CBCT or panoramic X-ray: how they differ, when each is used and how much radiation a dental CT scan gives

How does a panoramic X-ray differ from a CBCT scan?

A panoramic X-ray and a CBCT scan differ above all in the number of dimensions. A panoramic X-ray (orthopantomogram) is a single flat image showing all the teeth, the roots and the bones of the upper and lower jaw, laid out like a map. Cone beam computed tomography (CBCT) takes a series of images around the head and assembles them into a three-dimensional image, which the dentist views slice by slice, in any plane.

A panoramic X-ray answers the question of what is happening in the whole mouth. CBCT answers the question of exactly what a specific site looks like: how much bone there is for an implant, where the nerve canal runs in the lower jaw, how many canals a root has and whether it is fractured. On a flat image structures overlap; on a CT scan they can be separated.

CBCT is not the same as the computed tomography done in hospital. A dental cone beam scanner covers a smaller area and usually gives a clearly lower dose than medical CT of the jaws.

How much radiation does a dental CT scan give compared with a panoramic X-ray?

A dental CT scan usually gives a dose several times higher than a panoramic X-ray, but both are measured in microsieverts (µSv), thousandths of a millisievert. According to European guidelines, the typical effective dose of a panoramic X-ray is 2.7 to 24.3 µSv, of small and medium field CBCT 11 to 674 µSv (median 61 µSv), and of large field CBCT 30 to 1,073 µSv (median 87 µSv) (European Commission, Radiation Protection 172, 2012).

The spread is wide, because the dose depends on the machine, the field size and the settings. A 2015 meta-analysis reports for adults an average of 84 µSv with a small field, 177 µSv with a medium field and 212 µSv with a large field, and for children an average of 103 µSv with a small field (Ludlow et al., 2015). That is why the smallest practical field is chosen, covering only the area needed.

For comparison: natural background radiation in Poland gives an average of 2.55 mSv a year, about 7 µSv a day (Poland's National Atomic Energy Agency, 2025). We calculated the last column of the table from this value; it is an approximation for typical doses, not a measurement of a specific machine.

When is a panoramic X-ray enough?

A panoramic X-ray is enough when the dentist needs an overview of the whole mouth: at the first visit, when planning treatment of many teeth, before prosthetic treatment, and when assessing wisdom teeth and the buds of permanent teeth in children. One image shows larger cavities, lesions at the root tips, impacted teeth and bone loss.

For wisdom tooth removal, a panoramic X-ray is the first-choice examination. According to European recommendations, CBCT is not a routine examination here: it is taken only when the surgeon has a specific question that a flat image cannot answer, for example when the panoramic X-ray shows the root in close contact with the nerve canal in the lower jaw (EADMFR, 2019).

For details of a single tooth, such as assessing the canals during treatment or decay between teeth, the dentist usually turns to an intraoral X-ray. It covers a small area but shows it more sharply, at a very low dose.

When is a CBCT scan needed?

A CBCT scan is needed when the answer depends on the third dimension and a flat image cannot provide it. It is not a screening test: the American endodontic and oral radiology societies state that CBCT should not be used routinely, only for a specific indication (AAE and AAOMR, 2015).

A CT scan shows more, but more findings do not always mean less risk. In a study of 379 lower wisdom teeth assessed on both types of image, changes around the tooth were seen more often on CBCT, and on that basis more teeth would have been put forward for removal (Matzen et al., 2017), so the decision on the scan rests with the dentist, who knows what question it is meant to answer.

• Implant planning: bone height and width, the position of the nerve canal in the lower jaw and of the floor of the maxillary sinus.
• Root canal treatment with unclear symptoms, complex root anatomy or calcified canals.
• Failed root canal treatment and the planning of retreatment or an apicoectomy.
• Suspected vertical root fracture, dental injuries and root resorption.
• An impacted tooth whose root touches the nerve canal on the panoramic X-ray, if a 3D image would change the surgical plan.

Is a dental CT scan safe?

A dental CT scan taken for a justified indication gives a dose usually equivalent to days or weeks of natural background radiation. Safety in radiology, however, is not only about the dose being small but about every image being justified: it is taken when the result can change a treatment decision, and with as low a dose as possible.

That is why there is no single answer to how often a panoramic X-ray or a CT scan can be taken. The indication is decided by the dentist on the basis of the examination, earlier images and the treatment plan. If you have recent images from elsewhere, bring them to the visit, because they sometimes make a repeat unnecessary.

Are panoramic X-rays and CBCT covered by the NFZ?

A panoramic X-ray is covered by the NFZ, with restrictions, while CBCT is not included in the NFZ list of dental services. Adults are covered for a panoramic X-ray for the purposes of root canal treatment, and every patient before prosthetic treatment, no more than once every 5 years (Ministry of Health regulation, Dz.U. 2025 item 615).

The current text of the regulation requires a panoramic X-ray for an adult to be referred by a specialist or a doctor in specialist training, and the referring doctor justifies the need for the examination in the referral. Children and young people aged 5 to 18 are covered for a panoramic X-ray when it is medically justified, once every 3 years.

Intraoral X-rays under the NFZ are limited to 2 per calendar year for adults and 5 for children and young people. The law is stated as at 12 October 2026.

How much do a dental CT scan and a panoramic X-ray cost?

The price of a dental CT scan depends mainly on its extent: whether the image covers one jaw or both. A panoramic X-ray has one fixed price, and intraoral X-rays are charged per image.

In the clinic's price list, a CT scan of the upper or lower jaw costs 300 zł and of both jaws 350 zł. A panoramic X-ray is 120 zł, a sectional panoramic X-ray 60 zł, an intraoral X-ray 60 zł, a cephalometric X-ray 120 zł and a sinus X-ray 100 zł. A panoramic X-ray is also part of the first visit, with or without pain. The dentist decides which examinations are needed, and prices may change.

What happens during the scan and how do you prepare?

A dental X-ray, including a CBCT scan, needs no special preparation and you do not have to fast, because it is taken without contrast. The examination is short, and the patient stands or sits still in the machine.

• Remove earrings, glasses, hair clips, chains and removable dentures, because metal casts shadows on the image.
• Tell the team if you are pregnant or cannot rule it out: the dentist will judge whether the image is needed now or can wait.
• Bring earlier images if you have them, including on a disc or as a file.
• Keep still and breathe calmly during the exposure, because movement blurs the image and may mean a repeat.

How it works at DentalBlue

DentalBlue in Białystok has its own radiology unit, where CBCT scans, panoramic X-rays, cephalometric X-rays, sinus X-rays and intraoral X-rays are taken, so there is no need to go anywhere else for an image. A panoramic X-ray is part of the first visit, with or without pain. Implants are planned on a CBCT image from this unit, and CT is also used in root canal treatment under a microscope and before surgical procedures, when the dentist considers it necessary.