Justification and Radiation-Protection Criteria for the Use of CBCT in Orthodontics: A Scoping Review

Cone beam computed tomography (CBCT) represents a major advance in maxillofacial 3D imaging and has become increasingly used in dentistry and orthodontics. Compared with conventional 2D radiography, CBCT provides more detailed and accurate visualisation of dental and skeletal structures, improving diagnostic capability in selected clinical scenarios. Its applications in orthodontics include localisation of impacted and supernumerary teeth, assessment of the upper airway, detection of root resorption, planning of orthognathic surgery, and guidance for the placement of skeletal anchorage devices. These benefits are particularly relevant in complex cases requiring precise understanding of three-dimensional anatomical relationships. However, CBCT use raises significant radiological protection concerns, especially regarding ionising radiation exposure in children and adolescents, who constitute a substantial proportion of orthodontic patients. Adherence to radiation-protection principles such as ALARA (As Low As Reasonably Achievable) and ALADA (As Low As Diagnostically Acceptable) is essential. These principles highlight the need to justify CBCT prescription, optimise exposure parameters, and tailor field of view, acquisition settings and dose to the diagnostic question. International guidelines emphasise that CBCT should only be indicated when conventional imaging fails to provide sufficient information and that patients must give informed consent after understanding the risks and benefits. This scoping review aims to explore how CBCT is currently used in orthodontics and to examine the extent to which justification criteria and radiation-protection principles are respected in clinical practice. This review seeks to identify current evidence on CBCT use in orthodontics, evaluate its clinical indications, assess compliance with radiation-protection principles, and highlight gaps and inconsistencies. Ultimately, it aims to guide safer, more rational and evidence-based CBCT prescription in orthodontic practice.