CBCT as a Diagnostic Tool in Hard Tissue Imaging in Dentistry: A Review

Abstract

Cone Beam Computed Tomography (CBCT) has transformed dental and maxillofacial imaging by providing high-resolution, three-dimensional visualization of hard tissues with reduced radiation exposure compared to conventional CT. Its applications span oral medicine & radiology; implantology, oral and maxillofacial surgery, orthodontics, endodontics, periodontics, airway and ENT imaging, craniofacial assessment, and forensic dentistry. CBCT enables precise evaluation of bone morphology, implant site planning, fracture assessment, impacted teeth localization, temporomandibular joint analysis, airway patency, and volumetric measurement of dental and skeletal structures. Integration with computer-aided design, stereolithography, and artificial intelligence further enhances diagnostic accuracy, surgical planning, and treatment outcomes. Limitations include reduced soft tissue contrast, susceptibility to metal artifacts, and the need for specialized operator training. Selective use is recommended when conventional imaging is insufficient, balancing clinical benefit against radiation exposure. Overall, CBCT has become an indispensable tool in modern dentistry and maxillofacial practice, optimizing diagnosis, treatment planning, and patient safety.This article provides an overview of CBCT\'s role as a diagnostic tool in dental hard tissue imaging.

Introduction

Cone Beam Computed Tomography (CBCT) is a major advancement in dental imaging, offering three-dimensional, high-resolution visualization of the maxillofacial region with significantly lower radiation compared to conventional CT. Introduced independently by Arai and Mozzo, CBCT filled the gap between low-information 2D radiography and high-dose, high-cost medical CT, becoming widely adopted in dentistry for its affordability, efficiency, and diagnostic precision.

CBCT uses a cone-shaped X-ray beam and flat-panel detector that rotate once around the patient to capture hundreds of projections, which are reconstructed into 3D volumetric images. It provides isotropic voxels, short scan times, reduced radiation (3–20% of CT), compact machine size, and images viewable in multiple planes (axial, coronal, sagittal) as well as panoramic-like and 3D rendered views. Field of View (FOV) options—small, medium, large—allow targeted imaging with minimized radiation, following ALARA principles. Although CBCT offers lower soft-tissue contrast than CT, it is superior for hard-tissue evaluation.

CBCT has extensive clinical applications across dentistry:

• Oral Medicine & Radiology: Identification of cysts, tumors, infections, sinus diseases, developmental anomalies, bone destruction, and lesion margins, improving diagnostic accuracy and treatment planning.

• Implantology: Precise evaluation of bone height, width, density, angulation, and proximity to vital structures; aids in guided implant surgery, graft assessment, and surgical stent fabrication.

• Oral & Maxillofacial Surgery: Assessment of fractures, impacted teeth, TMJ changes, cysts, tumors, sinus floor elevation, orthognathic procedures, trauma evaluation, and intraoperative guidance.

• TMJ & Craniofacial Surgery: Evaluation of condylar morphology, joint space, ankylosis, arthritis, cleft defects, volumetric bone assessment, and virtual surgical planning.

• Orthodontics: Morphometric analysis, impacted tooth localization, airway assessment, root morphology, cephalometric reconstructions, growth analysis, 3D planning, and mini-implant placement.

• Endodontics: Detection of complex root canal anatomy, fractures, resorption, periapical lesions, extra canals, traumatized teeth, surgical planning, and diagnosis where 2D imaging is insufficient.

• Periodontics: Evaluation of intrabony defects, furcation involvement, dehiscence, fenestration, alveolar bone morphology, periodontal biotype, and postsurgical regenerative outcomes.

• Forensic Dentistry & Skeletal Assessment: Age estimation, pulp-to-tooth volume analysis, facial reconstruction, postmortem imaging, trauma evaluation, and CBCT sialography.

• Advanced and Emerging Uses: AI-assisted diagnosis, virtual treatment simulation, fusion with optical scanners, additive manufacturing, artifact reduction, airway analysis, musculoskeletal imaging, and interventional procedures.

Overall, CBCT provides accurate, three-dimensional, low-dose imaging essential for diagnosis, treatment planning, and surgical precision across dental specialties. It complements—not replaces—conventional radiography and continues to expand through technological innovations such as AI integration, improved reconstruction algorithms, and multimodal imaging.

Conclusion

CBCT has transformed dental diagnostics by providing highly accurate, three-dimensional imaging of hard tissues, enhancing clinical decision-making and improving patient outcomes when used appropriately. While exceptionally effective for visualizing bone and dental structures, CBCT is less ideal for soft tissue assessment, where fan-beam CT offers superior resolution and clarity for overlapping anatomical features. Optimal use of CBCT necessitates a solid understanding of dental anatomy and pathology, along with proficiency in image acquisition and reconstruction software.CBCT is a powerful tool for hard tissue evaluation in dentistry, offering enhanced diagnostic precision and treatment planning capabilities, but its application should be guided by clinical indications and operator expertise, with alternative imaging modalities considered for soft tissue assessment.

References

[1] Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol. 2014;6(10):794-807. [2] Dias LA dos R, Reis SCA, Ferreira LA. Use of fan beam computerized tomography and cone beam computerized tomography in oral and maxillofacial surgery and its indications: A literature review. Int J Front Life Sci Res. 2022;2(2):072–90. [3] Alok A, Singh ID, Panat SR, Singh S, Kishore M. Cone Beam Computed Tomography: A Third Eye For Dental Surgeon. 2014. [4] Nasti S, Khan FA, Srivastava T, Nalini MR, Ahmed CZ, Tiwari H. Advancing dental diagnostics: The significance of cone-beam computed tomography (CBCT) in modern dentistry. IP Int J Maxillofac Imaging. 2024. [5] Ró?y?o-Kalinowska I. Dental Cone-Beam Computed Tomography (CBCT). Cham: Springer; 2020. p. 65–77. [6] Reddy KS, Guttal KS, Nandimath K, Voora T. Integration of cone beam computed tomography for interdisciplinary diagnosis and treatment planning. J Orofac Health Sci. 2024. [7] Agarwal N, Gupta P. Evolving Oral Diagnostics: Cone-beam Computed Tomography’s (CBCT) Importance in Contemporary Dentistry. Int J Multidiscip Res. 2024;6(3). [8] Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72(1):75–80. [9] Alshomrani F. Cone-Beam Computed Tomography (CBCT)-Based Diagnosis of Dental Bone Defects. Diagnostics (Basel). 2024;14(13):1404. [10] Misra D, Misra A. Cone Beam Computed Tomography: An essential ally to Undergraduates in their Dental Practice. Univ J Dent Sci. 2024;10(2). [11] Machado GL. CBCT imaging - A boon to orthodontics. Saudi Dent J. 2015;27(1):12-21. [12] Venkatesh E, Elluru SV. Cone beam computed tomography: basics and applications in dentistry. J IstanbUnivFac Dent. 2017;51(3 Suppl 1):S102-S121. [13] Bromberg N, Brizuela M. Dental Cone Beam Computed Tomography. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan- [cited 2025 Nov 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK592390/ [14] Jaju PP, Jaju SP. Clinical utility of dental cone-beam computed tomography: current perspectives. Clin CosmetInvestig Dent. 2014;6:29-43. [15] Kurt Bayrakdar S, Orhan K, Bayrakdar IS, Bilgir E, Ezhov M, Gusarev M, et al. A deep learning approach for dental implant planning in cone-beam computed tomography images. BMC Med Imaging. 2021;21(1):86. [16] Yajima A, Otonari-Yamamoto M, Sano T, Hayakawa Y, Otonari T, Tanabe K, et al. Cone-beam CT (CB Throne) applied to dentomaxillofacial region. Bull Tokyo Dent Coll. 2006;47(3):133–41. [17] Tetradis S, Anstey P, Graff-Radford S. Cone beam computed tomography in the diagnosis of dental disease. J Calif Dent Assoc. 2010;38(1):27–32. [18] Ahmad M, Jenny J, Downie M. Application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J. 2012. [19] Kaeppler G, Cornelius C-P, Ehrenfeld M, Mast G. Diagnostic efficacy of cone-beam computed tomography for mandibular fractures. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:98–104. [20] Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic examination of the temporomandibular joint using cone beam computed tomography. DentomaxillofacRadiol. 2004;33(3):196–201. [21] Honda K, Matumoto K, Kashima M, Takano Y, Kawashima S, Arai Y. Single air contrast arthrography for temporomandibular joint disorder using limited cone beam computed tomography for dental use. DentomaxillofacRadiol. 2004;33(4):271–3. [22] Kapila SD, Nervina JM. CBCT in orthodontics: assessment of treatment outcomes and indications for its use. DentomaxillofacRadiol. 2015. [23] Kayg?s?z E, Tortop T. Cone beam computed tomography in orthodontics. Comp Tomograph. 2009. [24] Hechler SL. Cone-beam CT: applications in orthodontics. Dent Clin North Am. 2008;52:809–23. [25] Merrett SJ, Drage NA, Durning P. Cone beam computed tomography: a useful tool in orthodontic diagnosis and treatment planning. J Orthod. 2009;36:202–10. [26] Mazzi-Chaves JF, Camargo RV, Borges AF, Silva RG, Pauwels R, Silva-Sousa YTC, et al. Cone-beam computed tomography in endodontics—State of the art. Curr Oral Health Rep. 2021;8:9–22. [27] Patil S, Prasad BK, Shashikala K. Cone beam computed tomography: Adding three dimensions to endodontics. Int Dent Med J Adv Res. 2015;1:84–8. [28] Szabo BT, Pataky L, Mikusi R, Fejerdy P, Dobo-Nagy C. Comparative evaluation of cone-beam CT equipment with micro-CT in the visualization of root canal system. Ann Ist Super Sanita. 2012;48:49–52. [29] Wang P, Yan XB, Lui DG, Zhang WL, Zhang Y, Ma XC. Detection of dental root fractures by using cone-beam computed tomography. DentomaxillofacRadiol. 2011;40:290–8. [30] Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography. J Endod. 2007;33(9):1121–32. [31] Tyndall DA, Rathore S. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications [vii.]. Dent Clin North Am. 2008;52(4):825–41. [32] Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol. 2006;77(7):1261–6. [33] Aljehani YA. Diagnostic applications of cone-beam CT for periodontal diseases. [34] Eshraghi VT, Malloy KA, Tahmasbi M. Role of cone-beam computed tomography in the management of periodontal disease. Dentistry Journal. 2019. [35] Kabilan A, Ganapathy D, Jain AR. Role of cone beam computed tomography in periodontics-A review. Drug Invent. 2018. [36] Yang F, Jacobs R, Willems G. Dental age estimation through volume matching of teeth imaged by cone-beam CT. Forensic Sci Int. 2006;159 Suppl1:S78–83. [37] Pinchi V, Pradella F, Buti J, Baldinotti C, Focardi M, Norelli GA. A new age estimation procedure based on the 3D CBCT study of the pulp cavity and hard tissues of the teeth for forensic purposes: a pilot study. J Forensic Leg Med. 2015;36:150–7. [38] von See C, Bormann KH, Schumann P, Goetz F, Gellrich NC, Rücker M. Forensic imaging of projectiles using cone-beam computed tomography. Forensic Sci Int. 2009;190:38–41. [39] Pagare J, Johaley S. Diagnostic role of CBCT in fulminating mucormycosis of maxilla. Int J Res Rev. 2019. [40] D’Urso PS, Barker TM, Earwaker WJ, Bruce LJ, Atkinson RL, Lanigan MW, et al. Stereolithographic biomodelling in cranio-maxillofacial surgery: a prospective trial. J Craniomaxillofac Surg. 1999;27(1):30–7. [41] Suomalainen A, Pakbaznejad Esmaeili E, Robinson S. Dentomaxillofacial imaging with panoramic views and cone beam CT. Insights Imaging. 2015;6(1):1-16.

Copyright

Copyright © 2025 Dr. K. P. Azhanivel MDS, Dr. Priya Ramani MDS, Dr. Shanvarshini R, Dr. Sharmila Kumari V, Dr. Simi Vinod, Dr. Snega R. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.