ADA updates guidance on appropriate use of dental imaging

Dental Tribune International

Wed. 21 January 2026

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CHICAGO, US: The American Dental Association (ADA) has issued updated recommendations on dental imaging, reinforcing that radiographs and CBCT scans should be used judiciously based on clinical indication rather than routinely. For the first time, the guidance integrates patient-selection recommendations for both 2D and 3D imaging, marking the first major update in more than a decade. For clinicians, it underscores a shift towards judgement-led, patient-specific imaging decisions grounded in clinical findings and risk assessment.

The evidence-based recommendations place renewed emphasis on the clinical examination as the starting point for all imaging decisions, supported by a careful review of medical and dental history and any existing radiographs. Imaging is positioned as an adjunct to diagnosis and treatment planning, not a screening tool, and clinicians are encouraged to avoid duplicate imaging examinations or obtaining imaging for convenience rather than clinical need. To that end, the guidance promotes tailoring imaging frequency and modality to individual patient risk, age and disease status.

For caries detection and endodontic assessment, intra-oral 2D radiographs remain the primary imaging modality, and guidance is provided on specific views according to anatomy and suspected pathology. Panoramic radiography is recommended as the initial imaging option for orthodontic assessment, evaluation of dental development, and assessment of third molars and supernumerary teeth when clinically indicated, but routine radiographic screening in the absence of clinical indications is discouraged. In periodontal care, the ADA confirms that comprehensive clinical examination supported by a full-mouth 2D radiographic series provides an appropriate baseline and that subsequent imaging should be guided by disease progression and treatment response rather than fixed schedules.

CBCT is reserved for clearly defined clinical scenarios in which additional anatomical detail is required and cannot be obtained using lower-dose imaging. These include complex implant planning, inconclusive findings, endodontic retreatment and selected cases involving trauma. Across all indications, clinicians are reminded to apply dose-reduction strategies and to ensure that the anticipated diagnostic or therapeutic benefit outweighs the associated radiation exposure.

Speaking in an ADA press release, lead author of the new recommendations Dr Erika Benavides, clinical professor in the Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry in Ann Arbor, in the US, stated: “Dental imaging is an important diagnostic tool that can help improve oral and overall health outcomes when used appropriately. You wouldn’t get an X-ray of another part of your body unless the doctor believed there was reason to order one after an examination. Similarly, dental X-rays should be ordered only after first examining the patient’s medical and dental histories, prior X-ray images and current clinical exam findings.”

The newly published guidelines are the second of two publications addressing the optimal use of diagnostic imaging in dentistry. The first set of recommendations, published in 2024 in the Journal of the American Dental Association, focused on radiation safety and regulatory issues

Overall, these consensus recommendations reinforce a patient-centred approach to dental imaging, offering clinicians a structured framework to support high-quality decision-making while maintaining responsible radiation stewardship in everyday practice.

The guidelines, titled “American Dental Association and American Academy of Oral and Maxillofacial Radiology patient selection for dental radiography and cone-beam computed tomography”, were published in the January 2026 issue of the Journal of the American Dental Association.