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