Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.
Clin Oral Investig. 2019 Jun;23(6):2573-2581. doi: 10.1007/s00784-019-02907-y. Epub 2019 Apr 25.
A narrative review on the potential use of low-dose protocols for cone beam computed tomography (CBCT) was conducted to identify indications and their relevance for various dental disciplines.
Google Scholar was searched using the words "low-dose CBCT". Reviews, consensus papers, clinical studies, and experimental studies were eligible for the initial screening process, but for data extraction only original articles were selected. Similar search procedures were then performed with the additional search words "pedo," "ortho," "endo," "implant," "perio," and "oral surgery." Furthermore, references of included articles were examined to identify further relevant articles.
After screening, 27 publications remained for the data extraction process. Low-dose protocols have been reported for specialties such as pediatric dentistry (evaluating orofacial clefts, periapical lesions, impacted teeth, and autotransplantation), orthodontics (cephalometric analysis and interim assessment of treatment results), endodontics (detecting root fractures, resorptions and periapical bone loss), implant dentistry (planning implant insertion, evaluating peri-implant fenestration and dehiscence), periodontology (assessing periodontal structures), and oral and maxillofacial surgery (assessing mandibular third molars and TMJs). Nevertheless, most of the literature available is related to non-clinical studies. Furthermore, there is a lack of position statements or guidelines from authoritative bodies regarding the use of low-dose protocols in dental medicine.
Low-dose protocols for CBCT imaging seem to have potential in various disciplines in dental medicine ranging from pediatric dentistry to oral and maxillofacial surgery. Dose reduction is usually achieved by mAs reduction, use of partial rotations, reduced number of projections, and larger voxel sizes, but seldom by kV reduction.
Albeit low-dose protocols have potential to result in a reduction of dose exposure for 3D imaging due to dental indications, there is a need to more clearly specify indications and limitations to avoid indiscriminate use of standard and high-dose CBCT scans in the future on the lines of ALARA/ALADA principles.
对锥形束计算机断层扫描（CBCT）低剂量方案的潜在用途进行叙述性综述，以确定各种牙科专业的适应证及其相关性。
使用“低剂量 CBCT”一词在 Google Scholar 上进行搜索。综述、共识文件、临床研究和实验研究有资格进行初步筛选过程，但仅选择原始文章进行数据提取。然后，使用附加的搜索词“pedo”、“ortho”、“endo”、“implant”、“perio”和“oral surgery”进行类似的搜索过程。此外，还检查了纳入文章的参考文献，以确定其他相关文章。
经过筛选，有 27 篇出版物进入数据提取过程。低剂量方案已在儿科牙科（评估口面裂、根尖病变、阻生牙和自体移植）、正畸学（头影测量分析和治疗结果的中期评估）、牙髓学（检测根折、吸收和根尖骨丢失）、种植牙学（规划种植牙植入、评估种植体周围瘘和裂开）、牙周病学（评估牙周结构）和口腔颌面外科学（评估下颌第三磨牙和 TMJ）等专业领域中得到报道。然而，大多数现有文献都与非临床研究有关。此外，权威机构在牙科医学中使用低剂量方案方面缺乏立场声明或指南。
CBCT 成像的低剂量方案在从儿科牙科到口腔颌面外科学的各种牙科专业中似乎具有潜力。剂量减少通常通过减少 mAs、使用部分旋转、减少投影数量和增大体素大小来实现，但很少通过降低 kV 来实现。
尽管低剂量方案有可能因牙科适应证而导致 3D 成像的剂量暴露减少，但需要更清楚地规定适应证和限制，以避免未来根据 ALARA/ALADA 原则不加区分地使用标准和高剂量 CBCT 扫描。
