Purpose <p>The use of cone-beam computed tomographies (CBCT) in orthodontics and pediatric dentistry is constantly increasing. The aim of this systematic review was to critically appraise and summarize evidence from clinical studies on the prevalence of incidental findings from CBCTs of children and adolescents.</p> Methods <p>Systematic literature searches without restrictions were undertaken in eight databases from inception up to March 2024 for studies reporting on incidental findings from CBCT images of children and adolescents. After duplicate study selection, data extraction, and risk of bias assessment with a custom tool based on the Joanna Briggs institute’s tool for prevalence studies, qualitative (narrative) data synthesis was performed.</p> Results <p>Ten studies covering a total of 1818 patients (48.5% male; average age 12.3&#xa0;years) were included. The prevalence of incidental findings ranged from 0.4 to 80.3%, but high heterogeneity was seen between studies (<i>I</i>² = 99%). Incidental findings were most often related to airways (63.7%), followed by bone (23.6%), teeth (19.2), spine (26.2) and temporomandibular joint (3.8%). However, several methodological issues existed with included studies (incomplete reporting of patient- or CBCT-related details, incomplete categorization and reporting on the severity of findings, small sample sizes, and research transparency issues).</p> Conclusion <p>Evidence indicates that incidental findings can be often found in the CBCTs of child and adolescent patients. However, when a CBCT image is justified for children or adolescents, it should be adequately assessed for incidental findings by either a specialist oral and maxillofacial radiologist or a dentist with appropriate training and experience.</p>