CBCT-Assessed Outcomes and Prognostic Factors of Primary Endodontic Treatment and Retreatment: A Systematic Review and Meta-Analysis

Introduction: Periapical radiographs have limitations in assessing endodontic treatment outcomes, which can be addressed by cone-beam computed tomography (CBCT). This systematic review evaluates primary root canal treatment and retreatment outcomes using CBCT, focusing on periapical healing, success, and prognostic factors. Methods: A literature search (in PubMed, Embase, and Web of Science) was performed up to March 8, 2024, in collaboration with a medical information specialist. Three reviewers (J.F.B.M., A.C.G, P.D.N.) independently performed article selection and data extraction. Risk of bias was assessed, and evidence quality using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analysis and meta-regression established pooled periapical healing and outcome rates, 95% confidence intervals (CIs), and identify outcome predictors (P < .05). Results: Nineteen studies were included in the meta-analysis. The pooled periapical healing rate using “loose criteria” was 87% (95% CI: 81%–91%) for teeth and 84% (95% CI: 78%–88%) for roots; using “strict criteria” was 36% (95% CI: 22%–53%) for teeth, and 44% (95% CI: 16%–76%) for roots. The weighted pooled success rates for teeth were 85% (95% CI: 80%–89%) under “loose criteria” and 45% (95% CI: 31%–59%) under “strict” criteria. Meta-regression identified outcome predictors include number of visits, irrigant type, tooth type, operator experience, apical preparation size and taper, and obturation technique. Conclusions: CBCT reveals lower success rates under strict criteria compared to loose criteria (36% vs 88%). While CBCT offers greater diagnostic accuracy, its routine use for outcome evaluation may not be necessary, as it yields results similar to periapical radiograph under loose criteria.