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Meta-Analysis
. 2017 Dec;46(8):20170400.
doi: 10.1259/dmfr.20170400. Epub 2017 Nov 2.

Radiographic diagnosis of root fractures: a systematic review, meta-analyses and sources of heterogeneity

Fernanda Cristina Sales Salineiro  1 , Solange Kobayashi-Velasco  1 , Mariana Minatel Braga  2 , Marcelo Gusmão Paraiso Cavalcanti  1
Affiliations
Meta-Analysis

Radiographic diagnosis of root fractures: a systematic review, meta-analyses and sources of heterogeneity

Fernanda Cristina Sales Salineiro et al. Dentomaxillofac Radiol. 2017 Dec.

Abstract

Objectives: Many studies to evaluate the accuracy of root fracture diagnosis have been conducted. However, there is a scarcity of studies to assess the quality and the sources of heterogeneity in the literature. For this reason, the aim of this study was to conduct systematic reviews and meta-analyses to summarize the available evidence on detection of root fractures by cone beam CT (CBCT) and periapical radiograph (PR) images and the interference of artefact by investigating possible sources of heterogeneity.

Methods: Studies reporting root fracture detection, from January 2010 to February 2016, were selected. All selected studies were subjected to selection criteria and then, comparative and qualitative analyses by using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool were performed. Pooled sensitivity, specificity and diagnostic odds ratios were calculated. Also, receiver operator characteristics (ROC) curves were built to summarize the results. SROC curve analyses were performed to investigate the heterogeneity among studies.

Results: Initially, 799 articles were selected. After screening titles and abstracts, 743 articles were excluded. After reading the remaining 56 full-texts, 47 relevant articles were included in this study. Diagnostic odds ratio values revealed a wide range of results across the studies and determined a higher heterogeneity for PR compared with CBCT. The analyses of the SROC curves compared CBCT imaging versus PR in the diagnosis of root fracture, favouring CBCT modality.

Conclusions: CBCT was the imaging exam that rendered a higher diagnostic accuracy for root fractures.

Keywords: cone-beam computed tomography; imaging diagnosis; root fracture.

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Figures

Figure 1.
Figure 1.
Flow diagram.
Figure 2.
Figure 2.
QUADAS-2 domain.
Figure 3.
Figure 3.
Summary ROCcurves for detection of root fractures using cone beam CT and periapical radiographs with and without metallic artefacts, as well as, performed by maxillofacial radiologists or endodontists (SROC: central curve; other curves: upper and lower limits of confidence).
Figure 4.
Figure 4.
Comparison of summary ROC curves considering: cone beam CT with metallic artefacts vs without metallic artefacts; periapical radiograph with metallic artefacts vs without metallic artefacts and, maxillofacial radiologists vsendodontists performances for detecting root fractures. (Circles related to the curves demonstrate their respective confidence regions (CR).
See this image and copyright information in PMC

Comment in

References

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