Diagnostic efficacy of cone beam computed tomography in paediatric dentistry: a systematic review

Abstract

Purpose To determine in which clinical situations it is indicated or contra-indicated to prescribe cone beam computed tomography (CBCT) for paediatric patients. Methods Systematic review of in vivo paediatric research studies of diagnostic efficacy using CBCT, with supplementary searches for guideline documents on CBCT and for systematic reviews permitting inclusion of ex vivo and adult studies. Results After screening, 190 publications were included, mostly case studies. No systematic reviews were found of in vivo paediatric research. Fourteen studies of diagnostic efficacy were identified. The supplementary searches found 18 guideline documents relevant to the review and 26 systematic reviews. The diagnostic efficacy evidence on CBCT was diverse and often of limited quality. There was ex vivo evidence for diagnostic accuracy being greater using CBCT than radiographs for root fractures. The multiplanar capabilities of CBCT are advantageous when localising dental structures for surgical planning. Patient movement during scanning is more common in children which could reduce diagnostic efficacy. Conclusions No strong recommendations on CBCT are possible, except that it should not be used as a primary diagnostic tool for caries. Guidelines on use of CBCT in the paediatric age group should be developed cautiously, taking into account the greater radiation risk and the higher economic costs compared with radiography. CBCT should only be used when adequate conventional radiographic examination has not answered the question for which imaging was required. Clinical research in paediatric patients is required at the higher levels of diagnostic efficacy of CBCT.

Comparative analysis of the accuracy of periapical radiography and cone‐beam computed tomography for diagnosing complex endodontic pathoses using a gold standard reference – A prospective clinical study

“…However, due to difficulties with access, it may not always be possible to assess this parameter. Also, diagnostic accuracy is subjective in nature and can vary from one person to another (Horner et al, 2020). Lastly, CBCT scans were performed with voxel size of 90 microns.…”

Knowledge and Attitudes of Paediatric Dentists in Turkey Regarding Cone Beam Computed Tomography (Cbct)

“…In a review evaluating the use of CBCT in the field of endodontics, it was stated that CBCT would be useful in preoperative procedures such as the evaluation of periapical pathologies, root fractures, and resorption and/or postoperative evaluations. In their systematic review, Horner et al 7 stated that the use of CBCT for caries detection is not indicated in the paediatric population, but it may be indicated in cases such as acute infections and root resorption and fractures, where conventional radiographs are inadequate. According to the researchers, CBCT is indicated for the evaluation of developmental deformities and large bone defects.…”

“…CBCT involves a higher radiation dose than panoramic and intra-oral imaging but a lower dose compared to conventional tomography. 4,7 When evaluating an individual's radiation risk, the effective doses recommended by ICRP (International Commission on Radiological Protection) should be kept in mind. Using anthropometric phantom models, Theodorakou et al 3 determined that the lowest effective dose was achieved by selecting the smallest fields of view (FOV) and using small patient size settings.…”

Guidelines for oral and maxillofacial imaging: COVID-19 considerations

“…Therefore, DHCPs should delay entry into the operatory until a sufficient time has elapsed for enough air changes to remove potentially infectious particles. 13 , 52 Air changes per hour’ is the ratio of the volume of air flowing through a space in a certain period of time (the airflow rate) to the volume of that space (the room volume). Though ideally this should be 12 air changes per hour, particularly in new construction or recent renovations, a minimum of 6 is acceptable.…”

“…Therefore, DHCPs should delay entry into the operatory until a sufficient time has elapsed for enough air changes to remove potentially infectious particles. 13 , 52 …”