Salineiro Fernanda Cristina Sales, Kobayashi-Velasco Solange, Braga Mariana Minatel, Cavalcanti Marcelo Gusmão Paraiso
1 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
2 Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
Dentomaxillofac Radiol. 2017 Dec;46(8):20170400. doi: 10.1259/dmfr.20170400. Epub 2017 Nov 2.
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.
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.
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.
CBCT was the imaging exam that rendered a higher diagnostic accuracy for root fractures.
已经开展了许多评估牙根折诊断准确性的研究。然而，评估文献中异质性的质量和来源的研究却很匮乏。因此，本研究的目的是进行系统评价和荟萃分析，以总结关于锥形束CT（CBCT）和根尖片（PR）影像检测牙根折的现有证据，并通过调查异质性的可能来源来研究伪影的干扰。
选取2010年1月至2016年2月间报告牙根折检测情况的研究。所有入选研究均符合选择标准，然后使用诊断准确性研究质量评估（QUADAS-2）工具进行比较分析和定性分析。计算合并敏感度、特异度和诊断比值比。此外，绘制受试者工作特征（ROC）曲线以总结结果。进行SROC曲线分析以研究各研究之间的异质性。
最初，共筛选出799篇文章。在筛选标题和摘要后，排除了743篇文章。阅读其余56篇全文后，本研究纳入了47篇相关文章。诊断比值比的值在各项研究中显示出广泛的结果，并且确定PR的异质性高于CBCT。SROC曲线分析比较了CBCT成像与PR在牙根折诊断中的情况，结果显示CBCT方式更具优势。
CBCT是对牙根折诊断准确性更高的影像学检查。
