Introduction: Comparison between tomography and one or more digital intra-oral systems have been conducted with histological sectioning of the offending teeth as gold standard for comparison. The findings in the literature are contradicting, since some studies showed superiority of tomography. This systematic review aimed at evaluating the evidence in relation to the diagnostic accuracy of cone beam computed tomography compared to the digital and film-based intra-oral radiography. Methods: An electronic search was conducted on Medline Plus, PubMed, Science Direct, and Wiley databases. All articles published in English language up to October 2017 were eligible to be included in this review. Search on different search engines and different database websites including hand search revealed 496 articles. After reading titles and abstracts, irrelevant and duplicated articles 459 were excluded. The resulting articles were read carefully for comparison of accuracy between CBCT and other intra-oral radiographic systems and the references lists of the resulting articles were screened for additional studies. Results: A total of 22 articles, available according to the inclusion criteria, were included in this systematic review. Most of the studies (13 articles) were conducted on premolars and molars while, 5 studies were conducted on molars, one study was conducted on premolars, one study was on incisors, and two studies did not report the type of teeth used. The majority of the studies (21articles) were laboratory experiments (in-vitro) while, only one study was in-vivo. The sample size for the studies (number of teeth) ranged from 30 to 257 teeth. Conclusions: CBCT has similar diagnostic accuracy as other intra-oral systems for diagnosing dental caries. CBCT is not recommended for caries diagnosis unless the CBCT was undertaken for any other procedures where the dental caries should be included in the final report.