When is a Cone Beam Computed Tomography (CBCT) indicated in children?

CBCT, or cone beam computed tomography, is a radiographic examination aimed at diagnosing orthodontic problems. It is essentially the most modern method of diagnosis in orthodontics. Diagnosis is performed either traditionally, with the panoramic dental x-ray, also known as orthopantomogram (OPT), or more rarely with the lateral cephalometric radiograph, i.e. Ceph or LCR. In recent years, the introduction of three-dimensional X-ray imaging in orthodontics has resulted in the development of CBCT examination. Cone beam computed tomography, otherwise known as CBCT, has a particularly significant increase as a diagnostic test in orthodontics. There are some orthodontists who promote the use of CBCT, as a new and absolutely necessary diagnosis of any orthodontic problem. This preference aims for it to replace the well-known panoramic dental x-ray and Ceph exams. The question that is often asked regarding this test is whether it poses a health risk, and to what extent.

Is it safe to have CBCT imaging?

A CBCT test, having high resolution, can be a burden to the patient’s health. So far, it has been shown that CBCT causes a much higher exposure to ionizing radiation compared to the traditional combination of OPT and Ceph. Therefore, the following important question arises: Does increased exposure to cone beam tomography offer any benefits to the patient? All this ionizing radiation has an accumulative effect in every patient’s body and remains there during their lifespan. Is such an examination really necessary to diagnose any orthodontic problem? And another question yet, would be how much higher is the estimated radiation when comparing it with other radiological examinations?

The radiation rates involved in the CBCT test in relation to the OPT and LCR tests.

The authors of the “European Journal of Orthodontics” have created a systematic review of the CBCT examination, which investigated whether it is appropriate for children. They made a thorough evaluation of all the publications and scientific articles related to the CBCT examination. This evaluation concerned this specific diagnostic method for orthodontic treatment in children and adolescents until July 2018. The findings of this study were examining when the CBCT is indicated instead of the traditional combination of OPT/LCR. The cases where they reckon that each child/teen needs to undergo a cone beam computed tomography are the following:

● Existing cleft lip and palate

● Hereditary developmental disorders related to the face or teeth

● Impacted or ectopic teeth,

● Fractures located at the root of the teeth

● Diseases of the temporomandibular joint (TMJ) with bone involvement

Can CBCT be performed on children and adolescents?

As mentioned above, the aforementioned research deemed that the CBCT examination is necessary only in a small percentage of children and adolescents. Cone beam computed tomography is indicated only in children and adolescents who present with any of the above health issues. In any other case, a panoramic dental x-ray and lateral cephalometric radiograph can be used to diagnose the orthodontic treatment. The authors state in their assessment that the CBCT test can be performed instead of the traditional OPT/LCR pair in specific cases. These are cases when the traditional pair cannot provide us with the appropriate medical iIt is therefore necessary for children and adolescents to have a CBCT examination only in very special cases. And this is when other radiological examinations may not offer a full diagnosis. It is advisable not to burden the health of children with radiation that can be avoided when using other diagnostic methods. Before your children undergo any orthodontic treatment examination, please consult your orthodontist. Be properly informed regarding each method and select the safest and at the same time the most efficient for your child.