Assessment of knowledge and attitude pertaining to cone-beam computed tomography (CBCT) among dental health professionals in Maharashtra: A cross-sectional study

Amol Dhokar; Venetia Aranha; Aishwarya Bodhare; Vanshita Desai; Sunanda Bhatnagar; Nikhil Bhanushali

doi:10.4103/jnam.jnam_8_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 1 | Issue : 2 | Page : 65-71

Assessment of knowledge and attitude pertaining to cone-beam computed tomography (CBCT) among dental health professionals in Maharashtra: A cross-sectional study

Amol Dhokar¹, Venetia Aranha¹, Aishwarya Bodhare², Vanshita Desai¹, Sunanda Bhatnagar¹, Nikhil Bhanushali²
¹ Department of Oral Medicine, Diagnosis and Radiology, T.P.C.T.’s Terna Dental College, Navi Mumbai, Maharashtra, India
² Department of Public Health Dentistry, T.P.C.T.’s Terna Dental College, Navi Mumbai, Maharashtra, India

Date of Submission	23-Mar-2022
Date of Acceptance	03-May-2022
Date of Web Publication	27-Dec-2022

Correspondence Address:
Vanshita Desai
Department of Oral Medicine, Diagnosis and Radiology, T.P.C.T.’s Terna Dental College, Navi Mumbai 400706, Maharashtra
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnam.jnam_8_22

Abstract

Background: CBCT, the modern 3D imaging equipment, eases the intricacies of dental diagnosis. Aims: Our study aimed at assessing the knowledge and attitudes regarding Cone-beam computed tomography (CBCT) among dentists in Maharashtra. Subjects and Methods: A cross-sectional study design was conducted by administering an online questionnaire consisting of 17 questions to the dentists of Maharashtra. The online survey was distributed through Google forms shared on different social media platforms, emails and websites. SPSS version 17 software and Chi-square test was employed. Results: About 91.2% MDS were aware of the use of CBCT for dentomaxillofacial region. Approximately 77.7% general practitioners use digital imaging modality. 70.6% BDS refer patients for CBCT in their daily practice. Greater number of BDS (88.5%) than MDS (79.4%) are satisfied with the use of CBCT. Dentists with more than 10 years of practice (60%) agreed higher on utilization of CBCT in the future for selected dental applications than those with less than 10 years of practice (37.4%). A statistically significant difference with P <0.05 was revealed. Conclusion: Fostering cognizance and positive attitudes among dentists towards CBCT, would tremendously boost the present-day dental diagnosis. Its promotion through optimal hands-on sessions, workshops would aid in its efficient application.

Keywords: Computed tomography, cone-beam computed tomography, dental, diagnosis, radiography

How to cite this article:
Dhokar A, Aranha V, Bodhare A, Desai V, Bhatnagar S, Bhanushali N. Assessment of knowledge and attitude pertaining to cone-beam computed tomography (CBCT) among dental health professionals in Maharashtra: A cross-sectional study. J Niger Acad Med 2022;1:65-71

How to cite this URL:
Dhokar A, Aranha V, Bodhare A, Desai V, Bhatnagar S, Bhanushali N. Assessment of knowledge and attitude pertaining to cone-beam computed tomography (CBCT) among dental health professionals in Maharashtra: A cross-sectional study. J Niger Acad Med [serial online] 2022 [cited 2023 Jun 9];1:65-71. Available from: http://www.jnam.com/text.asp?2022/1/2/65/365604

Introduction

Cone-beam computed tomography (CBCT), a sub form of traditional computed tomography (CT), is an emerging modality that uses a three dimensional, accurate imaging method for scanning hard tissue structures.^[1] CBCT when compared to conventional CT scanners curtails the effective radiation dose up to 98%.^[2] In India, the spiraling demand of CBCT has expanded the domain of dental diagnosis and treatment opportunities for many patients. Strikingly, a detailed literature search revealed that there were extremely few studies published regarding the knowledge and attitude among the Indian dentists towards CBCT. The main objection of our research is to explore and assess the knowledge and attitude among the dentists in Maharashtra with respect to CBCT.

Materials and Methods

This research utilized an observational, cross-sectional study design and was conducted in accordance with the Strengthening the Re- porting of Observational Studies in Epidemiology (STROBE) guidelines^[3] to collect the data from dental professionals in Maharashtra. This study lasted for 5 months.

The participating dental professionals included the academicians as well as the practicing dentists in Maharashtra, who were willing to give their consent and those that had access to the online survey. The professionals unwilling to respond along with those that responded after the set duration of the study were excluded.

The questionnaire was pretested by taking a pilot survey on 30 randomly selected dental professionals (excluded in the final sample) to check for the flaws and feasibility of the study. The questionnaire comprised 17 questions, out of which 2 were demographic, 5 were based on knowledge regarding CBCT and 10 were pertaining to their attitude towards CBCT. The psychometric properties of these questions were analyzed for reliability (by using the Cronbach α test which gave a value of 0.7) and also for face and content validity.

Based on the pilot study, a sample frame of 370 was derived using the G* power statistical software version 3.1.9.2. Out of the final samples only 336 (18 were unable to access, 16 did not consent to participate in the study) participated. An online survey was shared via Google forms to all the potential dentists on various social media platforms, emails and websites. The sampling technique applied was convenience sampling.

The data derived from the questionnaire was coded with the help of Statistical Package for Social Sciences (SPSS) (version 17) software. Shapiro–Wilk’s test/Kolmogorov–Smirnov test was used to assess the normality of the data prior to analysis. Descriptive analysis through frequency distribution was established followed by applying the Chi-Square test. A p-value of less than 0.05 was considered significant for this study. Some questions had multiple choices to choose from; therefore the sum total of percentages is not always 100%

Results

The study obtained 336 responses from the pretested questionnaire distributed via Google links. With the aid of mandatory fields, partial responses were automatically rejected. Out of 336 dentists, 71.9% BDS and 28.1% MDS use digital imaging modality in their routine practice [Figure 1]. In regard to the attitude among dental health professionals concerning the application of CBCT in assessing tumors and cyst were more in MDS (11.8%) than BDS (3.8%) [Table 1]. The awareness regarding benefits of CBCT was compelling as half of the general practitioners (55.2%) responded positively to the advantages of CBCT being less radiation exposure, easy data storage, no processing required, and short time while 38.5%. general academicians also expressed the same [Table 2]. A significant difference (P <0.05) was observed between both the groups. More than half of the general academicians (61.5%) and 1/8^th (12.1%) of general practitioners considered less radiation to be the advantage of CBCT.

Figure 1: Attitude among dentists about the use of digital imaging modality

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Table 1: Attitude among dental professionals regarding the application of Cone-beam computed tomography (CBCT) in their prospective career

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Table 2: Knowledge among dental professionals regarding the benefits of Cone-beam computed tomography (CBCT)

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In regard to the attitude towards CBCT, general academicians (84.6%) were more content using the digital imaging modality than the general practitioners (78.2%). Males seemed to be largely pleased with the use of digital imaging than the females [Table 3]. 27.1% dentists having less than 10 years of practice deemed the cost of one quadrant imaging between 500–1000 INR while 20% of dentists above 10 years of practice believed the same. A statistically significant difference with P <0.05 was observed between the groups [Table 3]. Dentists above 10 years of practice cited pediatric referrals for CBCT more than those below 10 years of practice with a statically significant P <0.05 [Figure 2] between them. 1.7% males less than 3.7% females responded positively to “evaluation of Impacted teeth” as the major use of CBCT (P <= 0.001). A statistically significant difference was observed between genders in this regard.

Table 3: Attitude among dental professionals regarding digital imaging and Cone-beam computed tomography (CBCT)

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Figure 2: Attitude among dentists regarding the patient referral for Cone-beam computed tomography (CBCT)

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General academicians (100%) have a slightly greater cognizance regarding the application of CBCT in the dentomaxillofacial region than the general practitioners (85.1%), a (P <0.05) significant statistical difference was also noted. Half of the individuals less than 35 years (52.8%) and above 35 years (50%) came across CBCT through seminars while, 60.3% of males and 44.4% females were familiarized about CBCT through seminars [Table 4]. Dentists with <=10 years of practice accounted for 68.2%, who were aware about the availability of CBCT in the vicinity while dentists with >10 years of practice accounted for 40%.

Table 4: Awareness among dental professionals regarding Cone-beam computed tomography (CBCT)

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Discussion

The innumerable benefits and excellent outcomes provided by CBCT in the current years has increased its application worldwide. Being a contemporary, upcoming modality and availability of small units in India; its use is not widely accepted by the dental practitioners till date.^[4] Thereupon, our study examines the knowledge and attitude towards CBCT among dentists in Maharashtra, India; accounting to a total of 336 respondents. An analogous study on dental students’ knowledge and attitude pertaining to CBCT in Turkey, contains similar questions.^[5] This study revealed explicitly that fifth year dental students (DS5) and postgraduates (PGS) were the majority that had heard about CBCT’s application, especially for dental maxillofacial region.^[5]

CBCT scan must be recommended in cases where the potential benefits of treatment planning, treatment outcomes and even diagnosis overweigh the probable risks of increased dose of radiation.^[6] Before recommending a CBCT scan, weighing the risks and benefits should be the law of ethics every clinician should practice.^[7] In our study, clinicians with >10 years of practice responded greater than those with <=10 years of practice (55.1%) that “a single CBCT examination should be justified to demonstrate the benefits outweigh the risks.” Similarly, a greater response was achieved from MDS (76.5%) than BDS (46.2%) regarding the same. However, a statistically significant difference was noted in this group. This signifies that dentists’ with substantial experience and specialization seemed to accurately respond to the imperative ethics associated with the CBCT scan. Among the gender, males (56.9%) were slightly greater than the females (53.7%) that preferred “benefits must outweigh the risks during a CBCT examination” response. Differences among the gender was found to be statistically significant (P <0.05). This implies that male dentists might have had a greater opportunity to attend workshops and establish a higher sense of cognition regarding the use of CBCT in patients.

A review pertaining to CBCT in pediatric dentistry deduced the common indications for the utilization of CBCT in pediatric dentistry have not yet been accurately addressed.^[8] However, this review supported the claim of CBCT’s use in pediatric dentistry on a patient case individual basis when the advantages overweigh the disadvantages. Despite the guidelines of its use, only three research studies published the reasons for referral in pediatric dentistry.^{[9],[10],[11]} Another recent study conducted underscored that the majority of patients referred for trauma cases were the 12 year olds.^[12] Strikingly, more BDS (47.4%) than MDS (5.9%) would recommend CBCT in pediatric dentistry, was our finding. The difference obtained between them was statistically significant. Individuals above 35 years (50%) selected to advise CBCT in pediatric dentistry greater than individuals below 35 years (34%). The difference was statistically significant in the two groups (P <0.05).

Moreover, general practitioners accounted to the majority who had heard about CBCT through seminars [Table 4]. A statistically significant difference was obtained (P <0.05). From this, an inference can be drawn that general practitioners try to update their knowledge by attending seminars and therefore are more likely to learn from them. In the previous study, the majority of the participants acquainted with CBCT through seminars were the PGs (59.6%) as compared to the DS5 (3.3%).^[5] In view of the benefits of CBCT, statistically greater number of MDS than BDS opted for “No processing required” with a statistically significant difference P <= 0.001 [Table 2]. Considering the fact that the MDS deal with more complicated cases on a daily basis than the BDS, it is understandable that they possess a greater knowledge regarding the availability of a CBCT in their surroundings.

In addition, the rapid scan time ranges from 5–40 seconds as compared to panoramic radiography, which is exceptionally advantageous in plummeting the radiographic errors and artifacts, considering patient movement.^[13] Nearly, equal number of males (14.5%) and females (14%) choose short time to be the merit of CBCT. A significant P <0.05 was observed. This signifies that the knowledge between the genders is akin. The effective dose in particular to the model of CBCT apparatus and field of view chosen ranges from 29 to 477 μSv.^{[14],[15],[16],[17],[18]} Dentists’ >=35 years (79.1%) expressed less radiation, short time, easy storage of data, no processing required, and adjustments and measurements possible to be the positives of CBCT; greater than those <35 years (48.4%). Difference was statically significant in this group (P <= 0.001) [Table 2]. When correlated with the preceding study, it illustrated that low dose radiation was the most popular answer for the advantage of CBCT voted by 61.7% of the respondents.^[5]

An engrossing finding was that dentists below 35 years were more satisfied with the application of digital imaging than those above 35 years. This was found to be statistically significant [Table 3]. Several dentists were positive pertaining to the referral of CBCT scan to their patients. Clinicians with less than 10 years of practice suggested more patients for a CBCT scan than those with more than 10 years of practice [Figure 2]. While the BDS indicated more patients to CBCT scan than the MDS [Figure 2]. However no statistical significance was observed in these responses. The cost of CBCT for each quadrant was another question asked, where 27.4% of individuals less than 35 years and 16.7% above 35 years replied with the range being 500–1000 INR. Difference between the groups was found to be statistically significant (P <0.05). Although conventional CT describes 70% root fractures, the high expense and increased radiation exposure confines its use. Due to this, CBCT is currently considered superior to CT by accurately depicting images with high resolution.^[14]

Prospective general dentists and those specializing in the department of oral and maxillofacial surgery, endodontics, prosthodontics, orthodontics, and periodontics need to be fully equipped with this latest advanced 3D imaging technology as they are more likely to utilize it in their future professional career. Our study reported 88.1% general practitioners and 100% general academicians who feel the need of a CBCT unit in a dental institute. This indicates that the general academicians who train the budding young dentists, experience a great necessity of CBCT in their dental schools. The reason might be that inadequate availability of the CBCT facility can restrain the graduating dentists’ knowledge in this regard. Relatively, an equal number of practitioners (51.5%) and academicians (50%) felt the necessity of instilling knowledge of CBCT in the final year of dental school. In the survey among the dental students, an overall low result was obtained from the undergraduate students regarding the awareness of advanced imaging techniques.^[5]

With respect to numerous applications of CBCT such as the assessment of oral and facial structures for orthodontic diagnosis, evaluation of jaws for dental implants, examining temporomandibular joints for osseous degenerative alterations, inspecting the vicinity of the lower third molar and the mandibular canal before extraction, assessing cysts, tumors or any infection in the jaws.^[19] 79.5% BDS exceeded the 47.1% MDS that opined implant dentistry, evaluating impacted teeth, assessing cysts and tumors, orthodontic diagnosis, and cases of tumor to be the applications of CBCT [Table 1]. P <= 0.001 was achieved which was statistically significant. CBCT is majorly employed to examine the accurate position and extension of oral pathologies of the jaw, this allows to plan the treatment outcome with ease.^[19] Half of females than males believed assessment of cyst and tumors in the jaw is well explored by CBCT [Table 1]. A statistically significant difference was observed between the groups (P <= 0.001). The previous study conducted revealed that assessment of cyst and tumors was the second most cited utility of CBCT.^[5] In the same category, 11.8% MDS response was greater than 3.8% BDS response, which showed a significant P <0.001 value. Individuals with more than 10 years of practice also preferred this indication more than those with less than 10 years of practice with a statistically significant P = 0.02, suggesting that they might have been able to assess cysts and tumors more precisely in their careers with CBCT than other radiographic techniques.

In view of the dearth of literature evidence, evaluating the knowledge and attitudes of dental healthcare workers regarding CBCT, this study makes it more relevant to survey. Despite the strengths, few limitations were encountered in our study. Firstly the restricted entry of those dentists that had no online access. Secondly, the study population was bound only to the dental professionals in Maharashtra. Thirdly, the study did not delve in a detailed depth of its clinical efficiency and failed to examine the practical knowledge of the dentists that know how to use it.

Future research can be focused in filling the existing lacunae in terms of clinical utilization, practical efficiency, ease of diagnosis, cost effectiveness and technical aspects of CBCT. A study on a larger population across the country would portray an unequivocal picture about this technology in daily dental practice.

Conclusion

CBCT, a recent tool, has demonstrated promising results and has revolutionized the face of dentistry which further necessitates the cognizance among dentists to use it at its full capacity. Our study concluded that, majority of the participating dentists required a CBCT unit in their dental institution to ease their investigation. Several dentists did express that they would refer patients and broadly apply CBCT scans in the foreseeable future. However, there were several dentists with the opinion that CBCT should be included in the final year of dental education. This infers that future efforts to inculcate and provide continued dental education among the young dentists is the need of the hour. Also, it delineates the enthusiasm and positive attitudes of the dentists towards CBCT. Without an iota of doubt, advocating steps in organizing workshops, seminars and practical sessions in this regard would be immensely beneficial for the dental industry.

Acknowledgement

The authors are thankful to all the participants that contributed to this study.

Ethical considerations

The approval of the study was obtained from the Institutional Ethical Committee of T.P.C.T.’s Terna Dental College (Approval number: TDC/EC/07/2021).

Financial support and sponsorship

Not applicable.

Conflict of interests

There are no conflicts of interests.

References

1.	Kumar M, Shanavas M, Sidappa A, Kiran M Cone beam computed tomography - know its secrets. J Int Oral Health 2015;7:64-8.
2.	Cohnen M, Kemper J, Möbes O, Pawelzik J, Mödder U Radiation dose in dental radiology. Eur Radiol 2002;12:634-7.
3.	Cuschieri S The STROBE guidelines. Saudi J Anaesth 2019;13:31-4.
4.	Ramakrishnan P, Shafi FM, Subhash A, Kumara A, Chakkarayan J, Vengalath J A survey on radiographic prescription practices in dental implant assessment among dentists in Kerala, India. Oral Health Dent Manag 2014;13:826-30.
5.	Kamburoglu K, Kursun S, Akarslan ZZ Dental students’ knowledge and attitudes towards cone beam computed tomography in Turkey. Dentomaxillofac Radiol 2011;40:439-43.
6.	Rios HF, Borgnakke WS, Benavides E The use of cone-beam computed tomography in management of patients requiring dental implants: An american academy of periodontology best evidence review. J Periodontol 2017;88:946-59.
7.	Garib DG, Calil LR, Leal CR, Janson G Is there a consensus for CBCT use in orthodontics? Dental Press J Orthod 2014;19:136-49.
8.	Aps JK Cone beam computed tomography in paediatric dentistry: Overview of recent literature. Eur Arch Paediatr Dent 2013;14:131-40.
9.	Dobbyn LM, Morrison JF, Brocklebank LM, Chung LL A survey of the first 6 years of experience with cone beam Ct scanning in a teaching hospital orthodontic department. J Orthod 2013;40:14-21.
10.	Hidalgo-Rivas JA, Theodorakou C, Carmichael F, Murray B, Payne M, Horner K Use of cone beam CT in children and young people in three United Kingdom dental hospitals. Int J Paediatr Dent 2014;24:336-48.
11.	Suzuki H, Fujimaki S, Chigono T, Yamamura M, Sakabe R, Sakabe J, et al. Survey on the using limited area cone beam CT in pediatric dentistry. Japan J Pediatr Dent 2006;44:609-16.
12.	Van Acker JW, Martens LC, Aps JK Cone-beam computed tomography in pediatric dentistry, a retrospective observational study. Clin Oral Investig 2016;20:1003-10.
13.	Jain S, Choudhary K, Nagi R, Shukla S, Kaur N, Grover D New evolution of cone-beam computed tomography in dentistry: Combining digital technologies. Imaging Sci Dent 2019;49:179-90.
14.	Ludlow JB, Davies-Ludlow LE, Brooks SL Dosimetry of two extraoral direct digital imaging devices: Newtom cone beam CT and orthophos plus DS panoramic unit. Dentomaxillofac Radiol 2003;32:229-34.
15.	Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB Dosimetry of 3 CBCT devices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G and i-CAT. Dentomaxillofac Radiol 2006;35:219-26. Erratum in: Dentomaxillofac Radiol 2006;35:392.
16.	Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB Dosimetry of 3 CBCT devices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G and i-CAT. Dentomaxillofac Radiol 2006;35:219-26.
17.	Mah JK, Danforth RA, Bumann A, Hatcher D Radiation absorbed in maxillofacial imaging with a new dental computed tomography device. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:508-13.
18.	Schulze D, Heiland M, Thurmann H, Adam G Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography. Dentomaxillofac Radiol 2004;33:83-6.
19.	Venkatesh E, Elluru SV Cone beam computed tomography: Basics and applications in dentistry. J Istanb Univ Fac Dent 2017;51:102-21.