RadiographyFilm based versus Digital

Detect lesions, diseases and conditions of the teeth and surrounding structures

Confirm or classify diseases

Gather more info during procedures (implants and RCT)

Evaluate growth and development

Uses

Illustrate changes in caries, periodontal disease, or trauma

Document the condition of a patient at a specific point in time

Uses cont..

3 step process: Exposing Processing Mounting

Higher radiation and exposure time

Takes more time for each step More possibility of errors Quality of images Long term costs?

Film-based Radiography

First introduced in 1987 and greatly influenced x-ray processing and dental disease recognition and diagnosis

Definition: “filmless imaging system; a method of capturing a radiographic image using a sensor or plate, breaking it into electronic pieces, and presenting and storing the image using a computer”

Digital Radiography

Generate images that are diagnostically equivalent to film-based images and often show many conditions that go undetected

Digital file kept on hard drive◦ Format varies on software being used

(eg) Dexis- dex file Viewer software available for free

Purpose

1. X-radiation source (1/100 second exposure rate)

2. Intraoral sensor Wired = USB directly into computer Wireless = phosphor plates scanned

Equipment

3. Computer

Software and memory considerations

Image can be printed or emailed

Unique capabilities: fast, magnification, image manipulation, split screen & measurements

Will vary depending on manufacturer

1. Sensor preparation use a disposable barrier

2. Sensor placement use an XCP and paralleling technique

3. X-ray Kvp adjusted accordingly

4. Processing Scan/image storage

Procedure

1. Superior gray-scale resolution Uses 256 colors of gray compared with 16-25 shades on film Manipulation of contrast and resolution for better interpretation

2. Exposure reduction 50-80% less radiation Digital= 3 impulses (0.05 seconds) Film= 12 impulses (0.2 seconds)

3. Fast Instantaneous viewing and interpretation

4. Cost effectiveness over time Less film and processing solutions

Advantages

5. Environmental No chemicals & film wrappers/lead to dispose of

6. Efficiency More productive and versatility of storing/sending image

6. Image enhancement/manipulation Contrast, colorization, magnification, sharpness, and image

orientation

7. Client Education/Co-Diagnosis Magnified images can be used to facilitate dialogue

(visualization) and better acceptance of treatment

Advantages

1. Costs Set-up costs range depending on manufacturer and

features (average= $15,000/operatory)

2. Image quality Under debate as the human eye can only distinguish

resolution within a limited range (normal film is adequate)

3. Sensor size Some sensors are bigger and less flexible increasing

discomfort and gag reflex

Disadvantages

4. Infection ControlSome sensors cannot withstand heat sterilization and are

difficult to cover with plastic sleeves

5. Legal Issues (with some systems) Because original radiographs can be altered, it is

questionable if they can be used as evidence in lawsuits

6. Technology Changes System may become obsolete and no longer has

support

Disadvantages

Popular Systems

Removable cords

Fully integratable with Dentrix Software

No need for integration software Updates automatically X-rays are part of clients file Dexcam3 intraoral camera Guru educational software

Take radiograph following same procedures

Considerations: Exposure settings Placement/infection control Plates or sensor application

Dexis System Basic Functions

Plates1. Remove barrier, follow infection

protocol, open Dexis system pressing the Dexis icon and insert plate with magnet on right side of scanner

2. Select appropriate client or enter new client info

3. Click the x-ray icon and select appropriate tooth number where x-ray is to be mounted

4. Modify image for best diagnostic quality

Instant images with no scanning or processing (16,000 shades of gray)

Portability because of USB attachment

Perfect Size Sensor= one-size fits all (Size 0-2)

Client comfort◦ Thinnest sensor ◦ Bevelled edges◦ Angled wire

Automatically adjusts for best exposure

Dexis Sensors

http://www.dexis.com/index.php?option=content&task=view&id=253

great care must be taken with sensor Be prepared before you bring client in

room

1. Open Dentrix program and select client and select mount area

2. Place barrier on sensor and use appropriate XCP holder

3. Insert into USB port of tablet or netbook4. Place sensor in clients mouth5. Select icon to take radiograph6. Expose sensor and ensure diagnostic

quality

Using the Sensor

Why tablets?

Portability no need for wires use throughout the clinic

Infection control

Client friendly

Applications for client and operator

educational software drug reference book translator