Orthodontics in the CBCT era: 25 years later, what are the guidelines?

CBCT has become an essential tool in orthodontics, although its use must remain judicious and evidence-based. This study provides an updated analysis of international recommendations concerning the use of CBCT in orthodontics, with a particular focus on clinical indications, radiation dose reduction, and recent technological advancements.

A systematic review of guidelines published between 2015 and 2025 was conducted following the PRISMA methodology. Inclusion criteria comprised official directives from recognized scientific societies and clinical studies evaluating low dose protocols in orthodontics.

The analysis of the 19 retained recommendations reveals a consensus regarding the primary indications for CBCT in orthodontics, particularly for impacted teeth, skeletal anomalies, periodontal and upper airways assessment. Dose optimization and the integration of artificial intelligence emerge as major advancements, enabling significant radiation reduction while preserving diagnostic accuracy.

The development of low dose protocols and advanced reconstruction algorithms presents promising perspectives for safer and more efficient imaging, increasingly replacing conventional 2D radiographic techniques. However, an international harmonization of recommendations for these new imaging sequences is imperative to standardize clinical practices and enhance patient radioprotection.