Elevating Veterinary Dentistry: The Power of Digital Radiographic Imaging
Dental radiography is considered an essential part of human dentistry to aid diagnosis and treatment of dental disorders. The veterinary world is catching up rapidly and dental radiography is fast becoming the standard of care for our veterinary patients.
The production of high-quality dental radiographs requires a number of specific pieces of equipment. First, specific dental X-ray plates should generally be used.
These are small and specifically designed to fit within the oral cavity, minimizing the superimposition of structures within the skull and simplifying radiographic positioning.
They come in a range of sizes from 0 to 4, with size 4 being the largest. Sizes 2 and 4 are the most commonly used. Secondly, a specific dental X-ray generator, either handheld or wall mounted, allows accurate and easy positioning for the various views required.
Traditional analog radiography uses X-ray films with an intensifying screen, set within a light-proof cassette. After exposure to an X-ray beam, this film is then processed using either manual or automatic techniques to provide a high-quality diagnostic image.
The use of digital imaging systems first introduced in the early 2000s has revolutionized dental radiography and has many advantages over older analog systems.
There are two types of digital X-ray set-up - Digital Radiography (DR) and Computed Radiography (CR). DR, or direct, systems use a solid-state sensor plate in place of an X-ray film.
This is linked directly to a computer via either a wire or wirelessly via Bluetooth. CR, or semidirect, systems use a photo-stimulative phosphor (PSP) plate which stores the X-ray exposure.
These are then scanned and translated into a digital image on a computer. Both have advantages and disadvantages, but DR systems are most commonly used in dental radiography systems and are generally accepted as superior.
The advantages of digital dental radiography
While there are many advantages, the most notable include:
Speed - DR systems will produce an almost instant image and the sensor can be left in place making any repositioning for repeat exposures quicker and easier
Reduced number of exposures - Digital radiography systems can adjust for suboptimal exposure settings, meaning repeat exposures due to faults are less likely
Ability to manipulate and magnify images - This allows easier viewing and interpretation of radiographs, picking up more subtle pathologies as the images are more easily interpreted
No degradation over time if stored correctly
No requirement for toxic developing and fixing chemicals
Less space required
Access to telemedicine services
Lower exposure settings - reducing radiation doses to patients and personnel by an estimated 50-80%
Initial problems were reported with reduced image detail compared with analog films, however, these have now long since been resolved.
Another commonly reported disadvantage of digital radiography set-up is that initial costs are somewhat higher than analog systems.
This is certainly true, however, it has been estimated that in a busy veterinary clinic, it would take less than a year to make up for these costs thanks to significantly lower running costs. Recent cost-benefit analyses have shown the investment is worthwhile.
Full-mouth dental radiographs
There are demonstrated benefits of full mouth X-rays as standard for all new patients, or where a clinical condition has significantly changed.
It has been suggested that around 40% more pathology will be detected compared with clinical examination alone.
Radiographs are much more sensitive to detecting periodontal pockets that may be missed by probing alone. They also allow assessment of the thickness and quality of the surrounding bone, reducing the risk of iatrogenic fracture if extractions are attempted, especially in small breed dogs.
Dental radiographs can detect any unusual anatomy such as a curved root that may make extractions more difficult, and post-extraction radiographs can be used to check that no root fragments are remaining.
Especially in cats
Dental radiography is essential when assessing feline mouths where resorptive lesions are present. Without it, it is impossible to differentiate Type 1 lesions that require complete extraction from Type 2 lesions that are better treated with crown amputations.
Diagnosing the lesion type before treatment improves patient outcomes and reduces procedure times. Deciduous teeth, in both cats and dogs, which may have undergone partial resorption can also be properly assessed.
Dental radiographs are useful when assessing fractured or worn teeth for subtle evidence of infection. They are vital in helping to determine whether “missing teeth” are truly missing, fractured crowns with roots remaining or impacted teeth that may lead to serious complications such as dentigerous cysts.
They can also be used to help assess oral masses.
How to make the best use of your dental X-ray system
To make the best use of a dental X-ray system there are a few important considerations;
Correct exposures should be used for different-sized patients and teeth. Some machines will have settings for different teeth programmed in others, others will require the use of a manual exposure chart.
Dental X-ray plates or sensors and correct plate sizes should be used to minimize exposures and allow easier positioning
Good radiation safety should be adhered to at all times following ALARA (as low as reasonably achievable) guidelines
The use of a specific dental X-ray generator is recommended to allow easier and more accurate positioning
Correct radiographic techniques should be utilized - generally, images should be obtained using either a parallel or bisecting angle technique, depending on the teeth and species being imaged. For cats, a near parallel (intra- or extraoral) will be required for maxillary cheek teeth.
Standard views should be obtained for full-mouth radiographs
Dental radiographs should be performed under general anesthesia
All radiographs should be assessed to ensure they are of diagnostic quality
Good training of personnel is vital for both positioning and radiographic interpretation
Digital dental radiography is rapidly emerging as an essential tooth in modern veterinary practice
The whole team should be educated on its benefits to both pets and their owners. Digital radiographic imaging allows early detection of dental disease, simplifies treatment, and improves patient outcomes enhancing veterinary dental care, as well as providing an additional income stream for veterinary businesses.
https://newvetequipment.com/dental-xray-equipment
References:
[1] Niemiec, B. A., Gawor, J., & Viadimír, J. (2017). Practical Veterinary Dental radiography. In CRC Press eBooks. https://doi.org/10.1201/b20288
[2] Niemiec, B. A., & Wright, M. (2011). Digital Dental Radiology. Clinician’s Brief., https://www.cliniciansbrief.com/article/digital-dental-radiology . Accessed 02/08/2023
[3] Bailey, M. (2021). Veterinary dental radiology – an overview. Royal Canin - VetFocus. https://vetfocus.royalcanin.com/en/scientific/veterinary-dental-radiology-an-overview . Accessed 02/08/2023
[4] Haws IJ. The evolution of oral radiography in veterinary medicine. Can Vet J. 2010 Aug;51(8):899-901.
[5] Van Der Stelt, P. F. (2005). Filmless imaging: The uses of digital radiography in dental practice. The Journal of the American Dental Association, 136(10), 1379–1387
[6] DuPont GA. Radiographic evaluation and treatment of feline dental resorptive lesions. Vet Clin North Am Small Anim Pract 2005;943-962.
[7] Niemiec, B. A. (2015). The importance of dental radiography. Today’s Veterinary Practice. https://todaysveterinarypractice.com/dentistry/dental-radiography-series-the-importance-of-dental-radiography/ Accessed 02/08/2023
[8] Niemiec, B. A. (2015). Dental Radiology Series: Techniques for Intraoral Radiology. Today’s Veterinary Practice. https://todaysveterinarypractice.com/dentistry/practical-dentistry-dental-radiology-series-techniques-for-intraoral-radiology/ Accessed 02/08/2023
