Exploring Diagnostic Reliability of CBCT for Vertical Root Fractures: A Systematic Review and Meta-Analytical...

Area of Science:

• Dentistry
• Oral and Maxillofacial Radiology

Background:

• Vertical root fractures (VRFs) are a significant cause of tooth loss.
• Accurate diagnosis of VRFs is crucial for appropriate treatment planning.
• Cone-beam computed tomography (CBCT) is increasingly used for endodontic diagnostics.

Purpose of the Study:

• To systematically review factors influencing the diagnostic accuracy of CBCT for VRFs in vitro.
• To evaluate the impact of fracture type, intracanal materials, and imaging parameters on CBCT performance.

Main Methods:

• Systematic literature search of major databases up to May 2025.
• Inclusion of in vitro studies assessing CBCT diagnostic accuracy for laboratory-induced VRFs.
• Quality assessment using QUADAS-2 and meta-analysis with bivariate random-effects models.
• Meta-regression to investigate confounding factors and GRADE for evidence quality.

Main Results:

• CBCT demonstrated higher sensitivity for complete VRFs than incomplete fractures.
• Metal posts significantly reduced both sensitivity and specificity.
• Smaller voxel sizes improved VRF detection in teeth with metal posts.
• Fracture pattern, intracanal materials, and voxel size were key factors affecting diagnostic accuracy.

Conclusions:

• CBCT is a valuable tool for diagnosing VRFs, particularly complete fractures.
• The presence of metal posts and the chosen voxel size are critical considerations for optimizing diagnostic accuracy.
• Further research should focus on standardizing imaging protocols to enhance VRF detection.