskeletal strain (Hong et al., 2024; Pope-Ford and Jiang, 2015). This systematic review aimed to evaluate the effect of dental magnification on musculoskeletal outcomes among endodontists and dentists performing endodontic procedures. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. The protocol for this systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD420251181214), and the review was conducted in accordance with the registered protocol.Electronic searches were performed in PubMed, Scopus, Web of Science, Embase, Cochrane CENTRAL, and Google Scholar for studies comparing magnification-assisted practice with naked-eye practice. Eligible studies assessed musculoskeletal pain, posture, ergonomic risk, muscle fatigue, or muscle activity using validated tools such as electromyography (EMG), Rapid Upper Limb Assessment (RULA), and standardized questionnaires (Ortiz Hugues and Adorno, 2024; Valachi and Valachi, 2003). Results: Forty-one studies met the inclusion criteria. The majority of experimental and observational studies demonstrated improved working posture, reduced cervical flexion, and lower neck and shoulder muscle activity among clinicians using magnification compared with naked-eye practice (Hong et al., 2024; Ortiz Hugues and Adorno, 2024; Pazos et al., 2025; Pazos et al., 2022; Mines et al., 1999). EMG-based studies reported reduced trapezius and cervical muscle workload with both loupes and operating microscopes, particularly when devices were properly fitted (Hong et al., 2024; Pazos et al., 2020). Survey-based studies indicated lower prevalence and severity of musculoskeletal symptoms among regular magnification users (Aboalshamat et al., 2020; Kumar et al., 2014; Costa et al., 2024). Conclusion: Dental magnification devices are associated with reduced musculoskeletal strain among endodontists when appropriately selected and ergonomically optimized. Integration of ergonomic training and early adoption of magnification may play a critical role in preventing work-related musculoskeletal disorders in endodontic practice (Valachi and Valachi, 2003; Plessas and Bernardes Delgado, 2018).