Introduction

Digital Oral and Maxillofacial Imaging: A New Image for a New Age in Dentistry

New Year 2000 is now "virtual reality." It is the dawn of a new age, and people have millennium fever. Likewise, dentistry is at the threshold of a new age. Technological advances of the past decade have already changed many aspects of dental practice, and the future holds many more new and exciting possibilities. The Journal of the California Dental Association also shares this excitement and recognizes the unique opportunity in time afforded to this issue to view a vision of the future while still in the shadow of the past. As such, the Journal selected digital imaging radiography as the subject of this vision, deeming it the technology most ready to significantly affect the future practice of dentistry. To develop this issue, I was asked to arrange for the contributing authors and provide some introductory comments.

While the decision for the theme of the Journal was made several months ago, it is of interest that as we were finalizing the issue in October, the American Dental Association elected to recognize oral and maxillofacial radiology as dentistry’s newest specialty. Such recognition indicates that dentistry similarly shares the vision of a digital future and has identified a specialty to lead and direct the development of it for the entire profession.

The need for direction for the future is apparent by reviewing the past. Dental imaging, until recently, has only modestly evolved from the early days of Roentgen. It is still primarily film-based and directed toward periapical and bitewing radiography for general dentistry. Granted, other forms of radiographic imaging have been introduced during the past century, but other than panoramic technology, none have made a significant impact upon general practice dentistry. There has been some trickle down effect from medical imaging as advanced technology has produced an awareness of digital imaging and its potential application to dental radiography. This has influenced the development of digital dental imaging during the past decade. When introduced, digital radiography was seen as the key element in achieving the goal of the paperless dental office. Yet, despite availability and considerable media hype associated with digital imaging, as dentistry approaches the next century, the same cautious curiosity is apparent that confronted X-ray imaging at the beginning of the 20th century. Current estimates of digital imaging utilization in the United States are 5 percent to 7 percent of dentists. Why is this, and what will effect a change?

It is the purpose of these articles to highlight various aspects of digital imaging technology for dentistry and to answer the why and what questions. We did not intend to scientifically prove or disprove the validity of digital imaging for dentistry. The contemporary term "digital oral and maxillofacial imaging" has been used as the title theme to reflect the broad range of available capabilities rather than limiting the focus to intraoral imaging. This is consistent with the concept of recognizing the specialty as oral and maxillofacial radiology. The contributing authors are oral and maxillofacial radiologists familiar with the educational and clinical practice of digital radiography, a dental X-ray technologist, and representatives of the digital imaging industry. They were selected because of their expertise and interest in specific areas of digital imaging. The emphasis of the articles is upon improvements and developing research in digital technology and why, as perceived by these authors, these will influence eventual acceptance of the digital image format.

A cursory review of titles would seem to suggest that three of the articles are essentially identical. While these articles contain some overlapping information, each finds a specific path to explore. Drs. Miles, Langlais, and Parks report that "Digital X-Rays are Here" and question "Why Aren’t You Using Them?" Their article is an overview of digital radiography in dentistry as it is now and what it will be in the future with emphasis upon the advantages outweighing the disadvantages. Similarly, Dr. Preston states "Digital Radiography -- Not If, but When" His report focuses upon the specific improvements that have made digital radiography much more capable of challenging and eventually replacing film imaging. Drs. White, Yoon, and Tetradis indicate "Digital Radiography in Dentistry: What It Should Do for You." They describe the practical use of digital image subtraction techniques and explain how oral radiology consulting can occur between dentists using the computer and digital-based patient records.

The article submitted by Dr. Hatcher and Mr. Dial discusses how computer technology associated with the dental imaging center has made an impact upon orthodontic, TMJ, and dental implant imaging. One feature of particular interest is the development of a three-dimensional modeling system that has the potential to significantly change future methods of treatment planning. Similarly, Mr. Woods describes a new technology recently available that makes three-dimensional images of the dental structures, which allows for a "slice-of-bread" view of a tooth. This will allow direct viewing of the furcation if one chooses. Currently, these technologies may seem remote from practical use or directed toward the specialties, but with time, refinement, and reduced initial cost, various aspects will become available for the general dental practice.

Dr. Clark and student doctors Sanz, Roxas, and Menes report the results of a survey they conducted of 34 dental insurance companies regarding use of digital radiographs and electronic image transfer for processing claim forms. Insurance acceptance of digital images is considered an important factor for developing wider utilization of digital imaging. This report provides insight into the problems and concerns that are associated with insurance acceptance and the effect that these will have upon the dental practitioner.

The primary focus of these articles has been upon technology and why it will effect the change to digital imaging. While I agree that technology is a major factor, the role of dental education was not addressed and, in my opinion, is an important reason why the change will occur. The improvements in technology, specifically sensor size and user-friendly software support, have not only increased the appeal to practicing dentists, but have also benefited dental radiography education. Traditional teaching criteria and techniques for periapical and bitewing film radiography can be applied to the digital image. As a result, several dental and allied dental training schools have introduced digital radiography into their teaching programs. This encouraged us at the University of Southern California School of Dentistry to integrate digital imaging into our September 1999 freshman dental and junior dental hygiene dental radiology course. The students were receptive, proved to be computer-literate, and breezed through the imaging software program with ease. Teaching became interactive as rapid image acquisition allowed immediate feedback from any actions made during the alignment and exposure procedures. Our experience suggests that digital imaging will soon become a regular component of all dental radiology curricula. When this occurs, students will not find it a novelty, but rather a familiar option when entering private practice. So whether or not current practicing dentists embrace the technology, certainly, if nothing else, the numbers of new digitally competent graduates entering the marketplace will increase future utilization.

As contributors to this issue of the Journal, we appreciate the opportunity to share our opinions and vision about the future role of digital imaging in dentistry. Just as film radiography ushered in the beginning of the current century, so will digital imaging commence the next. We believe the impact will be significant because once one has experienced rapid image acquisition, it is difficult to get excited about trudging off to the darkroom. So, as we collectively look to the future, hopefully, some of our comments and opinions will be considered helpful to readers in determining their responses to a new image for a new age in dentistry.

Contributing Editor

Robert A. Danforth, DDS, is an assistant clinical professor in the Department of Oral and Maxillofacial Imaging at the University of Southern California School of Dentistry.