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Why vets we meet choose DR over CR for their dental radiographs

by
01 July 2017, at 1:00am

RAINE LEARY of Clark Dental explains why you are working blind if you don’t take quality digital radiographs of your patients

OVER MANY YEARS OF OFFERING both CR and DR in veterinary dental treatment, the vets we are associated with invariably choose the DR dental radiography system. We visit, demonstrate and train with both DR and CR systems on live animals in dental procedures and have found it is very rare for a vet to prefer the CR system. Why is this? Admittedly the financial outlay is somewhat higher with some manufacturers of CR, but we believe it is the speed of the DR system. Looking at the workflow, the CR system has approximately 10 steps and can take up to 20 minutes. The DR system has approximately seven steps and in experienced hands a total examination can be completed in just three to five minutes. With a CR dental system, the process is as follows:

  • Prepare the flexible imaging plates by placing each plate in a single-use clear sleeve.
  • Place the first plate in the animal’s mouth and set up the dental x-ray generator using a bisecting angle technique where required.
  • Fire the dental x-ray generator.
  • Repeat the process as many times as required to cover the maxilla and mandible.
  • Tear each sleeve to release the imaging plate, being careful not to allow strong light onto the plate as this would affect the image.
  • Be careful that you are not allowing blood/fur/dust to enter the CR scanner. Unlike large CR scanners for general full body radiography, dental plates are removed from their protective covering. Make sure you have plenty of gloves and wipes to hand.
  • Feed each plate into the scanner one by one. Each one will take 20 to 32 seconds before the image appears on screen, depending on resolution. So several plates could take several minutes just to feed plates through and see on the monitor. This time does not include the time taken to position and take the images.
  • If your angles are incorrect and you did not capture the area of interest, it is difficult to ascertain where the plate was in the animal’s mouth – in which case another attempt is necessary.
  • The plates must be clean, ready to use for the next animal and you must make sure you have plenty of consumable sleeves. Be careful when handling the plates as they can scratch and will deteriorate over time (from our experience, approximately a year).
  • Some vets like the idea that plates are flexible, but bent plates mean distorted images and all manufacturers have “do not bend” warnings in their literature. The DR dental system process is far simpler:
  • Place the DR sensor in a plastic sheath that you can use for as many images as you need to on that patient.
  • Position the animal in lateral recumbency. Radiograph the maxilla and mandible, then turn the patient to repeat the process on the other side.
  • Position your x-ray generator in a bisecting angle technique (this is simple and we can show you how) to take a view of the incisors and fire. Four seconds later, your image will be on the monitor with no manual processing required. The software does everything. 

Just three minutes

By following the details listed above you can capture 10 images on a cat, for example, start to finish in three minutes. If you should miss the region you were trying to capture, the DR sensor is still in situ and the x-ray generator – whether wall-mounted, trolley or Nomad handheld – has not moved so you can adjust slightly and fire again. Because you are using a DR sensor, you will never see a scratch or “feathering” on the image as you will over time with CR plates. Once you see an image on the monitor, four seconds after firing, the sensor is immediately ready to take the next image. The particular DR system that we supply is the Fona Stellaris/Schick system. The sensor has two years’ warranty and is supplied with a spare, user-changeable sensor cable. The perception can be that DR is expensive if it fails, but actually the Fona/Schick system is extremely robust and you are unlikely to need to change a cable for many years; in any case, you have a spare cable supplied with the system and could buy another if ever required.

Full body CR scanners don’t work for dental

We are often called in by vet practices who have CR dental plates included with their general full body CR scanners and they tell us that because of the time wasted fiddling around with plates and
envelopes, the slow, laborious work flow and the frustration of retakes, these are rarely used and they are interested in dental DR – often having been recommended our Fona Stellaris/Schick system by colleagues who already use it.

DR is fast and convenient

Vets always comment on how quick and easy the DR system is to use and invariably that is what they purchase – even though we do also promote and demonstrate quality dental CR systems. If I was a vet, I would use CR for my large images and I would definitely use DR for my dental images. As the well-known Specialist Martha Cannon states: “I have a specialist cat clinic and although smaller sizes were available for purchase, I chose the Fona Stellaris/ Schick DR size 2 sensor, which is perfect for our dental radiographs. I have been using the system for three years and it is excellent for taking feline dental radiographs quickly, diagnosing effectively and communicating with owners.” Matthew Oxford of New Forest Veterinary Dental Service Ltd has been using the Fona Stellaris DR system for many years. “Image quality, speed and simplicity are important in my work and the Fona Stellaris/Schick system is superb in my opinion,” he says. “The software is simple to use and the support from Clark Dental has been excellent.” 

The financials

A Clark Dental veterinary imaging specialist can visit to demonstrate both DR and CR systems and then we install, train and support our customers. It is very simple for the equipment to pay for itself as customers typically charge between £50 and £70 for a set of dental radiographs. The Fona Stellaris/Schick dental DR system, purchased with the Nomad handheld x-ray – the perfect partner to get the dental angles that you need (as well as taking radiographs in theatre and more) – costs around £50 per week total on finance over five years, so you can see that one paying customer per week covers the cost of the equipment. Add an opt-out clause on the consent form and you will find the majority of owners accept the extra cost for radiographs as you explain to them that without quality digital dental radiographs you are, in effect, working blind.