I HAVE WORKED IN THE HUMAN AND VETERINARY DENTAL INDUSTRY for over 25 years and while I can say a lot has changed, there have also been aspects of the industry that are very much the same today as when I first started. To help explain dental x-ray and why things are presently done the way they are, we need to look back to when I started in the dental imaging business.
Different from full body x-ray systems, the first digital systems used in human dentistry were DR imaging (direct radiography) based systems. In the early 1980s the market leader in x-ray imaging, Trophy Radiology, based in France, invented the first intra-oral imaging sensor for human use. By the late 1990s it was nearly as good as dental film, which required manual developing. In 2003, CR (computed radiography) was then brought onto the market with the same quality as DR but with greater flexibility. Ever since then, within human dentistry, CR has been leading the imaging market over DR.
Veterinary-specific dental imaging evolved from the USA and the first few pioneers were human dentists prior to moving into the vet world. They introduced the idea of DR being the best imaging method, which is why DR is still favoured in the veterinary industry in the USA. Although CR is becoming increasingly recognised as the optimum imaging method, DR remains the favoured method with some veterinary professionals.
As I previously mentioned, I worked in human dentistry and trained dentists on how to correctly position DR sensors; this was always hard as humans did not accept the hard sensor easily and with a child’s small mouth it was near impossible. But there were no choices in the beginning. When I moved to working on dental imaging in the veterinary sector, I could not believe that size 2 sensors were being used in dogs and even cats.
I had problems getting the sensors in human mouths as they were designed for bitewings (Figure 1), meaning positioning or even placing the sensor for full mouth radiographs in cats and dogs was going to be very difficult. I thought there must be a better, easier way, so I launched the CR7 Vet, with specially designed software for vets and special plates for rabbits. This was good in the beginning as it had a full range of film sizes: 0, 1, 2, 3 and even up to size 4 (5.7×7.5cm). But as I visited clients, again I found issues; due to how hard the plates were to position in cats’ and dogs’ mouths, vets were only taking x-rays of teeth they saw issues with.
This frustrated me as they were missing up to 40% of what they could not see, below the gumline. In my opinion this meant the animal was potentially walking out of the vet practice still in pain and still with problems. I asked why they were not doing full-mouth imaging on every animal that came into the practice; the answer was simple: in the real world they don’t have time to take 22 radiographs using a size 2 DR sensor or 16 radiographs using a size 4C image plate. They know from their radiography training that they should take full-mouths, but in the real world, vet clinics don’t have the time.
Not thorough enough
This was concerning, as the animals weren’t getting thorough dental examinations and it was like letting a dog walk out of the practice with a potentially broken leg. I could arrange all the training courses possible to show them how to do it, but if the vets didn’t have the time then it was not going to happen. So as a company, iM3 embarked on a quest to change the way x-rays were done.
We had to make it easier; we had to design it so any vet or nursevcould take full-mouth images of every animal. I asked vets what was the number of x-rays they were willing to take – they said six. First we brought out the size 5 plate; as you can see in Figure 2, the plate is much bigger (5.7×9.4cm) than any other plate currently on the market. This was a start – the bigger the film, the fewer x-rays they had to take. But we still had problems with teaching vets and nurses positioning.
In humans it is easy as there are readily available positioner guides and most radiographs are parallel; in veterinary practice there was nothing like that and the bisecting angle technique was needed for most teeth, which often confused vets and nurses. We set about designing a system to make taking dental radiographs easy and the solution solved the problems.
Firstly it protected the plate, secondly showed the centre of the plate, thirdly it showed the correct angle and lastly the correct distance from the x-ray tube. This meant that anyone, even without training, could take intraoral x-rays of dogs and cats.
A full-mouth image is now possible with only six x-rays. The next step was to produce guides to show how to do this. We tried to make it as easy as possible so anyone (not a dental specialist) could take full-mouth x-rays. We are now suggesting to all of our users to take full-mouth radiographs on every animal that comes into the practice. Users commonly charge up to £25 for the six x-rays. This means that if an operator charged only £25 for the full-mouth x-ray, this would still equate to an estimated extra income of £6,500 for the practice per year. It also means that as a result the vet can now see up to 40% more during the imaging procedure, so there is potentially up to 40% more chance of identifying an ailment. No more dogs walking out with a broken leg!
The process that has led us to our present offering began when we started
thinking what actually works in the real world, rather than just on paper or in a wet lab session. We hope that with the ability for vets and nurses to take x-rays more simply, animals will now get the treatment they need, pathology identified, and no longer potentially walk out of the practice in pain. We have carried out a number of studies that prove this simplified method works to increase the amount of dentistry performed within the practice.
In conjunction with the CR7’s ease of use and complete range of image plates, veterinary practices can grow dentistry within the clinic and know they are offering animals the very best care. We have recently brought out a new 30-degree x-ray positioner and extended the length of the 45/55-degree positioners to make the process even easier.