Diagnostic Accuracy of CBCT for Detection of Second Canal of Permanent Teeth: A Systematic Review and Meta-Analysis

Abstract

Introduction. Missed canal is one of the common reasons for nonsurgical endodontic retreatments. The missed canals were frequently associated with periapical pathology. The aim of this systematic review was to find the diagnostic accuracy of CBCT for detection of the second canal of the root canal system of permanent teeth. Materials and Methods. The articles were selected from seven electronic databases according to selection criteria. All eligible studies were judged by the reviewers. The selected studies were checked with the QUADAS-2 tool for risk of bias and applicability concerns. Finally, 12 studies were selected for qualitative and quantitative analyses. The summary estimates of sensitivities and specificities and SROC curves were calculated and drawn by RevMan 5.3 and MetaDTA software. Results. Summary estimates of CBCT for detection of second canal anatomy in permanent teeth were 94% sensitivity and 93.1% specificity. 96.6% sensitivity of MB2 was followed by 88.8% sensitivity of maxillary and mandibular premolars and 81% that of mandibular molars. The specificity of 97.6% for premolars was trialed by 85% specificity of mandibular molars and MB2. For permanent mandibular canines, 67% sensitivity and 100% specificity were estimated. CBCT showed more agreement with detecting the second canal with micro-CT, estimating 100% sensitivity and 95.6% specificity. The highest prevalence of the second canal comprised the highest sensitivity of 99.1% and lowest specificity of 77.5%. After the exclusion of case-control studies, a 3% drop of sensitivity from the summary estimate was observed. Multiple spectrum of the second canal had 8.6% higher sensitivity and 4.4% lower specificity than single spectrum. Conclusion. CBCT is informative for detecting the second canal. Clinicians should keep in mind that the accuracy can vary in different types of teeth, with the prevalence of second canal across different populations, and with the spectrum of second canal anatomy in spite of the reviewers having postulated overestimation of the findings.

Diagnostic Performance of Cone-Beam Computed Tomography to Diagnose in Vivo/in Vitro Root Resorption: A Systematic Review and Meta-Analysis

“…42 , 43 Some limitations that still need to be addressed include the heterogeneity of included studies, the differences between CBCT systems and their parameters, and the diagnostic ability of examiners. [10][11][12] The radiography equipment, exposure parameters, and radiation doses vary in both in vitro and in vivo studies, which could affect the overall results. Further studies, especially clinical trials, are crucial for more precise conclusions.…”

“…6 Nevertheless, although some previous studies described CBCT as the better choice for detecting ERR than routinely used radiographic techniques, there is as yet no conclusive scientific evidence available about the ability of CBCT to detect and quantify loss of root structure in vivo in terms of accuracy, as well as specificity and sensitivity for this type of root resorption. [7][8][9][10][11][12] A number of diagnostic studies in the literature [13][14][15][16][17][18][19][20][21][22] have evaluated the accuracy, specificity and sensitivity of CBCT for detection of root resorption according to criteria such as area under the receiver operating characteristic (ROC) curve, voxel size, field of view (FOV), milliamps, kilovoltage, exposure time, or processing tools such as filters, software, and examiners for the interpretation of ERR, suggesting that, even today, there is no definitive gold standard or single threshold criterion for the diagnosis of ERR. 15 The main aim of this systematic review is to critically analyze the specificity and sensitivity of CBCT for the in vivo/in vitro diagnosis of external root resorption, as well as to assess the accuracy of CBCT for the detection of incipient ERR lesions.…”

CBCT prevalence of MB2 canals in Maxillary molars and its subsequent clinical detection. A comparative clinical study.

“…While CBCT acquisition did not further increase the clinical prevalence of MB2 canals, as shown in this study, it has limited the impact of all the studied variables (tooth type and type of treatment) on the clinical detection of MB2 (Table 4). Also, it has likely improved the operator's e ciency and con dence during clinical intervention due to its high sensitivity in detecting MB2s (21), there was a good correlation between the CBCT ndings and the clinical detection of MB2 canal. Accordingly, CBCT can allow clinicians to operate with more certainty and follow a minimally invasive approach by searching for an MB2 only when the CBCT con rms its presence and avoiding unnecessary drilling/troughing for an MB2 canal when the CBCT con rms its absence.…”

Artificial Intelligence (AI) for Detection and Localization of Unobturated Second Mesial Buccal (MB2) Canals in Cone-Beam Computed Tomography (CBCT)

“…While periapical radiographs are the primary imaging modality for endodontic diagnosis and treatment planning, cone beam computed tomography (CBCT) is the recommended diagnostic tool for complicated endodontic cases, including teeth with the potential for extra canals or as an intra-operative examination for identification and localization of calcified canals [ 10 ]. Numerous studies have documented the efficacy of CBCT for detecting a second mesiobuccal canal (MB2) in maxillary first and second molars, reported at 69.2–96.6% [ 11 , 12 ]. However, in reality, the presence of metallic restorations and endodontic obturation creates significant artifacts that limit the visualization of missed canals and render evaluations time-consuming and challenging for the general dentist and specialist with questionable accuracy [ 6 , 13 ].…”