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Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities

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Abstract

Objectives

A narrative review on the potential use of low-dose protocols for cone beam computed tomography (CBCT) was conducted to identify indications and their relevance for various dental disciplines.

Materials and methods

Google Scholar was searched using the words “low-dose CBCT”. Reviews, consensus papers, clinical studies, and experimental studies were eligible for the initial screening process, but for data extraction only original articles were selected. Similar search procedures were then performed with the additional search words “pedo,” “ortho,” “endo,” “implant,” “perio,” and “oral surgery.” Furthermore, references of included articles were examined to identify further relevant articles.

Results

After screening, 27 publications remained for the data extraction process. Low-dose protocols have been reported for specialties such as pediatric dentistry (evaluating orofacial clefts, periapical lesions, impacted teeth, and autotransplantation), orthodontics (cephalometric analysis and interim assessment of treatment results), endodontics (detecting root fractures, resorptions and periapical bone loss), implant dentistry (planning implant insertion, evaluating peri-implant fenestration and dehiscence), periodontology (assessing periodontal structures), and oral and maxillofacial surgery (assessing mandibular third molars and TMJs). Nevertheless, most of the literature available is related to non-clinical studies. Furthermore, there is a lack of position statements or guidelines from authoritative bodies regarding the use of low-dose protocols in dental medicine.

Conclusions

Low-dose protocols for CBCT imaging seem to have potential in various disciplines in dental medicine ranging from pediatric dentistry to oral and maxillofacial surgery. Dose reduction is usually achieved by mAs reduction, use of partial rotations, reduced number of projections, and larger voxel sizes, but seldom by kV reduction.

Clinical relevance

Albeit low-dose protocols have potential to result in a reduction of dose exposure for 3D imaging due to dental indications, there is a need to more clearly specify indications and limitations to avoid indiscriminate use of standard and high-dose CBCT scans in the future on the lines of ALARA/ALADA principles.

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Funding

This study has been funded by departmental funds only. No external funding has been received.

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Authors and Affiliations

  1. Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China

    Andy W. K. Yeung & Michael M. Bornstein

  2. OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium

    Reinhilde Jacobs

  3. Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium

    Reinhilde Jacobs

  4. Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden

    Reinhilde Jacobs

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  1. Andy W. K. Yeung
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Correspondence to Michael M. Bornstein.

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Yeung, A.W.K., Jacobs, R. & Bornstein, M.M. Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. Clin Oral Invest 23, 2573–2581 (2019). https://doi.org/10.1007/s00784-019-02907-y

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