This paper presents a versatile and cost-effective system for the monitoring of X-ray exposure during dental cone beam computed tomography procedures based on silicon PIN photodiode detectors. The system, developed and implemented at the University of Pisa's School of Engineering, underwent characterization under a range of operational conditions focusing on full field-of-view 3D protocols used in adult patient examinations. This study was facilitated by the Azienda Ospedaliero Universitaria Pisana, which provided access to a Planmeca ProMax 3D Classic scanner for the research. During the investigation, photodiodes were placed both on the surface and inside an Alderson RANDO phantom head to assess the dose delivered to regions near radiation-sensitive areas such as the salivary glands, thyroid, eye lens, and laryngopharynx. The evaluation process spanned a spectrum of tube voltages, ranging from 60 to 90 kVp, and tube currents, extending up to 16 mA, to ensure a broad and thorough analysis. Furthermore, to reinforce the effectiveness of the silicon photodiodes' measurement capabilities, calibrated GR-200 A-type thermoluminescent dosimeters were positioned within the phantom head inserts to serve as a reference point. Complementing this setup, PCXMC Rotation 2.0 simulations were conducted to further the efficacy of the monitoring system, particularly tailored to the specific dental CBCT protocols being investigated. In conclusion, while the research revealed a generally consistent correlation across PCXMC simulations, photodiode readings, and thermoluminescent dosimeter measurements, it is important to note that a direct comparison was not exactly possible due to limitations in the size and positioning of the systems. Variations up to 20–35% were observed, primarily due to the different positioning of the dosimeters and the unique physical and operational traits of the different measurement methods employed. Nevertheless, the development of an affordable, easily deployable, and scalable dosimetry monitoring system may provide a substantial contribution to enhancing patient safety in dental radiology and aid in the optimization of diagnostic X-ray protocols.