Case Selection for the Use of Cone Beam Computed Tomography in Dentistry Based on Diagnostic Efficacy and Risk Assessment: An Update

Case selection for cone beam computed tomography (CBCT) for dental purposes is primarily based on individual risk–benefit assessment, balancing between the long-term radiation risks of CBCT and its ultimate benefit for each individual patient. Based on the currently available literature, the expected ultimate benefit to the patient, as evaluated by the level of diagnostic efficacy of CBCT in dentistry, is yet unclear, and it is mainly limited to its technical and diagnostic accuracy efficacies. Even for these, levels of efficacy evidence are incomplete, and may predominantly be based on studies with a high risk of bias. Therefore, the efficacy of CBCT in supporting the practitioner’s decision-making, treatment planning, and eventually in affecting treatment outcomes, is not fully elucidated. On the other hand, the potential radiation risks of a CBCT scan are uncertain and are stochastic in nature, thus requiring a preventive clinical approach. Furthermore, modern dentistry provides efficient technologies, such as the operating microscope in endodontics, that significantly improve the ability to diagnose and treat even complex cases, and in some cases make CBCT scans unnecessary. Consequently, cautious decision-making is warranted when a preoperative CBCT scan is considered, and in certain cases the decision to perform a preoperative CBCT may be postponed and reevaluated during the treatment. This chapter reviews the current literature concerning the benefits of CBCT in dental practice, alongside its risks in this use, and presents a practical case-selection algorithm for the use of CBCT in dentistry.