Buyer’s guide to digital dental x-rays

From the nitty gritty to the major, we have compiled all the factors that you’ll need to consider before buying a digital x-ray.

In the past two decades, dental imaging has evolved considerably.  Today, it is not an exaggeration to consider the dental x-ray machine a must-have equipment in any dentist’s office.

Ranging from simple intraoral periapical X-rays and panoramic radiographs to more advanced imaging techniques like computed tomography, cone beam computed tomography (CBCT), and recent iterations of intraoral x-ray devices, digital dental radiography has made staggering advances.

3D imaging has made investigation of complicated craniofacial structures much simpler. Similarly, diagnosing complex lesions is easier and more accurate.

Dental radiology is clearly moving away from the analogue towards digital X-rays. The growing uptake of DVT (digital volume tomography) alone indicates a very exciting future trajectory.

Not every dental x-ray is born equal

As well as provide healthcare professionals the flexibility and convenience to offer full services to their patients, digital dental X-ray equipment can help dentists diagnose their patients and narrow down the problem areas more accurately than ever before.

As with adopting any new technology, it is important to note upfront when purchasing a dental x-ray machine that along with the benefits, it also brings its share of challenges.

In fact, part of the challenge begins as soon as you start searching for that “high-quality, long-lasting digital dental x-ray machine” for your practice.

Read article: How to choose an intraoral sensor

Pros and cons of buying a digital dental x-ray

One of the most critical decisions you would have to make when choosing a dental x-ray machine is whether to buy a traditional film-type or digital x-ray. However, the widespread adoption and increasing popularity of digital dental x-rays is making this an easy decision.

Though the standard choice for decades, conventional film x-rays present many risks, both in terms of safety and convenience.

How to choose a dental x-ray sensor

Traditional dental x-rays use ionizing radiation, which can be harmful if not used properly. They often cost more than digital x-rays due to the cost of film, processing chemicals, and other supplies. The x-ray films must be stored physically, which can take up space and make it more difficult to access and organize patient records. The chemicals used to process traditional dental x-ray film can be harmful to the environment.

Although the radiation exposure from traditional dental imaging is minimal and not harmful on its own, repeated exposures can accumulate over time. Additionally, it is never a good idea to cause unnecessary concern for your patients.

Many patients are aware of the risks of radiation exposure from traditional dental x-ray systems, and may choose to visit a competitor that offers digital x-ray services instead.

Advantages of Digital X-rays:

Digital x-rays use less radiation

As mentioned, traditional x-rays involve the use of film, which is exposed to x-ray radiation in order to create an image. This process can result in higher levels of radiation exposure for patients compared to digital x-rays, which use advanced technology to produce images with significantly less radiation.

As a healthcare provider, it is important to consider the potential radiation exposure for your patients and choose the technique that minimizes this risk as much as possible.​

Digital X-Rays offer sharper and more detailed images

Traditional x-ray images can be difficult to interpret due to their low resolution and lack of detail. Digital x-rays, on the other hand, offer much higher levels of detail and resolution, making it easier to identify and analyze dental issues.

Modern digital x-ray units are sophisticated machines that do not require highly skilled technicians to operate, and allow you to zoom in on small details without sacrificing image clarity. In addition, digital x-ray machines often include features such as colour filtering and image manipulation tools to further enhance the quality of the images.

Digital X-Rays deliver instantaneous results

With dental digital x-ray photography, you can say goodbye to delays and uncertainties commonly experienced with traditional x-ray photography.

Instead of a lengthy development process, digital x-rays are available for immediate viewing. If a retake is necessary, you’ll know it right away.

Digital X-Rays make storing and sharing patient records a breeze

Unlike photographic films that can get lost or destroyed in transit, digital X-rays are conveniently stored on your computers or removable media – and they take up only a tiny amount of space . You can easily share them with a lab or other practitioners as easily as you would sending an email.

Having instant access to digital X-ray images also speeds up your work rate and thereby pass on the efficiency, convenience and time savings to your patients.

Disadvantages of Digital X-rays:

Expensive upfront costs

One potential disadvantage of digital x-rays is the cost. The start-up costs for a digital radiograph system can be significant, with estimates ranging from US$11,000 to US$50,000 depending on the type of system.

These costs may not include additional expenses such as computers, software, hardware, and maintenance and repair fees. Additionally, practices with multiple sensors will need to factor in the cost of these additional units. It may also be necessary to hire someone to convert old records to digital format, adding to the overall expenditure.

Staff training required to incorporate digital radiography

To set up a digital radiography service in a practice, it is necessary to ensure that both the dental team and the radiology technicians are trained to operate the new machinery and computer programs. This may require retraining and updating their knowledge with each new model or software upgrade, although the learning curve may be shorter than starting from scratch.

It is important to note that older radiology technicians who are unable or unwilling to learn how to use advanced digital radiography machines may risk losing their employment at the practice.

Fragility of digital imaging plates​

Intraoral radiography often utilizes photostimulable phosphor (PSP) plates as image receptors. These plates are converted into digital radiographic images using a scanning device after the exposure.

Also called intraoral phosphor plates, they are thinner and more flexible than film plates but may be more prone to damage from bending and may need to be replaced more frequently. Despite this, they can be reused thousands of times and are wireless.

Digital x-rays may require constant replacement of equipment

Digital radiography technology is constantly evolving, and it is not uncommon for newer, more advanced systems to become available on the market. This can be beneficial for the industry as a whole, but it also means that dental practices may need to invest in new equipment every few years in order to keep up with the latest software and hardware advancements. This can be a significant financial consideration for practices.

Types of dental X-rays

There are several types of dental x-rays that may be taken, each of which serves a distinct purpose and provides the dentist with different information. Differentiating between the types of x-rays helps the dentist to choose the best one for the clinical situation at hand and make an accurate diagnosis.

A periapical x-ray, for example, is used to inspect a specific tooth in great detail, but a panoramic x-ray offers a broad picture of the whole mouth. The dentist can gather the most accurate and relevant information to assist plan therapy and make a diagnosis by utilising the proper type of x-ray.

Bitewing X-rays: are used to examine the top and bottom surfaces of the teeth in a specific location of the mouth. They are frequently used to discover cavities and assess the condition of the supporting bone.

Panoramic X-rays: These provide a comprehensive image of the mouth, including the teeth, jaws, and surrounding tissues. They are frequently used to determine the location of erupting teeth or to arrange orthodontic therapy.

Periapical X-rays: show the whole tooth, from crown to root tip, as well as the surrounding bone. They are frequently used to detect abscesses or infections in the tooth or the surrounding bone.

Dental tomography X-rays: These create cross-sectional images of the mouth, allowing for detailed views of specific locations. They are frequently used to identify abnormalities or to guide surgical treatments.

Occlusal X-rays: These reveal the upper surfaces of the teeth as well as the roof of the mouth. They are frequently used to observe the growth of unerupted teeth in children.

Dental cephalometric X-rays: These show a side view of the head and neck. They are frequently used to plan orthodontic treatment or to evaluate jaw growth and development.

Types of digital dental x-ray systems

Intraoral X-ray Sensors: Compact and made to fit comfortably in a patient’s mouth, dental intraoral x-ray sensors produce images that have been demonstrated to be just as diagnostic as film radiographs. However, when it comes to the potential applications of the radiographic pictures, digital sensors provide clinicians with much more.

Digital dental x-ray systems are more patient- and doctor-friendly because they have superior resolution, significantly less radiation exposure for the patient, and software that allows physicians to zoom into specific areas of the image and apply filters for better diagnosis. The sensor technology used in these intraoral sensors is frequently either CMOS or CCD.

PAPAYA 3D Premium Plus x-ray imaging system

Read article: How to choose an intraoral sensor

Digital Panoramic X-rays: Allows dentists to see the whole mouth and teeth. Digital Panoramic X-rays are often used to get a comprehensive view of the teeth and jaws, and can be helpful for identifying problems such as tooth decay, impacted teeth, and abnormalities in the jaw. They use a digital X-ray sensor to capture the image, which can then be displayed on a computer screen and manipulated for better visualization. They are generally faster and more comfortable for the patient than traditional film-based X-rays, and produce images that are easier for dentists to interpret.

Cone beam computed tomography, or CBCT imaging: Cone beam computed tomography (CBCT) is a medical imaging procedure that employs a unique type of X-ray scanner to create 3D pictures of the bones and tissues within the body. It is frequently used in dentistry and oral surgery to provide detailed images of the teeth, jaw, and surrounding tissues.

The CBCT equipment is made up of a tube that emits a cone-shaped beam of X-rays that is focused at the region of the body being scanned. As the beam travels through the body, it is absorbed to varying degrees by various tissues such as bone and soft tissue. This data is captured by detectors on the opposite side of the body and utilised to generate a three-dimensional picture of the area being scanned.

The patient is positioned on a table under the CBCT machine, and the machine rotates around them to take multiple images from different angles. A computer then combines these photos to generate a comprehensive 3D representation of the region being photographed. The entire procedure usually takes less than a minute, and the patient is exposed to the same amount of radiation as during a regular X-ray check.

CBCT allows healthcare providers to see detailed images inside of the body in a non-invasive way. It can diagnose problems with the teeth and jaw, such as infections or abnormalities, and is used to plan for surgical procedures.

Cephalometric x-ray system: A cephalometric x-ray is a type of x-ray that produces a lateral image of the head and face and is commonly used in dentistry and orthodontics. The x-ray beam is directed towards the head from a side angle, and the resulting image shows the bones of the face and jaw, as well as the position of the teeth and soft tissue structures.

This type of x-ray can assist dentists and orthodontists in evaluating the growth and development of the jaw and teeth and planning treatment for issues such as malocclusion (misalignment of the teeth). It is considered a non-invasive and safe procedure, with minimal radiation in comparison to the benefits of diagnostic information.

Product: X-Vision Portable Handheld Dental X-Ray

Phosphor Plate X-ray Systems: A phosphor plate x-ray system is a sort of x-ray imaging technology that captures and records x-ray pictures using an unique type of film called a phosphor plate.

To utilise a phosphor plate x-ray system, the phosphor plate is positioned behind the body part being scanned, and x-rays are transmitted through the body part and onto the plate. When exposed to x-rays, the phosphor plate emits a weak light proportional to the intensity of the x-rays. This picture is then collected by a scanner and turned into digital data that may be shown on a computer screen or printed.

Phosphor plate x-ray systems have the benefit of not requiring the use of typical x-ray film, which must be developed and can be damaged or lost. Phosphor plates are reusable, and the digital pictures they generate are readily saved and retrieved.

How to choose a digital dental X-ray

There are many different models of digital dental x-ray equipment available on the market, and the wide range of prices can make the buying decision confusing. It is important to be clear about your diagnostic and imaging needs when comparing different models, as what works for one practice may not be the best fit for another.

It is also important to consider which features will be most beneficial for your practice, rather than just purchasing a feature-rich machine for the sake of having more features. When shopping for x-ray equipment, it is helpful to keep the following features in mind to help narrow down the selection.

Read article: How to choose an intraoral sensor

Digital dental x-ray features to look out for:

Type of sensor: When selecting a dental x-ray sensor, it is important to consider the quality of the images it produces. The industry standard for x-ray machines is +/- 5% accuracy for all tests. Both CMOS and CCD detectors can produce high-quality images, but CMOS technology has a limited photosensitive area and may have higher noise levels compared to CCD. However, CMOS requires less power to operate, has faster readout speeds, and can produce digital signals without the need for external converters. Ultimately, the choice between CMOS and CCD detectors will depend on the specific needs and preferences of the practice.

Compatibility with Practice Management Software (Dental PMS): The imaging software should be compatible with your current practice management software.

The question is: do you get the image management software that is sold by your Dental PMS company, or should you go for a third-party image program?

No hard and fast rules here. While the image software from your PMS company  guarantee tighter integration being build from the same source, their software may not work with a greater range of digital systems, as compared to a third party program. Also, a third-party program tends to cost a lot less than something a PMS company would sell you.

Image resolution and quality: Digital x-ray sensors can display images with higher resolution than film-based x-rays, but the specific resolution may be expressed in different ways depending on the make and model of the sensor.

For dental cone beam CT (CBCT), the voxel size is just one factor that affects image sharpness. While smaller voxel sizes may not always provide a higher diagnostic benefit, it is generally recommended to use a CBCT unit with a voxel size below 0.2 mm in order to properly visualize trabecular bone and other small structures.

To assess the quality of your radiographic images, it is helpful to compare them to recognized standards such as the European guidelines on radiation protection in dental radiology.

Other variables that can impact the quality of panoramic and cephalometric radiographs include accurate patient positioning and using a cephalostat and fixed x-ray source/patient/image receptor relationship.

It is generally accepted that no more than 10% of radiographs should be of unacceptable quality. If your radiographic equipment does not meet this standard, steps can be taken to reduce the proportion of unacceptable images, with the goal of reducing it by 50% in each successive audit cycle.

Image Processing: The sensor usually comes with a software that have basic image processing features, including image enhancement or image sharpening tools.

Thankfully, many software developers that offer these tools make accessing these features highly intuitive even to a new user. They do not require the user to understand image processing in detail, because the software manufacturers provide good starting values.

Still, it is helpful to appreciate the fact that image appearance can be altered by image processing, and that a new preferred setting (known as a preset) can be loaded and saved into the computer memory such that it becomes the new standard processing method.

DTX Studio suite dental imaging software

Ease of use: While most modern dental x-ray machines and imaging software are user-friendly, the learning curves can vary depending on the specific features and work parameters of the system. Dental technology is constantly evolving, and it can be challenging to keep up with and implement new technologies.

To make the process easier, it is helpful to work with an equipment supplier that provides good support over the life of the equipment and offers customer-side training to facilitate the transition. It is also important to set aside time for training in order to ensure that your team is fully equipped to use the new equipment and software effectively. Good training will lead to a better-equipped dental team and ultimately, success in adopting the new technology in your practice.

Equipment footprint and location: Size is an important factor to consider when introducing a new digital x-ray unit to your clinic space, as these can be bulky pieces of equipment.

It is recommended to have a dedicated radiographic room that is approximately 16 square meters in size, with enough space to accommodate the unit, patient, and any assistants, as well as a permanently built protective cubicle.

Most dental x-ray machines are wall-mounted, so you may need to use a wall board to secure the unit to the wall if the studs are not in the desired location. If you are replacing an old unit, it may be helpful to choose a machine with the same footprint as the previous one. Keep in mind that some x-ray machines are tethered to a PC, so you will need to find an appropriate area for the PC and ensure that the operator remains at a safe distance from the radiation source.

​Scan times: Shorter scan times can improve the comfort of your patients, enables a faster workflow and even minimise motion artefacts. If you want to focus on the quality of your patient care, and improve the health and safety of your patients, selecting a unit with faster scan times is always a good idea.

Brand reputation: It is important to work with a reputable supplier and brand when purchasing new or pre-owned x-ray machines to ensure that the benefits outweigh any potential diagnostic issues. Make sure to choose a certified dealer that offers technical support services and, if possible, an onsite training program to ensure that your staff and radiology team have the knowledge and skills to use the new equipment effectively. This will help ensure a smooth transition to digital x-ray technology.

Read article: How to choose an intraoral sensor

Summary

Dental imaging has come a long way in the past two decades, and digital X-ray equipment is now making it easier for dentists to diagnose their patients and pinpoint the source of their problems. ​

Digital x-rays have several benefits compared to traditional film-based x-rays, including lower radiation exposure, better image quality, and increased convenience. However, they can be more expensive to implement and may require staff training to use the new equipment and software.

It is important to choose a reliable supplier and consider factors such as image quality, features, and training when selecting a digital x-ray system. The size and placement of the equipment should be taken into account, as well as any potential impact on older staff members.

It is important to choose an imaging software that is compatible with your practice management software and consider factors such as image sharpness, patient positioning, and use of a cephalostat to ensure high-quality panoramic and cephalometric radiographs.

The ease of use of the equipment and software, as well as the availability of customer support and training, can also impact the success of implementing new technology in your practice.

Finally, keep in mind that dental technology is constantly evolving, so it may be necessary to invest in new equipment or upgrade software periodically.