Use of Artificial Intelligence in Diagnosing Vertical Root Fractures—A Systematic Review

<b>Background/Objectives:</b> Vertical root fractures (VRFs) present significant diagnostic challenges due to their subtle radiographic features and variability across imaging modalities. Artificial intelligence (AI) offers potential to improve detection accuracy, yet evidence regarding its performance across different imaging systems remains fragmented. To critically evaluate current evidence on AI-assisted detection of VRFs across periapical radiography, panoramic radiography, and cone-beam computed tomography (CBCT) and to compare diagnostic performance, methodological strengths, and limitations. <b>Methods:</b> A systematic review of literature up to January 2025 was carried out using databases such as PubMed, Scopus, Web of Science, and the Cochrane Library. The studies included in this review utilized AI-based techniques for detecting VRF through periapical, panoramic, or CBCT imaging. Extracted data encompassed study design, AI models, dataset sizes, preprocessing methods, imaging parameters, validation techniques, and diagnostic metrics. The risk of bias in these studies was evaluated using the QUADAS-2 tool. <b>Results:</b> Ten studies met inclusion criteria; CNN-based models predominated, with performance highly dependent on imaging modality. CBCT-based AI systems achieved the highest diagnostic accuracy (91.4-97.8%) and specificity (90.7-100%), followed by periapical radiography models with accuracies up to 95.7% in controlled settings. Panoramic radiography models demonstrated lower sensitivity (0.45-0.75) but maintained high precision (0.93) in certain contexts. Most studies reported improvements over human performance, yet limitations included small datasets, heterogeneous methodologies, and risk of overfitting. <b>Conclusions:</b> AI-assisted VRF detection shows promising accuracy, particularly with CBCT imaging, but current evidence is constrained by methodological variability and limited clinical validation.