Digital radiography originally became available in the dental practice in the 1980s, and although the technical side of digital radiography is very different from conventional radiography, the reasons, justification and referral criteria for a digital x-ray are the same as those for a conventional x-ray.1

There are many advantages and disadvantages to digital x-ray, some of which are given here.2

Advantages

  1. 1

    Less radiation – As a general rule, the exposure time needed for digital radiography systems is much less than with traditional film.

  2. 2

    Instant images – If a direct sensor system is being used, the images can appear on the screen immediately. A periapical radiograph on a phosphor plate system can be developed in about a minute.

  3. 3

    Involving the patient – Digital radiography has the potential to encourage patients' acceptance of and adherence to a treatment plan when they have been able to ‘see the problem’.

  4. 4

    Image enhancement and manipulation – The contrast and brightness of the monitor being used to view the image can be adjusted, eliminating the need for another exposure. Furthermore, digital x-ray systems come with manipulation software that can be used to enhance the image with colour and 3D and other techniques, all of which will help dentists to diagnose problems – possibly at an earlier stage than would have been possible with film.

  5. 5

    Information sharing – An electronically stored file which could be a word document letter to a specialist or colleague can be quickly sent and viewed by the other party electronically and a second opinion quickly and easily sought. Often more than one person can view the same image at the same time.

  6. 6

    No chemicals – No one on the dental team will be upset about no longer needing to deal with chemicals, processors, missing films or MSDS sheets, none of which are needed with digital radiography.

  7. 7

    Reusable sensors – Because the sensors detecting the x-rays are reusable, there is no need to buy film.

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    Time saving – Because the images are available instantly there is much time saved in processing.

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    Quick return on investment – Despite the apparently high investment made, the return can easily be realised in less than one year.

Disadvantages

  1. 1

    Initial capital outlay – The overall cost depends on several factors: choice of direct sensor or phosphor plate system, the number of surgeries to be equipped and whether or not the system will be networked across the practice. In addition, the digital system will need computers with interface cards and further computer screens for patients to see the images.

  2. 2

    Comfort – The average direct sensor is slightly thicker than a traditional x-ray film and as a result, some patients could have trouble tolerating these larger devices. The dentist and the rest of the team need to learn the appropriate way to position the sensor to reduce any patient discomfort.

  3. 3

    Network requirements – As with most new technologies, once the team becomes comfortable with using it, everyone will want access to it. It is possible to just equip one surgery with a digital x-ray system, but having access to the images from several places can be useful. One image can be viewed by a dentist in the surgery at the same time as the same image being accessed from another location in the practice. Although this requires a proper setup of the computer network and daily backup of all data, it adds a powerful dimension to the capabilities. Of course the quality of the monitor that is used to examine the images is important as the exposure time is difficult to determine if the brightness and contrast are not shown correctly. Furthermore, if the computer network goes down, then the images cannot be viewed. Of course all that is needed to view a traditional radiograph is a light box.1

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    Learning curve – Many practices that purchase digital systems fail to realise the importance of training for the whole team. People who are used to examining traditional film may have difficulty adjusting to seeing images on screen instead. Assisting all staff to feel comfortable with the new system is very important as conversion to a digital system may not be straight forward, and all members of staff would have to learn new procedures.