Evaluation of clinical indications for cone-beam computed tomography in children and adolescents: a cross-sectional investigation

Aims: This cross-sectional investigation aimed to systematically evaluate clinical indications for cone-beam computed tomography (CBCT) examinations in pediatric and adolescent patients. The specific objectives included determining the frequency distribution of various clinical indications, examining relationships between patient age, gender, and referral indication, and analyzing patterns of CBCT utilization in this population. Methods: A retrospective analysis was conducted on 960 children and adolescents aged 18 years or younger who underwent CBCT examination at a university-based dental clinic. Data were systematically extracted from electronic patient records and CBCT referral forms, including patient age, biological sex, and clinical indications. Clinical indications were categorized into twelve distinct groups: impacted third molars, impacted canines, other impacted teeth, periapical lesions, supernumerary teeth, mesiodens, cleft lip and palate, temporomandibular joint disorders, dento-alveolar trauma, endodontic reasons, orthognathic surgery planning, and implant planning. Statistical analyses included descriptive statistics, Pearson Chi-square tests to evaluate the relationship between sex and CBCT indication, and Mann-Whitney U tests to compare age distributions across different clinical indications.Results: Impacted teeth constituted the predominant indication for CBCT imaging, with impacted third molars representing the most frequent indication, followed by impacted canines. Significant gender-specific patterns were observed in the distribution of clinical indications, reflecting established epidemiological distributions of dental conditions. The age distribution varied significantly across different clinical indications, with concentration of referrals during adolescence corresponding to the developmental timeline of specific dental conditions.Conclusion: This study shows that impacted teeth constitute the primary indication for pediatric CBCT examinations, aligning with evidence-based guidelines and appropriate clinical practice. The findings underscore the importance of ongoing attention to radiation safety principles in pediatric CBCT utilization, highlighting the need for careful justification criteria and systematic optimization of technical parameters to minimize radiation exposure while maintaining diagnostic adequacy in developing patients.