Short communicationPatient discomfort and cross-infection control in bitewing examination with a storage phosphor plate and a CCD-based sensor
Introduction
Direct digital acquisition of intraoral radiographs has been possible in the past decade. Different concepts have been followed in the development of the digital imaging systems resulting in two basically different receptors: the CCD-based sensors and the storage phosphor plate. Several studies have shown that, theoretically, there are a number of advantages of digital radiography compared to conventional film [1], [2], [3]. However, most studies so far have only evaluated the performance of the systems in laboratory experiments [3]. Though they are sold worldwide, very little documentation exists on the efficacy of the systems in the clinic.
In comparison to the film, most digital receptors are stiff and cannot be bent in the mouth, and the CCD sensors are much thicker than film. The CCD sensors have not been optimal for bitewing examination in the clinic as the effective radiation field has been too small to image the tooth crowns in both jaws in the same exposure, not to mention marginal bone. A new CCD sensor with an effective image area almost as large as the size 2 film, has recently been developed. It has not been investigated whether this sensor size might facilitate bitewing examination, and if the use of the digital receptors is associated with discomfort for the patient.
Microbiological cross-contamination between patients may occur in association with intraoral radiographic examination and, in particular during development of disposable films [4], [5]. Protocols that aim at minimizing the risk of cross-contamination include wearing gloves when placing the film in the mouth and when unpacking the film in the dark room, disinfection of all surfaces or use of barriers, and sterilization of instruments and re-usable filmholders [6], [7]. Surface disinfection as well as enveloping of the films have been suggested and proved effective in minimizing this [8], [9]. In the digital radiography systems, the receptor is consecutively re-used and not sterilizable, which may cause a problem with regard to cross-infection control in the clinic. The phosphor plate may in particular pose a problem as it has to be placed in a scanner, resembling the conditions in the dark room. To our knowledge, no data to explore the extent of these potential problems have been published.
It was the aim of the present study to compare a CCD-based sensor and a storage phosphor plate with respect to patient discomfort and evaluate the efficacy of a simple cross-infection control procedure in connection with a posterior bitewing examination.
Section snippets
Materials and methods
Written informed consent was given by 130 patients (63 males and 67 females) after written and oral information regarding the study. One posterior bitewing (GX-1000 dental unit, 65 kV, 10 mA, f–f distance 40 cm, rectangular tube, exposure time 0.18–0.26 s (same exposure time used for both systems) was taken of the left and right side both with the Digora storage phosphor plate, 35×45 min external measures (Soredex/Orion Corp., Helsinki, Finland) and with the newly developed RVG XL sensor, 32×45×7.5
Results
The evaluation of patient discomfort revealed that 58% of the patients preferred the Digora plate, 30% the RVG sensor, and 12% had no preference. Median VAS score for discomfort with the Digora was 20 mm (range 0–82) and 32 mm with the RVG (range 0–99). The difference was statistically significant (P<0.001).
From Table 1, Table 2 it can be seen that bacterial contamination was a minor problem in both radiographic procedures. Only the coated RVG sensor and the enveloped Digora plates retained large
Discussion
Patient discomfort was on average significantly lower with the Digora plate than with the RVG sensor; however, VAS scores were low with both systems for most patients. A few patients could not tolerate the RVG sensor. These were examined only by the Digora plate. The sensor is 12 mm at its thickest part near the cord and naturally more bulky than the phosphor plate. This is a concern, and a smaller size sensor must therefore also be available in the clinic. The RVG system offers an additional
Conclusion
The phosphor plate was less unpleasant than the CCD sensor for the majority of the patients. Crosscontamination posed a minor problem for both systems when simple hygiene procedures were followed, however, both equipments could benefit from further developments in this aspect.
References (11)
- et al.
Efficacy of digital intra-oral radiography in clinical dentistry
Journal of Dentistry
(1997) - et al.
Interpatient microbiological cross-contamination after dental radiographic examination
Journal of the American Dental Association
(1978) - et al.
Bacterial adherence and contamination during radiographic processing
Oral Surgery, Oral Medicine, Oral Pathology
(1990) - et al.
Direct digital radiography in the dental office
International Dental Journal
(1995) Digital radiography and caries diagnosis
Dentomaxillofacial Radiology
(1998)
Cited by (36)
Hypochlorous acid and white vinegar: Artifact-free COVID-19 disinfection options for photostimulable storage phosphor plates
2022, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :Unfortunately, these methods are reportedly either ineffective or not applicable because of difficulty in use. Although wiping with ethanol is microbiologically effective,5,8,10,39,40 and 70% to 90% ethanol is recommended against COVID-19,21 this procedure causes severe artifacts, as found previously8 and in this study. Wiping with 2-propanol was found not to be microbiologically effective.8
An evaluation of microbiologic contamination on a phosphor plate system: is weekly gas sterilization enough?
2010, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodontologyPatient discomfort and retakes in periapical examination of mandibular third molars using digital receptors and film
2009, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodontologyCitation Excerpt :An earlier study also compared the 2 sensors from Schick and film and found that film was less unpleasant than both of the sensors and that no significant difference existed between the wired and the wireless sensors.2 Other studies on discomfort have similarly reported sensors to be less comfortable than PSP plates.4,5 In the present study, 217 third molar regions were radiographically examined, and the frequency of retakes using 5 intraoral digital receptors was assessed.
An evaluation of microbiologic contamination on phosphor plates in a dental school
2009, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodontologyCitation Excerpt :The majority of these studies used films and chemical processing, with only a few studies having been published that used digital receptors and electronic processing techniques 9,10 Our study focused on the possibility of cross contamination using the Op Time system. A similar study investigated the Digora phosphor plate system (Soredex Orion Corp.), and the authors reported that cross contamination was an issue in that study also.10 Since the first study, the plastic envelope of the tested system has been redesigned and a paper sheath has been incorporated to avoid touching and contaminating the plate.
Analysis of photostimulable phosphor plate image artifacts in an oral and maxillofacial radiology department
2008, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodontologyPhysical properties and ease of operation of a wireless intraoral x-ray sensor
2005, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology