Diagnostic Accuracy of CBCT for detection of Second Canal of Permanent Teeth; a Systematic Review and Meta-analysis
Introduction: Failure-to-notice second canal was the fourth most common which needed retreatment endodontics. The missed canals were frequently associated with periapical pathology. The research question of this systematic review was; what is the diagnostic accuracy of CBCT for detection of second canal of permanent teeth? Material and Method: The articles were selected from the 7 electronic databases according to selection criteria. All eligible studies were judged by the reviewers. The selected studies were checked with 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 sensitivity 94% and specificity 93.1%. 96.6% sensitivity of MB2 was followed by 88.8% sensitivity of maxillary and mandibular premolars, and 81% that of mandibular molars. The specificity 97.6% for premolars was trialed by specificity 85% of mandibular molars and MB2. For permanent mandibular canines 67% sensitivity and 100% specificity was estimated. CBCT showed more agreement in detecting second canal with micro-CT, estimated 100% sensitivity and 95.6% specificity. Highest prevalence of second canal comprised highest sensitivity 99.1% and lowest specificity 77.5%. After exclusion of case-control studies, 3% drop of sensitivity from the summary estimate was seen. Multiple spectrum of second canal had 8.6% higher sensitivity and 4.4% lower specificity than single spectrum. Conclusion: The clinicians should keep in mind that the accuracy can vary in different types of teeth, prevalence of second canal across different populations and the spectrum of second canal anatomy. The reviewer hypothesized these factors can lead to overestimation of the findings.