Incorporating digital imaging into your practice offers a range of benefits - from more rapid and more accurate diagnosis - to much better case acceptance and trust from patients.
This is the experience of well-known Melbourne Specialist Endodontist and Associate Professor in Endodontics at La Trobe University, Phillippe Zimet, who has incorporated the latest SOPRO digital radiography system into his recently-revamped Dandenong practice.
Dr Zimet has been using digital receptors for radiographs for some time, with the aim of having access to a good quality radiography image to assist with patient diagnosis and treatment planning. He says patients literally marvel at the image, which appears instantaneously on the monitor following exposure of the sensor.
"An objective image provides the information we need to make proper decisions on the correct course of treatment. I was looking for a system that is efficient, predictable and reliably produces a high quality image, while reducing patient exposure to radiation," Dr Zimet said.
After a period of evaluation, Dr Zimet purchased a complete Sopix2 digital system with the Sopix2 digital sensor from French manufacturer, Acteon - SOPRO Imaging, available through A-dec.
"There are some very substantial advantages of direct digital images. If you need information spontaneously, good quality direct digital such as the Sopix2 sensor is unsurpassable. You have the information at your fingertips instantly, which is a big advantage. Sopix2 also provides a consistent image contrast with minimal exposure time of the generator and auto shut-off to prevent over-exposure of the sensor.
"A further advantage is staff acceptance of the direct system as the direct digital image removes one more task in the staff's already busy day. Staff much prefer the direct system to even 'developing' phosphor plates.
"One of the advantages of the rigid sensor is that it produces an undistorted image. The sensor is slightly wider than film, but because the corners are cut off Sopix2 it doesn't affect patient comfort as much as other sensors. The Sopix2 sensor has very high predictability because of the rigidity and high dynamic range of the sensor which allows you to obtain a clear image."
While the digital sensor is very convenient, there is a learning curve to its implementation. The two major issues were receptor placement and getting used to the smaller image size relative to the sensor size. The phosphor plate has a slightly larger image area so you capture the image on the whole plate. For those who have difficulty adapting to the slightly smaller active area of a direct digital sensor, Sopro also provides the PSP!X phosphor plate system, which provides a larger image area.
Dr Zimet said Sopro can provide an ideal solution for anyone wanting predictable, consistent and comprehensive digital imaging with an integrated system comprising the direct digital Sopix2 as well as the phosphor plate PSP!X system, both running on Sopro Imaging software.
"Psychologically, the PSP!X phosphor plate system is more like a conventional film radiograph as the process is not that dissimilar to conventional X-ray films. An image is taken and then it is developed by the PSP!X scanner and is then displayed on a good quality screen.
"To get a good image with digital or celluloid film, you've got to position the object (tooth or gum), the film, sensor or phosphor plate and generator in an appropriate alignment. If all three are not aligned you will not get a good image.
"For me, it was a matter of finding a method that I could transition my technique from what I was doing previously with film to the digital sensor. Both the direct digital sensor and the phosphor plates are more rigid than traditional film.
"You therefore have to change how to position the device comfortably and to get the highest quality image result - for example positioning the direct digital sensor further towards the centre of the mouth for the upper pre-molars which are the most difficult to get to. I have managed to develop an accurate technique with some practice by re-positioning the generator from the back distally to capture the image required," Dr Zimet said.
"You also have to change some methods used with traditional film radiography by re-evaluating the angulation of the X-ray beam from the generator," Dr Zimet said.
The most important item in overcoming placement difficulties of the receptors is the use of appropriate sensor or phosphor plate positioning devices. Dr Zimet has found the Kerr Hawe holder works well for the Sopix2 sensor and the Rinn holders and bite-wing tabs (Dentsply) ideal for the PSP!X phosphor plate system.
"The other huge advantage of using the Sopix2 digital sensor and PSP!X phosphor plate system in combination is the ability to capture, manipulate and manage images easily through the included SOPRO Imaging software.
"We can set the parameters we like before we take the image and manipulate the contrast afterwards, for example maximum contrast to show soft or hard structures, and the software will save those preferences. This gives a high degree of consistency from one image to the next.
"You can also integrate scans of wet film radiographs from referring doctors into SOPRO Imaging software with either a digital import or a direct acquired image using a scanner as part of a paperless patient records system. This allows even the referral radiographs to become part of the patient's radiographic record."
Dr Zimet said digital imaging was the future of dentistry and once more people adopted the technology it would change the way they practice.
"Computers are now part of everyday practice, so it is a matter of looking around to see what else can be integrated in a dental setting to enhance the level of service and quality of the outcome for the patient.
"For example, intraoral cameras, apex locators, cone beam imaging and scanning and even traceability of instruments through the sterilizer builds confidence in dental procedures.
"Having these tools available creates an environment to allow discussion of the treatment plan with the patient, so the patient feels informed. It also forces you to interact with the patient and justify your treatment in an environment of transparency and accountability.
"The digital image becomes the vehicle for the dialogue with the patient and creates acceptance as well as providing a structure to develop a treatment plan.
"In endodontic work you often want to focus on a specific tooth and use the digital sensor to get an immediate image to discuss treatment options with the patient.
"If you need to take a bite-wing, you may elect to use the PSP!X phosphor plate because of the larger image area, and it is still very quick compared to conventional film. Although with some training even the Sopix2 system provides the level and quality of information required.
"Some dentists think they may need both systems (phosphor plate and digital sensors). If they are comfortable with traditional celluloid film they may start to use the phosphor plate system, but if they want an instantaneous high quality image they will slowly transition from phosphor plate to Sopix digital sensor," Dr Zimet said.
In summary, Dr Zimet said the benefits of digital radiography are vast: "In order to obtain the highest quality and maximum amount of information from digital images, the clinician needs to use appropriate sensor positioning devices, be prepared to adapt their technique and spend time to learn to how to manipulate the software. The learning curve is worthwhile."