Cone-beam computed tomography vs conventional radiography in visualization of maxillary impacted-canine localization: A systematic review of comparative studies

Introduction: We systematically reviewed observational, experimental, and diagnostic accuracy studies to assess the comparisons between cone- beam computed tomography (CBCT) and conventional radiography (CR) in the localization of maxillary impacted canines. Methods: An open-ended electronic search of PubMed, Web of Science, ProQuest, and other databases for both published and unpublished articles up to May 2016 was performed. The reference lists of the included studies were screened. Two authors performed the searches with no language restrictions. The research questions were outlined based on a hierarchical model. The primary outcomes were diagnostic accuracy, level of intermodalities agreement, effect of these images on treatment planning and treatment outcomes, and societal efficacy between the CBCT and CR in the localization of impacted canines. Two reviewers evaluated the risk of bias assessment by using the Quality Assessment of Diagnostic Accuracy Studies tool and the Newcastle Ottawa Scale. Results: Eight studies met the inclusion criteria. Two studies reported diagnostic accuracy, 6 reported intermodalities agreement in impacted canine localization, and 3 reported treatment planning agreement between the modalities. No therapeutic and societal efficacy study found. The accuracy of CBCT ranged from 50% to 95%, and the accuracy of CR ranged from 39% to 85%. A wide range of kappa intermodalities agreement from 0.20 to 0.82, with observed agreement of 64% to 84%, was reported in canine localization. Broad kappa treatment planning agreement values from 0.36 to 0.72 were reported. Most studies suffered from a high risk of bias in subject selection. Conclusions: The fair to moderate intermodalities agreement in maxillary canine localization might mean that the information obtained through these modalities is deviant and ultimately might affect treatment planning. Although there is still a lack of strong evidence, CBCT is more effective than CR in evaluating cases that are difficult to diagnose in the initial evaluation with CR.