Digital X-ray Imaging

Digital X-ray imaging systems take accurate X-rays of patients’ oral anatomy in 2D or 3D. Accurate and detailed 3D images are now achievable at ever lower doses making it possible to ensure accurate diagnosis and patient safety simultaneously.

Introduction

This interactive guide takes a deeper look into dental digital X-ray imaging and the different options available. What have been the recent developments in digital X-ray imaging and what are its applications in modern dentistry? What should you consider when purchasing a digital X-ray machine?

What is digital X-ray imaging?

X-ray imaging is the taking of X-rays of the mouth to generate images of the tooth and bone structure, soft tissue and nerve paths underneath the gums. Digital X-rays are taken by machines which have a digital image sensor which captures the X-ray and displays them on a digital screen. They are fast replacing traditional film X-rays due to the lower doses of radiation required and the impressive level of detail which can be achieved with digital technology.

There are two types of digital X-rays commonly used in dentistry, 2D digital X-rays and 3D X-rays. Traditionally in an effort to keep radiation doses as low as reasonably achievable and because 3D X-rays have until now required much larger doses of radiation, 2D digital X-rays have been widely used.

However, the technology behind Cone Beam Computed Tomography (CBCT) scanners, which are used to take 3D digital X-rays, has improved markedly recently and it is now possible to take extremely clear and detailed images at very low doses of radiation.

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The benefits of 3D digital X-rays

A 3D view

3D is often preferable to 2D as it shows depth as well as height and width. With 2D there is always an element of guesswork as the exact location of structures cannot be determined. Whilst 2D images are perfectly adequate for evaluating tooth decay, bone loss and other more common dental issues, 3D is essential for more complicated procedures such as implant placement and endodontics.

Outstandingly clear images

It is possible to achieve extremely clear, high-definition images with a digital 3D imaging machine which gives the clinician all the information they need to effectively diagnose and plan treatment. The technology behind digital X-ray machines has advanced significantly to enable the capture of sharp, accurate representations of patients’ oral anatomy in both 2D and 3D.

3D at low dose

The real game-changer in recent developments in 3D digital X-ray technology is the ability to capture 3D images at extremely low radiation doses. This has removed a common barrier for many clinicians who have discounted 3D images due to the higher radiation doses required.

Dental practices are required to adhere to both the Ionising Radiation (Medical Exposure) 2000 Regulations (IR(ME)R) and the Ionising Radiations Regulations 2017 (IRR17) , which are based on the ALARA principle of only exposing a patient to a radiation dose that is “as low as reasonably achievable.” As a rule, dental practitioners should favour a lower dose wherever practicable, as long as the resultant X-ray provides the detail and information required to make an accurate diagnosis and an effective treatment plan.

Better diagnosis

An accurate picture of the oral situation is key for diagnosis, especially for more complex treatment such as endodontics and implant surgery. For instance, it enables endodontists to determine much more easily the presence and location of disease and therefore decide upon the long-term prognosis of the tooth.

Better treatment planning

A clear 3D model of the oral anatomy enables clinicians to plan treatment much more effectively. Implant surgeons can determine the optimum placement and angle of the implant, taking into account bone density and the location of any nerves. Endodontists can accurately plan their access and ensure they know the number and configuration of root canals and the curvature of the roots. 3D removes the element of surprise.

Efficiency

From accurate diagnosis and comprehensive treatment planning comes efficient treatment. The clinician is ready with the requisite tools and materials to carry out a planned and optimised treatment and this leads to better patient outcomes. Having a CBCT scanner in-practice with both 2D and 3D capabilities, and a range of dosage and field of view options means the clinician is fully equipped to make the right treatment decisions in the shortest possible time frame – which benefits the patient and the business.

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Applications for digital X-rays

Implant surgery

Crystal-clear 3D X-rays are essential for implant placement planning. Only then can the clinician be sure they are placing the implant in the optimum position in terms of bone density and implant angulation, whilst avoiding any nerves or other anatomy.

A detailed 3D view also gives the implant clinician an accurate picture of any pathology and possible complications that might arise from it. An area for possible concern on a 2D image might look relatively small, but in 3D it may appear more significant. The exact location of any nerves will also be clearer.

Orthodontics

Extraoral X-rays reveal the relationship of the teeth to the jaw and rest of the head. They help orthodontists identify impacted teeth, monitor growth and development of the jaws and to identify potential issues between teeth, jaws and the temporomandibular joint.

A 2D orthopantogram (OPG) is commonly used in orthodontics to obtain a panoramic view of all the teeth in the lower and upper jaws in a single film, thereby demonstrating the number, position and growth of teeth, including teeth that have not surfaced yet.

Cephalometric X-rays show the entire side of the head, useful for examining the teeth in relation to the jaw and profile of the head.

CBCT X-rays provides the orthodontist with unrivalled accuracy particularly in relation to the three-dimensional location of different parts of the oral anatomy. It provides accurate measurements in 3D, improving such things as the localisation of impacted teeth, the existence of any airway abnormalities and the exact measurement of any asymmetry.

Endodontics

3D digital X-rays in particular help the endodontist to accurately assess the clinical situation and diagnose any disease. This facilitates their decision on the best treatment and then helps them plan the treatment meticulously to ensure that no root anatomy is missed and that the best access points are identified. It takes the guesswork out of endodontic treatment planning and ensures the clinician is primed and ready for the treatment with the best tools at their side.

How to evaluate digital X-ray machines

There are many factors to consider before investing in a digital X-ray machine. All of the following are recommended criteria:

  • Open and therefore able to be used by a variety of dental equipment and software
  • Clinically proven
  • Cost-effective
  • No ongoing fees or licences
  • Long warranty
  • Future-proof / easily upgradeable
  • Offers a range of definition settings and low dose options to cover all applications
  • Offers a range of fields of view to ensure adherence to the ALARA principle
  • Easy to use, including straightforward patient positioning
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Browse our three best-selling digital X-ray machines

ACTEON Logo
ACTEON X-Mind Prime 3D

Acteon X-MIND® Prime 3D

The Acteon X-MIND Prime offers a wide range of 32 CBCT and 24 panoramic options covering many clinical applications including implants, endodontics, TMJ and sinus imaging, all in one smart, compact unit. Designed to reduce patient preparation time, the X-MIND’s natural face-to-face positioning is supported by alignment lasers for correct patient positioning, whether sitting or standing at any height. Choose from 2D or 3D examination with settings and dose automatically adjusted with zero footprint space thanks to the innovative wall mounted system.

  • Dedicated holder allows for scans of 3D models in a range of materials and designs
  • Easy export of data in STL format
  • Metal artifact reduction filter
  • 100% Mac® and Windows® compatible with AIS software
  • Ready to install, delivered and assembled at your practice in just one hour
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Dentsply Sirona
Dentsply Sirona Axeos

Dentsply Sirona Axeos

The Axeos 2D/3D imaging solution provides the broadest range of functions of all the Dentsply Sirona extraoral X-ray systems. With excellent image quality, large field of view and tailor-made 3D volume sizes, it is fully optimised for enhanced patient comfort. The Direct Conversion Sensor (DCS) redefines standard panoramic imaging. Unlike conventional systems, X-rays are converted directly into electrical signals with no signal loss due to light conversion. This results in images with a uniquely high level of sharpness – even at an extremely low dose.

  • Autofocus for reliably sharp 2D images
  • 3D Low Dose for 3D information at a dose as little as 2D
  • Extraoral Bitewing with dedicated curve
  • MARS – Metal Artifact Reduction Software included
  • Sidexis 4 imaging software with connectivity to PACS, RIS, DICOM Worklist and DICOM Printers
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NewTom
NewTom GiANO 3D Imaging System

NewTom GiANO 3D Imaging System

The NewTom GiANO generates volumes providing accurate 3D, Ceph and carpal exams for every diagnostic need. Featuring patented SafeBeam™ technology, it automatically adjusts the radiation dose according to the density of the volume in the gantry using intermittent bursts of radiation, lasting only milliseconds, during image acquisition, eliminating the possibility of unnecessary exposures. With a wider range of adjustments for the X-ray voltage and current when compared to other CBCT systems, patient exposure is customised for each scan and image contrast remains consistent, regardless of patient size or bone density.

  • Constant magnification in all projections for highly reliable diagnostic images
  • Wide choice of fields of view and execution modes for dedicated applications for endodontic examinations
  • With high technology and a competitive price, GiANO can be considered the most competitive hybrid available today
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The power of digital scanning and X-ray imaging combined

Digital impressions and digital X-rays both deliver extraordinary accuracy and clarity and have revolutionised impression and X-ray taking respectively. But what happens when the two are combined?

CADCAM software can merge the surface scan from a digital impression with a 3D digital X-ray to give the clinician a complete picture of the oral situation above and below the gum line. This is invaluable for some areas of dentistry in particular and also for communication both with the patient and within the dental team.

Implant-borne restorations

Combining a surface impression from an intraoral scanner and a 3D digital scan together gives an implant surgeon all the information they require to plan the placement of one or more implants and a restoration on top. The surface impression and digital scan are imported into CADCAM software and merged. The restorative clinician designs the restoration within the software and plans the implant placement concurrently ensuring they work seamlessly together. They can even design a surgical guide within the software and print it out on a 3D printer, or order it along with the restoration from the laboratory. This means that implants can be placed and the prosthetic manufactured with pin-point accuracy which results in an optimally fitted, aesthetic and long-lasting restoration.

Orthodontics

Digital impressions and 3D digital X-rays can be used together to deliver custom, patient-specific orthodontic appliances – even in-house with the addition of a 3D printer. A 3D radiographic view of the patient’s anatomy means the clinician no longer has to guess the 3D location of an impacted tooth or the correct eruption vector. Merging the X-ray and the surface scan enables the clinician to use the root anatomy to devise the correct orthodontic treatment plan, improving the long-term outcome.

Patient communication

The ability to show the patient images of their oral anatomy both above and below the gums gives patients a much better understanding of the diagnosis and the intended treatment plan. Accurate pictures speak more than a thousand words which significantly improves patient understanding and therefore treatment uptake.

Acteon

Dental team communication

Digital images and CADCAM software have succeeded in improving communication between the whole dental team, including clinician, technician and any third-party partners. Communication is instant and misunderstandings are avoided because every team member has immediate access to the detailed images and design files. From a patient record-keeping point of view, digital images make it much easier to keep all patient information together in a single file on a practice management system for instance. Diagnostic images can then also be tracked more easily to monitor disease progression or any other changes in the patient’s dentition.

Invest in your future

The power of digital images to transform dentistry cannot be disputed. The high quality of treatment that they make possible is now well-documented and there is no doubt that they will play a significant role in the future of dentistry.

Accurate diagnosis and confident treatment planning are the foundation of successful treatment outcomes and the latest intraoral scanners and digital X-ray machines now make both consistently achievable. There has never been a better time to invest in digital imaging and Henry Schein Dental has picked the best equipment to help clinicians maximise its potential.

Our Capital Asset Finance schemes can help you to maximise the Annual Investment Allowance, where you can offset up to £1,000,000 of capital asset spend against pre-tax profits in any full financial year.

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