title: The Diagnostic Efficacy of Cone-beam Computed Tomography in Endodontics: A Systematic Review and Analysis by a Hierarchical Model of Efficacy.
abstract: BACKGROUND
  The aim of this study was to evaluate the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in endodontics based on a systematic search and analysis of the literature using an efficacy model.
  
  
  METHODS
  A systematic search of the literature was performed to identify studies evaluating the use of CBCT imaging in endodontics. The identified studies were subjected to strict inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for appraisal of the literature on the levels of efficacy of a diagnostic imaging modality.
  
  
  RESULTS
  Initially, 485 possible relevant articles were identified. After title and abstract screening and a full-text evaluation, 58 articles (12%) that met the inclusion criteria were analyzed and allocated to levels of efficacy. Most eligible articles (n = 52, 90%) evaluated technical characteristics or the accuracy of CBCT imaging, which was defined in this model as low levels of efficacy. Only 6 articles (10%) proclaimed to evaluate the efficacy of CBCT imaging to support the practitioner's decision making; treatment planning; and, ultimately, the treatment outcome, which was defined as higher levels of efficacy.
  
  
  CONCLUSIONS
  The expected ultimate benefit of CBCT imaging to the endodontic patient as evaluated by its level of diagnostic efficacy is unclear and is mainly limited to its technical and diagnostic accuracy efficacies. Even for these low levels of efficacy, current knowledge is limited. Therefore, a cautious and rational approach is advised when considering CBCT imaging for endodontic purposes.
authors.affiliation: Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: dr.eyalrosen@gmail.com.
authors.forename: Eyal
authors.initials: E
authors.lastname: Rosen
authors.affiliation: Università degli Studi di Milano, Department of Biomedical, Surgical and Dental Sciences, Research Centre in Oral Health, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Taschieri
authors.affiliation: Università degli Studi di Milano, Department of Biomedical, Surgical and Dental Sciences, Research Centre in Oral Health, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Fabbro
authors.affiliation: Department of Periodontology and Implant Dentistry, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Beitlitum
authors.affiliation: Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Tsesis
mesh_terms: D054893:Cone-Beam Computed Tomography; D003788:Dental Pulp Diseases / Q000000981:diagnostic imaging; D004708:Endodontics / Q000379:methods*; D055094:Evidence-Based Dentistry / Q000379:methods; D006801:Humans
keywords: Cone-beam computed tomographic imaging; efficacy; endodontics