Introduction: Cone-beam computed tomography (CBCT), which generates ionizing radiation, is widely used in orthodontics. Children and young people are more susceptible to adverse effects of radiation and those who mainly receive orthodontic treatment. The principle of optimization seeks to protect the patient from adverse effects of radiation, lowering radiation doses, maintainingdiagnostic image quality. The purpose of this review was to assess optimization strategies in orthodontic CBCT examinations. Material and methods: The main search for articles was conducted on PubMed, Scopus and Web of Science. For the complementary search, we used the reference lists of the full text systematic reviews included and websites of institutions with guidelines for the use of CBCT in orthodontics and/or dentistry. Original articles, systematic reviews and guidelines related to optimization for CBCT in orthodontic patients or in children, in English, were included. Review: 14 articles and 6 guides were found. General optimization strategies for exposure parameters are described: field of view, tube current, tube voltage, exposure time, filtration, voxel size, rotation arc, number of two-dimensional projections and shielding devices. Optimization strategies specific to clinical indications and research in low-dose orthodontic protocols are described. Conclusions: Radiationdose to the patient can be considerably reduced, preserving a diagnostic image quality in orthodontic CBCT examinations. This can be achieved by modifying exposure parameters, using optimized protocols for each indication and routinely using a thyroid collar.