The Diagnostic Accuracy of Cone-Beam Computed Tomography (CBCT) Imaging in Detecting and Measuring Dehiscence and Fenestration in Patients With Class I Malocclusion: A Surgical-Exposure-Based Validation Study

Background No study has evaluated the diagnostic accuracy of cone-beam computed tomography (CBCT) imaging in detecting bone defects in orthodontic patients with Class I malocclusions. This study aimed to evaluate the accuracy of CBCT in detecting dehiscences and fenestrations before orthodontic treatment compared to the gold standard i.e., the actual clinical detection of bone defects on surgical exposure. Methods A validation study was undertaken at the Department of Orthodontics, University of Damascus between 29 August 2018 and 1 November 2020. The sample included 16 patients who had Class I malocclusion with moderate crowding on the lower anterior teeth. Results The proportion of dehiscence diagnosed on CBCT images was approximately two-and-a-half times greater than that found on direct examination i.e., 42.7% versus 17.7%, respectively. The proportion of fenestrations was almost three times greater when diagnosed on CBCT images compared to the gold standard i.e., 39.5% versus 13.5%, respectively. The sensitivity of CBCT imaging in detecting dehiscence and fenestration was 100%. The specificity of CBCT imaging ranged from 45.5% to 86.7% and from 50% to 86.7% for dehiscence and fenestration detection, respectively. Also, the diagnostic accuracy of CBCT imaging ranged from 44% to 87.5% and from 56% to 87.5% for dehiscence and fenestration detection, respectively. Conclusions The proportion of dehiscence diagnosed on CBCT images was approximately two-and-a-half times greater than that found on direct examination, and the proportion of fenestrations was almost three times greater when diagnosed on CBCT images compared to the gold standard. The CBCT overestimates the dimensions of the linear measurements compared to those measured by the gold standard.