Comparative Analysis of 3D Imaging in Periodontal Disease Assessment: A Systematic Review and Meta-Analysis.

Objectives: The present systematic review and meta-analysis aimed to compare the efficacy of three-dimensional (3D) imaging techniques in terms of accuracy and precision for periodontal disease assessment.

Material And Methods: A literature search was conducted across multiple databases (PubMed, Scopus, Web of Science, Google Scholar, and ScienceDirect) following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The primary outcomes focused on comparing the accuracy and precision of 3D versus two-dimensional (2D) imaging techniques. Furthermore, it assessed their performance in determining periodontal diseases. Quality assessment was performed using the risk of bias (RoB)-2 for randomized controlled trials (RCTs) and ROB in nonrandomized studies-Intervention (ROBINS-I) for non-RCTs. Meta-analysis was conducted using RevMan 5.4 with a significance level set at 0.01. While meta-regression was performed using OpenMEE.

Results: After screening, 22 studies met the eligibility criteria for qualitative and quantitative analysis. Qualitatively, 3D imaging, particularly cone-beam computed tomography (CBCT), showed superior accuracy and precision over 2D techniques. The meta-analysis revealed significant differences in several areas: overall (p = 0.00001, Mean Difference (MD) = -0.36, 95% confidence interval [CI]: -0.96 to 0.24, I² = 93%), horizontal measurements (p = 0.00001, MD = -0.75, 95% CI: -2 to -0.49, I² = 92%), and vertical measurements (p = 0.00001, MD = -0.59, 95% CI: -2.40 to 1.23, I² = 92%). Nonsignificant differences were found for furcation height, width, and depth. Most studies showed good quality with a low risk of bias. Age of the participants and study quality were found to be the sources of heterogeneity.

Conclusions: Consistent trends highlight the advantages of 3D imaging in assessing both periodontal and nonperiodontal diseases. However, given the nonsignificant differences in furcation height, width, and depth, the recommended approach is to combine CBCT with digital intraoral radiography for more comprehensive periodontal bone assessment.