When Is Cone-Beam Computed Tomography Imaging Appropriate for Diagnostic Inquiry in the Management of Inflammatory Periodontitis? An American Academy of Periodontology Best Evidence Review

Background: Clinical and radiographic examinations are essential in establishing correct periodontal diagnoses as well as providing appropriate treatment options. Current radiographic examinations, however, do not provide adequate information regarding the severity of periodontal disease, presenting a need to investigate alternative methods. The aim of this best evidence consensus is to determine when cone-beam computed tomography (CBCT) imaging is appropriate for diagnostic inquiry in the management of inflammatory periodontitis.

Methods: Literature was systematically reviewed to answer three clinically relevant focused questions regarding the role of CBCT in the management of inflammatory periodontitis. 1) Clinical situation: In patients with periodontitis, what (if any) clinical situations/conditions exist where CBCT imaging improves diagnostic acumen and subsequent treatment recommendations compared with two-dimensional radiographic interpretation? 2) Intervention: Does CBCT imaging improve the accuracy of a diagnostic assessment and establishment of a prognosis in the analysis of furcation and/or intrabony defects? Is the execution of therapy improved and facilitated, or is it therapeutically challenged? 3) Outcomes: Does the use of CBCT imaging provide superior short-term or long-term clinical outcomes, more favorable patient-reported outcomes, or more consistent clinical treatment decisions affecting tooth prognosis (as measured by defect fill, improvements in bone anatomy, mobility patterns, and ultimate tooth survival)? An extensive literature search was performed using the MEDLINE database and the most respected journals in the field.

Results: An electronic database search identified 885 citations, and a manual search yielded an additional five citations. After screening of article titles and abstracts, studies were excluded if irrelevant to the topic of this systematic review. Of the remaining full-text articles, 74 were obtained and reviewed. Sixty-two articles not meeting inclusion criteria were further excluded. Twelve total references met the inclusion criteria to determine the role of CBCT in diagnosis and treatment of both intrabony and furcation defects. Intrabony and furcation defects were the two most commonly discussed bony defects when comparing efficacy of CBCT versus intraoral radiographs (IRs). After a review of the literature, while diagnostic aspects of intrabony and furcation defects can be improved via the use of CBCT, limited evidence supported the use of CBCT imaging improving the execution of therapy for both types of defects. There was also a lack of literature to support the use of CBCT imaging for superior short-term or long-term clinical outcomes. None of the literature reported patient-reported outcomes when CBCT imaging was used.

Conclusions: Currently, limited evidence supports the utilization of CBCT for diagnosis of intrabony and furcation defects. Despite the fact that there is rapidly accruing literature on CBCT, there are still no current evidence-based guidelines on its necessity and use for periodontal treatment planning. In selective cases, however, limited field of view CBCT may be useful for periodontal disease diagnoses due to less radiation dosage to the patient, higher spatial resolution, and shorter volumes to be interpreted.