Dual-energy computed tomography: current insights and future perspectives

UPFRONT Dental radiography Dual-energy computed tomography: current insights and future perspectives Since the introduction of cone-beam computed tomography (CBCT) in the late 1990s, this imaging modality has undergone continuous technological advancements aimed at improving image quality, reducing radiation exposure, and minimising artefacts such as motion and beam hardening. CBCT has become an essential imaging tool in dentistry due to its ability to provide highresolution three-dimensional visualisation of oral and maxillofacial structures, thereby supporting a wide range of diagnostic and treatment planning applications.1 Despite these advantages, most currently available CBCT devices operate using a single-energy x-ray beam, producing a constant polyenergetic spectrum during image acquisition. While this ensures stable exposure conditions, it limits the differentiation of materials and tissues with distinct attenuation properties, such as dental restorations and surrounding anatomical structures. Moreover, this approach increases susceptibility to artefacts caused by high-density materials, which may obscure adjacent structures and compromise diagnostic accuracy.1 Dual-energy computed tomography (DECT) has emerged as a promising alternative to overcome these limitations. By acquiring data at two different x-ray energy levels, DECT enables improved differentiation of tissues and materials based on their energy-dependent attenuation characteristics (Fig. 1). This approach supports virtual monoenergetic imaging and material decomposition, resulting in reduced beam-hardening artefacts, improved contrast-to-noise ratio, and enhanced visualisation of anatomical structures.2,3 Although DECT is well established in medical imaging, its application in dentistry, particularly as dual-energy CBCT (DE-CBCT), remains limited and largely confined to research settings. Nevertheless, preliminary evidence suggests that DE-CBCT is a feasible technique. A pilot study demonstrated a strong positive correlation between bone mineral density measurements obtained from DE-CBCT and those derived from multidetector CT (MDCT), supporting its potential as a more accessible alternative to conventional CT imaging.4 Fig. 1 Schematic overview of main dual-energy CT approaches: (A) dual-source, using two x-ray tubes at different kVp; (B) fast kVp switching, with rapid alternation of tube voltage in a single source; and (C) dual-layer detector, in which energy separation occurs at the detector level through multilayer sensors capturing low- and high-energy photons Fig. 2 Representative dual-energy CT reconstructions acquired using the NewTom 7G Dual Energy device (Cefla Dental Group, Imola, Italy). (A) Axial view of the mandible; (B) Coronal view focusing on the mandibular molar region; (C) Sagittal view of the left mandibular molar region; (D , E) Sagittal (D) and coronal (E) views of tooth 43, in which the enamel, dentine, root canal and surrounding alveolar bone can be clearly identified; (F) Axial view of tooth 37 showing an isthmus in the mesial root From a clinical perspective, DECT offers several advantages that may enhance diagnostic performance. Improved tissue characterisation enables more accurate differentiation between bone and highdensity dental materials, which is particularly relevant in oral rehabilitation and implant planning. Furthermore, enhanced image quality allows more precise evaluation of bone morphology and clearer delineation of critical anatomical structures, such as the mandibular canal and maxillary sinus floor. Figure 2 presents representative examples of DE-CBCT reconstructions illustrating dental and mandibular anatomical structures. In addition, DECT may help address the limitations of CBCT in quantitative bone assessment, as grey value measurements are not standardised across devices and are influenced by acquisition parameters.2,5 Beyond hard tissue evaluation, DECT also shows promise in the assessment of soft tissues and head and neck pathologies, including inflammatory lesions, cysts, and tumours. The generation of virtual noncontrast images, achieved by removing iodine-containing voxels, enhances visualisation of underlying soft tissues and may facilitate segmentation and diagnostic interpretation.2,3 From a radiation protection standpoint, DECT can achieve dose levels comparable to or lower than those of conventional CT, with reported reductions of approximately 10–12% without compromising image quality.2 However, challenges remain, including increased image noise in certain reconstructions, longer processing times, and potentially higher implementation costs. In summary, DECT represents a promising advancement in dental imaging, offering improved material differentiation, reduced artefacts, and enhanced diagnostic performance. Nevertheless, further studies are BRITISH DENTAL JOURNAL | VOLUME 240 NO. 10 | May 22 2026 © The Author(s) under exclusive licence to the British Dental Association 2026. 643 UPFRONT required to validate its clinical applications and optimise acquisition protocols, particularly to achieve lower radiation doses while maintaining diagnostic accuracy. R. C. Fontenele, Ribeirão Preto, Brazil and Bangkok, Thailand; M. S. Demonlin, Ribeirão Preto, Brazil; H. Gaêta-Araujom, Ribeirão Preto, Brazil References 1. 2. 3. 4. Fontenele R C, Gaêta-Araujo H, Jacobs R. Cone beam computed tomography in dentistry: Clinical recommendations and indication-specific features. J Dent 2025; DOI: 10.1016/j.jdent.2025.105781. Hamid S, Nasir M U, So A, Andrews G, Nicolaou S, Qamar S R. Clinical applications of dual-energy CT. Korean J Radiol 2021; 22: 970–982. Parakh A, An C, Lennartz S, Rajiah P et al. Recognizing and minimizing artifacts at dual-energy CT. Radiographics 2021; 41: 509–523. Kim H J, Kim J E, Choo J et al. A clinical pilot study of jawbone mineral density measured by the newly developed dual-energy cone-beam computed tomography method compared to calibrated multislice computed tomography. Imaging Sci Dent 2019; 49: 295–299. 5. Pauwels R, Stamatakis H, Bosmans H et al. Quantification of metal artifacts on cone beam computed tomography images. Clin Oral Implants Res 2013; DOI: 10.1111/j.1600-0501.2011.02382.x. https://doi.org/10.1038/s41415-026-9890-5 Professional development Oral surgery courses The British Association of Oral Surgeons (BAOS) wishes to raise concern regarding an increasing number of oral surgery courses whose promotional material implies equivalence to specialist registration or Tier 2 (enhanced practice) status. Such claims, whether explicit or implied, are misleading. Completion of a course, whether commercial or university-based, does not constitute approved specialty training, confer eligibility for entry to a GDC specialist list, nor automatically lead to Tier 2 recognition, which depends on defined competence frameworks, governance, and local commissioning arrangements. This blurring of boundaries between c (...truncated)