Cone Beam Computed Tomography in Oral Cancer: A Review of Bone Invasion Radiomics, and Artificial Intelligence

Vollständiger Abstract

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Cone beam computed tomography (CBCT) is prevalent in maxillofacial imaging due to its high-resolution bone detail and quick, chairside operation that generally exceeds conventional CT in radiation dose efficiency. However, recent clinical claims about its effectiveness in oral squamous cell carcinoma (OSCC) are not fully supported by physics. Current verified literature (up to June 2026) clarifies that CBCT should be reserved for secondary purposes like bone invasion evaluation, surgical planning, and radiotherapy, and not as a primary tool for mucosal screening. Although it can match CT and MRI in detecting cortical erosion in very specific cases, it cannot identify early dysplasia or superficial OSCC because of its poor soft tissue contrast and unreliable gray scale values. While artificial intelligence and radiomics show potential for automated radiotherapy guidance, their validation remains insufficient, keeping MRI as the gold standard for assessing marrow infiltration and perineural spread.