Management and prevalence of cone beam computed tomography (CBCT) findings generating external referrals

Objective

A debate regarding the responsibility of reporting all cone beam computed tomography (CBCT) findings exists, including the incidental findings (IFs) outside the region of interest. The possibility of missing a relevant diagnosis needing further investigation needs emphasis. Hence, our study aims to report the most prevalent IF with their management protocol to guide the dental professional in the decision-making and referral processes.

Study Design

Records of patients referred to the Advanced Imaging Centre-School of Dentistry were retrospectively reviewed. CBCT interpretive reports completed by Oral and Maxillofacial Radiologists were analyzed (N = 1260). The radiographic findings were divided into 8 zones on the basis of on their location: (1) airway, (2) temporomandibular joints, (3) cervical vertebrae, (4) bone lesions, (5) teeth, (6) soft-tissue calcifications, (7) paranasal sinuses, and (8) other. Descriptive statistics were used for demographic characteristics and locations of the radiographic finding. Inferential analyses were performed. The frequency and prevalence were determined for each specific finding requiring further investigation using quantitative analysis.

Results

A review of radiographic reports (N = 1260) showed a total of 501 scans with Ifs, which represents 39.7% of the total sample analyzed. The most prevalent radiographic findings outside the areas of interest were found in the cervical vertebrae (18%), followed by the sinuses (15%), temporomandibular joint (8%), jaw lesions (7%), airway (5%), teeth (5%), soft tissue calcifications (5%), and other (1%).

Conclusions

The most prevalent findings requiring referral were carotid atheroma (2.7%), osteoarthritis of cervical vertebrae (0.97%), jaw lesions (0.86%), adenoid hypertrophy (0.86%), and paranasal sinus pathology (0.73%). These entities were further explored, and guidelines were reported to help the dentists in the identification, decision making and referral processes. The management protocol proposed by our study should be used as a guideline for external referrals and follow-ups.