Transverse Diagnosis and CBCT Technology: A Systematic Review

Background: Diagnosis is the fundamental basis for understanding biomechanics in orthodontic treatment and for accurately designing the treatment plan. Traditionally, the sagittal plane has been the primary focus of assessment; however, it is essential to consider the patient in all three spatial planes. Therefore, it is necessary to explore the transverse plane, which is equally as crucial as the sagittal and vertical planes. With current technological advances, it is now possible to obtain three-dimensional images of the patient using cone-beam computed tomography (CBCT), allowing evaluation of all planes in a single diagnostic test. This study aimed to assess the diagnostic methods used for transverse analysis and the usefulness of CBCT for this purpose. Material and Methods: To select the studies for this review, we searched the PubMed, Scopus, and Cochrane databases for publications between 1965 and 2021. Our inclusion criteria targeted studies that evaluated the transverse plane using CBCT or CT. We assessed the level of evidence according to the OCEBM classification and evaluated the risk of bias using the QUADAS-2 scale. Results: After reviewing 535 articles, we selected 16 that met the established criteria. These studies compared various diagnostic methods for transverse analysis and their reproducibility indices. We identified the absence of a gold standard for measuring transverse discrepancies and high variability among diagnostic methods as the main limitations. Conclusions: Based on the available evidence, it can be concluded that dental and skeletal transverse discrepancies can be reliably differentiated using the diagnostic techniques evaluated in this study, particularly through CBCT-based assessment. Therefore, the diagnosis of transverse discrepancies should not be considered unclear, as it can be established using objective and measurable criteria. These findings reinforce the clinical value of current diagnostic tools and highlight the importance of accurate three-dimensional interpretation for informed and effective treatment decision-making.