Maria José Fernández Siguencia, Liliana Soledad Encalada Verdugo, Daniela Tobar Almache, Eleonor Maria Velez León
Available clinical evidence supports superior diagnostic accuracy of CBCT over OPG for detecting root resorption. Despite methodological limitations, evidence certainty is moderate for CBCT and low for OPG, supporting OPG primarily as a screening tool. Well-designed prospective studies with blinding and standardized protocols are needed to strengthen the evidence and enable future quantitative syntheses.
OBJECTIVE: To comparatively evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) vs panoramic radiography (OPG) in detecting root resorption in permanent teeth.
METHODS: A systematic review was conducted according to PRISMA-DTA guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, and LILACS were searched for clinical human studies published from 2010 to 2025. Comparative studies informed the descriptive diagnostic accuracy analysis, while CBCT-only studies contributed to the qualitative synthesis. Risk of bias was assessed using QUADAS-2 and certainty of evidence using GRADE-DTA. Because reporting of 2 × 2 contingency tables and confidence intervals was incomplete, meta-analysis was not performed; instead, a structured descriptive synthesis was conducted. Reported sensitivity and specificity values therefore represent descriptive summaries rather than pooled estimates. Subgroup analyses considered study design and CBCT technical parameters.
RESULTS: Twenty-four studies met the inclusion criteria. CBCT showed higher sensitivity and specificity than OPG. Mean CBCT sensitivity was 0.92 (range: 0.88-0.97) and specificity 0.90 (0.84-0.95), whereas mean OPG sensitivity was 0.68 (0.60-0.75) and specificity 0.71 (0.63-0.78). QUADAS-2 classified 32% of studies as low risk of bias, 48% as moderate risk, and 20% as high risk, mainly because of lack of blinding and predominance of retrospective designs. GRADE-DTA indicated moderate certainty for CBCT and low certainty for OPG.
CONCLUSIONS: Available clinical evidence supports superior diagnostic accuracy of CBCT over OPG for detecting root resorption. Despite methodological limitations, evidence certainty is moderate for CBCT and low for OPG, supporting OPG primarily as a screening tool. Well-designed prospective studies with blinding and standardized protocols are needed to strengthen the evidence and enable future quantitative syntheses.