A systematic review and meta-analysis of the genotoxic and cytotoxic effects on oral epithelium induced by cone beam computed tomography

Objective To evaluate the occurrence of genotoxic and cytotoxic effects in oral epithelium after exposure of patients to cone beam computed tomography (CBCT). Methods A systematic review (SR) was conducted following the PECO (Population, Exposure, Comparison, Outcome) criteria. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). A search was performed on the PubMed, Scopus, ScienceDirect, and Google Scholar databases. Effect size and heterogeneity of data were evaluated statistically. The Joanna Briggs Institute questionnaire for observational studies was utilized to assess the risk of bias. The GRADE tool was applied for assessment of the quality of evidence. Begg's funnel plot was used to evaluate publication bias. Results In total, 10 full-text articles were included in the SR, with 6 of them in the meta-analysis. The SR showed a significant increase in micronuclei after exposure, with a large effect size of 1.03. For genotoxicity, the heterogeneity for tau2 was 0.96, the chi-squared test for heterogeneity P<0.00001, the I2 statistics for random effects was 91%, and the overall effect for Z value was 2.46 (P=0.01). The measure of cytotoxicity after CBCT exposure was not possible due to the lack of homogeneity of included articles. Risk of bias was low, quality of evidence was strong, and publication bias was absent. Conclusion CBCT can cause genotoxicity in the oral epithelium with a large effect size. Statement of clinical relevance Several studies have assessed genotoxicity and cytotoxicity after CBCT exposures. CBCT was found to cause genotoxicity in the oral epithelium with a large effect size. Knowledge of the effect size could deter the unnecessary CBCT exposure.