Cone Beam Tomography and Periapical Radiographs for Early Vertical Root Fracture Diagnosis. Systematic Review

Background: Determining the position, direction, and size of the fracture in early stages is of great value in choosing the appropriate treatment. Purpose: To compare the diagnostic accuracy of conventional periapical radiographs (PR) with cone beam computerized tomography (CBCT) to identify vertical root fractures (VRF) in root treated teeth. Methods: This review used the Cochrane Handbook and the recommendations given by SIGN 50 as a guide. Meta DiSc 1.4 software was used to calculate the operative characteristics of sensitivity, specificity, positive, and negative values. Results: Initially 651 articles were obtained; after completing the review 4 articles were chosen: 2 studies had a sensitivity of 60-61 % using conventional PR and 80 % CBCT; specificity 70-71 % using conventional RP and 69 % CBCT; there were no significant differences between the two (p >0.05). Digital dental radiography (DDR) had a specificity of 78 % compared to 70 % of the conventional RP. Conclusions: Based on the results and the information published, both tools, digital dental radiograph (DDR) and CBCT are useful to diagnose VRF. There were no significant differences between the CBCT and conventional (PR) (p >0.05) either in advanced or early stages of VRF. To answer research the question more studies are required. To make an early VRF diagnosis on initial stages, the current imaging tools, clinical methods, and patient's symptoms must be considered. As a final option, a surgical exploration is required to confirm its presence.