usage of computer in dentistry for various diagnosis

1. COMPUTER APPLICATIONS IN
DENTISTRY
GUIDED BY PRESENTED BY
Dr. MANOHAR BHAT PARKHI BHATNAGAR
Dr. ABHISHEK KHAIRWA

2. CONTENTS
INTRODUCTION
CURRENT APPLICATIONS IN DENTISTRY
ADVANCEMENTS IN DENTAL IMAGING
CARIES DETECTION METHOD
SOFTWARES USED IN DENTAL CLINICS
VISTA SCAN
CONCLUSION
REFERENCES

3. INTRODUCTION
 Computers are becoming an integral part of the practice in
dentistry.
 Smaller , smarter and more ergonomic computing devices will
support an increasing proportion of dental practice activities.
 It helps in retention of facts about many patients and
selection of relevant facts to give a diagnosis.
 Comparative digital study of radiograph , segmental
cephalograms.
 Storage of facts associated with symptoms of patients and
selection of relevant facts to give a diagnosis.

4.  Digital dentistry can be defined in a broad
scope as any dental technology or device that
incorporates digital or computer controlled
components in contrast to that of mechanical or
electrical alone.

5. CURRENT APPLICATIONS IN DENTISTRY
I. RADIOVISIOGRAPHY
 It was invented by Dr. Francis Mouyens in 1981 and
commercially in 1989.
 Comprises of four basic components viz. x-ray set
with electronic timer, an intraoral sensor, a display unit
& a printer.
 Original system, which was based on digital
hardware without a microprocessor , will be referred
to as Mark 1.
 An initial second generation (Mark 2), was based on
a 32 – bit software driver central processing unit.

6. RADIOVISIOGRAPHY

7.  ADVANTAGES OF RVG
 Substantial dose reduction
 Production of instantaneous images.
 Control of contrast
 Ability to enlarge specific areas which may be of use in
visualizing instrument location during endodontic
treatment.
 Potential for computer storage &subsequent
transmission of the images.

9.  DISADVANTAGES
 Sensor size & it’s greater thickness than
conventional film.
 There also appears to be a loss of resolution of
the RVG image from the screen to the video print
due to the transfer of the signal from the DPU to the
printer.
 Cost of equipment.

10.  COMPONENTS OF RVG SYSTEM
1. X-RAY SET
 Conventional x-ray tube with generation operating
at 70 Kvp for use with the RVG system.
 It is connected to a microprocessor- controlled timer
which allows very short exposure time 0.02 seconds.
 Timer and x-ray set may also be used for
conventional intraoral radiography.

11. 2. INTRAORAL SENSOR
 Original intraoral sensor supplied with the Mark 1 system
was approx. 40×22×14 mm.
 Sensor houses a rare-earth intensifying screen which is
optically coupled to an array charge coupled devices
(CCD).
 In Mark 2 system , both normal & ‘200 m high resolution
(ZHR) was available.

12.  Updated sensor supplied with the Mark 3 has a
25% larger sensitive area & less thickness by
16%.
 Waterproof sensor has been developed which
can undergo cold sterilization procedures.

14. 3. DISPLAY PROCESSING UNIT
 Analog signal obtained from the CCD after radiation
exposure is stored in this unit & converted pixel by
pixel into discrete gray levels.
 CCD receiver together with digitizing boards & an 8
bit processor , allows upto 256 levels of gray to be
obtained.

15.  In mark 2 system , more flexible digital image
processing was available along with facility for
storing the image data by transmission to a micro
computer.
 Main distinction between the two mark 3 models is
that the ‘stand alone’ version can be used as such , or
may be connected to a compatible PC & used with
appropriate software.

16. 4. VIDEO PLAYER
 Original video printer sold in the UK with the Mark 1
system was manufactured by Sony .
 A dry silver images (3M UK) was used in the mark 2
mobile unit.
 The digital graphic printer used with the mark 3
system is also manufactured by Sony.

17.  FEATURES OF RVG
 Image enhancement: The ‘gray – window’ effect,
alternatively described as the ‘X- function’ , allows the
operator to select & expand on a specific 60 levels of
gray from the 256 available & may aid in diagnosis of
accessory root canals.
 Image can be electronically enhanced by smoothing edge
enhancement & edge detection.

18.  A millimeter grid has been incorporated into the mark 3
system.
 Use of pseudo- color available as part of the mini- Julie
software & integrated in the mark 3 system.
 This feature assigns different colors to certain gray
levels.

19.  RADIATION DOSE:
 Current radiation protection regulation recommend
the use of the fastest available films consistent
with satisfactory diagnostic results.
 Horner Walker determined the radiation dose on
the RVG setting on the Mark 1 system to be 23%
of that required for D speed film or 41% of the dose
required for exposure of E speed film.

20.  RESOLUTION
 The limiting resolution of the Mark 1 system was
estimated to be 5 to 6 line pairs /mm in normal mode & 7
to 8.5 line pairs / mm in ‘zoom ’mode 2.
 In the mark 3 & the subsequent deletion of the ZHR
function , the resulting resolution of the system is a line
pairs /mm.
 In vitro, & in vivo experiments suggest that although this
is inferior to the resolution achieved by conventional x-
ray films, it is adequate for most diagnostic tasks.

21.  COLLIMATION
 Incorporating rectangular collimation to the RVG
sensor would permit a further decrease in radiation
dose.

22. 2. DIGORA SYSTEM
 It is an image plate system which is an alternative, with
fundamentally different digital image acquisition from
that of CCD systems.
 DIGORA was introduced in 1994 & it provides two sizes
of imaging plates comparable with size = 0 = 2 films.
 A single plate can be scanned for approximately 30
seconds.
 In 1997, the Den Optix was introduced. The system has
five sizes of imaging plates which are mounted carousal
which can hold upto 29 imaging plates for scanning.

23.  Read out of image plate takes less than 30 seconds during
which the image gradually appears on the computer
monitor.
 The exposure range of the image plate is wide & linear.
 This system works in a Microsoft windows environment ,
which simplifies all operating procedures.
 Image brightness & contrast can be changed by moving &
angulating respectively where the gray level values in the
original image are seen on the X- axis and Y-axis.
 It allows edge enhancement & gray scale inversion.

26.  Different types of measurements such as linear distances
and angle can be performed. All the values are displayed
on the screen.
 It is possible to display a histogram of the distribution of
the gray levels within a chosen area the mean gray level
value & the deviation around the mean.

27.  ADVANCEMENTS IN DENTAL IMAGING
I. MAGNETIC RESONANCE SYSTEMS
 Used for lesions of extracranial head and neck .
 Imaging for tumors of the skull base, paranasal sinuses,
nasopharynx, parapharyngeal space & carcinomas of the
oral cavity , pharynx & larynx.
 Superior sensitivity in detecting small lesions.
 More accuracy in staging the lesion & narrowing the
diagnostic possibilities.

29. II. NUCLEAR IMAGING
 The advent of it occurred in the early 1950’s when
radiopharmaceuticals were first used to localize
radioactive molecular in specific organs for diagnostic
purposes.
 Useful in diagnosis of disease in the oral and
maxillofacial region.
 It has been reported to be useful in the evaluation of bone
metabolism in bony components of the TMJ for
assessment of facial skeletal growth.

30.  Positron emission tomography (PET) was a test with a
good predictive value for identifying recurrent
malignancies in the head & neck when used in
conjunction with CT.
 The high sensitivity of nuclear bone imaging makes this
procedure valuable in the initial detection of subtle bone
fractures if they are not readily apparent on standard
radiographs.

32. III.COMPUTED TOMOGRAPHY
 J Radon , 1917 was the first person to lay foundation for
such an imaging & later in 1972.
 The first clinical computed tomography x-ray unit was
developed by GN Housefield in England.
 It uses x-rays to portray cross sectional imaging of an
object without superimpositions.
 It uses multiple projections of an object radiation
detectors measure the object’s x-ray attenuation at reach
of these projections & a computer reconstructs the
attenuation data to produce a cross sectional image or
“slice” of the object.

33.  APPLICATIONS OF CT
 Used for the study of anatomic or pathologic structure.
 Useful for diagnosis, treatment planning, and post-
operative follow-up of patients with craniofacial
anomaly.
 Used for non-invasive estimation bone mass.

34.  Used for study of salivary glands diseases.
 Assessment of traumatic injuries to the skeleton.
 Used in dental implant treatment planning

36.  Disadvantages
 High radiation dose relative to that of plain film
radiography.
 High cost
 Relatively long term of image acquisition

37. IV) Spiral CT
 Technique of “Dental CT” also called as “DentaScan”
was developed by Schwarz et al.
 SCT or volume acquisition CT has been developed,
which employs simultaneous patient transition through
the x ray source with continuous rotation of the source
detector assembly.

38.  It acquired raw projection data with the spiral sampling
local in a relatively short period and without any
additional scanning time, these data can be viewed as
conventional transaxial images, such as multi-planer
reconstructions.
 By this it is possible to reconstruct overlapping structures
at arbitrary intervals.

40. V) Cone Beam CT Technology:
 CBCT is an imaging technique consisting of x-ray
computed tomography where the x-rays are divergent,
forming a cone.
 Attilio Tacconi, Piero Mozzo, Daniele Godi and
Giordano Ronca are the pioneers of this technology.
 CBCT allows the creation “for real-time” of images not
only the axial plane but also 2D images in the coronal,
sagittal or even oblique or curved image planes

41.  CBCT scanners are based on volumetric tomography
using a 2D extended digital array providing an area
detector.
 This is combined with a 3D x-ray beams.
 It involves a single 360 scan in which the x-ray source
and a reciprocating area detector synchronously move
around the patients head which is stabilized with a head
holder.
 The first system introduced was NewTom QR DVT 9000
introduced in April 2001 and the two currently used
systems are 3D Accuitomo-XYZ slice view tomography
and iCAT

42.  Advantages:
 It is well suited for the craniofacial area.
 Provides clear images of highly contrasted structures.
 Scan time is rapid (10-70 seconds)
 Real time analysis.
 Low level metal artifact

43.  Disadvantages:
 Increased susceptibility to movement artifacts
 Lack of appropriate bone density determinations .
 They do not allow for assessment of bone quality.

44.  Uses of CBCT:
 Implantology:
a) To assess Osseo integration
b)To determine quality of bone
c) To check the relation of implants
d) Surgical guidance
 Maxillofacial surgery
a) Diagnose tumors, impacted teeth, and fractures
b) To identify relation of teeth with new canals
c) Cystic lesions and delimitation

45.  Pediatric Dentistry
a) TMJ Evaluation
b) Evaluation of Grown
c) Lip cleft palate case
 Periodontology
a) Bone lesions and healing


46.  Orthodontics
a) Planning of orthogenetic surgery
b) Cephalometric analysis
 Endodontics
a) Diagnosis of periapical lesions
b) Identification of canal
c) Endodontic surgery

48. VI) OPG
 Panoramic radiograph is a panoramic dental x-ray
of the upper and lower jaw.
 It shows a 2D view of half circle from ear to ear.
 It is a form of focal plane tomography, thus images
of multiple planes are taken to makeup the
composite panoramic image.
 Dental X-Ray Radiology is moving from film
technology to digital x-ray technology which is
based on electronic sensors and computers.

49.  Lost x-rays can also be reprinted if the digital file is saved.
 Instantly viewable images.
 Ability to enhance image.
 Ability to e-mail images through practitioners and clients.
 Easy and reliable document handling.
 It has much greater exposure latitude. This means fewer
repeated scans which reduces cost, and also reduces patients
exposure to radiation.

50.  One particular type of digital system uses a
photostimulable phosphor plate in place of the film.
 After x-ray exposure the plate is placed in a special
scanner where the latent formed image is retrieved point
by point and digitized using a laser light scanning.
 The digitized image are sorted and displayed on the
computer screen.

52. Caries Detection Method
 Fiber optic transillumination
 Introduction
 FOTI has been used in common procedures since
1960
 In dentistry it was first used as an improved light
source for surgical retractors.
 In 1970, Friedman and Marcus, suggested the use of
FOTI in detection of caries lesions

53.  Fiber optics applied to transillumination of teeth and
other oval structures is a useful technique for detection of
caries, calculus and soft tissue lesions
 It permits a cold, high intensity light source to be used
anywhere in the oral cavity with ease and flexibility

56.  DIFOTI (digitally imaged FOTI)
Introduction
 Recent innovation to fiber optic transillumination
introduced by electro-optical sciences, Irvington, New
York.
 The unit was developed as a diagnostic tool for early
detection of caries without the need to use ionizing
radiation.

57.  USAGE
 The light from the DIFOTI probe is positioned on the
tooth to be assessed, then the tooth is illuminated & the
image on the opposite non- illuminated surface is
captured by a digital electronic CCD camera.
 These data collected are then analyzed by computer
software.
 It has the potential to both detect early carious lesions &
assess their progression.

59. STUDIES ON DIFOTI
 STUDY 1
 TOPIC :Approximal Caries Detection by DIFOTI: In
Vitro Comparison of Diagnostic Accuracy/Efficacy with Film
and Digital Radiography
 AIM: The aim of the present study was to compare the
diagnostic accuracy/efficacy of digital imaging fiber-optic
transillumination (DIFOTI) with film and digital radiography,
in detection of approximal caries lesions.
 One hundred and twelve approximal surfaces were scored for
caries, using DIFOTI images film and digital radiographs. All
three sets of images were examined twice by 8 observers, with
a minimal interval of one week between examinations.

60.  Material and Methods
 The material comprised 56 premolar teeth, extracted on
orthodontic indications and stored in thymol saturated
saline. The approximal surfaces of the selected teeth
presented a range of conditions, from sound to
noncavitated and cavitated caries lesions. There were
no visually detectable caries lesions on other surfaces.
 The teeth were rinsed in 10% sodium hypochlorite
solution for 20 min, followed by rinsing in distilled water
for 20 min.
 The blocks were then used to produce DIFOTI images
film and digital radiographs.

61.  The results of the present study therefore suggest that DIFOTI
records lesion depth more accurately than radiography. It
should, however, be borne in mind that the material involved a
high proportion of enamel caries which can favor the DIFOTI
method.
Conclusion
 The results suggest that within the limitations of the study, the
diagnostic accuracy/efficacy of DIFOTI is superior to
radiography .Lesion depths according to DIFOTI show closer
correlation with the reference standard than those recorded by
film or digital radiography.

62. STUDY 2
 Aim:
To evaluate the validity of the DIFOTI (Digital Fiberoptic
Transillumination) in terms of sensitivity and specificity.
 The DIFOTI system as used for visual interpretation of
digitized images has good sensitivity and specificity
properties for buccal and occlusal initial lesions.
 For proximal superficial lesions, however, due to the contact
between adjacent teeth, the DIFOTI has poor sensitivity and
specificity properties.

64.  Advantages:
 The advantages of DIFOTI over radiography include: no
ionizing radiation, no Film, real-time diagnosis, and higher
sensitivity in detecting early lesions
 It is not apparent to x-ray, as demonstrated in vitro [Keem and
Elbaum,1997], and not seen visually or through use of an
explorer [Electro-Optical Sciences, Inc., 2004].
 Furthermore, its unique advantage over other caries
monitoring methods is its ability to monitor quantitatively
selected lesions over a period of time [Keem andElbaum,
1997].
 Disadvantage:
 Handling of the device may pose a problem as the camera
may be bulky to be
 Manipulated in younger patients’ mouth.

65. DIFOTI image of a tooth with a smooth-
surface caries.
DIFOTI image of a tooth with an occlusal-
surface caries.

66. DIFOTI image of a tooth with a proximal-
surface caries.

67. SOFTWARES USED IN DENTAL CLINICS
A. SARAL SOFTWARE 3C +
 It is a window based software to maintain hassle
free account records for all medical practitioners
like physicians, surgeons, dentists, pathologists,
radiologists etc.
 Features
 Eliminate duplicate work
 Decision making reports
 Easy to learn , easy to use
 Secure & reliable
 Truly local

68. B. SARAL DENTAL SOFTWARE
 Maintains patient registration details
 Medical history
 Dental history
 Chief complaints, diagnosis, treatment planning, treatment
done,
 Reciepts
 SMS for appointments
 Recalls
 Birthday wishes
 Prescription
 Patient education
 Lab work management
 Imaging module manages images of RVG & OPG images

74. VISTA SCAN
 It is a FDA listed image management system
 It is one of the most widely used image management
systems in routine healthcare use & is used to manage
many different varieties of images associated with a
patient medical record.
HARDWARE REQUIREMENTS
 It uses hardware components to provide short & long
term storage.
 It takes advantage of network servers from storage.
 It uses a DICOM gateway system to communicate &
commercial PICTURE ARCHIVING &
COMMUNICATION SYSTEMS (PACS) & modalities
such as CT, MRI & computed radiography (x-ray)
devices for image capture.

76.  It utilizes a background processor for moving the
images to the proper storage device for managing
storage space.
TYPES OF DATA MANAGED
 It not only manages radiologic images, but also is
able to capture & manage pathology images,
gastroenterology images, laproscopic images,
scanned paper work, or essentially any type of
health care images.

78. CONCLUSION
Digital innovation in dentistry has definitely
proved to be a boon. It has become an integral
part of our field and has eased out our work
load and helped us to get specific diagnosis and
better management.

79. REFERENCES
 Shobha Tandon - Paediatric Dentistry , third edition
 Textbook of Pediatric Dentistry – Nikhil Marwah, third
edition
 International Journal Of Dentistry – 2012