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   GUEST EDITORIAL

   Dental digital radiography
   More than a fad, less than a revolution
   MEL L. KANTOR, D.D.S., M.P.H.


                r. Francis Mouyen



   D            ushered in the mod-                                   90                                                                         800




                                                                                                                                                        CUMULATIVE NUMBER OF ARTICLES
                ern digital era in den-
                tal radiography with                                  80                                                                         700
                his seminal 1989                NUMBER OF ARTICLES
                                                                      70
                                                                                                                                                 600
   paper describing radiovisiogra-
   phy.1 Since then, interest in den-                                 60
                                                                                                                                                 500
   tal digital radiography has in-                                    50
   creased significantly (Figure).                                                                                                               400
       The pundits were quick to                                      40
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   claim that dental digital radiog-                                  30                                                                     *
   raphy was revolutionary or a                                                                                                                  200
   new paradigm of imaging. Well,                                     20

   it is more than a fad, but it is                                   10                                                                         100
   less than a revolution. It is not
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                                                                      66




   sense of the term.2 The rotary
                                                                     19




   telephone was revolutionary                                                                                    YEAR
   and defined a whole new way of
                                             Figure. Number of articles about dental digital radiography published annually
   communicating; the touch-tone,            (bars) and cumulatively (line) since 1966. Data obtained from PubMed
   push-button telephone was a               (“www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed”) using the following
   technological improvement. The            search strategy: dental digital radiography [all fields] OR radiovisiography
                                             [all fields]. *: 2005 figures are for the first six months of the year.
   television was revolutionary
   and created an entirely new en-
   tertainment medium; color tele-           submit insurance claims elec-                                         commercially if you should want
   vision and even high-definition           tronically, to forward patients’                                      to consult with a distant den-
   television are mere technologi-           radiographs to a dentist on the                                       tist.”3 Teleradiography is an 80-
   cal advancements.                         other side of town or across the                                      year-old idea.
       Digital technology is a wel-          country, and to obtain specialty                                         A significant advantage of dig-
   come incremental advancement              consultations from experts                                            ital radiography is having in-
   in dental radiography, but it is          wherever they may be. But even                                        stant, or nearly instant, images
   far from a revolutionary                  this is nothing new. Consider                                         that are archivable and retriev-
   paradigm shift. The combina-              this excerpt from a 1929 paper:                                       able at the press of a button or
   tion of dental digital radiogra-          “Through the courtesy of the                                          click of a mouse, all without the
   phy and the Internet makes it             Western Union Telegraph                                               mess and bother of a darkroom.
   possible to send images to any-           Company, we publish two den-                                          Yet to the dismay of the propo-
   one, anywhere in the world                tal radiographs transmitted by                                        nents of dental digital radiogra-
   (provided they have a computer,           telegraph and photographs of                                          phy, a survey of a simple random
   an Internet connection and the            the simple-appearing but most                                         nationwide sample of 1,709 gen-
   appropriate software).                    ingenious machines which make                                         eral dentists in private practice
       The transmission of radio-            this modern wonder possible.                                          revealed that only 11.5 percent
   graphic images—teleradiogra-              Even the filled root canals show                                      use digital technology for all of
   phy—allows practitioners to               up well. This service is available                                    their intraoral imaging (M.K.,


   1358   JADA, Vol. 136   www.ada.org/goto/jada October 2005
                             Copyright ©2005 American Dental Association. All rights reserved.
V I E W S




                                             efficacy compare digital images              be judged on the basis of a sub-
   unpublished data, 2004).                  with film-based radiographs,                 jective assessment of what the
      Are the worries of maintain-           and they generally conclude that             image looks like. A ‘pretty’ image
   ing a darkroom or automatic               digital images are not statisti-             is not always a good image when
   processor that much greater               cally different from film-based              it relates to diagnostic imaging,”
   than those of maintaining the             radiographs.6 That is, digital               writes van der Stelt.7
   computer network necessary to             imaging is as good as film,                      Given all of the hype and
   view images in multiple opera-            which tells us that film remains             hoopla about dental digital
   tories? A properly exposed and            the gold-standard image of                   radiography, it is easy to think
   processed radiograph will be              dental radiographic diagnosis.               that digital is a must-have
   viewable for decades using only           Dental digital radiography may               technology for a modern dental
   a simple light box. Will the digi-        improve office efficiency, facili-           practice. Writing about the
   tal images stored on today’s lat-         tate filing insurance claims, be             paperless office, Sellen and
   est recording medium be view-             useful for marketing your prac-              Harper8 made the following
   able in five, 10 or 20 years?             tice and appeal to your inner                trenchant observation: “Change
   History suggests not. As recent-          gadgeteer, but it is not likely to           for the sake of change is hugely
   ly as the late 1980s, personal            make you a better dentist.                   problematic. Going paperless
   computers used 51⁄2-inch floppy              The cover story in this issue             for the sake of ‘out with the old,
   disks (which were truly floppy).          provides an optimistic yet well-             in with the new’ is destined to
   These were soon replaced by 31⁄2-         balanced overview of dental dig-             end in failure.” Substitute “digi-
   inch floppies (which were not),           ital radiography that should                 tal” for “paperless” and heed
   which were replaced by Zip                help practitioners decide                    their warning. Digital has more
   drives (Iomega, San Diego) and            whether and when to adopt this               bells and whistles and more
   CDs, which have been outdated             technology.7 The author de-                  razzle-dazzle, but film remains
   by DVDs and Universal Serial              bunks some of the myths that                 an excellent medium for record-
   Bus memory keys. Dentists will            enshroud the topic and discuss-              ing radiographic images. No
   need to invest resources to mi-           es some of the technological                 dentist in a film-based practice
   grate the information from one            capabilities, which, should they             should feel compelled to switch
   recording medium to the next,             become robust and stable as                  to digital radiography or be
   and the next, and the next, in            well as commercially and widely              made to feel out of step with
   order to ensure that they can             available, may make digital ra-              contemporary dental practice. s
   retrieve digital images when              diography the preferred imag-
                                                                                            Dr. Kantor is a professor, Department of
   they are needed (for example,             ing modality in the future.                  Diagnostic Sciences, New Jersey Dental
   perhaps to defend against a                  Someday, automatically en-                School, University of Medicine and Dentistry
                                                                                          of New Jersey, Newark.
   lawsuit). Perhaps the majority            abled algorithms may classify a
   of general dentists who have not          patient’s risk of experiencing                 1. Mouyen F, Benz C, Sonnabend E, Lodter
                                                                                          JP. Presentation and physical evaluation of
   switched to digital radiography           osteoporosis based on the trabec-            RadioVisioGraphy. Oral Surg Oral Med Oral
   know something that the digital           ular pattern of the alveolar bone            Pathol 1989;68(2):238-42.
                                                                                            2. Kuhn TS. The structure of scientific revo-
   experts don’t.4                           or detect carious lesions at an              lutions. 3rd ed. Chicago: University of
      Except for endodontics and             earlier stage of demineralization            Chicago Press; 1996.
                                                                                            3. Sending dental X-rays by telegraph. Dent
   some surgical procedures for              than is possible with film or cur-           Radiogr Photogr 1929;2(2):16.
   which instant intraoperative im-          rent digital technology. These                 4. Surowiecki J. The wisdom of crowds: Why
                                                                                          the many are smarter than the few and how
   ages are helpful, dental digital          would be advances that make                  collective wisdom shapes business, economies,
   radiography in its current incar-         digital radiography worthy of                societies, and nations. New York: Doubleday;
                                                                                          2004.
   nation is not likely to improve           serious consideration. More re-                5. Dunn SM, Kantor ML. Digital radiology:
   your ability to diagnose and              search is needed to determine                facts and fictions. JADA 1993;124(12):39-47.
                                                                                            6. Ludlow JB, Mol A. Digital imaging. In:
   treat patients. In the early days         which of even the currently                  White SW, Pharoah MJ, eds. Oral radiology:
   of dental digital radiography,            available image enhancements                 Principle and interpretation. 5th ed. St.
                                                                                          Louis: Mosby; 2004:225-44.
   film was the gold standard                actually improve diagnostic effi-              7. van der Stelt PF. Digital radiology in den-
   against which digital images              cacy. Practitioners cannot simply            tal practice. JADA 2005;136:1379-87.
                                                                                            8. Sellen AJ, Harper RHR. The myth of the
   were compared.5 It still is. Most         rely on what looks good to them.             paperless office. Cambridge, Mass.: MIT
   of the studies of the diagnostic          “The quality of an image cannot              Press; 2002.




   1360   JADA, Vol. 136   www.ada.org/goto/jada October 2005
                             Copyright ©2005 American Dental Association. All rights reserved.

				
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