A. Miles DDS, MS, FRCD, Dip. ABOMR,
bet that most readers do not realize
the tremendous and widespread impact
that digital imaging has already made
on our profession – especially upon
the specialties. Digital imaging is
used by endodontists, periodontists,
orthodontists, oral and maxillofacial
surgeons, oral and maxillofacial radiologists
(of course), cosmetic dentists and
prosthodontists. Digital x-ray systems
are used for subtraction radiology
in periodontics, CT and MRI by surgeons
and radiologists and for root canal
therapy by our endodontic colleagues.
Digital imaging systems using video
cameras are used by prosthodontists
(and general clinicians) for performing
CAD CAM restorations. And now, because
of imaging programs and engineers,
plastic "aligners" are used instead
of brackets for minor orthodontic
tooth movement (Invisalign™).
Imaging and Endodontic Treatment
no surprise that endodontists were
the "early adopters" of intraoral
digital x-ray systems. Rapid image
acquisition, low dose intra-treatment
x-ray assessment and speed were the
factors influencing these specialists
to "go digital". Even in the general
dentist’s office these attributes
are hard to resist. Who wouldn’t like
to lower the patient’s x-ray dose?
Who wouldn’t like a faster image for
establishing the "working length"?
Who couldn’t use a quicker image of
the "hot tooth" of a new "emergency
patient"? What dynamite ways of establishing
better patient rapport and treating
patients more efficiently! What a
great practice builder!
CCD image of successful endodontic
treatment taken with ProVision DEXIS
Imaging and Periodontal Therapy
group of early adopters were the periodontists.
The ability to use the software of
digital x-ray imaging systems to subtract
the original treatment x-ray from
the follow-up image and quantitate
and colorize the changes to better
assess the success of the procedure
was very attractive to this group
of specialists. Several software programs
on the market have this "digital subtraction"
capability. Although the application
is limited, it gives us one more impressive
tool to help us manage our therapy
In addition to the subtraction tool,
digital x-ray systems are being used
by periodontists to perform pre- and
post-surgical implant site assessment
and integration. More and more of
these specialists see the advantages
of digital imaging for implant procedures.
Pre-surgical assessment of multiple
implant sites using CT (computed tomography)
is another use of digital imaging.
Although more expensive than intraoral
imaging on a case by case basis, CT
images of implant sites have the advantage
of seeing the precise width of the
proposed site and can be reformatted
into 3D images when necessary. Even
the periodontist is "going digital"!
imaging and Orthodontics
have been "digitizing" plain cephalometric
images for years to perform various
orthodontic analyses to predict tooth
movement and assist treatment planning.
Orthodontists have also recently begun
to adopt a new treatment modality
called "InvisalignTM". This "non-braces"
approach was made possible by engineers
who could image the patient’s models,
construct a treatment approach by
mapping desired tooth movement, and
custom manufacture a set of plastic
"aligners" to be changed each 2 weeks
to move the teeth in small increments
until the teeth were straight. Although
the technique requires excellent patient
compliance and can only be used for
minor, adult tooth movement, it does
not require the patient to wear "braces".
Needless to say it is becoming very
popular, and it is made possible by
imaging in Oral and Maxillofacial
surgeons have been using CT and MR
for imaging facial trauma, for presurgical
planning for head and neck lesions
and temporomandibular joint assessment
for many years (figure 2). Knowingly
or not, these specialists too, have
been using digital imaging. 3D reconstruction
of digital data of bullet wounds,
motor vehicle accident trauma and
tumor assessment are all made possible
through the use of digital images
and computers. OMF surgeons are even
"performing" virtual surgery prior
to the actual procedure using experimental
robotic/surgery systems. It is possible
to "fly" through the patient anatomically
using digital imaging.
2 - MR image of TMJ meniscus
Imaging and Cosmetic Dentistry
of the first clinical or non-x-ray
uses of digital imaging software was
to allow the dentist to perform cosmetic
imaging of the patient to show what
the "end-product" could be like for
the patient. These software packages
used clinical video or still images
and image processing tools to show
the patient what they would look like
with a diastema closed, an edentulous
space restored, teeth bleached, etc.
All of these systems employed digital
imaging devices and image software
to help the dentist educate their
patient and to help the patient, in
turn, make an informed treatment decision.
The process is so much faster than
performing a "diagnostic wax-up"!
Imaging Applications for Prosthodontics
data supplied to the milling machines
used by the various CAD CAM systems
gets there by digital imaging. A video
image is acquired of the tooth preparation
and this image data is sent to the
lathe to precisely cut the appropriate
prosthodontic restoration. Yes, it’s
true, even the prosthodontist has
adopted digital imaging! And these
machines are truly capable of reproducing
the precise tapers of full crown preparations,
leaving only the pre-programmed space
for optimal cement thickness.
the patient’s clinical digital images
of tooth shape, size, translucency
and enamel characterization needs
can also be sent to the laboratory
technician with the prescription.
All of this is possible through digital
is almost no aspect of dentistry that
digital imaging technology has not
touched in some way. I have outlined
only a few of the current applications.
Digital imaging will allow us to detect
disease changes better, make more
informed and confident treatment decisions,
and allow all of us, specialist or
general practitioner to communicate
with our patients and each other more