Assessment of perceptions, attitudes, and clinical practices regarding CBCT among pediatric dentists in Türkiye: a cross-sectional questionnaire-based study

Background: This study aimed to evaluate the perceptions, attitudes, and clinical practices of pediatric dentists in Türkiye regarding cone-beam computed tomography (CBCT) and radiation safety guidelines. Methods: This cross-sectional study included 154 pediatric dentists working in Türkiye. Data were collected using a 17-item online questionnaire administered via Google Forms. The data were analyzed using IBM SPSS version 23, with the significance level set at p < 0.05. Pearson’s chi-square test and Z-tests with Bonferroni correction were used for statistical analyses. Results: Among the participants, 51.9% reported using CBCT in their clinical practice, and nearly all participants supported the ALADAIP (As Low As Diagnostically Acceptable for the Individual Patient) principle. The most common indications for CBCT were pathological lesions (84.2%) and impacted teeth (73.0%), while the most influential factor guiding its use was the inadequacy of other imaging methods (93.4%). Although 79.9% of the participants had not received specific training in CBCT, the main factors limiting its use were the need to restrict CBCT to limited clinical indications (65.6%) and concerns regarding a high radiation dose (59.7%). Furthermore, familiarity with radiation safety guidelines was significantly higher among academics than among specialist trainees (p = 0.001). As professional experience increased, the rates of receiving CBCT-related training (p = 0.013) and awareness of relevant guidelines (p = 0.001) also increased. Conclusions: While CBCT offers advanced diagnostic capabilities in pediatric dentistry compared with two-dimensional radiographs, its implementation remains challenged by significant gaps in radiation safety awareness. Therefore, the early integration and standardization of comprehensive CBCT protocols within dental education curricula are critically important for promoting safe imaging practices, dose optimization, and appropriate indication selection in clinical practice.

Cone-beam computed tomography; Pediatric dentistry; ALARA; ALADAIP

[1] Heller ZA, Hogge M, Ragan MR, Portnof JE. Applications of cone beam computed tomography scans in dental medicine and potential medicolegal issues. Dental Clinics of North America. 2024; 68: 55–65.
[2] ICRP; Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K, et al. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Annals of the ICRP. 2013; 42: 1–63.
[3] Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. The BMJ. 2013; 346: f2360.
[4] Bhardwaj SS, Alghamdi S, Almulhim B, Alassaf A, Almalki A, Bhardwaj A, et al. CBCT in paediatric dentistry: awareness and knowledge of its correct use in Saudi Arabia. Applied Sciences. 2022; 12: 335.
[5] White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, et al. The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology. 2014; 118: 257–261.
[6] Mendonça RP, Estrela C, Bueno MR, Carvalho TCASG, Estrela LRA, Chilvarquer I. Principles of radiological protection and application of ALARA, ALADA, and ALADAIP: a critical review. Brazilian Oral Research. 2025; 39: e14.
[7] European Commission: Directorate-General for Energy. Cone beam CT for dental and maxillofacial radiology: evidence-based guidelines. 2012. Available at: https://doi.org/10.2768/21874 (Accessed: 26 October 2026).
[8] Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B, et al. Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatric Radiology. 2018; 48: 308–316.
[9] Giray FE, Peker S, Yalcinkaya SE, Kargul B, Aps J. Attitudes and knowledge of paediatric dentists on digital radiography and cone beam computed tomography. Journal of the Pakistan Medical Association. 2019; 69: 205–210.
[10] Orhan AI, Cesur E, Bezgin T, Orhan K. Knowledge and attitudes of paediatric dentists in Turkey regarding cone beam computerized tomography (CBCT). Cumhuriyet Dental Journal. 2021; 24: 206–215.
[11] Uvarichev M, Sherstneva V, Mikheikina A, Polyakova M, Zaytsev A, Doroshina V, et al. CBCT: knowledge, attitude, and practice among dentists. BMC Oral Health. 2025; 25: 1540.
[12] Parveen S, Kulkarni U, Mascarenhas R, Shetty R. Awareness and practice of ethics and guidelines with cone-beam computed tomography prescription in orthodontics. Journal of Indian Orthodontic Society. 2019; 53: 49–56.
[13] Almohaimede AA, Bendahmash MW, Dhafr FM, Awwad AF, Al-Madi EM. Knowledge, attitude, and practice (KAP) of radiographic protection by dental undergraduate and endodontic postgraduate students, general practitioners, and endodontists. International Journal of Dentistry. 2020; 2020: 2728949.
[14] Chinna SK, Reddy NP, Thapaswini Y, Muppidi A, Pattepu SV, Sharma P. Knowledge, attitude, and practice towards digital imaging and cone beam computed tomography among dental practitioners in North Karnataka, India. Journal of Pharmacy and Bioallied Sciences. 2021; 13: S1047–S1049.
[15] Abdalla-Aslan R, Almoznino G, Moskovich L, Aframian DJ, Nadler C. Knowledge and responsibility in CBCT practice among general and specialized Israeli dentists—a questionnaire-based study. BMC Oral Health. 2025; 25: 291.
[16] Mizban L, El-Belihy M, Vaidyanathan M, Brown J. An audit and service evaluation of the use of cone beam computed tomography (CBCT) in a paediatric dentistry department. Dentomaxillofacial Radiology. 2019; 48: 20180393.
[17] Lavanya R, Babu DG, Waghray S, Chaitanya NC, Mamatha B, Nithika M. A questionnaire cross-sectional study on application of CBCT in dental postgraduate students. Polish Journal of Radiology. 2016; 81: 181–189.
[18] Altoukhi DH, Alaki S, El Ashiry E, Nassif O, Sabbahi D. Genotoxicity and cytotoxicity of cone beam computed tomography in children. BMC Oral Health. 2021; 21: 427.
[19] Albayrak SC, Özdemir ÖS. Awareness of cone beam computed tomography (CBCT) use and radiation safety among dentists and specialists. BMC Oral Health. 2025; 25: 1436.
[20] Mortazavi S, Sahebalam R, Sadeghi S, Shiezadeh I. Cone-beam computed tomography prescriptions in pediatric dentistry. Journal of Craniomaxillofacial Research. 2024; 11: 223–231.
[21] Yalda FA, Holroyd J, Islam M, Theodorakou C, Horner K. Current practice in the use of cone beam computed tomography: a survey of UK dental practices. British Dental Journal. 2019; 226: 115–124.
[22] Alzamzami ZT, Abulhamael AM, Talim DJ, Khawaji H, Barzanji S, Roges RA. Cone-beam computed tomographic usage: survey of American endodontists. Journal of Contemporary Dental Practice. 2019; 20: 1132–1137.
[23] Akleyin E, Eskibağlar BK. Reasons for requesting cone-beam computed tomography in children and adolescents: a 10-year study. Biotechnology & Biotechnological Equipment. 2022; 36: 858–864.
[24] Ertuğrul CÇ, Apaydin BK. Assessment of cone-beam computed tomography indications in pediatric patients: a retrospective radiographic analysis. BMC Oral Health. 2026; 26: 108.
[25] Van Acker JW, Martens LC, Aps JK. Cone-beam computed tomography in pediatric dentistry, a retrospective observational study. Clinical Oral Investigations. 2016; 20: 1003–1010.
[26] Gümrü B, Guldali M, Tarcin B, Idman E, Peker S. Evaluation of cone beam computed tomography referral profile: retrospective study in a Turkish paediatric subpopulation. European Journal of Paediatric Dentistry. 2021; 22: 66–70.
[27] D’Agostino S, Valentini G, Baldini A, Ferrara E, Dolci M. Cone-beam computed tomography assessment of bifid and trifid mandibular canals: a cross-sectional study. Oral. 2023; 3: 266–275.
[28] Yalcinkaya SE, Berker YG, Peker S, Basturk FB. Knowledge and attitudes of Turkish endodontists towards digital radiology and cone beam computed tomography. Nigerian Journal of Clinical Practice. 2014; 17: 471–478.
[29] Masyte V, Sefeldaite S, Venskutonis T. A questionnaire of digital radiography and CBCT use and knowledge among Lithuanian dentists. Journal of Oral & Maxillofacial Research. 2021; 12: e2.
[30] Cojocaru MO, Drăghici EC, Khaddour AS, Ghiţă RE, Marinescu IR, Simionescu AM, et al. Frequency for the use of CBCT analysis in dentistry. Romanian Journal for Dental Research. 2024; 1: 6–18.