CBCT at the Dentist: When Is 3D X-Ray Imaging Useful?

DVT is the German term for digital volume tomography.

Internationally, the term Cone Beam Computed Tomography (CBCT) is commonly used.

During the scan, numerous two-dimensional projections are acquired and then reconstructed into a three-dimensional data set of the region examined.

This allows certain anatomical structures to be viewed in multiple planes.

In dentistry, CBCT is particularly suited to imaging hard tissues such as teeth and bone.

With conventional dental radiographs, three-dimensional anatomical structures are represented in a two-dimensional image.

Examples include:

• periapical radiographs,
• bitewing radiographs,
• and panoramic radiographs.

These techniques are sufficient for a very large number of dental questions.

A CBCT scan, by contrast, produces a three-dimensional volume data set. This can reduce the superimposition of certain structures and allow spatial relationships to be assessed more effectively.

However, the additional spatial information is medically useful only if it actually answers a question relevant to diagnosis or treatment planning.

Not as a blanket rule.

CBCT can provide information for certain anatomical questions that cannot be shown sufficiently in a two-dimensional image.

That does not mean every dental diagnosis becomes better with CBCT.

A small caries lesion, a routine review and many conventional endodontic or periodontal questions do not automatically require three-dimensional imaging.

Good imaging does not follow the principle:

“as much data as possible”,

but rather:

“exactly the information needed for the medical question”.

Because CBCT is an X-ray examination that uses ionising radiation.

In Germany, it is governed by the Radiation Protection Act and Radiation Protection Ordinance.

Before a medical X-ray exposure, an appropriately qualified physician or dentist must establish a justified indication.

This means:

The expected health benefit of the specific examination must outweigh the risk associated with radiation exposure.

Existing relevant images and medical information should also be considered so that unnecessary additional exposure is avoided.

A CBCT scan should therefore not be taken simply because a device is available.

A justified indication is not merely a formality.

Before imaging, the following questions need to be considered:

• What specific question should the X-ray answer?
• Is the clinical examination sufficient?
• Are suitable radiographs already available?
• Can a two-dimensional image answer the question adequately?
• Is the additional 3D information likely to change diagnosis or treatment planning?
• Is the radiation exposure medically justified for that purpose?

Only this assessment determines whether CBCT is appropriate.

There is no single reliable figure that applies to every CBCT examination.

Radiation exposure can depend on factors including:

• the device used,
• the size of the scanned volume,
• resolution,
• exposure parameters,
• body region,
• and the imaging protocol.

The DGZMK guideline explicitly notes that CBCT devices can vary considerably in radiation exposure.

Blanket statements such as:

“one CBCT always equals X conventional X-rays”

are therefore problematic unless the device and protocol are specified.

FOV stands for Field of View, meaning the volume included in the scan.

Depending on the clinical question, only a relatively small area or a larger region may be imaged.

From a radiation-protection perspective, the principle is:

The scanned volume should be selected so that the diagnostic question can be answered without including unnecessarily large regions.

A “larger image” therefore does not automatically mean a “better examination”.

Before implant placement, the available bone and relevant anatomical structures must be assessed adequately.

In many cases, this assessment begins with a clinical examination and suitable conventional radiographic diagnostics.

Three-dimensional imaging becomes particularly relevant when the necessary information cannot be obtained sufficiently in this way.

Examples can include:

• complex anatomical conditions,
• markedly reduced or unusually shaped bone volume,
• close proximity to important anatomical structures,
• selected immediate-implant or augmentation questions,
• or planned guided implant placement.

At the same time, the CBCT guideline emphasises that a general superiority of 3D imaging in terms of implant treatment outcomes or complication rates has not been established as a blanket rule.

CBCT is therefore a planning tool for appropriate questions, not a guarantee of a better implant result.

More about dental implants

No.

The practice has an Orthophos 2D/3D system available for two- and three-dimensional radiographic diagnostics.

A CBCT examination is used only when the additional three-dimensional information is medically justified for the specific implant plan.

When 3D data are required, they can be incorporated into digital implant-planning and guided-surgery workflows in suitable cases.

The availability of the technology does not determine the indication.

CBCT is not a routine examination for every tooth in endodontics either.

Basic diagnostics come first, including medical and dental history, clinical examination and suitable conventional radiographs.

A limited-field CBCT scan can provide additional information in selected complex situations when an important question cannot be answered adequately using the existing findings.

Depending on the case, this may be relevant in situations such as:

• complex or unusual root-canal anatomy,
• changes that cannot be clearly localised,
• suspected types of resorption,
• selected fracture questions,
• or complex situations following previous endodontic treatment.

Whether the additional information actually changes treatment planning must be assessed for the individual case.

More about root canal treatment

No.

Three-dimensional imaging is not an automatic standard even for impacted or unerupted wisdom teeth.

The CBCT guideline describes selective use: CBCT can be appropriate when there is a specific individual question that cannot be answered adequately through clinical examination and two-dimensional imaging.

For example, the spatial relationship of a tooth to neighbouring anatomical structures may be relevant.

However, the fact that 3D images can show more spatial detail does not automatically mean they prevent complications in every wisdom-tooth extraction.

For certain bone-related questions, yes.

If clinical examination suggests a primarily bony temporomandibular-joint disorder, CBCT can be an appropriate imaging method.

CBCT is not, however, the appropriate method for assessing the articular disc and other soft-tissue structures.

Magnetic resonance imaging (MRI) is generally better suited to such questions.

This illustrates an important principle:

The technically most complex image is not automatically the right one — the imaging method should match the structure being assessed.

CBCT is primarily suited to high-contrast structures, especially teeth and bone.

Soft tissues can be assessed much less effectively than with imaging methods specifically designed for them.

CBCT is therefore not a general replacement for MRI in soft-tissue questions.

The choice of imaging method always depends on what needs to be visualised.

Yes.

Metallic or highly radiopaque materials can produce imaging artefacts.

This can make certain regions more difficult to assess.

This is relevant, among other situations, around implants: the immediate surroundings of an implant can be partly obscured by artefacts.

An existing 3D data set is therefore not automatically diagnostically perfect in every region.

Yes.

Because a three-dimensional volume can include a larger anatomical region, changes unrelated to the original reason for imaging may also become visible.

A CBCT data set must therefore be interpreted professionally.

This is another reason not to select an unnecessarily large scan volume.

More anatomy included in the image also means more diagnostic responsibility.

Not automatically.

The German Radiation Protection Ordinance explicitly requires available information from previous relevant uses of ionising radiation to be considered in order to avoid unnecessary exposure.

An existing data set can therefore be important.

Whether it is still sufficient for a new question depends, among other things, on:

• the age of the scan,
• the region shown,
• image quality,
• changes that have occurred in the meantime,
• and the new medical question.

An older CBCT should therefore neither be repeated automatically nor assumed to be sufficient for every later decision.

Keeping the scan volume as limited as reasonably possible can help reduce unnecessary radiation exposure.

However, it must not be so small that the medical question can no longer be answered reliably.

Radiation protection therefore does not simply mean “always choose the smallest possible scan”, but rather:

the lowest possible exposure that still provides diagnostic image quality sufficient for the specific question.

The practical procedure is usually brief for the patient.

Depending on the device, the patient stands or sits during imaging. The X-ray system moves around the head area and acquires the necessary projection data.

The three-dimensional data set is then reconstructed from these images.

For the medical decision, however, the length of the scan itself is less important than the subsequent professional interpretation of the relevant image region.

Extensive preparation is generally not required.

Metal objects in the head and neck area can cause interfering artefacts depending on the scan and may need to be removed beforehand.

Before every X-ray examination, information relevant to radiation protection is also considered.

If you are pregnant or could be pregnant, this should be stated before imaging so that medical urgency and the appropriate next steps can be assessed accordingly.

This page does not publish one fixed practice price for CBCT.

Costs and reimbursement depend, among other factors, on:

• the region being examined,
• the diagnostic question,
• the required scope of services,
• and insurance status.

Before a planned scan, the expected cost in the individual case and whether reimbursement may be available can be clarified.

CBCT is a three-dimensional X-ray technique for selected dental questions — not a routine examination for every patient.

Key points are:

• CBCT provides spatial information primarily about teeth and bone.
• Many dental questions can still be answered clinically and with 2D radiographs.
• Every CBCT examination in Germany requires a justified indication.
• The medical benefit must outweigh the radiation risk.
• Radiation exposure is not the same for every CBCT scan.
• Scan volume and protocol should match the clinical question.
• For implants, CBCT can be relevant to selected anatomical or guided-planning questions.
• In endodontics, CBCT is added only for selected complex questions.
• CBCT is not automatically required before wisdom-tooth removal.
• MRI may be more appropriate for soft tissue or the temporomandibular-joint disc.
• More three-dimensional data do not automatically mean a better treatment outcome.

The practice has Orthophos 2D/3D imaging available. Three-dimensional diagnostics are used when justified by the specific medical question.

Further information:

Technology at the practice Dental implants Root canal treatment

The medical information in this article is based on the S2k guideline “Dental Digital Volume Tomography” (AWMF 083-005), listed in the AWMF/DGZMK guideline register, as well as current German radiation-protection law.

The publicly accessible full version of the CBCT guideline is dated December 2022. Its central principles remain decisive for this page: clinical examination and medical history before additional radiographic diagnostics, use according to indication, limitation of exposure and selection of imaging according to the specific medical question.

The requirement for a justified indication is also anchored directly in the German Radiation Protection Act and in Section 119 of the Radiation Protection Ordinance.

Editorial review date: 10 August 2026. Whether CBCT is required for an individual patient can only be decided after clinical examination and assessment of the specific diagnostic question.

CBCT at the dentist: differences from 2D X-rays, useful indications, radiation protection and why 3D imaging is not performed routinely.