THE SET-UP“In the 1985 classic comedy ‘Fletch,’ Chevy Chase’s title character states, ‘It’s all ball bearings nowadays!’ In 2010, we could just as easily say, ‘It’s all electrons nowadays!’ Our profession is working on so many digital advances it can make your head spin, but the workhorse of all of my digital technologies is digital radiography. Of all the technologies at our disposal, digital radiography is one of the ‘first steps’ to truly changing the dental office. It creates so many advantages from cost savings, to workflow efficiency, to improved diagnosis that it truly is a ‘game changer.’ It’s also a necessity for the chartless office and is a key component in that process. I’ve never personally met anyone who went to digital and then wanted to go back to film…and I’ll bet you haven’t either. It’s such a great advantage, I can’t believe film is even an option anymore. But if you won’t take my word for it, read Dr. Bill Busch’s article. He has a lot to say about a technology that is one of the best investments a practice can make.”-Dr. John Flucke, Team Lead
Digital radiography, a technology that has been in development for the last 23 years, represents a major shift in imaging methods. The switch from traditional film x-ray to a digital system does not just represent a lateral move to another type of x-ray; it is a huge vertical move that improves the dental experience for the dentist, the staff and the patient.
Digital technology has so many benefits over traditional film, and this new sensor technology makes it even better. “360° feedback” is a method of determining the value of something in the workplace by asking the opinions of people in the circle of the office. For this Clinical 360° column, my feedback has been derived from the whole circle of my staff-and patients, with the digital x-ray right in the center of the action.
Focus on the patient
Digital x-ray raises our level of patient care. In a busy office, where time is at a premium, running behind schedule cultivates grumpy patients backing up in the waiting room. By the time their appointment begins, we are already rushing to catch up, and now we also must mitigate the patient’s impatience. With traditional film x-rays, the only way we could save time was by choosing to capture only the basic images necessary to get us through the procedure. But of course, this meant missing out on the chance to capture other potentially valuable and clinically significant images.
Digital imaging offers more time to concentrate on the patient, not the process. For instance, with a system such as the one from DEXIS I use in my practice, an FMX can be reduced from 25 minutes to five minutes from start to finish. That’s an extra 20 minutes of time per appointment, meaning not only can each patient receive extra attention, but more patients can fit on the schedule for any given day.
Besides pre-treatment images, digital’s time-saving elements allow for post-op images as well. When cementing crowns or after surgical extractions, taking a post-op x-ray should not be a luxury. These post-op images provide me with more confidence that my treatment will have a successful outcome, and serve as valuable references during future treatment.
With digital, we no longer worry about the clock ticking while the assistant develops, organizes, mounts and documents film x-rays. After the first click, my digital x-ray system automatically saves, dates, tooth numbers and orients the images.
Not only are the images automatically saved and organized, they are far easier to locate in the future. Accessible through the patient’s digital chart, sending them along to insurance companies or with case referrals is incredibly simple and convenient.
Along with the speed of capture, digital technology offers dentists tools that can intensify the details captured by the sensor. In my own practice, I have witnessed a noticeably improved level of clarity in images generated by the DEXIS Platinum sensor I use. Even sitting three feet away from the monitor, the images appear clear, clean and crisp. It should go without saying that a clear, well-defined image is easier to examine, and with the images in a digital format, I can zoom in, change the contrast, add touches of color and make other modifications that make diagnosis easier and help when I’m using the images to explain a case to a patient.
Also packed into the sensor are the detailed components involved in capturing high-quality images-the basis of diagnosis. An image’s spatial resolution, or clarity, is measured by how many pairs of lines (basically, adjacent black and white lines) can be discerned per millimeter (lp/mm). The resolution of imaging systems can be measured by a line-pair gauge (Fig. 3). More visible line pairs equal more detail.
Notice the spacing of the black and white lines varies, with a closer spacing toward one end and the lines farther apart on the other end. When examining a line-pair gauge, the lines on the closely spaced end appear blurred together; while at the other end, they are distinct. Somewhere between these extremes, the lines will appear barely separable. This mid-point location determined by the corresponding number on the calibrated scale determines the resolution of the line pair.
The other part of the partnership is accomplished by the megapixels. One megapixel equals one million pixels, and thus digital x-ray systems with high megapixel resolution capture images that can be enlarged so a clinician can hone in on areas of concern without pixilation or distortion of the image. It is important to me that my images retain their sharpness, even when I blow them up and zoom in to see certain details from closer than ever before.
Aside from improving image quality for diagnosis and treatment, technology can improve the patient’s radiographic experience. The latest in digital sensors are easier and faster for a hygienist to properly position with optimal angulation to capture the best possible image, and they also are designed to feel less intrusive within the patient’s mouth.
Color coding of the aiming rings for simpler and quicker identification is an additional way to create more efficiency. The more comfortable the patient, the easier it is for me and my team to do our jobs.
All of these digital advantages make for faster procedures and fewer retakes. Of course, when those retakes are necessary because the sensor wasn’t properly positioned or any other reason, the time needed for the extra exposure has already been saved. The digital image is available immediately, and the corrected x-ray can be ready before we would have even known a retake was necessary when using a film x-ray system.
For trauma cases, obtaining films taken prior to the injury is critical to proper diagnosis to gauge the progressive sizes of the lesion and provide appropriate treatment planning. In trauma and carious exposure cases in young patients with immature apices, the extent of the pulpal involvement and apical closure is of primary consideration. In cases where immature apices are affected, drug therapy with calcium hydroxide or mineral trioxide aggregate (MTA) can help promote apexification.
Reducing supplies and waste
Adopting a digital x-ray system does come with upfront costs that can seem daunting, but it is important to remember the new system will bring new savings, and the return on your investment begins immediately. With digital systems, fewer supplies are needed, and most of what you do need is reusable, thus reducing both inventory and waste. Also, space in the practice previously dedicated to develop film images can be converted to another use.
Digital x-rays also are a good way to decrease a practice’s environmental impact. No chemicals are needed to develop digital x-ray images, and thus no chemical waste is generated. Patients will certainly appreciate the fact that digital x-ray images require less radiation exposure. Additional waste reduction is realized because digital x-rays require less packaging than the boxes of film and other supplies that wind up in a practice’s garbage.
Clinically, clearer images provide for more precise diagnosis and treatment. The ability to zoom in, change contrast, draw on and colorize images facilitates patient education and increases case acceptance. Clerically and professionally, digital images are conveniently e-mailed to referring dentists, insurance companies or specialists, with no time or money wasted copying and mailing film. Economically, not only does digital technology free offices from never-ending consumable purchases (film, chemicals, mounts), it shortens appointment times, freeing up more time to schedule additional patients during the workday.
After first-hand and chairside observation of this technology, my 360° feedback indicates digital radiography is an all-around practice builder and an improvement over traditional x-rays in almost every way. Digital dentistry delivers!
Bill Busch, DMD, FAGD, has operated The North Kansas City Dental Group since 1991. His practice is dedicated to staying on the cutting edge of advances in dental techniques and technologies. As a co-founder of TeamSmile (teamsmile.org), he encourages volunteerism in the dental community and works to bring dental care to underserved children.