Accuracy of Ionizing‐Radiation‐Based and Non‐Ionizing Imaging Assessments for the Diagnosis of Periodontitis: Systematic Review and Meta‐Analysis

Aims: To evaluate the diagnostic accuracy of periapical, bitewing or panoramic radiographs (standard 2D radiographs) in detecting and monitoring periodontitis (PICO 1) and to assess the clinical relevance of alternative and emerging diagnostic methods (e.g., cone-beam computed tomography [CBCT], magnetic resonance imaging [MRI], ultrasound imaging [USG]) compared to standard 2D radiographs or clinical/intra-surgical examination in the diagnosis and surveillance of the disease (PICO 2). Materials and Methods: A systematic literature search was conducted through MEDLINE EMBASE, Scopus and Cochrane Library. When feasible (n > 2 comparable studies), a meta-analysis of diagnostic accuracy was performed. Results: For PICO 1, 26 studies met the inclusion criteria. Pooled-data analysis from three studies showed a sensitivity of 0.77 (95% confidence interval, CI: 0.66–0.85), specificity of 0.76 (95% CI: 0.64–0.84) and accuracy of 0.82, with a diagnostic odds ratio (DOR) of 137.99 (95% CI: 6.99–368.90). For PICO 2, 51 articles were included dealing with different techniques. The meta-analysis for CBCT (three studies) showed a pooled sensitivity and specificity of 0.98 (95% CI: 0.96–1.00) and 0.98 (95% CI: 0.95–1.00), respectively, and a diagnostic accuracy of 0.99 in the detection of furcation involvement compared to intra-surgical measurements. Conclusions: Standard 2D radiographs appear to have adequate diagnostic accuracy for periodontitis, while CBCT is highly sensitive and specific to detect and classify furcation involvement. The role of non-ionizing techniques (MRI and USG) in diagnosing periodontitis remains under investigation.