Received: 15 May 2023

| Accepted: 31 October 2023

DOI: 10.1111/iej.14000

ORIGINAL ARTICLE

Global cone-beam computed tomography adoption, usage

and scan interpretation preferences of dentists and
endodontists

Monique Charlene Cheung1 | Ove Andreas Peters2 | Peter Parashos1

1
Melbourne Dental School, The Abstract
University of Melbourne, Carlton,
Aim: This study investigated the adoption of cone-beam computed tomography
Victoria, Australia
2
School of Dentistry, The University
(CBCT) by dentists and endodontists around the world, including their preferences
of Queensland, Herston, Queensland, in endodontic CBCT usage.
Australia Methodology: An online questionnaire surveyed dental association members in
Correspondence Australia and New Zealand, and endodontic association members in Australia,
Monique Charlene Cheung, Suite 402, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history,
10-12 Clarke Street, Crows Nest, NSW,
considerations in acquisition/interpretation, access to and usage of CBCT, preferred
Australia.
Email: monique.c.cheung@gmail.com scan interpreter, and preferred endodontic scan settings. Data were analysed with
Chi-squared, independent sample t-tests, Cochran's Q and McNemar's tests.
Funding information
Results: Responses from 578 endodontic specialists or postgraduates (Group E) and
University of Melbourne
185 non-endodontic dentists (Group NE) were included. Continuing professional
education (CPE) was the most common source of CBCT training (69.2%). Factors
considered in CBCT acquisition/interpretation included beam hardening (75.4%),
radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher
CBCT usage (90.8%) than Group NE (45.4%, p < .001) and greater workplace access to
CBCT (81.1% vs. 25.9%, p < .001). Scans were interpreted by the respondent in most
workplace scans (83.3%) and externally taken scans (60.5%); Group E were signifi-
cantly more likely to interpret themselves than Group NE. Small field of view (83.6%)
and high resolution (86.6%) were most preferred as settings for endodontic CBCTs;
Group NE were less likely to choose these settings. There were some geographic vari-
ations within Group E.
Conclusions: CBCT training was most commonly acquired via CPE. Endodontic
respondents reported very high CBCT usage and access in the workplace. There are
educational implications regarding CBCT limitations, appropriate applications and
interpretation.

KEYWORDS
continuing education, diffusion of innovation, endodontics, questionnaire, radiology

© 2023 British Endodontic Society. Published by John Wiley & Sons Ltd

Int Endod J. 2023;00:1–13.  wileyonlinelibrary.com/journal/iej | 1

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2    GLOBAL CBCT ADOPTION AND ENDODONTIC USAGE PREFERENCES
I N T RO DU CT ION
Cone-beam computed tomography (CBCT), developed in
the late 1990s, has now become the accepted standard for
three-dimensional imaging of hard tissues in dentomax-
illofacial radiography (Brown et al., 2014). The clinical
indications in dentistry vary widely (e.g. comprehensive
treatment planning, implant dentistry, endodontics, peri-
odontics, orthodontics and dental trauma management)
but clinical evidence-based guidelines may be difficult to
develop and implement (Horner et al., 2015).
CBCT has many benefits including, for example,
lower radiation dosage than medical CT (Arai et al., 1999;
Mozzo et al., 1998), better assessment of external invasive
cervical resorption lesions (Patel et al., 2016) and dental
trauma injuries (Bornstein et al., 2009; Mota de Almeida
et al., 2021). Within endodontics, the indications for CBCT
usage are of clinical importance and can impact assess-
ment and diagnosis, treatment planning and treatment
procedures (Bornstein et al., 2009; Chogle et al., 2020;
Kakavetsos et al., 2020; Mota de Almeida et al., 2021;
Rodríguez et al., 2017; Wanzeler et al., 2020). CBCT also
has several limitations and factors to be considered in use
and adoption including greater effective radiation dos-
age than conventional periapical radiographs (Granlund
et al., 2016; Ludlow et al., 2015) and several types of image
artefacts (Celikten et al., 2019; Schulze et al., 2011; Spin-
Neto et al., 2016), variability in image production by dif-
ferent machines (Spin-Neto et al., 2014) and high costs as
a barrier to adoption (Rajeevan et al., 2018).
The adoption of CBCT among endodontists is high
but has geographic variations, ranging from 26% to
80% (Ferreira et al., 2017; Masyte et al., 2021; Rajeevan
et al., 2018; Setzer et al., 2017). The ideal settings for end-
odontic CBCT usage (e.g. high resolution, small field of
view) are recommended to minimize radiation exposure,
increase diagnostic resolution and minimize the vol-
ume requiring interpretation (Fayad et al., 2015; Patel
et al., 2019), but CBCT requirements (and available guide-
lines) vary for other disciplines (Gaêta-Araujo et al., 2021).
The requirements for clinicians to take or interpret a
CBCT scan vary widely across different countries and ju-
risdictions. For example, two levels are recommended by
the European Academy of Dentomaxillofacial Radiology
for CBCT referral and interpretation of CBCT scans, re-
spectively (Brown et al., 2014; Patel & Harvey, 2021); in
Australia, state-regulated radiology licences require at-
tendance at approved courses for use of CBCT machines
(EPA, 2023; VIC Govt, 2023).
Research surveys facilitate assessment of the adoption
of new technologies such as CBCT over time and can take
both clinical and non-clinical factors into account depend-
ing on the information gathered. A few surveys of CBCT
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usage have been conducted in various countries in recent
years, both among dentists in general (Masyte et al., 2021;
Yalda et al., 2019) and among endodontists (Hol et al., 2015;
Krug et al., 2019; Masyte et al., 2021; Rajeevan et al., 2018;
Setzer et al., 2017). However, none has directly compared
the preferences and responses of general dentists and en-
dodontists, where usage and training may differ, and none
has compared preferences of endodontists across different
geographic regions. Additionally, clinicians' education
sources and knowledge levels have rarely been surveyed
(Buchanan et al., 2017; Rabiee et al., 2018; Rai et al., 2018;
Reddy et al., 2013), and the potential gap between training
and clinical implementation does not appear to have been
investigated in an area where the evidence is still being
established. This information would allow comparison
with current evidence and evidence-based guidelines, to
provide educators with information to plan future cover-
age of the topic in primary dental degree programs, con-
tinuing professional education (CPE) and specialization
programs.
This study therefore aimed to investigate current access
to and usage of CBCT by dentists and endodontists around
the world, their training history in CBCT, knowledge of
relevant factors and limitations and scan interpretation
preferences. The study also investigated endodontic-spe-
cific usage of CBCT, hypothesising that there would be
differences in usage between an endodontic cohort (spe-
cialists and specialists-in-training) and non-endodontists.
Among the endodontic respondents, it was hypothesised
that there would be differences between geographic re-
gions around the world.
MATERIALS AND METHODS
This study followed the STROBE checklist, and ethics
approval for the study (Ethics ID 2057007) was granted
by the Human Ethics Advisory Group at the Melbourne
Dental School, the University of Melbourne.
A questionnaire was developed to survey dentists re-
garding their CBCT training, access and usage, including
the following:
• Demographic information (gender; geographic loca-
tion; registration type; years of experience; hours and
types of endodontic CPE; sector and location of prac-
tice; numbers of hours worked per week);
• CBCT education history and information sources;
• Knowledge of CBCT limitations and considerations in
interpretation;
• Workplace access to CBCT;
• Usage of CBCT in clinical practice and for endodontic
indications;
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CHEUNG et al.    3

• Who interpreted CBCT scans taken in-house or
externally;
• Preferred settings for endodontic CBCTs.
The questionnaire was part of a wider-ranging survey
that had 41 questions, with the results of nine questions
regarding CBCT reported in this paper. It was hosted on-
line (Qualtrics, Provo, UT, USA), and qualified dentists
globally were eligible to take part, with a focus placed
on recruitment of endodontists. The following organiza-
tions distributed the survey link electronically, with a fol-
low-up reminder sent after 1 month: the Australian Dental
Association, the New Zealand Dental Association, the
Australian and New Zealand Academy of Endodontists,
the Australian Society of Endodontology, the American
Association of Endodontists, the British Endodontic
Society, the Canadian Academy of Endodontics and the
Italian Academy of Endodontics. Newsletter bulletin
advertisements were also placed for three consecutive
months with the state branches of the Australian Dental
Association. There were no incentives on offer for partic-
ipation. Data were collected from September 2020 to May
2021, with participants providing consent for inclusion by
submitting the completed survey.
Statistical analysis was performed using SPSS (version
26.0; Chicago, IL, USA) with significance set at p < .0012
after Bonferroni correction for multiple comparisons.
Chi-squared tests were used to compare differences in
preferences between groups. Independent sample t-tests
were used to compare year of work commencement be-
tween those with different preferences. Cochran's Q and
McNemar's tests were performed to compare the relative
distribution of responses regarding education types and
information sources, factors considered in CBCT acquisi-
tion and interpretation, preferred CBCT interpreter, and
preferred CBCT settings. Figure 1 shows the flowchart of
the study sample and analysis.
RESULTS
Overall, 763 respondents answered all the questions
concerning CBCT training, access and usage.
Demographically, 26.3% were female and 76.1% male; 578
(75.8%) were endodontists or endodontic postgraduate
students (Group E) and 178 were general dentists (GDPs).
Seven other respondents were two oral surgeons, two
periodontists, two paediatric dentists or postgraduate
students and one prosthodontist, and with the GDPs they
constituted Group NE (n = 185).
The countries in which the respondents resided were
USA (n = 379, including 372 in Group E), Australia
(n = 203, 70 in Group E), Canada (n = 50, 46 in Group E),
New Zealand (n = 27, 4 in Group E), the UK (n = 18, 13 in
Group E), Italy (n = 15, 11 in Group E) and France (n = 10,
all in Group E), with 31 from other European countries
(27 in Group E), 12 from other countries in the Americas
(11 in Group E), 11 from Asia (8 in Group E) and 7 from
the Middle East and Africa (6 in Group E).
The following sub-sections primarily present overall
results and comparisons between Group E and Group
NE. However, as the global representation was not
equally distributed, due to convenience sampling based
on the organizations that agreed to distribute the survey,

Eligible for the study: den sts and

endodon sts who completed the CBCT
sec ons of the online survey (n=763)

Excluded from analysis (n=0)

Included in overall analysis (n=763)

(578 in Group E, 185 in Group NE) 154 respondents excluded from analysis due
to not using CBCT

An addi onal 15 of 609 users excluded due

to incomplete responses regarding
interpreta on preferences

Included in analysis of CBCT users (n=594)

27 respondents excluded from analysis due

to not using CBCT for endodon cs

F I G U R E 1 Flowchart of study Included in analysis of endodon c CBCT

users (n=567)
sample and analysis.
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4    GLOBAL CBCT ADOPTION AND ENDODONTIC USAGE PREFERENCES
post-hoc analysis was conducted within Group E (as
sufficient sample sizes were present) to compare trends
in responses across different geographic regions: Asia-
Pacific (subgroup EAP, n = 82), the Americas (subgroup
EAM, n = 429), and Europe and the Middle East (sub-
group EEM, n = 67).
The demographics of the respondents' workplaces (lo-
cation and sector) are shown in Table 1, with most work-
ing in the private sector and in metropolitan areas.
CBCT training
The most common types of CBCT training were CPE pro-
grams, lectures or webinars, discussion with colleagues or
at work and information from journals, cited by over half
of respondents (Table 2). Only a small proportion had re-
ceived CBCT training from their primary dental degree or
endodontic specialization program. Inclusion of CBCT in
the primary dental degree was higher (p < .001) for Group
NE respondents, who commenced working in dentistry in
the mean year 1997, significantly later than Group E (mean
year 1994, p = .031). Endodontists in Group E had com-
pleted their specialist endodontic training in the mean year
1999. Generally, Group E had attended more post-gradua-
tion education programs of almost all types and used more
sources of information (Table 2). Geographic subgroup
analysis generally showed no significant differences within
Group E, except that subgroup EAP had the highest level
of attendance at CPE programs run by private companies
(48.8%) compared with subgroup EAM (28.7%) and sub-
group EEM (26.9%) (p = .001 overall).
% of all
respondents (763)
Location of workplace(s) (one selection permitted)
Metropolitan area/major 73.7%
city
Rural/regional area 18.9%
Both of the above 7.5%
Sector of work (multiple selections permitted)
Private sector 87.3%
Public sector 8.5%
Academia 26.0%
Postgraduate residency 4.2%
Military (volunteered 1.0%
answer)
Abbreviation: n.s., not statistically significant.
*Chi-squared tests to compare Groups NE and E.
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Overall, those who had CBCT training in their pri-
mary dental degree had started working in the mean
year 2008, significantly later than those for whom it
was not included (mean year 1991, p < .001). Similarly,
among Group E, those who had CBCT training in their
specialization program had completed specialist train-
ing significantly later (mean year 2010) than those for
whom it was not included (mean year 1995, p < .001).
Respondents who had attended any CBCT CPE program
had commenced work significantly earlier (mean year
1992) than those who had not attended any CPE pro-
grams (mean year 2000, p < .001). Those who attended
multi-day courses (mean commencement year 1990,
p < .001) or used journals (mean year 1993, p < .001) had
also commenced work significantly earlier than those
who had not (mean years 1996 and 1997, respectively).
Overall, respondents who had not undergone any CBCT
training and/or used any information sources did not
have a significantly different mean work commencement
year from the rest of the cohort.
Comparing overall attendance at different CPE pro-
gram types, those organized by dental associations/pro-
fessional societies were most highly attended (Table 2),
significantly more than commercial company or private/
independent programs (p < .001).
Lectures or webinars were attended significantly more
(p < .001) than either single or multi-day courses. Of addi-
tional information sources, journals and discussions with
colleagues or in the workplace were most commonly re-
ported, significantly more than textbooks (p < .001), which
were significantly more commonly used again than on-
line/social media sources (p < .001).
T A B L E 1 Respondents' locations and
Group Group p
sectors of work (sample size in brackets).
NE (185) E (578) Value*
70.8% 74.6% n.s.
24.3% 17.1%
4.9% 8.3%
88.6% 86.9% n.s.
16.8% 5.9% <.001
11.9% 30.4% <.001
0.0% 5.5% .001
1.1% 1.0% n.s.
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CHEUNG et al.    5

TABLE 2 Sources and types of CBCT training attended by respondents (sample size in brackets).

All respondents Group NE Group E

(763)* (185) (578) p Value†

Types of education providers

Primary dental degree 19.7% 29.2% 16.6% <.001
Formal postgraduate university specialization 25.0% 2.7% 32.2% <.001
program
Any CPE program 69.2% 46.5% 76.5% <.001
CPE organized by a dental association/ 43.1%a 24.3% 49.1% <.001
professional society
CPE organized by a university 36.4%a,b 16.2% 42.9% <.001
CPE organized by a dental equipment/supply 32.5%b,c 17.8% 37.2% <.001
(commercial) company
CPE organized by a private organization or 26.6%c 11.9% 31.3% <.001
independent lecturer
Of the above, only commercial company CPE 2.6% 3.8% 2.2% n.s.
Modes of program delivery
Lectures or webinars 54.4%a 34.1% 60.9% <.001
b
Single-day course 19.8% 15.1% 21.3% n.s.
b
Multi-day course 18.6% 7.0% 22.3% <.001
Other information sources
Journals 51.0%a 30.8% 57.4% <.001
a
Discussion with colleagues or in the workplace 51.6% 38.9% 55.7% <.001
Textbooks 28.0%b 15.7% 32.0% <.001
c
Online website or social media pages 18.2% 11.9% 20.2% n.s.
None of the above 6.9% 19.5% 2.9% <.001
Abbreviation: n.s., not statistically significant.
*Different superscript letters indicate significant differences between: overall attendance at CPE types; program delivery modes; other sources. Cochran's Q and
McNemar's tests.
†
Chi-squared tests to compare Groups NE and E.

Considerations in acquiring and Geographic subgroup analysis showed that subgroup

interpreting CBCT images
Respondents were asked about the factors that should
be considered when acquiring and interpreting CBCT
images, to assess their knowledge of and attitudes to-
wards the limitations of CBCT (Table 3). A majority
(61.1%) considered the radiation exposure to the patient.
Awareness of factors affecting image quality ranged from
poor awareness of increased degradation with increased
distance from the central plane (29.4%), which was sig-
nificantly lower than the majority (75.4%) being aware of
beam hardening effects due to dense or metal materials
(p < .001). Three-quarters of Group E considered possible
differences between the CBCT and conventional periapi-
cal radiographic appearance of periapical spaces, signifi-
cantly more than Group NE (p < .001). A small proportion
of respondents (4.7%) indicated that they did not consider
any of the suggested factors.
EAM were less likely to consider differences in CBCT
scans between different machines (67.6%) than subgroup
EAP (85.4%) and subgroup EEM (86.6%) (p < .001 overall).
Similarly, subgroup EAM were less likely to consider dif-
ferences in CBCT scans between the same machine at dif-
ferent times (37.1%) than EAP (54.9%) and EEM (53.7%)
(p < .001 overall).
Overall, no factors were significantly associated with
differences in years of experience as a dentist.
CBCT access and use
Of the 763 respondents, 79.8% (n = 609) used CBCT in
any area of clinical practice (45.4% of Group NE, 90.8%
of Group E, p < .001) and 67.8% (n = 517) had access to it
in their workplace (25.9% of Group NE, 81.1% of Group
E, p < .001). There were no significant differences in
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6    GLOBAL CBCT ADOPTION AND ENDODONTIC USAGE PREFERENCES

TABLE 3 Factors considered by respondents in acquiring or interpreting CBCT scans (sample size in brackets).

All respondents Group NE Group E

(763)* (185) (578) p Value†
Radiation exposure to the patient 61.1%a 69.2% 58.5% n.s.
Artefacts or image degradation
Metal objects/dental materials 75.4%b 62.2% 79.6% <.001
a
Patient movement 58.3% 49.2% 61.2% n.s.
Increased degradation further from central plane 29.4%c 35.1% 27.5% n.s.
Differences in image quality – machine level
Between CBCT machines 68.5%d 56.8% 72.3% <.001
e
Between exposures on the same CBCT machine and varying with 41.3% 40.5% 41.5% n.s.
time between successive exposures
Differences in appearance compared with periapical radiographs
Periapical tissues 73.8%b,d 63.2% 77.2% <.001
a
Periodontal ligament spaces 59.4% 55.1% 60.7% n.s.
Do not consider any of the above 4.7% 10.3% 2.9% <.001
Abbreviation: n.s., not statistically significant.
*Different superscript letters indicate significant differences between all considered factors in the column; Cochran's Q and McNemar's tests.
†
Chi-squared tests to compare Groups NE and E.

TABLE 4 CBCT users' preferred interpreter of scans (sample size in brackets).

CBCT taken within CBCT taken

Preferred interpreter practice (508)* p Value† externally (425)* p Value†
Respondent themselves 83.3%a n.s. 60.5%A n.s.
b
Dentomaxillofacial radiologist (DMFR) 10.6% n.s. 26.1%B n.s.
c C
Medical radiologist 3.5% <.001 12.7% <.001
c,d D
DMFR if needed (volunteered answer) 3.3% n.s. 0.9% n.s.
A dentist colleague (volunteered answer) 2.2%c,d n.s. 1.9%D n.s.
d D
A non-dentist staff member (volunteered answer) 0.6% n.s. 0.9% n.s.
Abbreviation: n.s., not statistically significant.
*Upper- and lower-case superscript letters indicate significant differences within each column; Cochran's Q and McNemar's tests.
†
Chi-squared tests to compare Groups NE and E.

respondents' work commencement year according to
whether or not they used CBCT in any area of clinical
practice or had access in their workplace.
Of 594 CBCT users who answered all questions about
their preferences in taking and interpreting CBCTs, 85.5%
had access to it in their workplace (54.3% of 81 Group NE
CBCT users, 90.4% of 513 Group E CBCT users, p < .001).
Geographic subgroup analysis showed that subgroup
EAM had greater access to CBCT in the workplace (85.8%)
than subgroup EEM (71.6%) and subgroup EAP (64.6%)
(p < .001 overall).
Preferred CBCT scan interpreter
Of the 594 CBCT users, 508 (85.5%) took CBCTs within
the practice in which they worked, and 425 (71.5%) also
received CBCT scans that had been taken externally.
The respondents' preferred interpreter in each case is
shown in Table 4. For CBCTs taken within the practice,
Group E (84.7% of 464 who indicated their preferences)
were more likely to interpret the scan themselves com-
pared with 68.2% of Group NE (p = .005, not significant).
Geographic subgroup analysis showed that subgroup
EAP were less likely to interpret CBCTs taken in the
practice themselves (68.5%) compared with EAM (86.2%)
and EEM (91.7%) (p = .001 overall). Subgroup EAP were
more likely to have CBCTs taken in the practice inter-
preted by dentomaxillofacial radiologists (27.8%) than
EAM (8.6%) and EEM (6.3%) (p < .001 overall).
For CBCT scans referred externally, Group E (63.7%
of 355 who indicated their preferences) were more likely
to interpret the scan themselves compared with 44.3%
of Group NE (p = .002, not significant). Group NE CBCT
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CHEUNG et al.    7

users were significantly more likely than Group E CBCT
users to have the scan interpreted by a medical radiolo-
gist (p < .001). Geographic subgroup analysis showed that
subgroup EAP were also more likely to have externally
taken CBCTs interpreted by medical radiologists (21.8%)
compared with subgroup EAM (3.4%) and subgroup EEM
(10.7%) (p < .001 overall).
A few respondents had their scans interpreted by
non-dentist staff members such as dental assistants
(Table 4).
CBCT use in endodontics
Among the CBCT users, 567 respondents used CBCT for
endodontics and answered all questions regarding their
preferences, including 54 (66.7%) of the Group NE CBCT
users. There was no significant difference in work com-
mencement year depending on whether respondents used
CBCT for endodontic indications. Most used it for com-
plex clinical scenarios such as suspected missed canals
or complications such as perforations, assessment of root
resorption lesions, complex canal anatomy, and pathosis
where other tests were inconclusive (Table 5). Group E
used CBCT for all endodontic indications at higher rates
overall.
Almost one-third of Group E (32.7%) used CBCT
for routine preoperative assessment of canal anatomy.
Geographic subgroup analysis showed that subgroup
EEM were less likely to take CBCTs for routine preoper-
ative canal anatomy assessment (7.1%) than EAP (20.5%)
and EEM (39.1%) (p < .001 overall). Subgroup EEM were
also less likely to take CBCTs to detect calcified canals
(50.0%) than EAP (64.1%) and EEM (76.0%) (p < .001 over-
all). Subgroup EAM were more likely to take CBCTs to in-
vestigate missed canals and/or complications (96.3%) than
EAP (83.3%) and EEM (83.9%) (p < .001 overall).
Among respondents who used CBCT for endodon-
tics, a small field of view (83.6%) and high resolution
(86.6%) were the most highly preferred specifications
(Table 6). Otherwise, a medium FOV was preferred sig-
nificantly more than a large FOV (p < .001). Similarly, a
medium resolution was preferred significantly more than
no preference (p = .001), which was preferred significantly
more again than low resolution (p = .001). Group NE had
a significantly wider distribution of setting preferences
than Group E for both FOV and resolution (p < .001).
Geographic subgroup analysis showed no significant dif-
ferences within Group E.
DISC USSION
Regarding the response rate in this study, 490 complete re-
sponses for CBCT questions were received from 5612 email
addresses on the AAE mailing list, that is, a response rate
of 8.7%, similar to another recent survey of AAE members
(Martinho & Griffin, 2021), but lower than 35.2% achieved
by Setzer et al. (2017) and 24% in the survey of UK endo-
dontic practitioners (Rajeevan et al., 2018). With 180 en-
dodontists registered in Australia at the time of the survey,
a representative response rate of 38.9% was achieved in

TABLE 5 Use of CBCT for endodontic indications (sample size in brackets).

CBCT users Group NE Group E

Endodontic indications (567) (54) (513) p Value*
Investigation of possibly missed canals and/or complications, e.g. 92.8% 90.7% 93.0% n.s.
perforations
Assessment of root resorption lesions 91.9% 70.4% 94.2% <.001
Assessment of complex root canal anatomy, e.g. additional canals, dens 88.9% 81.5% 89.7% n.s.
invaginatus
Assessment of periapical pathoses if other tests are inconclusive 87.5% 68.5% 89.5% <.001
Assessment of root fracture if other tests are inconclusive 78.5% 68.5% 79.5% n.s.
Assessment of dento-alveolar trauma 70.2% 42.6% 73.1% <.001
Detection of calcified canals 70.0% 57.4% 71.3% n.s.
Assessment of nearby anatomical structures, e.g. nerves, blood vessels 63.3% 24.1% 67.4% <.001
and/or
pre-surgical assessment
Routine assessment of root canal anatomy prior to endodontic treatment 30.7% 11.1% 32.7% .001
Routine assessment of root canal treatment outcome 15.3% 7.4% 16.2% n.s.
Abbreviation: n.s., not statistically significant.
*Chi-squared tests to compare Groups NE and E.
 |
8    GLOBAL CBCT ADOPTION AND ENDODONTIC USAGE PREFERENCES
CBCT users Group NE
(567)* (54)
Preferred FOV: (one selection permitted)
Large 2.6%a 9.3%
b
Medium 9.0% 11.1%
Small (<5 cm) 83.6%c 64.8%
No preference 4.8%a,b 14.8%
Preferred resolution: (one selection permitted)
Low 0.7%a 1.9%
b
Medium 9.0% 20.4%
High 86.6%c 61.1%
No preference 3.7%d 16.7%
Abbreviation: n.s., not statistically significant.
*Different superscript letters indicate significant differences within FOV preferences and resolution
preferences; Cochran's Q and McNemar's tests.
†
Chi-squared tests to compare preference distribution of Groups NE and E.
this cohort. The response rate could not be calculated for
respondents recruited via Australian Dental Association
newsletter mail-out or advertising, or email distribution
by third parties such as endodontic societies to their mem-
bers, which all used an anonymous website link. Privacy
laws have increased in scope in recent years (OAIC, 2022),
such that the Australian national dental register is not
available for research purposes, and the above methods
were the most cost-effective way to contact as many po-
tential GDP participants as possible.
The sample size in this study may also have been
smaller due to a drop-out rate that occurred as the sur-
vey progressed, possibly due to its length and because no
incentives for participation were used (Cho et al., 2013;
Deutskens et al., 2004). As respondents who had access to
CBCT in their workplace were more likely to answer sub-
sequent questions about their interpretation and setting
preferences, there may be some sampling bias present in
this study. Those who did not have CBCT in their work-
place, or those who have less interest in CBCT and its end-
odontic applications may therefore be underrepresented
in the results.
Responses from various countries were received at
different rates in this study, reflecting the organizations
which agreed to distribute the survey. This is a limitation
of the study, but the results nevertheless provide a base-
line of current trends that can be compared in future sur-
veys, especially regarding differences between endodontic
and non-endodontic clinicians, which have not previously
been reported in the literature. Geographic subgroup
analysis within Group E was performed to investigate the
impact of unequal responses from different countries and
demonstrated some differences to be present. Possible
reasons for these differences will not be explored in great
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T A B L E 6 Preferred endodontic CBCT
Group E
† specifications (sample size in brackets).
(513) p Value
1.9% <.001
8.8%
85.6%
3.7%
0.6% <.001
7.8%
89.3%
2.3%
detail in this paper but could be due to factors such as
variations in published guidelines (Fayad et al., 2015;
Patel et al., 2019), geographic differences in practising
philosophy reflected in undergraduate and postgraduate
education trends, availability and cost of equipment, and
education or licensing requirements (EPA, 2023; Patel &
Harvey, 2021).
The proportion of female participants in this study was
lower than in the Australian dentist workforce in 2019
(43.7%), for example, although it was similar to the pro-
portion of female endodontists in Australia (AIHW, 2022)
and in another survey of endodontists (Krug et al., 2019),
with gender participation seldom reported in other sur-
veys of CBCT usage. This may mean that the views of
female non-endodontists are underrepresented in this
survey, or that they have lower interest or usage of CBCT.
Further research is indicated to better investigate the rea-
sons behind these results.
Overall, survey research in recent years may be more
difficult to conduct with surveys of health professionals
yielding decreasing response rates in recent years (Cho
et al., 2013; McLeod et al., 2013). This may be due to
more frequent survey requests, email spam volume, lim-
ited access to valid email addresses or staff management
of emails (Klabunde et al., 2012, 2013). An investigation
into dentists' response rates was only able to achieve a
high response after multiple follow-ups via online, mail
and in-person methods were used, an expensive exer-
cise (Funkhouser et al., 2017). Previous research found
much lower response rates achieved with an online sur-
vey compared with a mailed survey, but the former was
more cost-effective (Hardigan et al., 2012). Another main
advantage of a web-based survey is in its global reach,
with many countries represented in this study's findings.

CHEUNG et al.
Further investigations may compare differences in adop-
tion of CBCT between different geographic areas.
CBCT education
Although less than 20% of respondents in this study had
received CBCT training in their primary dental degree,
those with more years of experience as a dentist dem-
onstrated greater attendance at CPE courses, multi-day
programs and greater use of journals to update their
knowledge. Usage of CBCT in endodontics was not signifi-
cantly affected by years of experience, and this was similar
to a survey of endodontists in Germany and Switzerland
(Krug et al., 2019).
CBCT training and information sources have not
been commonly surveyed in the past. In this study,
CPE provided by dental associations/societies was most
highly attended (43.1%) followed by those from univer-
sities and commercial companies. These results are sim-
ilar to surveys conducted in Georgia, USA (Buchanan
et al., 2017) and Lithuania (Masyte et al., 2021) where
courses run by professional or independent organiza-
tions were most commonly attended (46%, 45.1% re-
spectively). In the Georgia study, 40% attended courses
run by manufacturers, including 22% who only had
training from manufacturers (Buchanan et al., 2017).
Comparatively, a much smaller proportion of 2.6% in
this study had received CPE only from commercial com-
panies. The problem of training received from CPE or-
ganized by manufacturers may be similar to that which
exists in implant dentistry (Cheung et al., 2020), where
content may be determined in part by company repre-
sentatives who lack dental training.
Journals were used by over half of the respondents
in this study, and internet sources (websites and social
media) were used by almost 20%. Internet sources and
self-training have also been common in other surveys in
India (21.7%) (Reddy et al., 2013) and Lithuania (34.1%)
(Masyte et al., 2021). Lectures or webinars were more
highly attended in this study rather than single- or multi-
day courses, but this may reflect the types of programs
that are available.
CBCT interpretation and considerations
There are some notable limitations in interpreting
periapical tissues on CBCT that continue to be discussed
in the literature. The periapical spaces of healthy vital
teeth (Pope et al., 2014), and endodontically treated
teeth that demonstrate no signs of persistent disease
using clinical and conventional radiographic parameters
|
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   9
(Torabinejad et al., 2018), may appear significantly
larger than in conventional radiography. Some have
warned therefore against possible over-diagnosis
(Torabinejad et al., 2018) or lower diagnostic accuracy
(Kruse et al., 2019) in root-filled teeth. Despite this,
suggested indices such as that by Estrela et al. (2008)
are widely used in the research literature, although they
have not been validated and are not universally accepted
(Torabinejad et al., 2018). It is therefore concerning that
up to 40% of Group E did not consider differences in
periodontal ligament space appearance between CBCT
and conventional radiography, when interpreting CBCT
scans.
Other limitations of CBCT with regard to artefacts and
image quality are well-established (Celikten et al., 2017,
2019; Freitas et al., 2019; Schulze et al., 2011; Spin-Neto
et al., 2016), but knowledge of some of the less-commonly
known limitations, for example, increased degradation
further from the central plane, and differences in imaging
quality using the same CBCT machine at different times
(Spin-Neto et al., 2014) were relatively low in this study.
Consideration of radiation exposure
Of some concern in this study, many in Group E (41.5%)
did not consider radiation exposure to the patient as a fac-
tor in acquiring CBCT scans, more than 30.8% of Group
NE although this was not statistically significant. This
correlates to the other finding in this study that 16.7%
of Group E who used CBCT for endodontics used it for
routine assessment of treatment outcome, while 32.7%
used it for routine preoperative assessment of root canal
anatomy. This postoperative outcome assessment contra-
dicts the recommendation from the AAE/AAOMR Joint
Position Statement that intraoral radiographs should be
the imaging modality of choice (Fayad et al., 2015), while
preoperative CBCT assessment is recommended only for
teeth with suspected complex morphology or previous
complications (Fayad et al., 2015) or where the additional
information is likely to enhance diagnosis, planning and/
or clinical management (Patel et al., 2019). The effective
radiation dose for small FOV CBCT has been shown to
average 84 μSv (range 5–652 μSv) across a variety of CBCT
units (Ludlow et al., 2015), compared with 0.1–2.6 μSv for
one digital periapical radiograph (Granlund et al., 2016).
Clinicians should aim to minimize the radiation to which
the patient is exposed, as there is some evidence of in-
creased cancer risk with low-dose diagnostic radiogra-
phy in children (Pearce et al., 2012), although it remains
limited and debates regarding the principle of ALARA
continue in the medical literature (AAPM, 2018; Hall &
Brenner, 2012; Siegel et al., 2017).
 |
10   
The importance of considering radiation exposure
may need to be reinforced among those for whom use of
technological advances such as CBCT may be considered
routine.
CBCT access and use
On-site access to CBCT among endodontic respondents
in this global survey (81.1%) was higher than 50%–60%
in German/Swiss (Krug et al., 2019) and USA sur-
veys (Setzer et al., 2017) and 22% in the UK (Rajeevan
et al., 2018). Usage of CBCT among the endodontic
respondents was very high (90.8%) in this study com-
pared with previous surveys: 80.3% in the USA (Setzer
et al., 2017), 50% in Lithuania (Masyte et al., 2021),
47% in Brazil (Ferreira et al., 2017) and 26% in the UK
(Rajeevan et al., 2018).
Among non-endodontic respondents in this survey,
on-site access (25.9%) was also higher than in surveys of
general dentists in the Netherlands (8.4%) (van der Zande
et al., 2015) and New Zealand (12.3%) (van der Zande
et al., 2018). The usage of CBCT for any dental indication
in this group (45.4%) was higher than reported in previ-
ous studies in Lithuania (17.3%) (Masyte et al., 2021),
New Zealand (18.2%) (Loch et al., 2019), South Africa
(4%) (Buchanan et al., 2019) and Malaysia (1.6%) (Wong
et al., 2019).
Because the survey as a whole was focused on endodon-
tic practice trends (results reported elsewhere) as well as
CBCT preferences, the respondents may have self-selected
for those with a higher interest in both of these topics,
especially among non-endodontists. However, the find-
ings among endodontic respondents show that uptake of
CBCT for endodontic indications appears to be increas-
ing rapidly over time, although there may be geographic
variations.
Preferred CBCT scan interpreters
Prior to this study, the referral of CBCTs for interpretation
by maxillofacial radiologists has rarely been investigated.
The preference for interpretation of CBCTs by
dentomaxillofacial (DMFR) radiologists in this study
was low at 10.6% for in-house scans and 26.1% for
external scans. Comparatively, other surveys that did
not differentiate between the scan location found that
reports were received from DMFR by 36.4% of endodontic
practitioners surveyed in the UK (Rajeevan et al., 2018)
and 77% of CBCT users (general dentists, periodontists,
oral surgeons) surveyed in Georgia, USA (Buchanan
et al., 2017).
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GLOBAL CBCT ADOPTION AND ENDODONTIC USAGE PREFERENCES
Respondents were most likely to interpret scans
themselves in this study (60.5%–83.3%), and it was simi-
larly the most popular choice in UK surveys of endodon-
tic practitioners (44%) (Rajeevan et al., 2018) and dental
practices with CBCT machines (52%) (Yalda et al., 2019)
as well as dentists and specialists surveyed in Lithuania
(59.8%) (Masyte et al., 2021). This preference remains
in line with the AAE/AAOMR Joint Position Statement,
which only suggests that clinicians should refer to an
oral and maxillofacial radiologist in the event of uncer-
tainty (Fayad et al., 2015). However, more recent stud-
ies of incidental findings and accuracy of interpretation
have universally recommended interpretation of CBCT
scans by maxillofacial radiologists (Beacham et al., 2018;
Dief et al., 2019; Oser et al., 2017). Incidental findings
of abnormalities have been found in 87% of small FOV
endodontic scans (Oser et al., 2017). Another concern
was the unexpected finding that a small number of cli-
nicians in this study preferred to have their CBCT scans
interpreted by staff members who were not qualified
dentists.
Setting preferences
Group E's overall strong preferences for small FOV
(85.6%) and high resolution (89.3%) correspond to rec-
ommendations in current endodontic clinical guide-
lines (Fayad et al., 2015). The results are higher than in
previous surveys of endodontists, where a limited FOV
(≤5 cm diameter or width) was preferred by 55.3% of
respondents in the USA (Setzer et al., 2017) and 60.1%
in a German and Swiss survey (Krug et al., 2019). This
may be due to users developing greater understanding
of endodontic-specific requirements and implications
of needing to interpret the entire volume as they gain
experience over time. While the dimensions of a small
FOV were not specified in this study, and definitions
of FOV dimensions vary with small defined as ≤10 cm
height in a systematic review of effective radiation dos-
age (Ludlow et al., 2015), the smallest selectable FOV
varies between CBCT machines in any case (Setzer
et al., 2017).
The preference for high resolution in this study
among Group E was also higher than the 52.5% who
preferred a voxel size of 60–150 μm in the German and
Swiss survey (Krug et al., 2019). Higher resolution is
achieved with higher radiation exposure when voxel
size is reduced (Ludlow et al., 2015) and thus should
be used with a small FOV to minimize patient radiation
exposure.
However, a finding of concern in this study was that
non-endodontic clinicians using CBCT for endodontics

CHEUNG et al.
had a much greater range of preferred FOV, with 9.3%
preferring a large FOV and 14.8% having no preference.
Similarly, 16.7% of this group had no preference re-
garding the degree of resolution. The level of radiation
exposure some patients is subjected to could therefore
be excessive while not providing sufficiently useful in-
formation for the assessment of complex endodontic
problems such as those included in this survey. This is
of particular importance where general dentists are able
to purchase CBCT units (Parashar et al., 2012) and ap-
propriate settings for complex endodontic indications
may not be well understood, especially if most clinicians
taking in-house CBCT scans are interpreting the results
themselves.
Implications for clinicians and educators
Overall, this study's results indicate that wider dissemi-
nation of less widely known CBCT limitations, appropri-
ate applications and interpretation to clinicians may be
needed. Profession-wide dissemination of information
from respected sources, for example, via webinars run by
national dental associations or inclusions of review arti-
cles in their newsletters may be of benefit. Alternatively,
attendance at CPE training programs run by dentomaxil-
lofacial radiologists prior to use of in-house CBCT could
be made mandatory.
CON C LUS I ON
In this global survey, CBCT education primarily occurred
after graduation from the primary dental degree or
endodontic specialization. Relevant limitations of CBCT
were considered by only small majorities of respondents.
Endodontic respondents had much greater usage of
and access to CBCT in their workplaces than non-
endodontic dentists, and used recommended settings for
endodontic scans at significantly higher rates. Most CBCT
scans were interpreted by the respondents themselves
with interpretation by a medical or dentomaxillofacial
radiologist occurring only in a minority of cases. There
may be educational implications regarding the limitations,
appropriate application and interpretation of CBCT
imaging.
AUTHOR CONTRIBUTIONS
MC Cheung: designed the study; acquired, analysed and
interpreted the data; and drafted the manuscript. OA
Peters: interpreted the data and reviewed the manuscript.
P Parashos: assisted in study design and data analysis and
interpretation, and reviewed the manuscript.
|
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   11
FUNDING INFORMATION
Melbourne Dental School, The University of Melbourne.
CONFLICT OF INTEREST STATEMENT
The authors deny any conflicts of interest related to this
study. Outside of this work, Prof. O Peters has been a
consultant for Dentsply Sirona.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are
available from the corresponding author upon reasonable
request.
ORCID
Monique Charlene Cheung https://orcid.
org/0000-0001-5326-3048
Ove Andreas Peters https://orcid.
org/0000-0001-5222-8718
Peter Parashos https://orcid.org/0000-0001-7191-0560
REFERENCES
AAPM. (2018) American Association of Physicists in Medicine posi-
tion statement on radiation risks from medical imaging proce-
dures. Available from: https://​www.​aapm.​org/​org/​polic​ies/​
detai​ls.​asp?​id=​2548&​type=​[Accessed 7th July 2022].
AIHW. (2022) Oral health and dental care in Australia: dental work-
force. Australian Institute of Health and Welfare. Available
from: https://​www.​aihw.​gov.​au/​getme​dia/​02a81​091-​37f3-​4325-​
b329-​82b78​b7ac5​fa/​aihw_​den_​231_​denta​lwork​force_​datat​
ables_​oralh​ealth​andde​ntalc​arein​austr​alia_​tranc​he_5_​17032​
022-​xlsx.​xlsx.​aspx [Accessed 12th July 2022].
Arai, Y., Tammisalo, E., Iwai, K., Hashimoto, K. & Shinoda, K.
(1999) Development of a compact computed tomographic ap-
paratus for dental use. Dentomaxillofacial Radiology, 28(4),
245–248.
Beacham, J.T., Geist, J.R., Yu, Q., Himel, V.T. & Sabey, K.A. (2018)
Accuracy of cone-beam computed tomographic image inter-
pretation by endodontists and endodontic residents. Journal of
Endodontics, 44(4), 571–575.
Bornstein, M.M., Wölner-Hanssen, A.B., Sendi, P. & Von Arx, T.
(2009) Comparison of intraoral radiography and limited cone
beam computed tomography for the assessment of root-frac-
tured permanent teeth. Dental Traumatology, 25(6), 571–577.
Brown, J., Jacobs, R., Levring Jäghagen, E., Lindh, C., Baksi, G.,
Schulze, D. et al. (2014) Basic training requirements for the
use of dental CBCT by dentists: a position paper prepared by
the European Academy of DentoMaxilloFacial Radiology.
Dentomaxillofacial Radiology, 43(1), 20130291.
Buchanan, A., Thachil, K., Haggard, C. & Kalathingal, S. (2017)
Predoctoral and postdoctoral education on cone-beam com-
puted tomography. Journal of Evidence Based Dental Practice,
17(4), 310–316.
Buchanan, G.D., Gamieldien, M.Y. & Tredoux, S. (2019) Endodontic
trends by South African Dental Association members: an on-
line survey. Saudi Endodontic Journal, 9(3), 198–204.
Celikten, B., Jacobs, R., de Faria Vasconcelos, K., Huang, Y., Shaheen,
E., Nicolielo, L.F.P. et al. (2019) Comparative evaluation of cone
 |
12   
beam CT and micro-CT on blooming artifacts in human teeth
filled with bioceramic sealers. Clinical Oral Investigations,
23(8), 3267–3273.
Celikten, B., Jacobs, R., Vasconcelos, K., Huang, Y., Nicolielo, L.F.P.
& Orhan, K. (2017) Assessment of volumetric distortion arti-
fact in filled root canals using different cone-beam computed
tomographic devices. Journal of Endodontics, 43(9), 1517–1521.
Cheung, M.C., Hopcraft, M.S. & Darby, I.B. (2020) Dental implant
maintenance teaching in Australia—a survey of education pro-
viders. European Journal of Dental Education, 24(2), 310–319.
Cho, Y.I., Johnson, T.P. & VanGeest, J.B. (2013) Enhancing surveys
of health care professionals: a meta-analysis of techniques to
improve response. Evaluation and the Health Professions, 36(3),
382–407.
Chogle, S., Zuaitar, M., Sarkis, R., Saadoun, M., Mecham, A. & Zhao,
Y. (2020) The recommendation of cone-beam computed to-
mography and its effect on endodontic diagnosis and treatment
planning. Journal of Endodontics, 46(2), 162–168.
Deutskens, E., De Ruyter, K., Wetzels, M. & Oosterveld, P. (2004)
Response rate and response quality of internet-based surveys:
an experimental study. Marketing Letters, 15(1), 21–36.
Dief, S., Veitz-Keenan, A., Amintavakoli, N. & McGowan, R. (2019)
A systematic review on incidental findings in cone beam com-
puted tomography (CBCT) scans. Dentomaxillofacial Radiology,
48(7), 20180396.
EPA. (2023) Radiation user licence – criteria. Environmental
Protection Agency, NSW Government, Australia. Available
from: https://​www.​epa.​nsw.​gov.​au/​your-​envir​onment/​radia​
tion/​radia​tion-​user-​licen​ce/​user-​licen​ce-​intro​ducti​on/​user-​
licen​ce-​crite​ria#​IA24 [Accessed 15th June 2023].
Estrela, C., Bueno, M.R., Azevedo, B.C., Azevedo, J.R. & Pécora, J.D.
(2008) A new periapical index based on cone beam computed
tomography. Journal of Endodontics, 34(11), 1325–1331.
Fayad, M.I., Nair, M., Levin, M.D., Benavides, E., Rubinstein, R.A.,
Barghan, S. et al. (2015) AAE and AAOMR joint position state-
ment: use of cone beam computed tomography in endodontics
2015 update. Oral Surgery, Oral Medicine, Oral Pathology and
Oral Radiology, 120(4), 508–512.
Ferreira, A.C.G., Frozoni, M., Prado, M., Gomes, B., Signoretti, F.
& De-Jesus-Soares, A. (2017) Current trends in technological
armamentarium and treatment among Brazilian endodontists.
Brazilian Journal of Oral Sciences, 169, e17045.
Freitas, D., Nascimento, E., Vasconcelos, T. & Noujeim, M. (2019)
Diagnosis of external root resorption in teeth close and distant
to zirconium implants: influence of acquisition parameters and
artefacts produced during cone beam computed tomography.
International Endodontic Journal, 52(6), 866–873.
Funkhouser, E., Vellala, K., Baltuck, C., Cacciato, R., Durand, E.,
McEdward, D. et al. (2017) Survey methods to optimize re-
sponse rate in the National Dental Practice–Based Research
Network. Evaluation and the Health Professions, 40(3), 332–358.
Gaêta-Araujo, H., Leite, A.F., Vasconcelos, K.F. & Jacobs, R. (2021)
Two decades of research on CBCT imaging in DMFR – an ap-
praisal of scientific evidence. Dentomaxillofacial Radiology,
50(4), 20200367.
Granlund, C., Thilander-Klang, A., Ylhan, B., Lofthag-Hansen, S.
& Ekestubbe, A. (2016) Absorbed organ and effective doses
from digital intra-oral and panoramic radiography applying
the ICRP 103 recommendations for effective dose estimations.
British Journal of Radiology, 89(1066), 20151052.
13652591, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/iej.14000 by Univ of Sao Paulo - Brazil, Wiley Online Library on [21/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
GLOBAL CBCT ADOPTION AND ENDODONTIC USAGE PREFERENCES
Hall, E. & Brenner, D. (2012) Cancer risks from diagnostic radiol-
ogy: the impact of new epidemiological data. British Journal of
Radiology, 85(1020), e1316–e1317.
Hardigan, P.C., Succar, C.T. & Fleisher, J.M. (2012) An analysis of
response rate and economic costs between mail and web-based
surveys among practicing dentists: a randomized trial. Journal
of Community Health, 37(2), 383–394.
Hol, C., Hellen-Halme, K., Torgersen, G., Nilsson, M. & Møystad,
A. (2015) How do dentists use CBCT in dental clinics? A
Norwegian nationwide survey. Acta Odontologica Scandinavica,
73(3), 195–201.
Horner, K., O'Malley, L., Taylor, K. & Glenny, A.-M. (2015) Guidelines
for clinical use of CBCT: a review. Dentomaxillofacial Radiology,
44(1), 20140225.
Kakavetsos, V.D., Markou, M.-E. & Tzanetakis, G.N. (2020)
Assessment of cone-beam computed tomographic referral
reasons and the impact of cone-beam computed tomographic
evaluation on decision treatment planning procedure in end-
odontics. Journal of Endodontics, 46(10), 1414–1419.
Klabunde, C.N., Willis, G.B. & Casalino, L.P. (2013) Facilitators and
barriers to survey participation by physicians: a call to action
for researchers. Evaluation and the Health Professions, 36(3),
279–295.
Klabunde, C.N., Willis, G.B., McLeod, C.C., Dillman, D.A., Johnson,
T.P., Greene, S.M. et al. (2012) Improving the quality of sur-
veys of physicians and medical groups: a research agenda.
Evaluation and the Health Professions, 35(4), 477–506.
Krug, R., Connert, T., Beinicke, A., Soliman, S., Schubert, A., Kiefner,
P. et al. (2019) When and how do endodontic specialists use
cone-beam computed tomography? Australian Endodontic
Journal, 45(3), 365–372.
Kruse, C., Spin-Neto, R., Evar Kraft, D.C., Vaeth, M. & Kirkevang,
L.L. (2019) Diagnostic accuracy of cone beam computed tomog-
raphy used for assessment of apical periodontitis: an ex vivo
histopathological study on human cadavers. International
Endodontic Journal, 52(4), 439–450.
Loch, C., Ratnayake, J., Veerasamy, A., Cathro, P., Lee, R. & Brunton,
P.A. (2019) Direct restorations, endodontics, and bleaching: ma-
terials and techniques used by general dentists of New Zealand.
International Journal of Dentistry, 2019, 6327171.
Ludlow, J., Timothy, R., Walker, C., Hunter, R., Benavides, E.,
Samuelson, D.B. et al. (2015) Effective dose of dental CBCT—a
meta analysis of published data and additional data for nine
CBCT units. Dentomaxillofacial Radiology, 44, 20140197.
Martinho, F.C. & Griffin, I.L. (2021) A cross-sectional survey on the
impact of coronavirus disease 2019 on the clinical practice of
endodontists across the United States. Journal of Endodontics,
47(1), 28–38.
Masyte, V., Sefeldaite, S. & Venskutonis, T. (2021) A questionnaire
of digital radiography and CBCT use and knowledge among
Lithuanian dentists. Journal of Oral & Maxillofacial Research,
12(1), e2.
McLeod, C.C., Klabunde, C.N., Willis, G.B. & Stark, D. (2013) Health
care provider surveys in the United States, 2000–2010: a review.
Evaluation and the Health Professions, 36(1), 106–126.
Mota de Almeida, F.J., Hassan, D., Nasir Abdulrahman, G., Brundin,
M. & Romani Vestman, N. (2021) CBCT influences end-
odontic therapeutic decision-making in immature trauma-
tized teeth with suspected pulp necrosis: a before-after study.
Dentomaxillofacial Radiology, 50(8), 20200594.

CHEUNG et al.
Mozzo, P., Procacci, C., Tacconi, A., Martini, P.T. & Andreis, I.B.
(1998) A new volumetric CT machine for dental imaging based
on the cone-beam technique: preliminary results. European
Radiology, 8(9), 1558–1564.
OAIC. (2022) History of the Privacy Act. Office of the Australian
Information Commissioner. Available from: http://​www.​oaic.​
gov. ​ a u/ ​ p riva ​ c y/ ​ t he-​ p riva​ c y-​ a ct/​ h isto​ r y-​ o f-​ t he-​ p riva ​ c y- ​ a ct
[Accessed 17th June 2022].
Oser, D.G., Henson, B.R., Shiang, E.Y., Finkelman, M.D. & Amato,
R.B. (2017) Incidental findings in small field of view cone-beam
computed tomography scans. Journal of Endodontics, 43(6),
901–904.
Parashar, V., Whaites, E., Monsour, P., Chaudhry, J. & Geist, J.R.
(2012) Cone beam computed tomography in dental education:
a survey of US, UK, and Australian dental schools. Journal of
Dental Education, 76(11), 1443–1447.
Patel, K., Mannocci, F. & Patel, S. (2016) The assessment and man-
agement of external cervical resorption with periapical radio-
graphs and cone-beam computed tomography: a clinical study.
Journal of Endodontics, 42(10), 1435–1440.
Patel, S., Brown, J., Semper, M., Abella, F. & Mannocci, F. (2019)
European Society of Endodontology position statement: use of
cone beam computed tomography in endodontics. International
Endodontic Journal, 52(12), 1675–1678.
Patel, S. & Harvey, S. (2021) Guidelines for reporting on CBCT scans.
International Endodontic Journal, 54(4), 628–633.
Pearce, M.S., Salotti, J.A., Little, M.P., McHugh, K., Lee, C., Kim, K.P.
et al. (2012) Radiation exposure from CT scans in childhood
and subsequent risk of leukaemia and brain tumours: a retro-
spective cohort study. Lancet, 380(9840), 499–505.
Pope, O., Sathorn, C. & Parashos, P. (2014) A comparative investi-
gation of cone-beam computed tomography and periapical
radiography in the diagnosis of a healthy periapex. Journal of
Endodontics, 40(3), 360–365.
Rabiee, H., McDonald, N.J., Jacobs, R., Aminlari, A. & Inglehart,
M.R. (2018) Endodontics program directors', residents', and en-
dodontists' considerations about CBCT-related graduate educa-
tion. Journal of Dental Education, 82(9), 989–999.
Rai, S., Misra, D., Dhawan, A., Tyagi, K., Prabhat, M. & Khatri, M.
(2018) Knowledge, awareness, and aptitude of general dentists to-
ward dental radiology and CBCT: a questionnaire study. Journal of
Indian Academy of Oral Medicine and Radiology, 30(2), 110.
Rajeevan, M., Chandler, N.P., Makdissi, J. & San Chong, B. (2018) A
survey of cone beam computed tomography (CBCT) use among
endodontic practitioners in the UK. Endodontic Practice Today,
12(1), 29–33.
Reddy, R.S., Kiran, C.S., Ramesh, T., Kumar, B.N., Naik, R.M. &
Ramya, K. (2013) Knowledge and attitude of dental fraternity
towards cone beam computed tomography in South India – a
questionnaire study. Indian Journal of Dentistry, 4(2), 88–94.
Rodríguez, G., Patel, S., Durán-Sindreu, F., Roig, M. & Abella, F. (2017)
Influence of cone-beam computed tomography on endodontic
retreatment strategies among general dental practitioners and en-
dodontists. Journal of Endodontics, 43(9), 1433–1437.
Schulze, R., Heil, U., Gross, D., Bruellmann, D.D., Dranischnikow,
E., Schwanecke, U. et al. (2011) Artefacts in CBCT: a review.
Dentomaxillofacial Radiology, 40(5), 265–273.
|
13652591, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/iej.14000 by Univ of Sao Paulo - Brazil, Wiley Online Library on [21/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   13
Setzer, F.C., Hinckley, N., Kohli, M.R. & Karabucak, B. (2017) A sur-
vey of cone-beam computed tomographic use among endodon-
tic practitioners in the United States. Journal of Endodontics,
43(5), 699–704.
Siegel, J.A., Pennington, C.W. & Sacks, B. (2017) Subjecting radio-
logic imaging to the linear no-threshold hypothesis: a non se-
quitur of non-trivial proportion. Journal of Nuclear Medicine,
58(1), 1–6.
Spin-Neto, R., Gotfredsen, E. & Wenzel, A. (2014) Variation in voxel
value distribution and effect of time between exposures in six
CBCT units. Dentomaxillofacial Radiology, 43(4), 20130376.
Spin-Neto, R., Matzen, L.H., Schropp, L., Gotfredsen, E. & Wenzel,
A. (2016) Movement characteristics in young patients and the
impact on CBCT image quality. Dentomaxillofacial Radiology,
45(4), 20150426.
Torabinejad, M., Rice, D.D., Maktabi, O., Oyoyo, U. & Abramovitch,
K. (2018) Prevalence and size of periapical radiolucencies
using cone-beam computed tomography in teeth without ap-
parent intraoral radiographic lesions: a new periapical index
with a clinical recommendation. Journal of Endodontics, 44(3),
389–394.
van der Zande, M., Gorter, R.C., Aartman, I.H. & Wismeijer, D.
(2015) Adoption and use of digital technologies among gen-
eral dental practitioners in the Netherlands. PLoS One, 10(3),
e0120725.
van der Zande, M., Hong, C.L., Gorter, R., Wismeijer, D. & Broadbent,
J. (2018) Use of newer technologies by dentists in New Zealand.
New Zealand Dental Journal, 114, 107–115.
VIC Govt. (2023) Dentists – use licences. Department of Health,
Victorian Government, Australia. Available from: https://​www.​
health.​vic.​gov.​au/​radia​tion/​denti​sts-​use-​licences [Accessed
15th June 2023].
Wanzeler, A.M.V., Montagner, F., Vieira, H.T., da Silveira, H.L.D.,
Arús, N.A. & Vizzotto, M.B. (2020) Can cone-beam computed
tomography change endodontists' level of confidence in diag-
nosis and treatment planning? A before and after study. Journal
of Endodontics, 46(2), 283–288.
Wong, L., Liew, A.K.C., Abdullah, D. & Chong, B.S. (2019) The scope
and pattern of practice in the delivery of endodontic treatment
in Malaysia: a survey study. Archives of Orofacial Sciences,
14(1), 1–10.
Yalda, F.A., Holroyd, J., Islam, M., Theodorakou, C. & Horner, K.
(2019) Current practice in the use of cone beam computed
tomography: a survey of UK dental practices. British Dental
Journal, 226(2), 115–124.
How to cite this article: Cheung, M.C., Peters,
O.A. & Parashos, P. (2023) Global cone-beam
computed tomography adoption, usage and scan
interpretation preferences of dentists and
endodontists. International Endodontic Journal, 00,
1–13. Available from: https://doi.org/10.1111/
iej.14000