EVANGELISTA, Karine; CAIADO, Grasielle Di Manoel; FREIRE, Maria do Carmo Matias; VALLADARES-NETO, José; SILVA, Maria Alves Garcia

doi:10.1590/2177-6709.30.2.e252486.oar

ORIGINAL ARTICLE • Dental Press J. Orthod. 30 (2) • 2025 • https://doi.org/10.1590/2177-6709.30.2.e252486.oar linkcopiar

Cone-beam computed tomography prescription by Brazilian orthodontists

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Investigar os fatores que influenciam a prescrição de exames de tomografia computadorizada de feixe cônico (TCFC) na prática ortodôntica brasileira.

Métodos: Este estudo transversal foi realizado em 2020, por meio de uma pesquisa online enviada a todos os ortodontistas brasileiros registrados no Conselho Federal de Odontologia. As variáveis foram as características demográficas dos ortodontistas e a prescrição de TCFC na prática clínica. Análises descritiva e comparativa foram implementadas por meio de frequências e do teste qui-quadrado, respectivamente.

Resultados: A amostra consistiu em 939 respondentes. A prescrição de TCFC e o uso de diretrizes para prescrição de imagens em Ortodontia foram confirmados por 81,9% e 52,6% da amostra, respectivamente. O treinamento para TCFC foi relatado por 37,0%, principalmente durante programas de especialização em Ortodontia (50,0%), feitos há cerca de um a cinco anos atrás (64,7%), com duração de 4 a 8 horas (53,4%). A prescrição de TCFC foi indicada predominantemente para casos específicos (71,0%), geralmente relacionada a dentes impactados (74,7%), pacientes submetidos a cirurgia ortognática (46,2%) e reabsorção radicular (41,9%). Os resultados indicaram diferenças na prescrição de TCFC entre as regiões brasileiras, com relação aos critérios de prescrição, seguimento de diretrizes, razões para não recomendar o exame, propósitos diagnósticos, tamanho de voxel e treinamento para o uso de TCFC (p < 0,05).

Conclusão: A prescrição de TCFC foi adequada por parte dos ortodontistas brasileiros para casos envolvendo dentes impactados, intervenções cirúrgicas e reabsorção radicular. No entanto, a adesão às diretrizes para prescrição de exames de imagem foi observada em aproximadamente50% da amostra. Há uma deficiência no entendimento dos parâmetros técnicos e uma falta de treinamento específico em TCFC. Disparidades entre as regiões brasileiras foram evidentes, particularmente em relação aos custos de TCFC e outras variáveis analisadas.

Palavras-chave:
Tomografia computadorizada de feixe cônico; Ortodontia; Prescrição

Variable	n (%)
Sex
Female	420 (44.7)
Male	514 (54.7)
Not answered	5 (0.5)
Age
20-39	358 (38.1)
40-49	304 (32.4)
50-59	193 (20.6)
>60	80 (8.5)
Not answered	4 (0.4)
Brazilian macro-regions
North	63 (6.7)
North East	111 (11.8)
Midwest	150 (6.0)
South	190 (20.2)
South East	402 (42.8)
Not answered	23 (2.4)
Number of years as a licensed orthodontist
< 5	196 (20.9)
6-20	453 (48.2)
> 20	290 (30.9)

Variables	Total	Brazilian macro-regions					Adjusted residual	p-value
	Total	North	North East	Midwest	South	South East
	n/%	n/%	n/%	n/%	n/%	n/%
Prescribe CBCT
Yes	747 (81.9)	46 (74.2)	94 (84.7)	122 (82.4)	145 (76.3)	340 (84.8)	-2.3 (2.0)	0.053
No	165 (18.1)	16 (25.8)	17 (15.3)	26 (17.6)	45 (23.7)	61 (15.2)
Not answered	27
How do you use CBCT images?
To evaluate all axial, coronal and sagittal slices	340 (46.1)	24 (52.2)	36 (39.6)	61 (50.0)	69 (48.6)	150 (44.5)	-1.3 (1.0)	0.449
For 3D model analysis	9 (1.2)	1 (2.2)	2 (2.2)	2 (1.6)	2 (1.4)	2 (0.6)	-1.4 (0.9)	0.665
Both	389 (52.7)	21 (45.7)	53 (58.2)	59 (48.8)	71 (50.0)	185 (54.9)	-1.1 (1.1)	0.402
Not answered	201
Have a CBCT machine in your own office?
Yes	18 (2.4)	1 (2.2)	0 (0)	2 (1.6)	2 (1.4)	13 (3.8)	-1.6 (2.3)	0.195
No	722 (97.6)	45 (97.8)	92 (100)	120 (98.4)	139 (98.6)	326 (96.2)
Not answered	199
Criteria used for prescribing CBCT in orthodontic practice*
For treatment planning purposes, in every case	9 (1.0)	0 (0.0)	1 (0.9)	0 (0.0)	0 (0.0)	8 (3.9)	-1.3 (2.7)	0.017
For treatment planning purposes, in most of cases	55 (6.0)	4 (6.3)	3 (2.7)	8 (5.3)	9 (4.7)	31 (7.7)	-1.6 (1.9)	0.043
During treatment, in every case	9 (1.0)	0 (0.0)	0 (0.0)	1 (0.7)	0 (0.0)	8 (2.0)	-1.5 (2.7)	0.018
After treatment, in every case	8 (0.9)	1 (1.6)	1 (0.9)	0 (0.0)	1 (0.5)	5 (1.2)	-1.3 (1.1)	0.089
For selected cases only	650 (71.0)	36 (57.1)	86 (77.5)	110 (73.3)	128 (67.4)	290 (72.1)	-2.5 (1.6)	0.057
Not answered	213
Follow guidelines
Yes	387 (52.6)	20 (43.5)	43 (46.7)	60 (49.2)	69 (48.6)	195 (58.4)	-1.3 (2.9)	0.067
No	349 (47.4)	26 (56.5)	49 (53.3)	62 (50.8)	73 (51.4)	139 (41.6)
Not answered	203
Guideline followed*
AAROM	170 (18.6)	8 (12.7)	20 (18.0)	21 (14.0)	31 (16.3)	90 (22.4)	-1.6 (2.6)	0.004
SEDENTEXCT	23 (2.5)	0 (0.0)	0 (0.0)	2 (1.3)	7 (3.7)	14 (3.5)	-1.3 (1.7)	0.001
Local or national	206 (22.5)	9 (14.3)	24 (21.6)	38 (25.3)	33 (17.4)	102 (25.4)	-1.6 (1.8)	0.005
Other	357 (39)	16 (25.4)	40 (36)	57 (38.0)	60 (31.6)	184 (45.8)	-2.3 (2.7)	0.476
Not answered	542
Reason for not prescribing CBCT**
High cost	436 (47.3)	35 (55.6)	57 (51.4)	78 (52.0)	80 (42.1)	186 (46.3)	-1.7 (1.3)	0.002
Not having a specialized radiology center nearby	33 (3.6)	4 (6.3)	7 (6.3)	4 (2.7)	7 (3.7)	11 (2.7)	-1.2 (1.2)	0.025
CBCT will bring no new information	15 (1.6)	1 (1.6)	1 (0.9)	2 (1.3)	4 (2.1)	7 (1.7)	-0.7 (0.6)	0.117
Not answered	232

Variables	Total	Brazilian macro-regions				Adjusted residual		p-value
	Total	North	North East	Midwest	South	South East
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Impacted teeth	684 (74.7)	38 (60.3)	87 (78.4)	118 (78.7)	132 (69.5)	309 (76.9)	-2.7 (1.3)	0.046
Root resorption	384 (41.9)	22 (34.9)^A.B	55 (49.5)^A.B	76 (50.7)^B	81 (42.6)^A.B	150 (37.3)^A	-1.9 (3.8)	0.001*
Dental anomalies	296 (32.3)	15 (23.8)	36 (32.4)	52 (34.7)	59 (31.1)	134 (33.3)	-1.5 (0.7)	0.168
Facial asymmetry	291 (31.8)	14 (22.2)	37 (33.3)	54 (36.0)	55 (28.9)	131 (32.6)	-1.7 (1.2)	0.132
Dental position	241 (26.3)	12 (19.0)	29 (26.1)	39 (26.0)	43 (22.6)	118 (29.4)	-1.4 (1.8)	0.105
Upper airway analysis	144 (15.7)	7 (11.1)	20 (18.0)	23 (15.3)	25 (13.2)	69 (17.2)	-1.1 (1.1)	0.147
Palate cleft	206 (22.5)	10 (15.9)	24 (21.6)	39 (26.0)	37 (19.5)	96 (23.9)	-1.3 (1.1)	0.117
Surgical cases	423 (46.2)	19 (30.2)	56 (50.5)	73 (48.7)	87 (45.8)	188 (46.8)	-2.6 (1.0)	0.078
Dentofacial deformities and craniofacial abnormalities	315 (34.4)	13 (20.6)	38 (34.2)	50 (33.3)	70 (36.8)	144 (35.8)	-2.4 (0.8)	0.048
Anatomical TMJ signs	298 (32.5)	12 (19.0)	36 (32.4)	55 (36.7)	51 (26.8)	144 (35.8)	-2.4 (1.9)	0.033
Third molar evaluation	249 (27.2)	12 (19.0)	23 (20.7)	40 (26.7)	58 (30.5)	116 (28.9)	-1.6 (1.2)	0.018
Temporary anchorage devices insertion (mini-implants)	106 (11.6)	5 (7.9)	10 (9.0)	16 (10.7)	16 (8.4)	59 (14.7)	-1.5 (2.6)	0.032
Digital smile design imaging (Clear Aligner Therapy)	80 (8.7)	5 (7.9)	5 (4.5)	18 (12.0)	20 (10.5)	32 (8.0)	-1.7 (1.5)	0.023
Customized orthodontic appliance - Sure Smile^TM	98 (10.7)	6 (9.5)	15 (13.5)	20 (13.3)	19 (10.0)	38 (9.5)	-1.1 (1.1)	0.096

Variables	Total	Brazilian macro-regions					Adjusted residual	p-value
	Total	North	North East	Midwest	South	South East
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Which voxel size do you choose for the acquisition of CBCT images?
I do not specify	445 (63.3)	28 (70.0)^A.B	60 (67.4)^A.B	82 (69.5)^A.B	97 (70.8)^B	178 (55.8)^A	-3.8 (0.9)	0.006*
Small one (<0.3 mm)	59 (8.4)	0 (0.0)	5 (5.6)	5 (4.2)	9 (6.6)	40 (12.5)	-2.0 (2.6)	0.005
Large one (≥0.3 mm)	16 (2.3)	0 (0.0)	0 (0.0)	2 (1.7)	2 (1.5)	12 (3.8)	-1.5 (2.4)	0.149
Depends on the clinical application	183 (26.0)	12 (30.0)	24 (27.0)	29 (24.6)	29 (21.2)	89 (27.9)	-1.4 (1.0)	0.599
Not answered	236
Which field of view do you prescribe?
I do not specify	273 (38.8)	20 (50.5)^A.B	40 (44.9)^A.B	48 (40.7)^A.B	66 (48.2)^B	99 (31.0)^A	-3.9 (1.5)	0.002*
Small area (around 4 - 6 cm)	49 (7.0)	1 (2.5)	6 (6.7)	12 (10.2)	6 (4.4)	24 (7.5)	-1.3 (1.5)	0.323
Large area (around 8 - 16 cm)	19 (2.7)	1 (2.5)	1 (1.1)	0 (0.0)	3 (2.2)	14 (4.4)	-2.0 (2.5)	0.103
Full skull	27 (3.8)	2 (5.0)	3 (3.4)	3 (2.5)	3 (2.2)	16 (5.0)	-1.1 (1.5)	0.568
Depends on the clinical application	335 (47.7)	16 (40.0)	39 (43.8)	55 (46.6)	59 (43.1)	166 (52.0)	-1.2 (2.1)	0.274
Not answered	236

Variables	Total	Brazilian macro-regions					Adjusted residual	p-value
	Total	North	North East	Midwest	South	South East
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Have you taken any training/course for using CBCT units or images in orthodontic practice?
Yes	260 (37.0)	11 (28.2)^A.B	35 (39.3)^A.B	54 (45.8)^B	36 (26.3)^A	124 (38.8)^A.B	-2.9 (2.2)	0.014*
No	443 (63.0)	28 (71.8)^A.B	54 (60.7)^A.B	64 (54.2)^B	101 (73.7)^A	196 (61.3)^A.B
Not answered	236
Where was this training/course in CBCT?
During undergraduate training	2 (0.8)	0 (0)	0 (0)	1 (1.9)	0 (0)	1 (0.8)	-0.6 (1.0)	0.828
Specialty programs in orthodontics	127 (50.2)	6 (54.5)	22 (64.7)	27 (51.9)	17 (48.6)	55 (45.5)	-1.4 (1.8)	0.388
Specific CBCT course	65 (25.7)	3 (27.3)	4 (11.8)	19 (36.5)	8 (22.9)	31 (25.6)	-2.0 (2.0)	0.146
Other	59 (23.3)	2 (18.2)	8 (23.5)	5 (9.6)	10 (28.6)	34 (28.1)	-2.6 (1.7)	0.103
Not answered	686)
When was this CBCT training/course?
Around 1 year ago	61 (24.2)	3 (27.3)	8 (23.5)	14 (27.5)	9 (25.0)	27 (22.5)	-0.6 (0.2)	0.967
Around 5 years ago	102 (40.5)	4 (36.4)	19 (55.9)	24 (47.1)	11 (30.6)	44 (36.7)	-1.3 (2.0)	0.162
Around 10 years ago	64 (25.4)	4 (36.4)	5 (14.7)	8 (15.7)	12 (33.3)	35 (29.2)	-1.8 (1.3)	0.117
Other	25 (9.9)	0 (0.0)	2 (5.9)	5 (9.8)	4 (11.1)	14 (11.7)	-1.1 (0.9)	0.681
Not answered	687
How long was this CBCT training/course?
Less than 4 hours	1 (0.4)	0 (0.0)	0 (0.0)	1 (2.0)	0 (0.0)	0 (0.0)	-1.0 (2.0)	0.420
From 4 to 8 hours	133 (53.4)	5 (45.5)	22 (66.7)	30 (58.8)	20 (58.8)	56 (46.7)	-2.1 (1.6)	0.214
More than 8 to 20 hours	77 (30.9)	4 (36.4)	8 (24.2)	18 (35.3)	6 (17.6)	41 (34.2)	-1.8 (1.1)	0.320
More than 20 hours	36 (14.5)	2 (18.2)^A.B	3 (9.1)^A.B	1 (2.0)^B	8 (23.5)^A	22 (18.3)^A	-2.8 (1.7)	0.026*
Other	2 (0.8)	0 (0.0)	0 (0.0)	1 (2.0)	0 (0.0)	1 (0.8)	-0.6 (1.0)	0.828
Not answered	690
Was a state/province/government-recognized certificate granted?
Yes	67 (26.5)	4 (6.3)	6 (5.4)	16 (10.7)	12 (6.3)	29 (7.2)	-0.8 (1.7)	0.015
No	186 (73.5)	7 (11.1)	28 (25.2)	36 (24.0)	24 (12.6)	91 (22.6)
Not answered	686

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[TFN1] *Total of respondents who answered “yes” to CBCT prescription and to follow guidelines. **Total of respondents who answered “no” to CBCT prescription. Pearson’s Chi-square test: Statistically significant results for bivariate analysis (p<0.05). Bonferroni post-hoc test: values less than ± 2.80 of the adjusted residuals do not indicate statistical differences between the macro-regions.