Background
Methods
Criteria for inclusion
Criteria for exclusion
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Problem specification:
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Literature search:
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Study retrieval:
Database and its supplies | Index terms | Results |
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Pubmed (US National Library of Medicine (NLM)) | Cone beam computed tomography [MeSH]) OR Cone beam computed tomography [Title/Abstract]) OR Cone beam CT [Title/Abstract]) OR CBCT [Title/Abstract]) OR Dental computed tomography [Title/Abstract]) OR Digital volume tomography [Title/Abstract]) OR Volumetric tomography [Title/Abstract]) OR 3D image [Title/Abstract]) OR Three dimensional imaging [Title/Abstract]) OR Imaging, three dimensional [MeSH] AND Periodontitis [MeSH] OR Periodontal disease [Title/Abstract]) OR Periodontal diseases [Title/Abstract]) OR Furcation defects [MeSH]) OR Furcation involvement [Title/Abstract]) OR Alveolar bone loss [MeSH]) OR Intrabony defect [Title/Abstract] | 539 |
Scopus (Elsevier) | TITLE-ABS-KEY (Cone beam computed tomography) or TITLE-ABS-KEY (Cone beam computed tomography) or TITLE-ABS-KEY (Cone beam CT) or TITLE-ABS-KEY (CBCT) or TITLE-ABS-KEY (Dental computed tomography) or TITLE-ABS-KEY (Digital volume tomography) or TITLE-ABS-KEY (Volumetric tomography) or TITLE-ABS-KEY(3D image) or TITLE-ABS-KEY (Three-dimensional imaging) AND TITLE-ABS-KEY (Periodontitis) or TITLE-ABS-KEY (Periodontal disease) or TITLE-ABS-KEY (Periodontal diseases) or TITLE-ABS-KEY (Furcation involvement) or TITLE-ABS-KEY (Furcation defects) or TITLE-ABS-KEY (Intrabony defect) | 746 |
Cochrane (Wiley InterScience) | Cone beam computed tomography [MeSH] or Cone beam computed tomography (word variations ti, ab, kw) or Cone beam CT (word variations ti, ab, kw) or CBCT (word variations ti, ab, kw) or Dental computed tomography (word variations ti, ab, kw) or Digital volume tomography (word variations ti, ab, kw) or Volumetric tomography (word variations ti, ab, kw) or 3D image (word variations ti, ab, kw) or Iamging, three dimensional [MeSH] or AND Periodontitis [MeSH] or Periodontal disease (word variations ti, ab, kw) or Periodontal diseases (word variations ti, ab, kw) or Furcation involvement (word variations ti, ab, kw) or Furcation defects [MeSH] or Alveolar bone loss [MeSH] or Intrabony defect (word variations ti, ab, kw) | 71 |
Web of Science | Cone beam computed tomography (Topic) or Cone beam CT (Topic) or CBCT (Topic) or Dental computed tomography (Topic) or Digital volume tomography (Topic) or Volumetric tomography (Topic) or 3D image (Topic) or Three dimensional imaging (Topic) or AND Periodontitis (Topic) or Periodontal disease (Topic) or Periodontal diseases (Topic) or Furcation defects (Topic) or Furcation involvement (Topic) or Alveolar bone loss (Topic) or Intrabony defect (Topic) | 555 |
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Data extraction & quality assessment:Finally, each of the selected studies was assigned for data extraction and analysis. After that, each study was allocated its suitable level of efficacy. A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS 2) was used for quality assessment. This tool contains four domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias and the first three domains are assessed in terms of concerns regarding applicability. Signaling questions are included to help judge the risk of bias [37].
Result
Studies allocation
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Quality assessmentAfter allocating each study its suitable efficacy level, special tools of quality assessment were used for each one as described in the literature [37].
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Technical efficacy studies:There was no study identified on this level of efficacy.
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Diagnostic accuracy studies:
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Diagnostic thinking efficacy:Only one study was found to be on the level of diagnostic thinking efficacy [66]. The author investigated the effect of CBCT on the treatment decision-making after taking into consideration the clinical parameters.
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Therapeutic efficacy:In this level of efficacy, only one study, Pajnigara et al. [67], seemed relevant.
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Patient outcome efficacy:Our research resulted in eight studies in which CBCT was used to address the patients’ outcomes in relation to periodontal disease. All of the studies are randomized clinical trials [68, 72, 75, 77, 79, 82, 85]. Table 4, the CASP (critical appraisal skills program) checklist, was used to assess outcomes.
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Societal efficacy:Only one study was found to be relevant in this level of efficacy, Walter et al. [69]. The quality assessment was done using the QUADAS 2 tool.
Included studies | Excluded studies | Exclusion reason | ||||||
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Efficacy levels | Systematic Review | |||||||
1 | 2 | 3 | 4 | 5 | 6 | |||
Nagao et al. 2006 [65] | Walter et al. 2009 [66] | Pajnigara et al. 2016 [67] | Grimrad et al.2009 [68] | Walter et al. 2012 [69] | Walter et al.2016 [70] | Micsh et al. 2006 [42] | Ex vivo | |
Walter et al. 2010 [71] | Gupta SJ et al. 2014 [72] | Anter et al.2016 [73] | Naitoh et al. 2006 [63] | Case report | ||||
De Faria et al.2012 [74] | Khosropana et al.2015 [75] | Nikolic-Jakoba et al.2016 [6] | Nagao et al.2007 [62] | Did no check for periodontitis | ||||
Fiejo et al. 2012 [76] | Bhavsar et al. 2016 [77] | Haas et al. 2018 [78] | Vandenberghe et al. 2007 [47] | Ex vivo | ||||
Walter et al. 2012 [69] | Pajnigara et al. 2017 [79] | Choi et al. 2018 [80] | Mol et al. 2008 [43] | Ex vivo | ||||
Raichur et al. 2012 [81] | Dutra et al. 2017 [82] | Woelber et al. 2018 [83] | Vandenberghe et al. 2008 [46] | Ex vivo | ||||
Marinescu et al. 2013 [84] | Nemoto et al. 2018 [85] | Noujeim et al. 2009 [44] | Ex vivo | |||||
Qiao et al. 2013 [86] | Leung et al. 2010 [60] | Ex vivo | ||||||
Haghgoo et al.2014 [87] | Evangelista et al.2010 [58] | Addressed naturally occurring dehiscence and fenestration in patients with malocclusions | ||||||
Banodkar et al. 2015 [88] | Ferreira et al.2013 [57] | Study targets bone coverage | ||||||
Cimbaljevic et al. 2015 [89] | DG Pour et al. 2015 [61] | Does not involve patients with periodontitis | ||||||
Darby et al. 2015 [90] | AlShaer et al. 2013 [55] | Does not belong to any level of efficacy | ||||||
Li F et al. 2015 [91] | Fliener et al. 2013 [40] | Ex vivo | ||||||
Guo et al. 2016 [92] | Kamuroglu et al. 2013 [41] | Ex vivo | ||||||
Zhu et al. 2016 [93] | Amorfini et al.2014 [54] | Does not belong to any level of efficacy | ||||||
Suphanantachat et al. 2017 [94] | Sun L et al. 2015 [59] | Excluded patients with periodontal diseases | ||||||
Padmanabhan et al. 2017 [95] | Yang et al. 2015 [53] | Does not belong to any level of efficacy | ||||||
Zhang et al. 2018 [96] | Bagis et al. 2015 [38] | Ex vivo | ||||||
Takeshita et al. 2015 [28] | Ex vivo | |||||||
Kolsuz et al. 2015 [48] | Ex vivo | |||||||
Kamburoğlu et al. 2015 [49] | Animal study and not plaque-induced periodontitis | |||||||
Deng et al. 2015 [64] | Not in English Language | |||||||
Lim et al. 2016 [51] | Does not belong to any level of efficacy | |||||||
Al-Zahrani et al. 2017 [56] | Targets bone density in aggressive periodontitis and normal patients | |||||||
Ozcan et al.2017 [52] | Does not belong to any level of efficacy | |||||||
Almeida et al.2017 [39] | Ex vivo | |||||||
Salineiro et al.2017 [45] | Ex vivo | |||||||
Elashiry et al. 2018 [50] | Not plaque-induced periodontitis |
Study | Sample | Index test | Reference standard (comparator) | Risk of bias | Applicability concern | |||||
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Patient Selection | Index test | Reference test | Flow and timing | Patient selection | Index test | Reference standard | ||||
Nagao et al. 2006 [65] | Developing novel method for alveolar bone resorption assessment caused by periodontitis | Dental CT | Not applicable | N/A | N/A | |||||
Walter et al. 2010 [71] | 14 patients, five women and nine men, with a mean age of 57.0 years (range 42–81 years) and a diagnosis of generalized chronic periodontitis | CBCT Accuitomo with settings in the range of 74–90 kV, 5–8 mA and voxel sizes in the range of 0.08–0.25 mm | Intrasurgical measurements | |||||||
De Faria et al. 2012 [74] | Image records of 39 teeth from 11 adult patients of both genders, aged between 39 and 66 years | CBCT i-CAT with 120 kV and 36.12 mAs. The field of view (FOV) was 6 cm and the voxel size was 0.260.260.2 mm | Intraoral radiography (Kodak) with 120 kV and 36.12 mAs. The field of view (FOV) was 6 cm and the voxel size was 0.260.260.2 mm | Not available | N/A | N/A | |||||
Fiejo et al. 2012 [76] | 6 patients with 12 measurement sites | CBCT i-CAT with voxel size of 0.2 mm and 40 seconds acquisition time | Intrasurgical measurements | |||||||
Walter et al. 2012 [69] | 12 patients, 3 women and 9 men, with an average age of 57.5 years (range: 41–80 years) and a diagnosis of generalized chronic periodontit-is | CBCT 3D Accuotom with volumes of 4 9 4 cm to 6 9 6 cm | Intrasurgical measurements | |||||||
Raichur et al. 2012 [81] | 7 patient (3 males and 4 females) having moderate to severe periodontitis | Digital volume tomography Kodak 9000 C3D with (exposure parameters were set at 70-74 kV, 10 mA and 10.8 seconds} & Radiovisiography (with a size #2 charged couple device (CCD) intraoral digital sensor§ and a standard X-ray unit* operating at 60-63 kV, 8 mA and 0.25-0.32 sec) | Direct measurements with UNC 15 probe | |||||||
Marinescu et al. 2013 [84] | 19 patients with (presenting a total of 25 lower molars with different degrees of furcation defects ) | CBCT | Clinical measurements | |||||||
Qiao et al. 2013 [86] | 15 patients (9 women and 6 men) with an average age of 43.5 years and a diagnosis of generalized chronic periodontitis | CBCT Accuitomo with settings in the range 74–90 kV and 5–8 mA and voxel size of 0.125 × 0.125 × 0.125 mm | Intrasurgi-cal measurem-ents | |||||||
Haghgoo et al. 2014 [87] | 50 interproximal sites in patients having periodontitis are assessed | CBCT (Newtom 3G, Verona. Italy) and direct digital intraoral radiography (Sopro-La Ciotat-France) was taken. | Intrasurgi-cal findings | |||||||
Banodkar et al. 2015 [88] | 15 patients with hundred periodontal bone defects | CBCT promax (Planmec) with 90 kv, voxel size-400 μm, current-10 mA, and exposure time-13 s | Intrasurgical measurements | |||||||
Cimbaljevic et al 2015 [89] | 15 patients (4 men and 11 women aged 35 to 60 years; mean age 44.5 ± 8.4 years) with 174 furcation sites | CBCT unit (SCANORA 3Dx, Soredex) with 80 × 100 mm field of view, 0.25 mm voxel size, 90 kV tube voltage, 10 mA tube current, and 2.4 seconds active scanning time | Probing using a Nabers probe (PQ2N, Hu-Friedy) | Not available | N/A | N/A | |||||
Darby et al. 2015 [90] | Clinical records ( Retrospective ) from the Periodontics clinic at the Royal Dental Hospital of Melbourne (RDHM) | CBCT i-CAT with slice thickness 1 mm, voxel size 0.2 mm. 120 kV, 20.7 mAs−1, 14.7 s acquisition time) | Not available | N/A | N/A | |||||
Li F et al. 2015 [91] | 44 patients (22 men and 22 women) with 44 intrabony defects | CBCT New Tom, Verona, Italy (12-17mA and 110 Kv), and digitalperiapical radiography (70kVp and 12-25mA) | Intrasurgi-cal measurements made with a probe (HU-Friedy) | |||||||
Guo et al. 2016 [92] | 6 patients (2 males and 4 females) | CBCT 3D Accuitomo with a field of view of 4 3 4 cm, tube voltage of 75–85 kVp and tube current of 5 mA. The voxel size used was 0.125 3 0.125 3 0.125 mm. | Intrasurgical measurem-ents | |||||||
Zhu et al. 2016 [96] | 11 patients (Thirty-nine sites with degree II FI, classified by probing of 21 maxillary molars, were investigated} | CBCT 3D Accuitomo with volumes of 4 × 4 to 6 × 6 cm, with a setting in the range of 80 kV, 5.0 to 6.3 mA and a voxel size of 0.125 × 0.125 × 0.125 mm | Not available | N/A | N/A | N/A | ||||
Suphanantachat et al.2017 [94] | 25 patients | Intraoral radiograph (Kodak) with 70 kV, 7 mA, exposure time 0.2–0.4 s | CBCT 3D Accuitomo with volumes of 100 3 100 mm, 80 kV, 5 mA, exposure time of 17.5 s and a voxel size of 0.25 mm | Not available | N/A | N/A | |||||
Padmanabhan et al. 2017 [95] | 14 patients (20–60 years) with 25 mandibular molar furcation sites | Intraoral periapical radiography | CBCT with 84 kv, 5 mA, 20 s, Voxel size of 180 μm | Intrasurgi-cal measurem-ents | |||||||
Zhang et al. 2018 [96] | 83 patients with chronic periodontitis | CBCT with a field of view (FOV) of 150 × 90 mm2. The scans were acquired at 90 kVp, 10 mA, 16 s and a 0.2 mm3 voxel size with a Kodak 9500 unit (Carestream Health, Inc., Rochester, NY, USA), Intraoral using the unit (Instrumentarium Dental, Charlotte, NC, USA) operating at 70 kVp, 7 mA , and an exposure time corresponding to the exposed area, Clinical measurements | Not available | N/A | N/A |
Criteria | Dutra et al. 2017 [82] | Gupta SJ et al. 2014 [72] | Grimrad et al.2009 [68] | Khosropana et al.2015 [91] | Nemoto et al. 2018 [85] | Bhavsar et al. 2016 [77] | Pajnigara et al. 2017 [79] |
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Did the trial address a clearly focused issue? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Was the assignment of patients to treatments randomized? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Were all of the patients who entered the trial properly accounted for at its conclusion? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Were patients, health workers and study personnel ‘blind’ to treatment? | Can’t tella | Can’t tella | Yes | Yes | Yes | Yes | Yes |
Were the groups similar at the start of the trial | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Aside from the experimental intervention, were the groups treated equally? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
How large was the treatment effect? | Satisfactory | Satisfactory | Satisfactory | Satisfactory | Satisfactory | Satisfactory | Satisfactory |
How precise was the estimate of the treatment effect? | Acceptable | Acceptable | Acceptable | Accept-able | Acceptable | Acceptable | Acceptable |
Can the results be applied to the local population or in your contex | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Were all clinically important outcomes considered? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Are the benefits worth the harms and costs? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Systematic reviews
Criteria | Systematic Reviews | |||||
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Haas et al. 2018 [78] | Anter et al. 2016 [73] | Walter et al. 2016 [70] | Nikolic-Jakoba et al. 2016 [6] | Choi et al. 2018 [80] | Woelber et al. 2018 [83] | |
1. Did the research questions and inclusion criteria for the review include the components of PICO? | Yes | No | Yes | Yes | Yes | Yes |
2. Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? | Yes | Yes | Partial yes | Yes | Partial yes | Yes |
3. Did the review authors explain their reasons for selection of the study designs for inclusion in the review? | Yes | Yes | Yes | Yes | No “Some failed to continue” | Yes |
4. Did the review authors use a comprehensive literature search strategy? | Partial yes | Partial yes | No | Yes | Yes | Yes |
5. Did the review authors perform study selection in duplicate? | Yes | Yes | No | Yes | Yes | Yes |
6. Did the review authors perform data extraction in duplicate? | Yes | No | Yes | Yes | Yes | Yes |
7. Did the review authors provide a list of excluded studies and justify the exclusions? | Yes | Yes | Yes | Partial yes | Partial yes | Yes |
8. Did the review authors describe the included studies in adequate detail? | Yes | Partial yes | Partial yes | Yes | Yes | Yes |
9. Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies included in the review? | Yes | Partial yes | No | Yes | No | No |
10. Did the review authors report on the sources of funding for the studies included in the review? | No | No | No | No | No | No |
11. If meta-analysis was performed, did the review authors use appropriate methods for a statistical combination of results? | Yes | No meta-analysis conducted | No meta-analysis | No meta-analysis conduct-ed | No meta-analysis | No meta-analysis performed |
12. If meta-analysis was performed, did the review authors assess the potential impact of RoB on individual studies based on the results of the meta-analysis or other evidence synthesis? | No | No meta-analysis conducted | No meta-analysis | No meta-analysis conducted | No meta-analysis performed | No meta-analysis performed |
13. Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review? | Yes | Yes | Noa “No RoB assessed” | Yes | No | No |
14. Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? | Yes | Yes | Yes | Yes | Yes | Yes |
15. If they performed quantitative synthesis, did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? | No | No meta-analy-sis cond-ucted | No meta-analysis conduct-ed | No meta-analysis conduc-ted | No meta-analysis performed | No meta-analysis perform-ed |
16. Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting | No | Yes | No | Yes | No | Yes |