Various digital radiographic instruments have been commonplace in clinical practice for many years. The various approaches will not be addressed in this course, but they are addressed in many publications and forums for "technology" in dental practice. An article by Parks and Williamson26 reviews radiographic approaches using digital radiography. Publications continue to support the superiority of digital radiographic systems over conventional radiographic film. One such article27 presents evidence that phosphor plates significantly improve the accuracy of caries diagnosis while reducing observer variability. Jacobsen et al.28 compared four different digital radiographic systems using histologic measures as graded by 4 trained clinicians. Two of the systems were determined to be more accurate than the other two for caries depth measurement. More studies of this nature are needed to help guide clinical practitioners in the selection of the approach that they wish to use in diagnosis of early caries in the clinical setting. An example of a digital bitewing radiograph and the clinical sensor are provided below to illustrate the presence of carious lesions.
CCD Sensors for direct digital radiography shown as size #2, size #1, and size #0.
Images taken with digital radiography showing various stages of caries.
Different systems have various software functions for viewing the digital radiographs as shown here. The ability to change contrast, colorize, flip to a negative, measure density, measure lengths, and otherwise adjust an image for diagnosis greatly enhances the ability of the clinician to get information. The goal is to make the diagnosis of proximal caries at the earliest stage when remineralization can be achieved instead of surgical intervention and restoration.
The above screen capture illustrates bitewing radiographs taken and viewed using the Mediadent system. Note the one area circled in red showing interproximal caries for the patient. Below the digital radiographs, the tools are shown for managing the images.
The screen capture above shows a digital bitewing radiograph using the Vipersoft system. The highlighted areas were marked during a discussion with the patient. Toolbars for image management are seen on the left and at the top of the image.
The screen capture above illustrates a digital peri-apical radiograph from the Schick system for digital radiography. The icons for image management are seen above the image.
In 2006, the ADA conducted and published an online professional product review of digital radiography systems “ADA Professional Product Review - Digital Radiography Systems: ACE Panel Dentist Interviews.” One of the key findings of this review was: “Digital radiography has advantages and disadvantages, but once the dentist and his or her staff conquer the learning curve, these dentists seemed to agree that digital radiography is an overall plus for them, their patients, and their practices.”