A preliminary survey of cone-beam computed tomography use in orthodontics in the UK

Abstract

Objective:

To investigate access to, frequency of use, justification, challenges and training regarding cone-beam computed tomography (CBCT) imaging in orthodontics in the UK.

Design:

Cross-sectional questionnaire study.

Setting:

Web-based.

Methods:

An online questionnaire was developed after a review of the literature and discussion with practising orthodontists to identify key themes of importance. It was piloted before use and then distributed via the British Orthodontic Society (BOS). All responses were anonymous.

Results:

A total of 82 complete responses were received (~7% response rate). Access to CBCT facilities was primarily through NHS secondary care (68%). Usage was mainly for assessment of impacted teeth, and 80% of respondents who use CBCT reported increased CBCT imaging referrals over the past 5 years. Barriers included geographic distance and cost. Almost 60% of respondents had formal CBCT training, but over one-third lacked easy access to dental/maxillofacial radiology reporting.

Conclusions:

Access to CBCT for orthodontic patients in the UK was mainly through NHS secondary care. Most respondents reported using CBCT for fewer than 10% of patients, most commonly for assessment of unerupted or impacted teeth. The majority of those who used CBCT reported an increase in CBCT referrals over the past 5 years. Reported challenges included cost, travelling distance to CBCT facilities, and limited access to dental and maxillofacial radiology reporting. Although most respondents had undertaken formal CBCT training, over one-third reported difficulty accessing specialist radiology support.

Plain language summary

Current use of cone-beam CT in orthodontics across the UK

In the UK, orthodontists mainly access cone-beam computed tomography (CBCT) 3D x-ray scans through NHS hospitals. The use of CBCT is increasing, especially for impacted teeth. However, cost, travel and lack of specialist support challenges remain as concerns. Improved training, radiologist support and patient information are important aspects to focus on. Why was the study done? CBCT scans are used by orthodontists to help plan treatment, especially when teeth have not come through properly. In the UK, we have limited information about how often orthodontists use CBCT, how easy it is to access and what training they have undergone to read the scans. Understanding this can help to ensure patients get the right scans at the right time. What did the researchers do? The researchers sent an online survey to orthodontists across the UK through the British Orthodontic Society. The survey asked about access to CBCT, how often it is used, why it is used, any problems with access and training in reading scans. Responses were collected between November 2022 and January 2023. What did the researchers find? In total, 82 orthodontists completed the survey. Most respondents had access to CBCT in NHS hospital settings. For most orthodontists, fewer than 10% of their patients needed a CBCT scan. The main reason for using CBCT scans was to assess teeth that had not come through into the mouth. For those who use CBCT in their clinical practice, about 80% said their use of CBCT had increased over the past 5 years. This was mainly due to better access and greater awareness of its benefits. Common problems included the cost of scans, long travel distances and lack of access to a specialist radiologist to report scans. Almost all said they would use a national patient information leaflet if one were available. What do the findings mean? This study gives some information regarding how CBCT is currently used by orthodontists in the UK, although the response rate was quite low so may not apply to all orthodontists. Although use is increasing, there are still some problems with cost, travel, training and access to specialist support. Better training, easier access to specialist radiologists and clear patient information are important for ensuring effective use of CBCT.