CBCT technology has transitioned from specialty-only equipment to general practice consideration. Current systems range from $40,000 to $150,000, with expanding clinical applications justifying investment for practices meeting specific volume thresholds.

Evidence-Based Clinical Indications

The American Academy of Oral and Maxillofacial Radiology publishes clinical guidelines for CBCT use. Established indications include: implant planning and placement, evaluation of impacted teeth, assessment of pathology extent, endodontic diagnosis of complex anatomy, and TMJ evaluation.

Emerging applications include airway assessment for sleep apnea screening, orthodontic treatment planning, and guided endodontics. A 2025 study in the Journal of Endodontics found CBCT identified missed canals in 24% of teeth with persistent apical periodontitis, changing treatment planning significantly.

Radiation Dose Considerations

Modern CBCT systems deliver effective doses of 30-100 microsieverts for limited field-of-view scans—comparable to 2-6 periapical radiographs. Large field-of-view scans range from 150-300 microsieverts, still substantially less than medical CT scans.

The ALARA principle (As Low As Reasonably Achievable) requires justification for each CBCT scan. Practices should establish protocols ensuring CBCT is used when 2D imaging is insufficient and clinical benefits outweigh radiation risks.

Financial Analysis

ROI calculation requires estimating scan volume, reimbursement rates, and operational costs. Medicare reimburses CBCT at approximately $150-250 per scan depending on field of view and geographic location. Private insurance reimbursement varies but typically ranges from $100-300.

A practice performing 8-10 scans monthly at $200 average reimbursement generates $19,200-24,000 annually. With equipment costs of $60,000 (mid-range system), 5-year financing at 6% yields monthly payments of approximately $1,160. Break-even requires 6-7 scans monthly at these rates.

Integration and Workflow

DICOM compatibility ensures CBCT integration with practice management and imaging software. Cloud-based viewers eliminate the need for expensive workstations, though diagnostic interpretation still requires appropriate training.

Practices should budget for staff training (typically 8-16 hours) and consider radiology reading services for complex cases. Several companies offer remote interpretation by board-certified oral radiologists for $50-100 per scan.

Purchase Considerations

Field of view requirements depend on clinical applications. Limited FOV systems (5x5cm to 8x8cm) suffice for endodontics and single-tooth implants at lower cost. Medium FOV (10x10cm to 13x13cm) accommodates most general practice needs. Large FOV is rarely necessary outside specialty practices.

Voxel size affects image resolution and radiation dose. Systems offering 0.075-0.15mm voxels balance diagnostic quality with reasonable scan times and doses. Practices should evaluate multiple systems with actual patient scans before purchasing.