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.
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.