Comparison of the diagnostic efficacy of 2D radiography and cone beam computed tomography in persistent apical periodontal disease: A PRISMA-DTA systematic review and meta-analysis.

Objective The objective of this study was to answer the question: Do conventional radiographs (periapical/panoramic) afford better diagnostic outcomes than cone beam computed tomography (CBCT) as a complement for clinical diagnosis of apical lesions with persistent apical periodontitis or disease after root canal treatment? Study Design Five electronic databases were searched and provided information to enable construction of a table to determine primary diagnostic measures and secondary parameters. The evidence was appraised with the Quality Assessment of Diagnostic Accuracy Studies tool and GRADEpro software. Results Twenty-seven articles (9903 diagnostic images) were included. The pooled sensitivity, specificity, area under the receiver operating characteristic curve (AUCROC), positive predictive value, negative predictive value, negative likelihood ratio, and accuracy were 0.58, 1, 0.77, 1, 0.68, 0.45, and 0.79, respectively. Conclusions Moderate certainty evidence suggested that conventional radiographs showed poor sensitivity and excellent specificity but good diagnostic performance in terms of AUCROC and accuracy. Sensitivity, AUCROC, and negative likelihood ratio values could be reduced if the time elapsed to diagnosis after root canal treatment exceeded 5 years. The use of CBCT with a reduced field of view or a 2D radiographic technique should be weighed considering patient-specific and indication-oriented criteria as taking precedence over the therapeutic goal.