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Technology: Brief History of Digital Sensors in Dentistry by James W. Ramey

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The “digital revolution,” where digital imaging began to replace the use of traditional film X-rays, started a little more than 15 years ago in the dental profession. In that amount of time, numerous companies have entered the market. Some have come and gone, some have changed hands and some may pass the test of time. We now have a wide variety of digital sensors and sensor companies to choose from – both CCD and CMOS sensors – all at a wide range of price points.

CCD Sensors
The first digital sensor that came to market was the CCD sensor. In general, images from a digital sensor are “blurry” compared to film X-ray images. The first X-ray images from a CCD sensor started out very blurry – so much that doctors had to “re-learn” how to read X-rays! A good digital image looked completely different from a good film X-ray. In order to compensate for the blurriness of this raw digital image, the imaging software had to compensate.

Another issue the first digital sensors had to overcome was big signal-to-noise ratios. When the “raw” image was returned from the sensor to the software, many of the first sensors had more noise than “good” data. This is another area in which the imaging software had to compensate – not just a little, but a lot.

Given those two big limitations, the software that came with your sensor was probably a bigger factor in the resulting image quality than the actual sensor itself. The imaging software that was included with the sensor had to apply complex algorithms in order to make the image readable or diagnostic. Even after these algorithms (commonly known as “filters”) were applied to the image, many doctors were still not impressed with the quality of the resulting images. A third area in which the digital image was lacking was the resolution of the image. Those of you who were early adopters of the technology know that, if you zoomed into the image once or twice, the image became pixelated and you couldn’t tell what you were looking at. This almost defeated the purpose of having those tools available. Doctors using highspeed film and loupes were still able to see an image much more diagnostically than with a digital image – even with all the advanced diagnostic tools available.

Major improvements were made to the CCD sensors over the next several years, including improved CCD scintillators. Companion components were also improved (some of the image processing takes place in the “box” for the sensor) so that when the image was returned to the computer it was of a higher quality. When the image started out (in its raw format) with a higher resolution and a better signal-to-noise ratio, software programmers had much more to work with. Instead of trying to make a bad image good, they were able to take a decent image and make it better. At this point the resulting image was truly diagnostic, and the tools programmed in the software were then able to create and improve tools to make the image even more diagnostic. Zoom tools, enhancement tools and other diagnostic tools became more usable.

Debate
Now there was a true debate over film versus digital.

Some claimed film still provided a more diagnostic image, and, in some cases, that argument was true. Others cited the imposing cost to make the switch from film to digital and the learning curve of the software. Digital users emphasized the speed, lack of chemicals, lower radiation and real time retakes (without waiting for the original to develop – a big time saver).

As more improvements were made, the tide started switching. Arguments for switching to digital started outweighing arguments for staying on film. About this time, many schools started teaching digital imaging, as well. This meant that graduating doctors, hygienists and assistants were now “pre-trained” on digital and viewed working in a film-based office as going a step backward. Along with this newer generation’s aptitude for adapting to new technology quickly, the digital imaging market boom began. Today graduating dental students expect to work in an office that is digital.

Patient education has also become part of the digital revolution. It is much easier to show the patient images on the computer monitor, where you can mark the image with labels, circle problem areas, etc. Not only does this help educate the patient, it is also a great sales tool to help sell treatment plans!

CMOS Sensors
As CCD sensor technology continued to improve, a new player came onto the field – the CMOS sensor.

With vast improvements in lithography technology, the CMOS sensor was able to fit onto one small chip, with the same components that the CCD sensor contained in its external box. With direct USB connectivity, the CMOS sensors were much easier to move between operatories. All of this, along with lower power consumption, made the new CMOS sensor a formidable new opponent to the CCD digital sensor.

For the last several years, most sensor manufacturers have been playing “catch up.” The few manufacturers that made the first CMOS sensors started taking market share from the CCD sensor companies; along with the release of Microsoft’s Windows 7 and the availability of 64-bit computers started a race for the sensor manufacturers. The first company to release a CMOS sensor grabbed a big share of the sensor market. The “old” king of sensors, with arguably the best image quality, was no longer king – it had been dethroned!

A second company produced an even better CMOS sensor just slightly after the first was released. The rest of the “big” guys had to scramble to catch up. All of the big sensor manufacturers’ newest digital X-ray sensors are now the CMOS variety. There are still a few companies selling CCD sensors, but for the most part, they are starting to dwindle. Most companies now sell CMOS sensors at various price points, including DentiMax, which offers an excellent cost effective system.

Change
Only a few years ago the whole paradigm shifted. The “gold standard” sensors are now CMOS sensors. Most of them use a direct USB connection, and they require less power so there is no external “box” to deal with. The image quality is even better than film, and the sensors are very easy to transport from operatory to operatory.

Right now the CMOS sensor is the sensor of choice (if you’re still using a CCD sensor in your practice, it’s about time to make the switch to CMOS), but who knows what will happen in the next five to 10 years? Whatever technology comes along, you can be sure that going digital now is a great choice. Newer technologies will not only be better and more cost effective, but will make practicing dentistry, as well as educating your patients easier, more efficient and more effective.
Author's Bio
James W. Ramey has a bachelor of science degree in management information systems from the University of Akron. For the last eight years, he has worked exclusively with digital radiography technology and has experience with most sensors on the market, including digital, panoramic, cephalometric and intra-oral cameras. You can reach Mr. Ramey at jimramey70@gmail.com.
Dentaltown Magazine
September 2025
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