Detection of Caries under Fixed Prosthodontic Restorations Using Cone-beam CT: A Meta-analysis

Abstract

Aim: Secondary caries is the most common cause of failure of fixed prosthodontic restorations and radiography is often depended upon for the detection of caries under these restorations. Current radiographic techniques are specific, but they lack sensitivity. The inherent limitations in two-dimensional radiography led to the development of computed tomographic imaging techniques. Hence, this review aims to compile the available evidence on the utility of cone-beam computed tomography (CBCT) for detecting caries under fixed restorations. Materials and methods: Electronic databases were screened for eligible studies using an appropriate search strategy. Full-texts were obtained and necessary data were extracted. The risk of bias of included studies was assessed using New Castle Ottawa scale. The mean gray values obtained on CBCT were recorded on a Forest Plot using RevMan 5 in Non-Cochrane mode. Mean difference with 95% confidence interval was used as the effect estimate of the mean gray values. Heterogeneity was assessed using Chi-square and I2 tests Results: Three studies were included. Although there was significant heterogeneity between the studies as observed using the I2 values, a statistically significant difference in mean gray values between caries and dentin was observed when CBCT was used under lithium disilicate, zirconia, and metal-ceramic restorations. This indicates that caries can be diagnosed with accuracy under these restorations without the need for removing the restoration. The problem of metal artifacts in CBCT can be reduced if the field of view is small. Conclusion: The results seem to indicate considering CBCT as a possible option if secondary caries is suspected, and in patients with high caries risk. If appropriately used with clinical judgment in high caries risk patients, a possible tooth loss could be prevented.