V I E W S 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 40 300 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 a new paradigm or a paradigm 0 0 8 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 shift, certainly not in the true 0 0 0 0 -6 0 0 19 20 19 19 19 19 20 20 20 19 19 19 19 19 19 20 20 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.