Exploring Diagnostic Reliability of CBCT for Vertical Root Fractures: A Systematic Review and Meta-Analytical Approach.

This systematic review investigated the different factors associated with the diagnostic accuracy of vertical root fractures (VRFs) with cone-beam computed tomography (CBCT) scans, assessed by in vitro studies. Studies were screened from PubMed, Embase, Scopus, Web of Science, and Lilacs, up to May 2025. The included studies assessed the diagnostic accuracy of CBCT scans for laboratory-induced VRFs. The quality assessment of the included studies was performed using the QUADAS-2 tool. Meta-analyses were performed using the bivariate model with random effects to produce summary sensitivity (SSe) and specificity (SSp) with a 95% confidence interval (CI). The influence of confounding factors on the accuracy of CBCT images was investigated by meta-regression models. Covariates were added to the bivariate model to assess the impact on sensitivity, specificity, or both. The quality of evidence of each meta-analysis was assessed using the GRADE approach. One hundred studies were included. Twenty-four studies presented a low risk of bias, 22 moderate risk, and 54 high risk. CBCT scans presented a higher sensitivity for the diagnosis of complete VRFs compared to incomplete fractures. The presence of metal posts impaired both sensitivity and specificity. Smaller voxel sizes favored the detection of VRFs in teeth with metal posts. In laboratory settings, the diagnosis of VRFs by CBCT images is mainly affected by the fracture pattern, presence of intracanal materials, and voxel size.