Early dental radiology began in 1895 when Wilhelm Conrad Roentgen discovered "X" radiation. A German dentist, Otto Walkoff, produced the first dental radiograph ever recorded with a 25-minute exposure using a glass receptor in his mouth while lying on the floor of his dental treatment room.
Even though technology has improved drastically over time, the basic principles have remained. An X-ray source is used to generate the X-rays, which pass through a tooth; and the remnant beam exposes a receptor.
Thankfully, the appearance of these images has changed quite a bit due to advances in receptor speeds and technology. Over the years, there have been many upgrades in dental radiology, most notably the advent of panoramic imaging. In fact, panoramic imaging was considered the most profound technological advancement in dental radiology in the second half of the 20th century.
Fast-forward to the 1990s and early 2000s and digital imaging took over as the most influential advancement. Even with the advent of digital technology; however, we still had the 2D problem, which is the absence of alveolar width and depth perception, or any 3D information. This 2D problem is inherent with all 2D imaging techniques such as periapicals, bitewings and panoramic images. When we take 2D X-rays of our patient's mouths, we don't know precisely how far away a root tip might be from the lingual cortex, buccal cortex or mandibular nerve canal.
To borrow from an old cigarette marketing campaign, 2D imaging has come a long way from 1895, but it still provides insufficient information for today's implant and/or restorative dentist who demands reliable precision in their diagnostic imaging technology. Cone beam CT is able to provide reliably accurate three dimensional images at reasonable radiation doses for those patients with advanced dental treatment planning needs; and, these machines can be used in the private practice setting.
The use of cone beam technology in private practice has improved the dental office experience in many ways:
- Improves diagnostic ability. We can image our 3D patients using 3D dental imaging.
- Advanced treatment planning. We can look at our ability to treat complex endodontic anatomy, fractured roots, plan for dental implants and more.
- Enhanced patient education. Again, we can look at 3D patient anatomy and 3D images. We also have larger computer screens which enable the patient to see their own anatomy, helps them better understand their condition and facilitates co-diagnosis.
- Foundation for digital dentistry. These DICOM datasets can be integrated into CAD/CAM and stereolithic surgical guides.
- Document patient care. The images are digital datasets and enable you to document dental care more efficiently for your patients.
- 3D research tool. This technology can be used in educational institutions and by dentists in private practice.
Jeffery B. Price, DDS, Assistant Professor and Director of OMFR, Meharry Medical College School of Dentistry.