Role of Cone-beam Computed Tomography in Diagnosis of Vertical Root Fractures: A Systematic Review and Meta-analysis

Introduction: The detection of vertical root fractures (VRFs) is a significant challenge for clinicians. Cone-beam computed tomographic (CBCT) imaging has been used recently in this field with high accuracy and sensitivity. Research results about its superiority over periapical radiographs (PRs) are mixed and inconclusive. The aim of this review and meta-analysis was to provide evidence about the accuracy of CBCT imaging in diagnosing VRFs in human teeth with and without endodontic treatment compared with conventional/digital radiography and to establish optimal imaging parameters for accurate VRF detection using CBCT imaging through a systematic approach. Methods: A search for eligible studies was conducted from January 1990 to November 2013 in PubMed, Embase, and Cochrane Central Register of Controlled Trials. The Quality Assessment of Diagnostic Accuracy Studies 2 and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklists were used to assess the quality of the included studies. Statistical pooling of sensitivity, specificity, and the diagnostic odds ratio were calculated using random effects meta-analysis model and depicted through paired forest plots. The presence of heterogeneity of the included studies was also estimated. Results: Eleven studies qualified for systematic review, and 4 studies were considered for meta-analysis. Pooled sensitivity, specificity, and the diagnostic odds ratio of CBCT imaging and PR in filled and unfilled teeth were as follows: CBCT imaging (filled): 0.752, 0.652, and 5.527; PRs (filled): 0.242, 0.961, and 8.586; CBCT imaging (unfilled): 0.776, 0.946, and 94.26; and PRs (unfilled): 0.425, 0.939, and 14.42, respectively. Overall, studies presented, heterogeneity varying from moderate to high. Conclusions: Results showed better sensitivity and specificity of CBCT scans than PRs in the detection of VRFs in unfilled teeth, particularly when a voxel size of 0.2 mm was used. Low pooled sensitivity and specificity of CBCT imaging was noted in detecting VRFs in endodontically treated teeth.