CBCT in dental age estimation: A systematic review and meta analysis

Objectives: This study aimed to investigate the reproducibility of dental age estimation methods in cone beam computed tomography (CBCT) and the correlation between dental (DA) and chronological (CA) ages. Methods: The scientific literature was searched in six databases (PubMed, Scopus, LILACS, Web of Science, SciELO, and OATD). Only observational studies were selected. Within each study, the outcomes of interest were (I) the quantified reproducibility of the method (ic statistics and Intraclass correlation coefficient); and (II) the correlation (r) between the dental and chronological ages. A random-effect three-level meta-analysis was conducted alongside moderator analysis based on methods, arch (maxillary/mandibular), population, and number of roots. Results: From 671 studies, 39 fulfilled the inclusion criteria, with one study reporting two different methods. The methods used in the studies were divided into metric (n = 17), volumetric (n = 20), staging (n = 2), and atlas (n = 1). All studies reported high examiner reproducibility. Group 1 (metric and volumetric) provided a high inverse weighted r (delta = -0.71, CI [-0.79,-0.61]), and Group 2 (staging) provided a medium-weighted r (delta = 0.49, CI [0.44, 0.53]). Moderator analysis on Group one did not show statistically significant differences between methods, tooth position, arch, and number of roots. An exception was detected in the analysis based on population (Southeast Asia, delta = -0.89, CI [-0.94,-0.81]). Conclusion: There is high evidence that CBCT methods are reproducible and reliable in dental age estimation. Quantitative metric and volumetric analysis demonstrated better performance in predicting chronological age than staging. Future studies exploring population-specific variability for age estimation with metric and volumetric CBCT analysis may prove beneficial.