Influence of metal artefact reduction tool on the detection of vertical root fractures involving teeth with intracanal materials in cone beam computed tomography images: A systematic review and meta‐analysis

Abstract

Background The effectiveness of the metal artefact reduction (MAR) tool for the detection of vertical root fracture (VRF) by cone beam computed tomography (CBCT) images is controversial. Objective To evaluate the effectiveness of the MAR tool on VRF detection involving teeth with intracanal materials in CBCT images. Methodology In September 2019, an electronic search was performed in six databases (PubMed, Scopus, Web of Science, Cochrane, Lilacs and Embase). The electronic search was updated in May 2020 through searches in Google Scholar and references of included studies (embracing the electronic and gray literature searches). No language or year restrictions were applied. Independently, two reviewers examined titles, abstracts and full texts according to the eligibility criteria that were as follows: diagnostic studies that evaluated the effectiveness of the MAR tool on the diagnosis of VRF in human teeth (laboratory or in vivo studies) on CBCT images. The risk of bias was evaluated using the Quality Assessment Tool for Diagnostic of Accuracy Studies‐2 (QUADAS‐2). For conducting the meta‐analysis, the values of sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUC) were obtained, considering the subgroups with and without MAR active. The Grading of Recommendation, Assessment, Development and Evaluation instrument was applied to assess the level of evidence across the studies using GRADEpro software. Results A total of 8 laboratory studies were included in both systematic review and meta‐analysis. The values of sensitivity, specificity, DOR and AUC to VRF diagnosis with and without MAR active were, respectively, 0.586 and 0.603; 0.699 and 0.713, 3.037 and 3.767; 0.67 and 0.71. The quality of the evidence suggested low confidence in estimating the outcomes. Discussion The MAR tool decreased slightly the diagnostic values of VRF involving teeth with intracanal materials in laboratory studies. However, it is important to highlight that most studies had an uncertain risk of bias. Conclusions Although a low level of evidence and high heterogeneity were observed in the included studies, the meta‐analysis revealed better diagnosis values for VRF detection when the MAR was deactivated when analysing extracted teeth in a laboratory setting. Registration PROSPERO—CRD42020145222. Funding This study was financed in party by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES).

Influence of Artifacts Induced by Dental Implants on The Detection of Vertical Root Fractures in Cone Beam Computed Tomographic Scans. An in-Vitro Study

“…The highest sensitivity (100%) were for scan group without implant with which denotes that CBCT images are highly accurate in vertical root fracture detection and diagnosis when metal artifacts are not present. (20,29,30,(32)(33)(34)(35)37,38) The sensitivity level for scan group with implant without AR was 96.7%. The decrease in sensitivity means that metal artifact could obscure the fracture line in CBCT image giving false negative results.…”

“…The highest specificity levels were reported for group without implant (100.0%) highlighting the high validity and diagnostic ability of CBCT in detection of vertical root fracture as reported in many studies to be attributed to the parameter's selection and the homogeneity of the study samples. (20,30,32,35,38) However, results by Dias et al (23) disagree as they reported poor specificity for CBCT in vertical root fracture with or without metal artifact presence. Specificity for group with implant without AR was 90.0%.…”

Efficacy of low-dose cone beam computed tomography and metal artifact reduction tool for assessment of peri-implant bone defects: an in vitro study

“…The application of these strategies has been examined, but the ndings have been uneven. Fontenele et al [45] found that the MAR tool has a negative effect on the diagnostic accuracy of vertical root fracture in the presence of intracanal lling. Also, Kamburoglu et al…”

Efficacy of low-dose cone beam computed tomography and metal artifact reduction tool for assessment of peri-implant bone defects: an in vitro study

“…The application of these strategies has been examined, but the findings have been uneven. Fontenele et al [ 46 ] found that the MAR tool has a negative effect on the diagnostic accuracy of vertical root fracture in the presence of intracanal filling. Also, Kamburoglu et al [ 47 ] evaluated the effects of four MAR protocols (off, low, medium, and high) for the assessment of periodontal and peri-implant defects, and they found no difference in diagnostic accuracy with any MAR protocol.…”