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  • Guy Robertson

Digital Dental X-Rays

Updated: Jun 27, 2019

x-ray of child's teeth
“Bitewing” x-ray of a child with a mixture of deciduous and permanent teeth demonstrating decay (caries).

During the first part of my dental career x-ray images (properly known as radiographs) were produced by exposing a film to x- radiation and then developing the film. The development process involved tanks of developer and fixer chemicals, washing with clean water after each stage. This “wet film” method produced images about the size of a large postage stamp which could be filed in patients physical record file.

A variety of digital x-Ray technologies have been developed and used for dental diagnosis but the most popular for intra-oral images is a phosphor plate system. An image recording device is then used to transfer the image to the patients permanent digital clinical record.

This system has the advantages that it is quick and clean and the x-ray dose required is about 10% of that used for conventional films.

Modern x-ray image software such as “Examine Pro” (compatible with “Exact” practice management software) can be used to manipulate the images to aid diagnosis. Zoom and contrast adjustments are used quickly and easily when assessing every image.

The most important everyday use of radiography in dentistry is the diagnosis of tooth decay. Early digital systems were not good at this but modern ones are superb. In the peri-apical x-ray of upper left posterior teeth, below, there are multiple findings: 1. shows bone loss, 2. is a missing tooth and 3. shows poor quality root canal treatment. If an implant was being considered to replace the missing tooth a CBCT scan of the region would be indicated

x-ray of a patient's teeth showing multiple problems
x-ray diagnostic of multiple problems

Digital images are easy to duplicate so copies can be given to patients to store on mobile devices. This is particularly useful if you require referral to other clinicians or need emergency care in a different country. If we need to e-mail images we naturally have an encrypted system that is GDPR compliant.

We now have a digital x-Ray machine in our practice that is capable of taking larger images and in 2 or 3 dimensions. Panoramic images are in 2 dimensions, can encompass all of your teeth and jaws and are traditionally used to assess impacted wisdom teeth and to screen for other pathologies.

Showing an impacted wisdom tooth where the tips is adjacent to the inferior dental nerve

Three dimensional images in the form of Cone Beam Computer Tomography (CBCT) are now routinely used for assessment prior to placing dental implants. Images that record bone shape and quality along with the exact position of vital structures in 3 dimensions represent significant progress in the precision of planning. CBCT uses x-ray dosages of between 5% and 10% of conventional medical CT scans.

CBCT scans used to plan an implant
Multiple images from a CBCT scan being used to plan precise placement of a dental implant.

To embrace any digital technology, it must be faster, safer and more precise than older technologies. Digital dental radiography has come a very long way in the last 10 years.

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