Cone beam computed tomography (CBCT) is the most used advanced digital dental imaging modality. It is designed for dentistry and its use is recommended in multiple dental specialties. One of its most common uses is in the field of dental implants where it is a useful preoperative tool for multiple purposes, including the evaluation of bone quantity and quality. Although there may be a wide acceptance of CBCT-based bone quantity assessment, there is a debate about the reliability of bone CBCT-based quality assessment. This is because CBCT measurements are based on the grayscale value rather than the true Hounsfield units (HU) or Computed Tomography (CT) numbers. The present review is a simplified approach to explain the inherent problems of CBCT regarding bone quality assessment and the proposed protocols to deal with the related limitations. Different techniques for numerical density assessment are presented. Also, supplementation with the visual technique for bone quality assessment is discussed.