Dental Tribune USA

Making sense of digital radiography

By Dr Lorne Lavine, USA
December 19, 2009

The look and feel of the modern dental practice has changed dramatically over the past 10 years. Systems that were once paper-based have now moved into the digital realm. In many dental advances over the past few years, there’s no doubt that the technology has been the driving force in this process. This is as true in other fields as it has been in dentistry.

In the early 1990s, intraoral cameras were all the rage. In the late ’90s, it was digital cameras. At present, no other topic seems to generate greater interest than digital radiography. While entire books can be written on the subject, the goal for this article is to focus on how digital radiography can improve the profitability of the practice, particularly by improving case acceptance.

In Part II, which will be published in a few weeks, we’ll take a closer look at the infrastructure that is required as this is often overlooked by many practices.

Having worked with hundreds of offices that have installed digital radiography, the biggest hurdle to adopting this technology is financial. While these initial costs are high, there is little doubt that using digital radiography can definitely help the bottom line of the practice by increasing patients’ willingness to come to the practice and accept treatment. There are a number of key areas where digital radiography makes sense.

Image size and quality matters

There is no doubt that in order to increase case acceptance, we have to improve our ability to diagnose disease, and the vast majority of dental practices find digital radiography to be superior to film.

In a recent survey, over 73 percent of the respondents claimed that they found digital radiography to be more diagnostic than film. There are a few reasons for this.

First, there’s a big difference between seeing a life-size image that is around 1 inch compared to an image magnified to fill up a typical 17- or 19-inch screen. Secondly, and just as important, all digital radiography software gives us incredible tools to improve diagnostics. There are a few programs that really simplify this process.

For example, XDR, a smaller company from the Los Angeles area, offers a “caries” icon and a “perio” icon. One click of the icons will apply numerous filters and enhancements to bring out the diagnostic features of the image with minimal muss and fuss.

One thing to keep in mind, however, is that if it’s necessary to enhance every image in order to make it diagnostic, then there’s probably something wrong with the exposure times on the X-ray head or other problems. It’s not an efficient use of your time if you have to modify every raw image that you take.


A practice that is efficient and saves time will be very attractive to your patient base, many who are busy and would prefer to minimize the time spent in the office. The time saved with digital radiography is quite significant. However, it’s important to understand that the time saved is limited to the hard sensors.

While an excellent option for many offices, phosphor plate systems do not provide any timesaving over traditional film. Many offices can start and finish a full mouth series of radiographs in well under 10 minutes, allowing patients to get in and out of the office quicker.

From the practice’s standpoint, being able to see patients quicker means that additional patients can be scheduled during the day, improving the profitability of the practice.

Reduced exposure time

Another key feature of digital radiography is the fact that you can reduce the exposure time of the radiographs. This can be a big selling point for current and future patients.

One thing to be cautious of is that many vendors still claim unrealistic amounts of exposure reduction.

When digital radiography was first introduced, film was much slower and the claims of 80–90 percent reduction in exposure were accurate. However, over the past 15 years, the speed of film has greatly increased, and many offices are now using E speed film.

While offices using digital radiography should still expect a reduction, it’s closer to 30–50 percent over film.

What I always suggest for practices, which may seem counter intuitive to what most people expect, is to take the X-rays at the highest possible setting without overexposing them.

Not only do underexposed digital X-rays appear grainy, you may end up missing many problems because there’s not enough radiation to pick up on pathology.


Probably the biggest selling point of digital radiography for case acceptance is the concept of co-diagnosis. In the past, patients had to rely on their trust of the practice and the dentist to proceed with dental treatment.

In many cases, their dental conditions were not apparent to them and did not have any associated pain, so patients were completely unaware of their dental problems.

While we often tried to show patients the X-rays on a light box, this is not ideal for most patients as they have difficulty seeing the problems. Digital radiography changes all of that.

Now, dental problems that show up in a radiograph can be viewed on a 17- or 19-inch screen and the patients, for the first time, can see exactly what we as dental professionals can see. Once they see and understand their condition, they will be far more accepting of our treatment plans as there will be no doubt in their mind about the status of their condition.

There’s little doubt that digital radiography is still a very hot topic in dentistry. By my estimation, around 40 percent of practices are now digital and I expect that to rise to 60 percent in the next two to three years.

With the federal government mandating an electronic health record by the year 2014 and stimulus funds soon available, there’s no time like the present to get started.

About the author

Dr Lorne Lavine, founder and president of Dental Technology Consultants (DTC), has more than 20 years invested in the dental and dental technology fields. A graduate of USC, he earned his DMD from Boston University and completed his residency at the Eastman Dental Center in Rochester, NY, USA. He received his specialty training at the University of Washington and went into private practice in Vermont until moving to California in 2002 to establish DTC, a company that focuses on the specialized technological needs of the dental community.

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