Articles and Position Statements
AADC Position Statement: Cone Beam Computer Tomography

Cone Beam Computer Tomography

Position Statement


Recently there has been an increased interest in the field of CBCT as evidenced by articles in contemporary journals, adoption of new CDT Codes to reflect the data gathering and interpretation of images, general discussion in the industry about when and where the procedures are most appropriate, as well as the risk versus benefits of the procedures. AADC Position Committee decided to do a search of the literature to answer some questions. Specifically:

1. Does there exist at the present time sufficient data to establish a cost/benefits analysis as to radiation risk?

2. Is there a need for the technology in dentistry and if so is it a generalized or specialized need?

3. Does CBCT have a role in routine diagnostics?

4. Are there unintended consequences, such as establishing an unnecessary high bar as Standard of Care?

5. Is there sufficient understanding surrounding the risk of liability for any failure to identify possible pathology in the interpretation of CBCT images?


Sixty-one articles were reviewed using Medline as a resource. Many of these referenced articles gathered by the Cochrane Institute and so were judged to meet the criteria of the Committee; i.e. large population studies with double blind conditions when appropriate and longitudinal consequence long enough to provide meaningful data. One interesting article from November 2012 provided data from a survey of dental schools in the US, Great Britain, and Australia about dental students and graduate dental students who received training in CBCT. Several articles dealt with various applications of the technology and a few centered on the subjects of cost and radiation in an effort to provide standardization.

This paper will attempt to organize those papers to establish a position of standards, suggested usage, and next steps toward implementing the technology into the dental delivery system.


Cone Beam Computed Tomography (CBCT) is a medical imaging technique consisting of x-ray computed tomography where the x-rays are divergent, forming a cone. During the CBCT scan, the scanning machine rotates around the patient’s head, obtaining hundreds of distinct images. The specialized scanning software collects the data and reconstructs it producing 3-dimensional anatomical data that can be manipulated and visualized with specialized software58.

Articles concerning dental application for CBCT began in 2005 with a significant article from Canada describing the technique published in 200657. Initial interest was in use of CBCT as an adjunct to placement of implants. From the beginning there were economic concerns over the advantage of CBCT versus conventional 2-dimensional images. In medicine the comparable discussion centered on the advantages over conventional CT scans. In both cases there arose serious concerns over whether the newer technology offered significant advantages.

A 2011 study showed that 89% of dental schools in the United States offered training in the use of CBCT. Fewer (62.5%) of schools in the UK and only one (14%) school in Australia offered training8. In all three countries, much of the training was directed to graduate studies. It is clear that more training in the use and interpretation of CBCT imaging should be included in dental schools both at the undergraduate dental school and graduate dental school curricula. This should be accomplished before more expanded use of this technology can be properly accomplished.

Regardless, the technology was there, and soon dentistry began to search for applications. First was whether there was more precise information for implant placement by using a 3D image18, 22, 30, 31, 33, 38, 40, followed shortly by Periodontists searching for more precise results from sinus lifts11, 14. Soon Endodontists were looking for applications in repairing root fractures, finding hidden canals, and facilitating apical surgery2, 13, 32, 49, 50. Orthodontists followed, looking for bone density, precise screw placement, facilitation of impacted canine eruption and other related issues4, 24, 25, 28, 41, 56.

Although the Oral and Maxillo-Facial Surgeons were familiar with the medical applications of the technology and the potential value in implant placement, they began to find more specific dental applications, such as: variance in stab wound damage to cortical or cancellous bone, placement of zygoma implants, and treatment of cleft lip and palate3, 12, 15.

The search for applications of CBCT are far-ranging across many disciplines and in many countries39, 16, 31, 35, 19. Clearly we need to see what data is available from this growing list of CBCT use. It would seem prudent to have more science before we rush to find more applications for the technology.


A review of the literature on this topic was less a study in the efficacy of the procedure than an opportunity to determine what effect the technology will have on how common procedures are being performed. Four basic questions arose:

1. Is there sufficient data to determine a cost/benefit analysis25?

2. Has the liability for possible diagnostic errors been evaluated?

3. Is there evidence that the technology demonstrates a new “gold standard” for use in common procedures7, 17, 27, 42, 51, 55?

4. Has enough data been collected to establish radiation dosage standards or implementation standards20, 23, 34, 44, 53?

From our review we would have to say the answer at this point in time to all four questions would be “No.” Several authors led us to this conclusion: Christianson in more than one paper argues that a dentist’s desire to embrace new technology should be tempered by a comfort level or discomfort level with how he or she is performing the procedure with current technology42, 51, while other authors take an opposing, but cautiously so, view7. Many of the articles confined themselves to descriptions of the applications rather than conclusions as to their value.

The Committee also felt that it might be premature to support applications since that might imply their acceptance and have an unintended consequence of setting a Standard of Care, which would negatively affect Access to Care by requiring special training or special procedures in placing implants, providing orthodontic care, or even providing dentures, all procedures which are commonly provided at the present time without CBCT.

Conclusions and Recommendations

1. A Cost/Benefit analysis remains elusive. Questions arise even as to what actually defines the Current Dental Terminology codes and who would provide them.

2. What procedures and diagnostic imaging are currently available and adequate for routine use? Is CBCT necessary for most procedures?

3. As with most dental procedures what is likely to evolve will be a variation in the tools and technology individual dentists will use in the delivery of dental care: Choices will be made using the criteria of what is in the interest of the patient concluded from Evidenced-based Dentistry and Best Practices, what is most cost-effective to achieve the desired result, and what meets the needs and desires of the patient.

4. Radiation is a continuing concern to both the profession and the public as we have seen in the now expanded use of digital radiography. Caution should be the watchword and unnecessary risk should be a major factor before embracing this technology.


Given the preponderance of evidence, it is the position of the AADC that CBCT imaging is not indicated for routine diagnostic imaging for dental procedures, as an improvement over current procedures. At the present time, CBCT imaging should be considered and reserved for situations where other existing imaging techniques are not adequate and only CBCT can clearly demonstrate the anatomy, when diagnostically difficult situations may directly affect treatment options. However, dental schools should strive to educate undergraduate dental and graduate students in the use and applications of the technology, so that they may take an intelligent position as to how to incorporate the technology in their practice.


1.Cone beam luminescence computed tomography: A feasibility study: Chen D, Zhu S, Yi H, Zhang X, Chen D, Liang J, Tian J. ; Med Phys 2013 Mar;40(3):031111.doi: 10.1118/1.4790694. PMID: 23464291 [PubMed – in process]

2. Contemporary management of horizontal root factures to the permanent dentition: diagnosis-radiologic assessment to include cone-beam computerized tomography: May J.J., Cohenca N, Peters O.A.; J Endod.2013 Mar; 39(3 Suppl):S20-5. Doi: 10.1016/j.joen.2012.10.022 PMID: 23439041 [PubMed – in process]

3.Does cone beam CT actually ameliorate stab wound analysis in bone?: Gaudio D., Giancamillo M., Gibelli D., Galassi A., Cerutti E., Cattaneo C.; Int J Legal Med.2013 Feb 8 [Epub ahead of print] PMID: 23392761 [PubMed – as supplied by publisher]

4. Cone beam CT in orthodontics: The current picture: Makdissi J.; Int Orthod. 2013 Mar; 11(1): 1-20. doi: 10.1016/j.ortho.2012.12.011. Epub 2013 Feb 1.; PMID 23375864 [PubMed – in process]

5. Estimating the effective radiation dose imparted to patients by intraoperative cone-beam computed tomography in thoracolumbar spinal surgery: Lange J., Karellas A., Street J, Eck JC, Lapinsky A, Connolly PJ, Dipaola CP., Spine (Phila Pa 1976). 2013 Mar 1; 38(5):E306-12. doi: 10.1097/BRS.0b013e318281d70b. PMID: 23238490 [PubMed - in process]

6. An intra-oral cone for an 18 MeV linear accelerator: Biggs PJ, Wang CC. Int J Radiat Oncol Biol Phys. 1982 Jul;8(7):1251-6. PMID: 6811519 [PubMed - indexed for MEDLINE]

7. Technology is here to stay: Lunn RH. Cranio 2012 Oct;30(4):237. No abstract available. PMID: 23156964 [PubMed - indexed for MEDLINE]

8. Cone beam computed tomography in dental education: a survey of the US, UK and Australian dental schools: Parashar V, Whaites E, Monsour P. Chaudbey J. Geidst JR. J Dent Educ. 2012 Nov;76(11):1443-7. PMID: 23144479 [PubMed - indexed for MEDLINE]

9. Cone beam computed tomography in dentistry: what dental educators and learners should know: Adibi S. Zhang W. Servos T. O’Neill PN. J Dent Educ. 2012 Nov;76(11):1437-42. Review. PMID: 23144478 [PubMed - indexed for MEDLINE]

10. Identification of dental root canals and their medial line from micro-CT and cone beam CT records: Benyo B. Biomed Eng Online. 2012 Oct 29;11:81. doi: 10.1186/1475-925X-11-81 PMID: 23107190 [PubMed - in process]

11. Clinical applications of digital 2-D and 3-D radiology for the Periodontist: Eshraghi T. McCallister N

McCallister B J Evid Based Dent Pract. 2012 Sep;12(3 Suppl):36-45. doi: 10.1016/S1532-3382(12)70010-6 PMID: 23040338 [PubMed - in process]

12. Usine computer-guided surgery for partial guidance of zygoma implants: Balshi T. Wolfinger G. Balshi S: Compend Contin Educ Dent. 2012 Oct;33(9):682-4, 686, 688-9. PMID: 23030730 [PubMed - indexed for MEDLINE]

13. Different representations of vertical root fractures detected by cone-beam volumetric tomography: a case series report: Fayad MI. Ashkenaz PJ. Johnson BR. J Endod. 2012 Oct;38(10):1435-42. doi: 10.1016/j.joen.2012.05.015. Epub 2012 Jul 20. PMID: 22980194 [PubMed - in process]

14. Maxillary sinus augmentation using computer-aided design/computer-aided manufacturing (CAD/CAM technology): Mangano F. Zecca P. Pozzi-Taubert S. Macchi A. Ricci M. Luango G. Mangano C. Int J Med Robot. 2012 Sep 7. doi: 10.1002/rcs.1460. [Epub ahead of print] PMID: 22961733 [PubMed - as supplied by publisher]

15. Three dimensional assessment of the pharyngeal airway in individuals with non-syndomic cleft lip and palate: Cheung T. Oberoi S. PLoS One. 2012;7(8):e43405. doi: 10.1371/journal.pone.0043405. Epub 2012 Aug 29. PMID: 22952677 [PubMed - indexed for MEDLINE]

16. Cerec Guide: rapid and streamlined manufacture of surgical guides in dental practice: Bindl A. Ritter I. Mehl A. Int J Comput Dent. 2012;15(1):45-54. English, German. No abstract available. PMID: 22930947 [PubMed - indexed


17. Cone beam computed tomography: third eye in diagnosis and treatment planning: Seth V. Kamath P., Vaidya N. Int J Orthod Milwaukee. 2012 Summer;23(2):17-22. PMID: 22873019 [PubMed - indexed for MEDLINE]

18. Use of cone beam computed tomography and a laser intraoral scanner in virtual dental implant surgery: part 1: Lee CY. Ganz SD. Wong N. Suzuki JB. Implant Dent. 2012 Aug;21(4):265-71. doi: 10.1097/ID.0b013e31825e5739. PMID: 22814549 [PubMed - indexed for MEDLINE]

19. Cone beam computer tomography in veterinary dentistry: Van Theilen B. Siguenza F. Hassan B. J Vet Dent. 2012 Spring;29(1):27-34. PMID: 22792858 [PubMed - indexed for MEDLINE]

20. Dose distribution for dental cone beam CT and its implication for defining a dose index: Pauwels R. Teodorakou C. Walker A. Bosmans H. Jacobs R. Horner K. Bogaerts R. SEDENTEXCT Project Consortium. Dentomaxillofac Radiol. 2012 Oct;41(7):583-93. Epub 2012 Jun 29. PMID: 22752320 [PubMed - indexed for MEDLINE]

21. The single-visit implant crown technique: MacFarland B. Dent Today. 2012 Jun;31(6):78, 80, 82. No abstract available. PMID: 22746067 [PubMed - indexed for MEDLINE]

22. Digitally designed surgical guides for placing implants in the nasal floor of dentate patients: a series of three cases: Van der Meer WJ. Raghoebar GM. Gerrits PO. Noorda WD. Vissink A. Visser A. Int J Prosthodont. 2012 May-Jun;25(3):245-51. PMID: 22545253 [PubMed - indexed for MEDLINE]

23. A comprehensive study on the relationship between the image quality and imaging dose in low-dose cone beam CT: Yan H. Cervino I. Jia X. Jiang SB. Phys Med Biol. 2012 Apr 7;57(7):2063-80. doi: 10.1088/0031-9155/57/7/2063 PMID: 22459913 [PubMed - indexed for MEDLINE]

24. Quantitative and qualitative bone analysis in the maxillar lateral region: Georgescu CE. Rusu MC. Sandulescu M. Enache AM. Didilescu AC. Surg Radiol Anat. 2012 Aug;34(6):551-8. doi: 10.1007/s00276-012-0955-6. Epub 2012 Mar 22 PMID: 22437467 [PubMed - indexed for MEDLINE]

25. A framework for costing diagnostic methods in oral health care: an application comparing a new imaging technology with the conventional approach for maxillar canines with eruption disturbances: Christell H. Birch S. Horner K. Rohlin M. Lindh C. SEDENTEXCT consortium. Community Dent Oral Epidemiol. 2012 Aug;40(4):351-61. doi: 10.1111/j.1600-0528.2012.00674.x. Epub 2012 Mar 14. PMID: 22417184 [PubMed - indexed for MEDLINE]

26. Is there a role for the use of volumetric cone beam computed tomography in periodontics?: du Bois AH. Kandachi B. Bartold PM. Aust Dent J. 2012 Mar;57 Suppl 1:103-8. doi: 10.1111/j.1834-7819.2011.01659.x. Review. PMID: 22376102 [PubMed - indexed for MEDLINE]

27. Paul Feuerstein, DMD discusses the newest trends in technology for 2012: Feuerstein P. Dent Today. 2012 Jan;31(1):17. No abstract available. PMID: 22360114 [PubMed - indexed for MEDLINE]

28. Cone beam computed tomography in evaluation of some side effect of orthodontic treatment: Lund H. Swed Dent J Suppl. 2011;(219):4-78. PMID: 22338281 [PubMed - indexed for MEDLINE]

29. A case report of six canals in a maxillary first molar: Du Y. Soo I. Zhang CF. Chin J Dent Res. 2011;14(2):151-3. PMID: 22319758 [PubMed - indexed for MEDLINE]

30. Accuracy of a new developed open-source system for dental implant planning: Dreseidler T. Tandon D. Ritter L. Neugebauer J. Mischkowski RA Scheer M. Zoller JE. Int J Oral Maxillofac Implants. 2012 Jan-Feb;27(1):128-37. PMID: 22299089 [PubMed - indexed for MEDLINE]

31. Comparison of restoratively projected and surgically acceptable virtual implant position for mandibular overdentures: Scarfe W. Vaughn WS. Farman AG. Harris BT. Paris MM. Int J Oral Maxillofac Implants. 2012 Jan-

Feb;27(1):111-8. PMID: 22299087 [PubMed - indexed for MEDLINE]

32. The use of cone-beam computed tomography and virtual reality simulation for pre-surgical practice in endodontic microsurgery: Suebnukarn S. Rheinmora P. Haddawy P. Int Endod J. 2012 Jul;45(7):627-32. doi: 10.1111/j.1365-2591.2012.02018.x. Epub 2012 Jan 30 PMID: 22288913 [PubMed - indexed for MEDLINE]

33. Case presentation: full mouth implant treatment via a trio of modalities: Shapiro SA. Dent Implantol Update. 2011 Dec;22(12):81-8. No abstract available. PMID: 22276485 [PubMed - indexed for MEDLINE]

34. Effective doses in panoramic images for conventional and CBCT equipment: Batista WO. Navarro MV. Maia AF. Radiat Prot Dosimetry. 2012 Aug;151(1):67-75. doi: 10.1093/rpd/ncr454. Epub 2011 Dec 14. PMID: 22171097 [PubMed - indexed for MEDLINE]

35. Technology is altering the dental laboratory landscape: Brown C. Compend Contin Educ Dent. 2011 Nov-Dec;32(9):64-8, 70, 72 passim. No abstract available PMID: 22167931 [PubMed - indexed for MEDLINE]

36. Digital imaging in dentistry: Essen SD. Today’s FDA. 2011 Sep-Oct;23(6):62-8. PMID: 22132658 [PubMed - indexed for MEDLINE]

37. An open system approach for surgical guide production: Abboud M. Orentlicher G. J Oral Maxillofac Surg. 2011 Dec;69(12):e519-24. doi: 10.1016/j.joms.2011.07.027. PMID: 22117708 [PubMed - indexed for MEDLINE]

38. Technology makes a complicated implant restoration simple: Kosinski T. Dent Today. 2011 Sep;30(9):128, 130, 132-5. No abstract available. PMID: 21980729 [PubMed - indexed for MEDLINE]

39. Dental students’ knowledge and attitudes towards cone beam computed tomography in Turkey: Kamburogle K. Kursyn S. Akarslan ZZ. Dentomaxillofac Radiol. 2011 Oct;40(7):439-43. doi:10.1259/dmfr/21915689. PMID: 21960402 [PubMed - indexed for MEDLINE]

40. The “first implant” protocol for the GP part I: treatment planning Tischler M. Ganz SD. Dent Today. 2011 Aug;30(8):64, 66, 68-9. No abstract available PMID: 21899020 [PubMed - indexed for MEDLINE]

41. Precise insertion of orthodontic miniscrews with a stereolithographic surgical guide based on cone beam computed tomography: a pilot study: Morea C, Hayek JE, Oleskovicz C, Dominguez GC, Chilvarquer I. Int J Oral Maxillofac Implants. 2011 Jul-Aug;26(4):860-5. PMID: 21841996 [PubMed - indexed for MEDLINE]

42. Is the current generation of technology facilitating better dentistry?: Christensen G. J Am Dent Assoc. 2011 Aug;142(8):959-63. No abstract available. PMID: 21804064 [PubMed - indexed for MEDLINE]

43. The use of 3-dimensional imaging in dentoalveolar surgery: Orentlicher G, Abboud M. Compend

Contin Educ Dent. 2011 Jun;32(5):78-80, 82, 85-6 PMID: 21755898 [PubMed - indexed for MEDLINE]

44. Technological advances in nontraditional orthodontics: Bonnick AM, Nalbandian M, Siewe MS. Dent Clin North Am. 2011 Jul;55(3):571-84, ix. doi: 10.1016/j.cden.2011.02.012. PMID: 21726691 [PubMed - indexed for MEDLINE]

45. In my view: CT scanning in the dental office: cone beam computed tomography: Miller KG. Pa Dent J (Harrisb). 2011 Mar-Apr;78(2):27-8. No abstract available. PMID: 21661499 [PubMed - indexed for MEDLINE]

46. Dose reduction and cone beam technology: perception is reality: Mupparapu M, Singer SR. Quintessence Int. 2011 Apr;42(4):279. No abstract available. PMID: 21661266 [PubMed - indexed for MEDLINE]

47. Validation for 2D?43D registration: anew gold standards set: Pawiro SA, Markelj P, Pernus F, Gendrin C, Figl M, Weber C, Kainberger F, Nöbauer-Huhmann I, Bergmeister H, Stock M, Georg D, Bergmann H, Birkfellner W. Med Phys. 2011 Mar;38(3):1481-90. PMID: 21520860 [PubMed - indexed for MEDLINE]

48. An overview of three dimensional imaging in dentistry: Milne DM. Dent Update. 2011 Mar;38(2):136; discussion 136. No abstract available. PMID: 21500625 [PubMed - indexed for MEDLINE]

49. CBCT technology: endodontics and beyond, Part 2: Roth JS. Dent Today. 2011 Feb;30(2):146, 148, 150-1. No abstract available. PMID: 21400996 [PubMed - indexed for MEDLINE]

50. CBCT technology: endodontics and beyond, Part 1: Roth JS. Dent Today. 2011 Feb;30(2):146, 148, 150-1. No abstract available. PMID: 21400996 [PubMed - indexed for MEDLINE]

51. New technology: mandatory, elective, or hype?: Christensen GJ. Child P Jr. Dent Today. 2011 Feb;30(2):134, 136, 138 passim. PMID: 21400995 [PubMed - indexed for MEDLINE]

52. Cone beam technology: Guttman JL. J Am Dent Assoc. 2011 Mar;142(3):244, 246; author reply 246. No abstract available.

53. Comparison of a dental cone beam CT with a multi-detector row CT on effective doses and physical image quality: Y, Tokumori K, Okamura K, Yoshiura K. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2011;67(1):25-31. Japanese. PMID: 21301168 [PubMed - indexed for MEDLINE]

54. A diagnostic dilemma: Plunkett L. N Y State Dent J. 2010 Nov;76(6):6-7. No abstract available. PMID: 21226398 [PubMed - indexed for MEDLINE]

55. The ethics of routine use of advanced diagnostic technology: Khelemsky R. J Am Coll Dent. 2011 Winter;78(4):35-9. No abstract available. PMID: 22416617 [PubMed - indexed for MEDLINE]

56. The current status of cone beam computed tomography imaging in orthodontics: Kapila S, Conley RS, Harrell WE Jr. Dentomaxillofac Radiol. 2011 Jan;40(1):24-34. doi: 10.1259/dmfr/12615645. Review. PMID: 21159912 [PubMed - indexed for MEDLINE]

57. Technical description of CBCT: from University of Manchester. Citing: J Can Dent Assoc 2006; 72(1); 75-80

58. Operational principles for cone-beam computed tomography. Hatcher, DC. JADA 2010;141(10S):3S-6S

59. AAE and AAMOR Joint Position Statement on Use of Cone-Beam-Computed Tomography in Endodontics: 2010

60. The use of cone-beam computed tomography in dentistry: an advisory statement from the ADA Council on Scientific Affairs: JADA August 1, 2012 vol. 143 no. 8 899-902

61. Selective Use of Cone-Beam Computed Tomography Offer Advanced Point-of-Care Imaging: ADA Press Release July 30, 2012


AADC Positions Committee

Michael DL Weisenfeld, DDS, Chair

Dee FitzGerald, DDS, Principal author

Andrew Mogelof, DDS

Cary Sun, DDS

Marc Zweig, DDS

Stephanie Lepsky, DDS

Robert Sherman, DDS