CBCT is valuable for diagnosis of tooth fracture

PubMed, Embase, Web of Science, ProQuest Dissertations & Theses, CNKI and SIGLE databases.

Two reviewers independently selected studies. Studies examining the diagnostic accuracy of CBCT for tooth fractures in vivo were considered. Only studies with a minimum of ten participants using a reference test of surgical exploration or extractions to establish the diagnosis of tooth fractures were included.

Data abstraction was carried out independently by two reviewers and study quality assessed using the Quality Assessment of Studies of Diagnostic Accuracy-2 (QUADAS-2) tool. The main study outcomes were sensitivity, specificity, positive likelihood ratio (LR), negative LR and summary receiver operating characteristic (SROC).

Twelve studies were included in a meta-analysis. The pooled sensitivity was 0.92 (95% CI=0.89-0.94) and pooled specificity 0.85 (95% CI=0.75-0.92). The pooled positive and negative likelihood ratios were 5.68 (95% CI=3.42-9.45) and 0.13 (95% CI=0.09-0.18) respectively. The summary receiver operating characteristic was 0.94 (95% CI=0.90-0.98). The pooled prevalence of tooth fractures in patients with clinically suspected but periapical-radiography-undetected tooth fractures was 91% (95% CI = 83%-97%). Positive and negative predictive values were 0.98 and 0.43 (subgroup analysis: 0.98 and 0.28 for endodontically treated teeth; 0.99 and 0.77 for non endodontically treated teeth).

We suggest that CBCT has a high diagnostic accuracy for tooth fractures and could be used in clinical settings. We can be very confident with positive test results but should be very cautious with negative test results. For patients with negative results, close follow-ups are recommended. The diagnostic accuracy of CBCT is similar among different types of tooth fractures, which should be interpreted with caution due to unavailability of data for subgroup analysis on horizontal and oblique tooth fractures.