Alveolar bone loss is considered a fundamental drawback of periodontal diseases. Mostly, the assessment and treatment decision depend on clinical measurements supported by conventional imaging modalities. However, 2D imaging has its own limitation for detecting bone defects, including overlapping. An estimation of bone loss bucco-lingually has led to the consideration of 3D imaging. On the contrary, there is no clear evidence for when to use 3D imaging such as cone beam computed tomography in case of periodontal diseases. Accordingly, our systematic review aimed at summarizing the available evidence according to the hierarchal model of efficacy [34].
Diagnostic Accuracy Level:
As mentioned earlier in this review, the QUADAS 2 tool was used for the quality assessment of diagnostic accuracy studies. Based on our inclusion criteria, we decided to include studies done in vivo as it represents the reality when comparing CBCT to intrasurgical findings or comparing radiographic methods to each other. However, it was found that the ones done by [69] [70] [76] [78] did not use explicit reference standards in their studies. Cimbaljevic.et al 66 compared the periodontal probing with CBCT in the terms of furcation involvement in the absence of a reference standard. Likewise, Darby.et al67 addressed the discrepancies in the clinical measurements obtained from patient’s records with their available CBCT images. A Study conducted by Suphaanantachat.et al73) compared CBCT to conventional intraoral radiography for the purpose of periodontal conditions assessments. Therefore, they have not used an actual reference standard to compare the radiographic modalities. Similarly, Zhu J.et al75 has focused on the reproducibility of the different parameters of CBCT for the furcation involvement evaluation, and hence, no reference standard was used.
Therapeutic Efficacy:
According to our interpretation and, at the same time, in correlation with the hierarchical model of efficacy [34], we found that the study conducted by Kolte.et al84 fits on this level. They investigated the pre-post-surgical measurements of clinical and CBCT in case of furcation defects. Although they reported statistically significant differences between clinical-presurgery CBCT (P < 0.0001, 95% CI) and post-surgery clinical-post surgery CBCT, the Presurgical and postsurgical three-dimensional imaging give dental practitioners the chance to optimize treatment decisions and assess the degree of healing more effectively.
Systematic reviews:
Our review has resulted in six studies, which are systematic reviews. Each review is supposed to adhere to the criteria provided by AMSTAR and scores YES whenever applicable.
The review published by [96] did not elaborate on whether they included the study registries or consulted content experts in the field in terms of comprehensive literature search strategy. Although meta-analysis was conducted in such a review, the review authors did not assess the potential impact of risk of bias in individual studies on the results of the meta-analysis or other evidence synthesis. Moreover, authors did not carry out an adequate investigation of publication bias (small-study bias) or discuss its likely impact on the results of the review. Based on our interpretation, the study has not reported any source of funding or mentioned any conflict of interest.
The study by Walter.et al94 did not clearly have an explicit statement that the review methods were established prior to the conduct of the review and did not justify any significant deviations from the protocol. In addition, only one database has been searched for relevant studies. According to the AMSTAR criteria, the included studies were not described adequately. The study has not reported on the source of funding for the individual studies included in the review. To our knowledge, the risk of bias has not been elaborated about in the relevant sites in the review. Moreover, the review authors did not account for risk of bias in individual studies when interpreting or discussing the results of the review. In addition, the authors have not reported any source of conflict including any funding they received for conducting the review.
The review by Anter E.et al33 addressed the extent of accuracy of the cone beam computed tomography as a tool for measurement of alveolar bone loss in periodontal defect. However, the authors did not report that they followed PICO, which is a framework for review question formulation [40]. In terms of a comprehensive search strategy, we saw that this review did not fulfill the criteria regarding study registries and expert consultation in the field. Furthermore, the authors did not conduct the search in duplicates for the purpose of study selection. The review authors have also not performed the data extraction in duplicates. To our interpretation, the included studies were not described appropriately in detail. Additionally, the source of funding for each relevant individual study was not reported.
The study reported by Choi.et al98 did not specify whether there is a deviation from protocol, meta-analysis plan, or causes of heterogeneity if appropriate. In addition, a list of the excluded study in association with a justification for exclusion of each potential studies has not been provided. Regardless of whether it is one of the targets of the review, this review has not discussed any potential risk of bias of the included studies. Moreover, the source of funding of each included study was also not reported. It could be included that this review does fulfill the AMSTAR2 [100] checklist to some extent.
The review by Woelber.et al99 neither mentions any deviation from protocol whenever applicable nor elaborates on whether there is a plan for meta-analysis, if appropriate. In addition, a plan for investigating the possible causes, if appropriate, regarding heterogeneity was also not reported. The source of funding for each included study was not reported either. To some extent, the review fulfills the checklist of AMSTAR2.
According to our systematic review and AMSTAR2 tool, we found that the review conducted by [6] best fulfills the tool criteria. However, the study’s authors did not justify the reason for exclusion of each potentially relevant study from the review. As other reviews were included in our study, the source of funding of each included publication was not reported.