Attitudes and perceptions of Albanian dentists regarding the advantages of CBCT over panoramic radiography

Material and methods

This cross-sectional study was conducted from June to August 2025. A convenience sampling approach was employed, including both general practitioners (GPs) and specialists with varying years of work experience. Efforts were made to include participants from diverse clinical settings to enhance the representativeness of the sample.

In accordance with the ethical standards of the Declaration of Helsinki, the study was approved by the Ethics Committee of Albanian University (ref.). no. 331, dated 21.05.2025.

The questionnaire used was developed after an extensive literature review [6,14,16–17].

It consisted of 18 questions addressing:

1. Demographic (gender, age, work experience, specialty, and practice type);
2. Attitude and perception of CBCT

The statistical analyses were performed using SPSS 26. Categorical variables were summarized as frequencies and percentages. Percentage data were converted to absolute frequencies using the total sample size (n = 209) to enable accurate estimation of effect sizes. Associations between GPs and specialists were initially assessed using the chi-square test. For effect size estimation, binary logistic regression comparisons were conducted, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Variables with more than two response categories were dichotomized (e.g., “Yes” versus “No”), and responses such as “I don’t know” were excluded from these analyses to minimize misclassification bias.

Statistical significance was set at p < 0.05.

Results

Of the 218 returned questionnaires, 209 were correctly filled out and included in the study. Pertinent results by sample demographics are shown in Table 1. 58% of the questionnaires received were from female dentists. Almost half of the sample (50.3%) belongs to the 35–45 age group. The more representative with respect to work experience were those with 10–20 years (53.8%). 62.8% were GP. Among dental specialists, 18% were oro -maxillo-facial surgeons (OMF) and 14.6% orthodontists. More than half of the respondents work in their own private practice.

Relevant answers to attitude and perceptions are shown in Table 2. Of the participants, 47.5% prescribed CBCT, and 41.5% reported interpreting themselves. As for the source of knowledge on CBCT use, 38% received knowledge during postgraduate (PG) specialization studies. For questions aimed at assessing their awareness of radiation safety, 68% responded that CBCT delivers higher radiation compared to PR, 23% knew the meaning of ALADAIP, and 31% knew FOV.

The results comparing GP and specialist are depicted in Table 3. Specialists were more likely to recognize the advantages of CBCT than GPs (OR = 1.43, 95% CI: 0.58–2.84). Specialists also showed slightly higher awareness regarding radiation dose reduction in pediatric patients (OR = 1.36, 95% CI: 0.58–2.68). Although a slightly lower likelihood of CBCT as first choice was observed among specialists, the association was not statistically significant (OR = 0.79, 95% CI: 0.38–1.41).

When compared by work experience (Table 4), a significant difference was observed in knowledge of the advantages of CBCT over PR (p=0.019). CBCT, as the first choice, was more prevalent among those with 5–10 years’ work experience, with no significant change across groups. Self-interpretation was more frequent among those with 10–20 years of work experience (27.5%) but was not statistically significant.

Discussion

This survey study among Albanian dentists aimed to assess their attitudes and perceptions regarding the advantages of conebeam computed tomography (CBCT) compared with panoramic radiography (PR). Overall, the results indicate that the participants demonstrated a good understanding and positive perception of the advantages of CBCT use.

Of the 205 participants, 47.5% reported referring patients for CBCT examinations, a lower rate than reported in previous studies (92%, 93%, and 94.7%) [17–19]. Rather than suggesting underutilization, this lower referral rate may reflect prudent clinical decision-making, minimizing unnecessary patient exposure to ionizing radiation [13]. Previous research has highlighted the risks of using CBCT as a first-choice imaging modality. Uvarichev et al. reported that 40% of dentists believed CBCT should be performed even when sufficient clinical and conventional radiographic data were available, and 44% supported its use as a screening tool before clinical examination [17]. In the present study, a similar tendency to consider CBCT as a first-line investigation was observed among dentists with 5–10 years of experience, though this association was not statistically significant. Similar findings from dentists in Thessaloniki have been attributed to limited clinical experience and resulting diagnostic insecurity. In contrast, Lithuanian dentists have shown that younger practitioners may be more inclined to adopt novel technologies [13,20].

Although CBCT provides superior diagnostic detail, it exposes patients to higher radiation doses than PR; hence, patient protection from radiation exposure remains essential. Doses must be kept as low as reasonably achievable (ALARA) [21]. This principle was further refined as Low as Diagnostically Acceptable, Indication-oriented, and Patient-specific (ALADAIP), which, according to Oenning et al. [22], emphasizes two key questions before prescribing CBCT: why is the examination needed, and who is the patient? Recent studies have shown that dentists have insufficient knowledge regarding appropriate CBCT use and radiation safety [6]. Identifying gaps in knowledge and training in dental imaging is essential to ensure the safe use of ionizing radiation [11, 16]. In this regard, the present study indicates limited awareness among participating dentists regarding methods to minimize radiation exposure. Although a majority of participants (68%) correctly identified that cone-beam computed tomography (CBCT) delivers higher radiation doses than panoramic radiography (PR), this knowledge alone did not appear to influence their understanding of radiation dose reduction, as indicated by their years of clinical experience. The lack of a significant association with work experience suggests that prolonged clinical practice does not necessarily enhance awareness of radiation protection principles.

Additionally, limited awareness of minimizing radiation dose is evident, as only 23% of participants were aware of the meaning of ALADAIP and 31% of FOV. Further, 42.5% of participants were prescribed CBTC at pediatric ages. The existing literature agrees on the need to carefully evaluate the clinical situation in children, justifying CBCT prescription in cases that cannot be accurately diagnosed with PR [23–24]. Without impacting the diagnostic accuracy of CBCT, reducing FOV allows children to receive minimal achievable doses [25–26].

CBCT cannot be considered an effective diagnostic modality unless the information it generates is interpreted accurately and systematically, as its diagnostic efficacy depends not only on the quality of image acquisition but also on the clinician’s expertise in the critical analysis and appropriate clinical application of the radiographic data [7,27]. In line with a previous study [16], fewer than half of the dentists in this study were able to interpret CBCT images independently. In contrast, Cheung et al. [28], in their study, found that the majority of participants stated their self-interpretation. Nevertheless, according to them, the concern arises from the unexpected finding that a small number of clinicians in this study preferred to have their CBCT scans interpreted by staff members who were not qualified dentists. Concerns regarding the interpretation of CBCT images by unqualified personnel are reflected in our results, as 54% of participants indicated a preference for interpretations provided by a radiologist. In Albania, there is currently no structured or specialized training program in dentomaxillofacial radiology, raising questions about the quality and accuracy of CBCT interpretations provided by general radiologists. A variety of factors influence the effective utilization of CBCT in dental practice. In particular, a thorough understanding of normal anatomic variations and the radiographic manifestations of pathological changes in the dental and supporting structures is essential for accurately distinguishing true anatomical features and pathological findings from imaging artifacts [29]. Hence, only an adequately trained dentist can reliably interpret dental radiographs and arrive at an accurate diagnosis [19].

Evidence suggests that practitioners’ knowledge of CBCT remains below average, underscoring the need for structured education and targeted training programs to ensure its appropriate and effective clinical use [15,30]. The comparison between general practitioners and specialists revealed only modest differences in CBCT-related knowledge and attitudes. Although specialists were more likely to recognize the advantages of CBCT, this association was not statistically significant, and the effect size was limited. A similar pattern was observed regarding awareness of radiation dose reduction in pediatric patients, with specialists showing slightly higher awareness but without a meaningful magnitude of association. These findings are consistent with previous studies reporting variability in CBCT knowledge among dental practitioners, often influenced by differences in education and training [6,13,18,27].

There are limitations to consider in this study. Due to the uneven distribution of participants across different dental specialties, separate analyses by specialty were not feasible. As with all survey-based studies, the results may be influenced by biases. Selection and response biases could affect the representativeness of participants’ knowledge and attitudes.

Conclusion

Albanian dentists recognize CBCT as a more accurate diagnostic tool than PR; however, its safe and effective use is limited by gaps in interpretation skills and radiation safety awareness. Targeted education and training programs are essential for strengthening clinicians’ competencies and ensuring the reliable clinical application of CBCT in dental practice.

Conceptualization

A,Th; R,I; Validation G.E; E.K; Data curation: A.Th; E.K; Writing-Preparation of the original draft A.TH; G,F; Writing- Review and supervision R.I; A.TH

Funding

None

Conflict of Interest

“The authors declare no conflict of interest.”