Diagnosis of Vertical Root Fractures by Cone Beam Computed Tomography in Root Filled Teeth with Confirmation by Direct Visualization- A Systematic Review and Meta-Analysis.

Abstract

AIM\nThe purpose of this review was to determine the diagnostic accuracy of CBCT in detecting vertical root fracture in root filled teeth when compared to a reference standard (direct visualization).\n\n\nMETHODS\nElectronic searches were performed in Medline, Scopus, Cochrane and Grey Literature for English language articles till June 2020. Prospective and retrospective clinical studies using CBCT to diagnose VRF in root filled teeth were included. Case reports and in-vitro studies were excluded. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias (RB) and applicability concerns. Meta-analysis was done using STATA 16.1 software via MIDAS 3.0 package and METANDI module. Publication bias was evaluated using Deeks funnel plot analysis. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was done to evaluate certainty of evidence. This systematic review was registered in the Open Science Framework (10.17605/OSF.IO/7JKE2).\n\n\nRESULTS\n8 articles were included in this systematic review and meta-analysis. RB assessment showed that 5 articles in the patient selection domain had low RB with low applicability concern. In the index test and reference standard domains, 7 articles had moderate RB with moderate applicability concern. 3 articles had high RB in the flow and timing domain. There was no publication bias. CBCT had pooled sensitivity and specificity of 0.78 (95% CI =0.64-0.88) and 0.80 (95% CI =0.63-0.91) respectively and accuracy of 0.86 (95% CI =0.83-0.89). CBCT also had pooled positive and negative likelihood ratios of 4 and 0.2 respectively. In GRADE analysis, the quality of evidence was low for sensitivity and moderate for specificity when CBCT was used for diagnosis of VRF.\n\n\nCONCLUSIONS\nOverall quality assessment of included articles showed that in patient selection domain, the risk of bias was low and it was moderate in index test and reference standard domains. Evidence from this updated systematic review and meta analysis indicates that CBCT is still not a good tool for diagnosing VRF in root filled teeth as compared to direct visualization.