The Open Dentistry Journal

ISSN: 1874-2106 ― Volume 14, 2020

Vertical Tooth Root Fracture Detection through Cone-beam Computed Tomography: An Umbrella Review Protocol Testing Four Hypotheses

Kelvin Ian Afrashtehfar1, 2, *, David MacDonald3, 4
1 Department of Oral Surgery & Stomatology, School of Dental Medicine, Faculty of Medicine, University of Bern, Berne, Switzerland
2 Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
3 Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
4 British Columbia Cancer Agency, Vancouver, Canada


Detecting vertical root fractures represents an immense challenge for oral health professionals. One of the main tools used to detect this type of biological complication is the periapical radiograph. However, conventional radiography consists of two-dimensional imaging that is limited by the superimposition of bony structures that complicate the detection of root fractures. The alternative, a Cone-Beam Computed Tomography (CBCT) scan, cannot be prescribed in every case since radiation should be kept to a minimum as stipulated by the “As Low As Reasonably Achievable” (ALARA) principle. Therefore, to justify the use of a CBCT scan to detect a vertical tooth root fracture, the clinician must prove that it has significant benefits over traditional imaging. Since few systematic reviews have compared CBCT technology to traditional radiography for the diagnosis of vertical root fractures, it is of utmost importance in clinical practice, especially in endodontology and clinical dental medicine, where the available reviews are examined to generate a clinical recommendation. The four hypotheses of this protocol are that (1) CBCT is superior to traditional radiography for detecting vertical root fractures of vital teeth; (2) CBCT is superior to traditional radiography for detecting longitudinal root fractures of vital teeth with radiopaque restorations; (3) CBCT is superior to traditional radiography for detecting vertical root fractures of root-filled teeth without a radiopaque post that may cause artifacts; and (4) CBCT is superior to traditional radiography for detecting vertical root fractures of root-filled teeth with a radiopaque post regardless of its longitude. To test these hypotheses, all the current secondary resources related to the aim of this meta-review are evaluated. If there is sufficient evidence to support clinical decisions, then the appropriate recommendations will be formulated.

PROSPERO ID: CRD42018067792

Keywords: Cone beam computed tomography, Diagnosis, Tooth fractures, Diagnostic imaging, Meta-analysis, Root canal therapy, Systematic review, Overview.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 449
Last Page: 453
Publisher Id: TODENTJ-13-449
DOI: 10.2174/1874210601913010449

Article History:

Received Date: 8/6/2019
Revision Received Date: 20/10/2019
Acceptance Date: 21/11/2019
Electronic publication date: 31/12/2019
Collection year: 2019

© 2019 Afrashtehfar and MacDonald.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Universität Bern, Zahnmedizinische Kliniken (zmk bern), Freiburgstrasse 7, CH-3010 Berne / Schweiz; E-mail:


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