Title Cone Beam Computed Tomography Has Greater Diagnostic Value for Evaluating Maxillary Impacted Canines Than Conventional Radiography.
Clinical Question Is CBCT a better imaging modality than CR in diagnosing and evaluating the location of impacted maxillary canines?
Clinical Bottom Line For patients with impacted maxillary canine, conventional radiography is less effective than cone beam computed tomography in evaluating impacted maxillary canines. This is based on a systematic review of comparative studies and a prospective study showing that 3D imaging provides improved information for diagnosis and treatment planning.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
28153153Eslami /2017224 patients have 292 maxillary impacted canines, a typodont with a simulated ectopic canine mounted in 9 different positions and 10 simulated cases of maxillary canines impaction in human skulls in 8 included studiesSystematic review of non-randomized trials
Key resultsTwo of the studies included in this systematic review, reported the level of accuracy between the modalities. “The accuracy of CBCT ranged from 50% to 95%, and the accuracy of conventional radiographs ranged from 39% to 85%”. CBCT has higher accuracy than conventional radiographs. Six studies reported inter modalities agreement in impacted canine localization, “there was a statistically significant difference with a wide range of kappa agreement from 0.20 to 0.82 and with observed agreement of 64% to 84% reported between the modalities in canine localization”. Three studies reported treatment planning agreement between the modalities, “broad kappa values from 0.36 to 0.72”.
20451777Haney E /201025 patients with impacted maxillary caninesProspective Cohort Study
Key resultsDecisions were made depending on the x-ray method, “there were 21% disagreement in the mesiodistal cusp tip position and 16% difference in the labiopalatal position”. Judges changed the treatment plans for 27% of the impacted teeth after viewing the 3D CBCT images (McNemar test, chi-square, 4.45; P = 0.035). The dentists confidence of CBCT accuracy for diagnosis and treatment planning was statistically higher (P<0.001)
Evidence Search Cone beam computed tomography AND conventional radiography AND canine
Comments on
The Evidence
Validity: Eslami's 2017 SR represents a large patient sample that strengthen the conclusion that CBCT is more effective than CR in evaluating impacted maxillary canines. Additionally it is notated that overall subject selection is heterogeneous and shows increased risk of bias. There were inconsistencies in the reporting of adjacent root resorption. Perspective: CBCT affords advantages for maxillofacial imaging beside the evaluation of impacted maxillary canines. CBCT images provide accurate measurements, air way visualization, accurate placement of implants and evaluation of nerve canals. Furthermore, it can be used to evaluate periodontal structures and identify endodontic pathosis and problems.
Applicability Cone beam CT starts to be widely accessible to clinicians for examining dental and maxillofacial regions. Despite the high cost in comparison to conventional radiographic images, CBCT provides accurate detailed images, these images can assist in case management and aid the dentists in deriving a proper diagnosis and appropriate treatment planning for impacted teeth.
Specialty (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Periodontics)
Keywords CBCT, cone beam computed tomography, CR, conventional radiography, impacted, maxillary and canine.
ID# 3347
Date of submission 11/02/2018
E-mail abuqdais@uthscsa.edu
Author Laith Abu Qdais
Co-author(s) e-mail
Faculty mentor S.Thomas Deahl II, DMD, PhD
Faculty mentor e-mail deahl@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available