A global overview of the use of cone beam computed tomography in dentistry: a bibliometric review focusing on paediatric patients

Introduction

Cone beam computed tomography (CBCT) represents a diagnostic imaging approach using x-radiation to reproduce a specific section of the human body in any of the three planes of space.¹ In contrast to conventional radiographs, which project all the structures traversed by X-rays in a single plane, CBCT highlights structural relationships in depth, presenting images in “slices”.² Unlike multi-slice computed tomography (MSCT), CBCT uses an X-ray source composed of a fixed low-energy anode, similar to those used in dental panoramic tomography.³ Despite having a lower incidence of radiation than MSCT, CBCT generates high-resolution images and minimizes the likelihood of metallic artefacts. In addition, it offers the ability to generate all two-dimensional images as required.^4,5

Although CBCT is a growing imaging technology with several dentomaxillofacial applications, its use in paediatric dental patients remains a sensitive point, mainly due to the radiation doses involved.⁶ Specific recommendations aimed at guiding the justified indication of the use of CBCT in paediatric dental patients were discussed as part of the European project DIMITRIA (Paediatric dentomaxillofacial imaging: an investigation into low-dose radiation-induced risks), which focused on optimizing the doses applied to children.⁷ Despite the need for a cautious approach, particularly for the investigation and appropriate treatment of orofacial and jawbone pathologies, as well as specific situations such as dental trauma, orofacial clefts and supernumerary teeth, the use of CBCT is justified.⁴ Given this scenario, the use of CBCT in paediatric dental patients has emerged as a crucial imaging exam to help professionals diagnose and prognosticate numerous oral conditions in children.^5,8,9

Despite the widespread use of CBCT in paediatric dental care, there is a lack of comprehensive bibliometric analyses that examine the trends, geographical distribution, and scientific collaborations in this area. Many studies have focused on the technical aspects and clinical applications of CBCT,^{1,3–5,7–9} but no studies have been found to date that have systematically mapped the research landscape to identify gaps in knowledge and areas that need further investigation. Furthermore, concerns about radiation exposure in children underscore the importance of establishing clearer protocols and guidelines for its safe application. Existing studies tend to concentrate on specific clinical outcomes, leaving a broader understanding of CBCT’s impact on paediatric dental care largely unexplored.

Bibliometric studies map existing concepts, indicating the main trends in scientific research and the main dental methods and tools used.^10,11 These analyses allow researchers to identify patterns, assess influential indicators, recognise leading authors, evaluate prominent journals, and highlight countries with the most significant research output. Additionally, bibliometric analysis enables the visualisation of collaborative networks between researchers.¹² Although bibliometric studies have been conducted in several fields of dentistry,^13–16 no studies to date have specifically focused on the use of CBCT in paediatric dentistry. In light of this gap, the aim of this study was to conduct a bibliometric analysis to provide a comprehensive panorama on the scientific landscape of CBCT on paediatric dentistry and to guide future clinical and research developments.

Methods

This study complies with the Guideline for Reporting Bibliometric Reviews of Biomedical Literature (BIBLIO)¹⁷ and follows a rigorous standard of data collection and analysis.^17,18

A literature review was conducted to identify studies using CBCT in paediatric dental patients. The search covered publications up to February 2024, with no restrictions on language or publication year. The bibliographic search was conducted in the Web of Science - Core Collection (WoSCC) database, using the following search strategy: [TS=(“Cone-Beam Computed Tomography” OR “Cone Beam Computed Tomography” OR CBCT OR “Computed Tomography, Cone-Beam” OR “Cone Beam Computed Tomography” OR “CT Scan, Cone-Beam” OR “CT Scan, Cone Beam” OR “CT Scans, Cone-Beam” OR “Cone-Beam CT Scan” OR “Cone-Beam CT Scans” OR “Scan, Cone-Beam CT” OR “Scans, Cone-Beam CT” OR “Tomography, Cone-Beam Computed” OR “Tomography, Cone Beam Computed” OR “CAT Scan, Cone-Beam” OR “CAT Scan, Cone Beam” OR “CAT Scans, Cone-Beam” OR “Cone-Beam CAT Scan” OR “Cone-Beam CAT Scans” OR “Scan, Cone-Beam CAT” OR “Scans, Cone-Beam CAT” OR “Cone-Beam Computer-Assisted Tomography” OR “Computer-Assisted Tomography, Cone-Beam” OR “Cone Beam Computer Assisted Tomography” OR “Tomography, Cone-Beam Computer-Assisted” OR “Cone-Beam Computerized Tomography” OR “Computerized Tomography, Cone-Beam” OR “Cone Beam Computerized Tomography” OR “Tomography, Cone-Beam Computerized” OR “Cone-Beam CT” OR “CT, Cone-Beam” OR “Cone Beam CT”) AND ((“Paediatric Dentistry” OR “Dentistry, Paediatric” OR “Paediatric Dentistry” OR “Dentistry, Paediatric”) OR (child* OR schoolchild* OR “school child*” OR adolescen* OR juvenil*) OR (“tooth, deciduous” OR “deciduous tooth” OR “deciduous teeth” OR “milk teeth” OR “milk tooth” OR “primary teeth” OR “primary tooth” OR “primary dentition”))]. Two researchers independently conducted the study selection process, and a third author was consulted in the event of disagreements. Studies were only included when all the reviewers reached a consensus. Studies that were not research articles (such as conferences or editorials) and did not use CBCT in paediatric dental patients were excluded.

For each article, data was collected such as number and density of citations (number of citations per year), year of publication, journal impact factor (JIF), study design, theme (main objective of the study), country and continent, institution (based on the corresponding author), authors and keywords. The study designs were categorized as systematic review, interventional, observational, case report or series, literature review and laboratory study. Considering the theme, the studies were grouped considering the central outcomes of each study. Themes that were reported in only one study were grouped under “other”.

The selected articles were entered into the VOS Viewer software (version 1.6.18) (https://www.vosviewer.com) to create visual representations that show collaboration between authors and keywords. Words associated with the most prominent foci indicate greater frequency, while words of the same color and linked together form networks, highlighting more intense collaboration between studies. The correlation between the number of citations, the year of publication and the journal’s impact factor was explored using SPSS for Windows statistical software (SPSS, version 24.0; IBM, Armonk USA Corp). The Kolmogorov-Smirnov test was used to verify the normality of the data distribution, and Spearman’s correlation test was used due to the non-normal distribution. As an alternative, Microsoft Office Excel can be used to carry out these statistical calculations (normality test and correlation), with the relevant database provided in the Data Availability section.¹⁹

Results

The literature search identified a total of 1,147 records. After the selection process, 517 articles were included for bibliometric analysis. Of the articles not included, two were editorials, three were from conferences, and the remaining (n=625) were excluded because they did not address the objective of the study.¹⁹

The selected articles accumulated a total of 7,538 WoSCC citations. Of these, 896 were self-citations (11.53%). The average number of citations per year was 396.7. The most cited article on WoSCC was “Effective dose of dental CBCT-a meta-analysis of published data and additional data for nine CBCT units”, with 257 citations, published in Dentomaxillofacial Radiology.²⁰ Spearman’s correlation revealed a weak positive correlation between the number of citations and the journal’s impact factor (rho=0,272; p<0.001) and a strong negative correlation between the number of citations and the year of publication (rho=-0.762; p<0.001).

The articles were published between 2005 and 2024, spanning 19 years. The earliest publications date back to 2005,⁷ while the most recent, up to February 2024, total two.^21,22 The year with the highest number of publications was 2023, with 71 articles indicating a recent and significant interest in research related to this topic. The distribution of the number of publications over the years can be seen in Figure 1.

Figure 1. Distribution of the number of publications over the years.

The most frequent journals that published articles on the use of CBCT in paediatric dental patients are shown in Table 1. The American Journal of Orthodontics and Dentofacial Orthopedics (n=69) was the most prominent journal, followed by Angle Orthodontist (n=30) and Dentomaxillofacial Radiology (n=23). According to Journal Citation Reports, the journals with the highest IF in 2022 linked to this study were the Journal of Dental Research (IF 7.7; 1 occurrence), European Radiology (IF 5.9; 2 occurrences) and the International Endodontic Journal (IF 5.0; 1 occurrence), all contributing one article each.

Most of the articles were observational studies (n=352), followed by laboratory studies (n=54), case reports or series (n=39), interventional studies (n=41), literature reviews (n=20) and systematic reviews (n=11). About the themes of the selected studies, the majority of studies used CBCT to plan and assess maxillary expansion (n=87), followed by aid in endodontic diagnosis and treatment (n=39) and to aid in the diagnosis and treatment of cleft lip and/or palate (n=38). Table 2 lists the different themes with their respective study designs and the year in which the articles were published.

A total of 52 countries contributed to the articles related to the use of CBCT in paediatric dental patients. Considering the number of publications per country, the most prevalent were the USA (n=64), China (n=63), Turkey (n=55), South Korea (n=37) and Brazil (n=36). Among the continents with the most articles, Asia stands out (n=232), followed by Europe (n=144) and North America (n=80). The worldwide distribution of publications can be seen in Figure 2.

Figure 2. Worldwide distribution of the use of CBCT in paediatric dental patients.

Through the data contained in the corresponding authors of the selected studies, 301 different institutions were identified. The University of Alberta (Canada) was the institution with the largest number of documents (n=11). Table 3 shows the top 10 institutions.

The authors with the highest number of articles were Jacobs R (n=19), Lagravere MO (n=16) and Sekerci AE (n=14). Figure 3 highlights the collaboration and the main groups of authors, while Table 4 shows the 10 authors with the highest number of publications.

Figure 3. Description and collaboration between the main authors.

A total of 1,841 keywords were identified. The most prevalent was “children” (n=118), followed by “CBCT” (n=85) and “cone-beam computed tomography” (n=83). Figure 4 shows the most prevalent keywords (5 or more occurrences) and the collaborative relationships between them.

Figure 4. Description and collaboration between the main keywords.

Discussion

In paediatric dental patients, CBCT plays a crucial role in diagnosing oral conditions such as dental fractures and bone lesions.⁴ In addition, it serves as an essential tool in planning procedures such as maxillary expansion and correction of nasopalatine clefts.²³ This study identified the main applications of CBCT in paediatric dental patients, analysed the profile of publications related to this topic and discussed possible future trends for research in this field. The results revealed that the emphasis is predominantly on observational studies, concentrating on the diagnosis and planning of patients with maxillary atresia who require expansion procedures.

Conclusions

This bibliometric review provided an overview of the current state and trends in research into the use of CBCT for dental purposes in children and adolescents. An important finding was the greater research interest in Asia and Europe. Although the oldest article was published 19 years ago, there has been substantial growth in this area in the last four years, with an emphasis on observational studies aimed at assessing maxillary expansion. It is important to note that most of these studies were published in the American Journal of Orthodontics and Dentofacial Orthopedics, with the United States and China being the most frequent origins of these contributions. This panorama reflects not only the significant advance in research involving CBCT in paediatric dental patients but also points to a geographic distribution that highlights interest and scientific production in this specific area.

Ethics and consent

Ethical approval and consent were not required.