Powerful 3-D X-rays for kids in braces should be the exception, not the rule

—Some orthodontists may be exposing young patients to unnecessary radiation when they order 3-D X-ray imaging for simple orthodontic cases before considering traditional 2-D imaging, suggests a paper published by University of Michigan faculty.

There is ongoing debate in the orthodontic community over if and when to use cone beam computed tomography (CBCT) for orthodontic diagnosis and treatment planning, said Dr. Sunil Kapila, lead author of the paper and chair of the Department of Orthodontics and Pediatric Dentistry at the U-M School of Dentistry.

A very small number of orthodontists utilize the 3-D imaging on a routine basis when developing a treatment plan, and this raises concerns of unnecessary radiation exposure. In contrast, the evidence summarized in Kapila's paper suggests that 2-D imaging would suffice in most routine orthodontic cases. One of the tradeoffs for the superb 3-D images is higher radiation exposure, Kapila said.

The amount of radiation produced by 3D CBCT imaging varies substantially depending on the machine used and the field of view exposed, and some clinicians may not realize how much higher that radiation is compared to conventional radiographs. One CBCT image can emit 87 to 200 microsieverts or more compared to 4 to 40 microsieverts for an entire series of 2-D X-rays required for orthodontic diagnosis, Kapila said. ...

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