Diagnostic methods for assessing maxillary skeletal and dental transverse deficiencies: A systematic review.
OBJECTIVE
To evaluate the accuracy and reliability of the diagnostic tools available for assessing maxillary transverse deficiencies.


METHODS
An electronic search of three databases was performed from their date of establishment to April 2015, with manual searching of reference lists of relevant articles. Articles were considered for inclusion if they reported the accuracy or reliability of a diagnostic method or evaluation technique for maxillary transverse dimensions in mixed or permanent dentitions. Risk of bias was assessed in the included articles, using the Quality Assessment of Diagnostic Accuracy Studies tool-2.


RESULTS
Nine articles were selected. The studies were heterogeneous, with moderate to low methodological quality, and all had a high risk of bias. Four suggested that the use of arch width prediction indices with dental cast measurements is unreliable for use in diagnosis. Frontal cephalograms derived from cone-beam computed tomography (CBCT) images were reportedly more reliable for assessing intermaxillary transverse discrepancies than posteroanterior cephalograms. Two studies proposed new three-dimensional transverse analyses with CBCT images that were reportedly reliable, but have not been validated for clinical sensitivity or specificity. No studies reported sensitivity, specificity, positive or negative predictive values or likelihood ratios, or ROC curves of the methods for the diagnosis of transverse deficiencies.


CONCLUSIONS
Current evidence does not enable solid conclusions to be drawn, owing to a lack of reliable high quality diagnostic studies evaluating maxillary transverse deficiencies. CBCT images are reportedly more reliable for diagnosis, but further validation is required to confirm CBCT's accuracy and diagnostic superiority.
Department of Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada.
Dena
D
Sawchuk
Department of Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada.
Kris
K
Currie
Department of Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada.
Manuel Lagravere
ML
Vich
Department of Orthodontics, Case Western University, Cleveland, OH, USA.
Juan Martin
JM
Palomo
Department of Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada.
Carlos
C
Flores-Mir
Cone-beam computed tomography; Diagnosis; Maxillary transverse deficiency; Systematic review
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