title: Cone-beam Computed Tomography for Detecting Vertical Root Fractures in Endodontically Treated Teeth: A Systematic Review.
abstract: BACKGROUND
  A vertical root fracture (VRF), commonly found in teeth with endodontic treatment, is challenging to diagnose and has poor treatment outcomes. Cone-beam computed tomography (CBCT) has become an increasingly popular imaging modality in endodontics, but image artifacts arising from root-filling materials may hinder VRF detection. The aim of this investigation was to conduct a systematic review to assess the diagnostic ability of CBCT for detecting VRFs in endodontically treated teeth.
  
  
  METHODS
  A systematic review of in vivo clinical diagnostic literature (initial search December 2014, updated August 2015) was conducted. Assessment of methodological quality was performed by using the modified Quality Assessment of Diagnostic Accuracy Studies tool.
  
  
  RESULTS
  Four studies with a total of 130 patients were included. The reported ranges of values were 40%-90% for VRF prevalence, 84% (0.64-0.95) to 100% (0.83-1.00) for sensitivity, 64% (0.35-0.87) to 100% (0.03-1.00) for specificity, 71% (0.51-0.87) to 100% (0.63-1.00) for positive predictive value, and 50% (0.01-0.99) to 100% (0.84-1.00) for negative predictive value. All 4 studies revealed multiple items at high risk or unclear risk of bias.
  
  
  CONCLUSIONS
  Because of the significant imprecision in the range of reported estimates and the biases observed in the included studies, there is currently insufficient evidence to suggest that CBCT is a reliable test in detecting VRFs in endodontically treated teeth.
authors.affiliation: Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Edwin
authors.initials: E
authors.lastname: Chang
authors.affiliation: Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ernest
authors.initials: E
authors.lastname: Lam
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Prakesh
authors.initials: P
authors.lastname: Shah
authors.affiliation: Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. Electronic address: amir.azarpazhooh@dentistry.utoronto.ca.
authors.forename: Amir
authors.initials: A
authors.lastname: Azarpazhooh
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000379:methods*; D006801:Humans; D014082:Tooth Fractures / Q000000981:diagnostic imaging*; D014092:Tooth Root / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000293:injuries*; D019553:Tooth, Nonvital / Q000000981:diagnostic imaging*
keywords: Cone beam computed tomography; diagnosis; review literature as topic; tooth fractures