Improved Dentistry through Advanced Digital Radiography by Andrew Koenigsberg, DDS, and Mason Kostinsky


Ten years ago, we bought our first digital X-ray sensor. At the time, we were using paper charts and practice management software that did not allow for the integration of digital images. We also had a laptop for the operatories and kept a separate database of our patients’ images.

Technology sure has changed in a decade! Digital radiography is critical to providing our patients with the highest level of care, which is why we continually look for ways to improve, and are on our fourth generation of sensor. Dental technology advances lead to clinical improvements and better patient acceptance and care.

While our office has been using 3D cone beam computed tomography (CBCT) for about five years, 2D images on a #2 digital intra-oral sensor remain our primary diagnostic tool for detecting inter-proximal decay, marginal bone loss, and changes in the periodontal ligament (PDL) and apical bone. Older generations of sensors simply do not provide the same detailed information as today’s sensors. The Schick 33, which we currently use, has a resolution of 33 LinePairs/mm—compared to 12.5 LP/mm for the original Schick CDR sensor—giving my practice the ability to magnify or zoom in on areas of particular interest while maintaining detail and sharpness.

Many doctors, who are used to having dental equipment last 20 years, struggle with the decision to upgrade to digital sensors, as they perceive their current sensor is still working fine. However, the digital revolution extends beyond our phones, computers and TVs—equipment upgrades are an essential part of our digital dental world.

Reducing Patient Exposure and Wait Time

Our initial decision to transition to digital radiography was based on convenience and efficiency. Convenience for staff not having to spend time processing film, maintain chemicals or take duplicate films, as well as convenience for patients not having to wait for their X-rays. While early digital images often did not have the quality of the best film images, they were predictable and consistent, something film often is not.

A huge advantage of digital images is the availability of immediate feedback. Evaluating an image while the sensor is still in the patient’s mouth makes it easier to make corrections to eliminate overlap, visualize the apex and confirm that the area of interest was captured. Close to 50 percent of film X-rays don’t show what they are intended to show. Unfortunately, by the time the film can be read, the patient may be gone or the clinician may have no idea what they need to do differently to get a better image. With digital radiography, we rarely need to take a second bitewing, saving the patient exposure and money.

Digital Improvements

We found the learning curve for digital radiography to be minimal. With careful placement, we did not have any more patient complaints than with film, and the sensors’ rigidity prevented the distortion so common when film bends. The software was easy to use and made it impossible to lose or misfile images. These advantages made integrating digital radiography an exciting time for our office as doctors, staff and patients could immediately appreciate the advantages. The one drawback a decade ago, was that the image quality did not have the resolution we would have liked. In 2014, that is no longer the case.

Technical improvements have been made to every component of the sensor, as well as the connection to the computer. The scintillator, which converts radiation energy to light energy, is made of cesium iodide, which is more effective at converting radiation into light energy. The newer fiber optic plates, which transmit light energy from the scintillator to the sensor, are more effective at light transmission. Additionally, they reduce the amount of radiation required, which results in less “noise,” a better diagnostic image and greater longevity of the sensor.

Another benefit of digital radiography is the ability to manipulate images by changing the contrast. Schick 33 has this built in so any image can be viewed in four different pre-set modes or tasks: general dentistry, restorative, periodontic and endodontic. These options optimize the image for diagnosis of inter-proximal decay, marginal bone and bone density.

Mission Critical Radiography

In the last decade, dentistry has been inundated with new technologies and equipment, much of it expensive and difficult to implement. It is a challenge to decide which technologies to invest in and which will give us the most clinical benefit. Most experts consider digital radiography to be “mission critical,” meaning that a modern office cannot practice without this technology. We certainly agree and that is what has driven us to upgrade our sensors regularly. We believe that our patients deserve the best care. These days, that means having a digital sensor that provides as much information as possible.



  Author's Bio
Dr. Andrew Koenigsberg graduated from Columbia University School of Dental and Oral Surgery in 1980. In 1983 he completed the Prosthodontics Graduate Program at Montefiore Hospital. Gallery57Dental, which Dr. Koenigsberg co-founded in 2006, has been featured in Modern Dental Practice magazine and is a leader in integrating dental technology. In 2010, he co-founded CAD/CAM Excellence where he is clinical director.

Since 2006 Mason Kostinsky has served as Chief Operating Officer and Director of Marketing and Business Development for Gallery57Dental, a dental practice and laboratory in Manhattan. In addition, Mason is President of Infinity Practice Development and co-founder of CAD/CAM Excellence, an advanced education center to promote practice growth with CAD/CAM technology. Mason focuses on practical application of advanced clinical and administrative technologies that are influencing practice business models and are key elements to providing modern dental care.

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