Ionizing radiation in pediatric cone-beam computed tomography: Would you scan your own child for orthodontic diagnosis?

Abstract

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  The use of cone-beam computed tomography (CBCT) in orthodontics has been increasingly widespread.
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  In recent years, there has been a remarkable increase in the number of publications involving the use of CBCT.
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  What factors should be carefully considered when establishing a “genuine” indication for CBCT, particularly in pediatric patients, to minimize exposure to ionizing radiation?
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  Why have researchers increasingly turned to CBCT in recent years? Can this trend be attributed solely to scientific quality?

The use of cone-beam computed tomography (CBCT) in orthodontics has increased substantially over recent years. Although CBCT provides valuable 3-dimensional (3D) diagnostic information, its use in pediatric patients requires careful justification because it involves exposure to ionizing radiation. Children are more radiosensitive than adults, and the cumulative effects of radiation exposure should be considered when prescribing imaging procedures. This narrative review critically examines the current use of CBCT in pediatric orthodontics from clinical, radiological, and ethical perspectives. Current evidence and international guidelines consistently emphasize that CBCT should not be used routinely when conventional clinical examinations and 2-dimensional imaging provide sufficient diagnostic information. The diagnostic benefits of CBCT must be weighed against potential radiation risks, particularly in situations in which 3D imaging is used primarily for research purposes or to obtain additional anatomic detail without influencing treatment decisions. Advances in low-dose and ultra-low-dose CBCT protocols have reduced radiation exposure; however, dose reduction does not eliminate the need for strict justification. CBCT should be prescribed only when the expected 3D information directly influences diagnosis, treatment planning, or clinical outcomes and when no suitable lower-dose or nonionizing alternative is available. Furthermore, ethical self-reflection may support more responsible imaging decisions, encouraging clinicians and researchers to consider whether they would recommend the same examination for their own child or close relative. Adherence to the principles of justification, optimization, and dose minimization remains essential to ensure safe and ethically sound CBCT use in pediatric orthodontics.

The use of cone-beam computed tomography (CBCT) in orthodontics has increased substantially over recent years. Although CBCT provides valuable 3-dimensional (3D) diagnostic information, its use in pediatric patients requires careful justification because it involves exposure to ionizing radiation. Children are more radiosensitive than adults, and the cumulative effects of radiation exposure should be considered when prescribing imaging procedures. This narrative review critically examines the current use of CBCT in pediatric orthodontics from clinical, radiological, and ethical perspectives. Current evidence and international guidelines consistently emphasize that CBCT should not be used routinely when conventional clinical examinations and 2-dimensional imaging provide sufficient diagnostic information. The diagnostic benefits of CBCT must be weighed against potential radiation risks, particularly in situations in which 3D imaging is used primarily for research purposes or to obtain additional anatomic detail without influencing treatment decisions. Advances in low-dose and ultra-low-dose CBCT protocols have reduced radiation exposure; however, dose reduction does not eliminate the need for strict justification. CBCT should be prescribed only when the expected 3D information directly influences diagnosis, treatment planning, or clinical outcomes and when no suitable lower-dose or nonionizing alternative is available. Furthermore, ethical self-reflection may support more responsible imaging decisions, encouraging clinicians and researchers to consider whether they would recommend the same examination for their own child or close relative. Adherence to the principles of justification, optimization, and dose minimization remains essential to ensure safe and ethically sound CBCT use in pediatric orthodontics.