Patient Image Selection Criteria for Cone Beam Computed Tomography Imaging

The recent introduction of cone beam imaging into dentistry, and specifically including orthodontics, offers valuable new information for patient diagnosis and treatment planning. However, cone beam imaging adds to patient costs, both in terms of dollars and radiation dose. We propose an algorithm for obtaining radiographs for the patient requiring orthodontic care. A full-mouth examination is recommended for patients with extensive periodontal or restorative needs. Otherwise bitewings and selected periapicals are recommended. A cone beam examination is recommended when the patient has severe facial asymmetry or facial disharmony, sleep apnea, impacted maxillary cuspids, or if minidental implants are being considered. In the absence of these conditions, a lateral cephalometric and panoramic views are recommended. Temporomandibular joint imaging is recommended for patients with persistent symptomatic joints and a carpal index is recommended for patients at the end stages of growth for whom orthognathic surgery is contemplated.