Abstract
Introduction: The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. In recent years, CBCT imaging has become a common diagnostic tool in endodontics. CBCT should only be used to ensure that the benefits to the patient exceed the risks. As such, our aim in this study was to evaluate the high level diagnostic efficacy studies and their risk of bias. Methods: A systematic search of the literature was conducted to identify studies evaluating the use of CBCT imaging in endodontics. The following databases were searched: Medline (PubMed), Scopus, and Cochrane Central. The identified studies were subjected to rigorous inclusion criteria. Studies considered as having a high efficacy level were then subjected to a risk of bias assessment using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Results: Initially, 1568 articles were identified for possible inclusion in the review. Following title and abstract assessment, duplicate removal, and a full-text evaluation, 22 studies were included. Of those studies, 2 had a low risk of bias and 20 had a high risk of bias. Six studies investigated non-surgical treatment, eight investigated surgical treatment, two investigated both non-surgical and surgical treatment, and six studies investigated diagnostic thinking or decision making. Conclusion: The evidence for the influence of CBCT on decision making and treatment outcomes in endodontics is predominantly based on studies with a high risk of bias.
Highlights
The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments
In an effort to select studies evaluating the effects of Cone-beam computed tomography (CBCT) on clinical diagnosis, decision making, and treatment outcomes, articles were categorized into one of six levels of efficacy based on the diagnostic efficacy hierarchical model presented by Fryback and Thornbury [3,18,19]
The results of the electronic databases search and the manual search are shown in Figure 1, which presents a flowchart of the systematic review process [21]
Summary
The integration of clinical inspection and diagnostic imaging forms the basis for endodontic diagnosis, decision making, treatment planning, and outcome assessments. Numerous studies have addressed the use and efficacy of CBCT for various clinical indications in endodontics including: surgical versus non-surgical treatment [4]; pre-operative versus intra- [5] and post-operative [4] evaluations; and the evaluation of anterior versus posterior teeth [6]. These studies present substantial inconsistencies in terms of study design, results, and conclusions [4,5,6]. A comprehensive review of the diagnostic efficacy and risk of bias assessment of CBCT imaging in endodontics literature, using evidence-based dentistry principles, would be of great use [3,8,9]
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