Focusing On Digital Radiography
Andrew Koenigsberg, DDS
Gallery57 Dental
New York, New York
Cofounder and Clinical Director
CAD/CAM Excellence
Dental digital imaging technology has come a long way since its introduction more than 25 years ago. Advantages of digital radiography, such as lower patient exposure, simplified record keeping and record transfer, and lack of processing chemicals, have always been apparent. These advantages have grown in significance with increased patient awareness of radiation exposure, growth of digital practice management software, and environmental concerns and laws. Having an immediate image for diagnosis remains a significant advantage, and it is hard to imagine performing endodontic or implant placement without this technology.
Another advantage is the ability to manipulate the digital image. Once film is developed, you are limited by what has been captured on it, whereas digital data can be enhanced and sharpened to increase contrast in the image. This can be especially useful for adjusting over- or underexposed images and diagnosing caries. The ability to greatly magnify an area of the image versus using a magnifying glass and light box has always been a useful feature of digital radiography.
Many of the early limitations of digital radiography have been solved or mitigated. While early sensors had inferior image quality compared to film, that is no longer the case for higher quality digital sensors. Though initial cost for a quality sensor can still be significant, the amortized cost over time is lower than film. With the increased prevalence of computerization in the dental office, there is often no need to buy additional computers and the integration between sensor and practice management is usually seamless for the major brands. Sensors have gotten thinner and more ergonomic, and with training, they are easy to use and comfortable for patients.
For panoramic radiographs, where film size is larger and patient exposure is increased, the advantages are proportionately greater. Some digital pans can be upgraded to take 3D cone-beam computed tomography (CBCT) images. 3D CBCT is only available as digital technology and provides a 3D image of anywhere from a few teeth to the entire head and neck. CBCT has already had a significant impact on implant treatment, endodontics, and oral surgery. As this technology continues to become integrated with other technologies in the “digital workflow,” it is sure to play an increasing role in dentistry.
When considering digital technologies, the clinician can easily evaluate “initial” image quality and cost. When calculating long-term cost, it is important to remember that a sensor’s image quality may deteriorate over time. Some sensors may not hold up well in the daily clinical environment and not all sensors can be readily repaired. It can be challenging to determine which company will stand behind their product and which product is most durable. Equally important is the level of software support and training each company provides. Since digital technology relies on computers, it is critical to work with a company that can keep their product current as computers and software evolve.
It is challenging to assess which features may become important as new technologies integrate into dentistry. Applications such as implant surgical guides, occlusal and sleep appliances, integration with face scanning software, and jaw tracking are being introduced but may not be compatible with every system. Practitioners should consider how they see their practice evolving when making technology decisions.
Many aspects of dentistry are going digital, such as practice management, imaging, impressions, restoration fabrication, and orthodontics, among others. Imaging will experience continued improvements in hardware and software that will allow for better diagnosis, consistent image quality, fewer variables, and increased automation and efficiency.
