Chapter 3

Dental Imaging
 Computer Imaging Concepts
Types of Graphic images
– Bitmap Images: (raster images)
– Vector Images:
– Hybrid programs
Computer Imaging Concepts
Bitmap Images: (raster images) are made up of an
array of thousands or millions of pixels.
They are larger files than vector produced files.
They are resolution-dependent, so that when
magnified they appear jagged. 
Creates softer images and images can be
transparent.
Image-editing programs examples are CorelPaint™,
Microsoft Photo Editor™ and Photoshop™ 
Bitmapped images are saved on the computer with
one of the following file extensions; TIF, BMP,
JPG, GIF, PSD
 Computer Imaging Concepts
Vector Images: are made up of objects such as shapes,
lines, and fonts, which are defined mathematically, not
by pixels.
Vectors are better suited to graphics composed of basic
shapes, as in a corporate logo. The files are smaller in
size than are bitmap files.  
They are resolution-independent, so they can be shrunk or
magnified with no loss of detail.
Illustration programs examples are: Illustrator™,
Freehand™ and CorelDraw™
Vector images are saved on the computer with one of the
following file extensions; EPS,  CDR,  AI (Illustrator).
 Computer Imaging Concepts
Hybrid programs: combine both vector and
raster technology--Macromedia
Fireworks™-PNG files.
 Computer Imaging Concepts
Graphics Image Programs Used in
Dentistry
Bitmap (raster) imaging programs in
Dentistry are designed for images
obtained from input devices such as
scanners, digitized x-rays, intraoral
cameras and dental caries diagnostic
programs (laser technology).  
 Graphics Program Example

Photoshop’s basic tools

– Eraser
– Crop
– Rotate
– Zoom
– Blur & Sharpen
– Eye Dropper
– Paint Bucket
 Use of Imaging in Dental
1.
Practice
Treatment Planning.
-Having photographs or short video makes treatment
planning easier when patient is not available.

2. For Consulting Purposes.

3. Document Caries.

4. Document Questionable Soft Tissue Lesions.

 Use of Imaging in Dental
Practice
5. Pre and Post-treatment Photographs.

6. Document Periodontal Disease areas.

7. Document Oral Hygiene Care.

8. Document Diagnosed But Untreated Areas.
9. Documentation for Medical-Legal Purposes.
 Types of Dental Imaging
There are two major types of dental imaging
systems; dental x-ray imaging and
dental non x-ray imaging systems.
Dental X-rays systems are divided into two
main types: intraoral (meaning the X-ray
film is inside the mouth) and extraoral
(meaning the X-ray film is outside the
mouth).
 Types of Dental Imaging
Dental non x-ray imaging systems are a
variety of systems that do not depend on
x-rays to produce dental images. Those
systems are mainly digital imaging
systems that are either intaoral or
extraoral systems.
 Dental X-Ray Systems
Intraoral X-rays are the most common type of dental X-
ray taken. These X-rays provide a lot of detail and allow
the dentist to find cavities, check the health of the tooth
root and bone surrounding the tooth, check the status of
developing teeth, and monitor the general health of the
teeth and jawbone.
Types of Intraoral X-Rays
There are several types of intraoral X-rays, each of which
shows different aspects of teeth.
– Bite-wing X-rays
– Periapical X-rays
– Occlusal X-rays
 Dental X-Ray Systems
Types of Intraoral X-Rays
• Bite-wing X-rays show details of the upper
and lower teeth in one area of the mouth.
Each bite-wing shows a tooth from its crown
to about the level of the supporting bone.
Bite-wing X-rays are used to detect decay
between teeth and changes in bone density
caused by gum disease. They are also useful
in determining the proper fit of a crown (or
cast restoration).
 Dental X-Ray Systems
Types of Intraoral X-Rays
• Periapical X-rays show the whole tooth -- from
the crown to beyond the end of the root to where
the tooth is anchored in the jaw. Each periapical
X-ray shows this full tooth dimension and
includes all the teeth in one portion of either the
upper or lower jaw. Periapical X-rays are used to
detect any abnormalities of the root structure
and surrounding bone structure.
 Dental X-Ray Systems
Types of Intraoral X-Rays
• Occlusal X-rays are larger and
show full tooth development
and placement. Each X-ray
reveals the entire arch of teeth
in either the upper or lower jaw.
 Dental X-Ray Systems
Extraoral X-rays show teeth, but their main focus is
the jaw and skull. It is not used for detecting cavities or
for identifying problems with individual teeth, instead, it
is used to look for impacted teeth, monitor growth and
development of the jaws in relation to the teeth.
Types of Extraoral X-Rays
• Panoramic X-rays
• Tomograms
• Cephalometric projections
• Sialography
• Computed tomography
Extraoral X-Rays
 Panoramic X-rays
show the entire mouth
area -- all the teeth in
both the upper and
lower jaws -- on a
single X-ray. This type
of X-ray is useful for
detecting the position
of fully emerged as
well as emerging teeth,
can identify impacted
teeth and aid in the
diagnosis of tumors.
Extraoral X-Rays
 Tomograms show a
particular layer or "slice" of
the mouth while blurring
out all other layers. This
type of X-ray is useful for
examining structures that
are difficult to clearly see --
for instance, because other
structures are in very close
proximity to the structure to
be viewed.
Extraoral X-Rays
 Cephalometric
projections show the
entire side of the head.
This type of X-ray is
useful for examining the
teeth in relation to the
jaw and profile of the
individual. Orthodontists
use this type of X-ray to
develop their treatment
plans.
Extraoral X-Rays
 Sialography involves visualization of the
salivary glands following the injection of
a dye. The dye, called a radiopaque
contrast agent, is injected into the
salivary glands so that the organ can be
seen on the X-ray film (the organ is a
soft tissue that would not otherwise be
seen with an X-ray).
Extraoral X-Rays
 Computed tomography,
CT scanning, shows the
body's interior structures as
a three-dimensional image.
This type of X-ray, which is
performed in a hospital
rather than a dentist's
office, is used to identify
problems in the bones of
the face, such as tumors or
fractures.
 New Techniques in Dental X-
ray
Digital X-rays
• The film is replaced with a flat electronic pad
or sensor. The X-rays hit the pad instead of
the film and instead of developing the film in a
dark room, the image is electronically sent
directly to a computer where the image
appears on the screen. The image can then be
stored on the computer or printed out.
• The technique uses less radiation than the
typical X-ray and there is no wait time for the
X-rays to develop -- the images are available
on screen a few seconds after being taken.
 New Techniques in Dental X-
ray (Cont.)
Digital X-rays
• The image taken, of a tooth for example, can
be enhanced and enlarged many times it's
actual size on the computer screen, making it
easier for your dentist to show you where and
what the problem is.
• If necessary, images can be electronically sent
to another dentist or specialist -- for instance,
for a second opinion on a dental problem -- to
determine if a specialist is needed, or to a new
dentist (if you move).
 New Techniques in Dental X-
ray (Cont.)
Digital X-rays
• One of the great advantages of this is that
radiographs can be digitally compared to
previous radiographs in a process called
subtraction radiography. The computer
subtracts out everything that is the same and
give a clear image of anything that is
different, this means that tiny changes (not
seen with the naked eye) can be caught
earlier and more clearly with digital-
subtraction radiography.
 Dental Non X-Ray Systems
• Digital cameras are designed to be used with a computer
they use the computer screen to display captured
images.
• They also provide other functions: such as storage of
images on the computer (usually together with other
information about the same patient), image manipulation
(for instance for esthetic dentistry), and flexible output (for
instance to a printer or as part of an e-mail message).
• Digital images (and associated documentation) can be e-
mailed to consulting colleagues and shared between
different offices equipped with a central server.
• Dental software manufacturers offer a list of camera
systems compatible with their programs.
Dental Non X-Ray Systems
Intraoral Digital Cameras
• Standard 35mm film camera with a
macro lens and a ring light. 
• Wand type intraoral Digital Camera
(Intraoral Video). 
– Good for viewing and magnifying
various area in the mouth.  Provides
good images for viewing on a monitor
by the patient and dental staff.
• 5-6 megapixel extraoral Digital
Camera for intraoral photography. 
– Provides good quality graphics for
printing.
Dental Non X-Ray Systems
Extraoral Digital Cameras
• Good for face, smile and
anterior teeth images. Can
provide short video.
 Dental Non X-Ray Systems
Extraoral Digital Cameras Intraoral Wand Camera
Good for face, smile and anterior Good for hard to reach areas
teeth images. (posteriors) and areas where light is
difficult to provide.
Excellent for locating early white spot
lesions.
Can provide short video Some can provide video

Camera is placed several inches Wand is placed into the mouth

from the patient. No sterilization is providing a complete view of any
required.  area of the oral cavity on the monitor.
Barrier covering is required.
USB or smart card transfer of images Transfer of images directly or
to computer. wirelessly to patient file in computer-
Faster.
Better graphics if you wish to print. Good for diagnostic purposes
because of high intensity light and
magnification up to 40-50X.
 Other Dental Imaging Techniques
3D Imaging In Dental Practice:
    CEREC 3D system (CAD/CAM)
used for all ceramic crowns, inlays,
and onlays.  Scans tooth
preparation and  create computer
manufactured crown in the dental
office rapidly.

Orthodontics uses "Orthocad" system

which creates 3D models from
impressions.  Used for diagnosis
and determining bracket alignment. 
Store 3D models in virtual reality. 
 Digital Imaging Fiber-Optic Trans-
Illumination (DIFOTI)
• Uses safe white light and instantly creates high-resolution
digital images. It enables dentists to discover or confirm
the presence of decay that cannot be seen
radiographically or visually.
• The disposable mouthpiece is placed over the tooth in
question allowing light to be shined from one surface,
through the tooth, and captured on the opposite side
using a camera in the DIFOTI handpiece.
• A high resolution image appears instantly, in real time, on
the computer monitor. A hygienist can place DIFOTI on
one tooth and image in 3 seconds or take a full mouth set
off images in a matter of minutes.
 Dental Images
The output device and/or the software
package lets you designate the file save
type.

pict, gif, jpg, tif, bmp, raw, mpg, and avi

are all bitmap file formats in which to save
images.
 Dental Images
Types of Image Files
• bmp and raw files are large (no compression), will print
to a maximum  dpi and are RGB files.
• tif files have better resolution and are good for outputs
for printing an image such as RGB and CMYK.   Files
saved as tif files are generally about half the size of bmp
files and are compatible with the Mac. 
• gif files are used for files to be placed on the Web.  They
display only 256 ( 8 bit) colors or shades of gray.  Use in
PC or the Mac. It is ideal for cartoons, logos, graphics
with transparent areas and animations.
• png is a newer format  better than gif.  It is a web
graphic format that can support up to 32 bit color and
can contain transparency.  On the other hand it might not
work in all browsers. 
 Dental Images
Types of Image Files
• jpg files are used for Web publishing or e-mail  supports
millions of colors (24-bit).  Files are compressed so they
will load faster on the Web.  Better graphics than
with gif, better compression and can be used in the PC
or Mac.   Good for scanned photographs and images
that require more than 256 colors.
• pict is  Mac image format and is similar to the bmp in
the PC.
• avi is video format.
• mpg1 or 2 are video compression format better than
avi. mpg3 are audio files and mpg4 are for both audio
and video files.
• eps (encapsulated postscript), drw, wmf, cmx and cdr
are examples of file types used with vector programs. 
 Dental Images
DICOM (Digital Imaging and Communications
in Medicine)
• is a standard that has been developed for medical and
dental images (x-rays or visible light images) allowing  the
electronic transfer of  images from one machine to another,
between different platforms such as Windows or Mac, from
one application to another, and on a variety of memory
devices, such as CDs and SmartMedia cards.

• Be sure that any imaging product that you buy (x-ray or

visible light) is Dicom-conformant.   This encodes the image
into a standard format which includes patient name, date of
image and the tooth number when placed into a file type.
 Color Management of
Graphics
• Resolution (number of pixels on a screen)

• Bit-depth  (number of colors in each pixel)

• Image size (height and width of image)

 Color Management of
Graphics
Resolution. Is the number of pixels on a screen (dpi-dots
per inch). 
• Low resolution-VGA monitors display at 640 x 480
pixels. SVGA monitors display with a resolution at 800
X 600 pixels and will result in a sharper but smaller
image. XGA monitors display up to 1024 x 768
pixels.  The resolutions available depend on the
combination of the quality of the graphics card, its
memory and the native resolution of the monitor.
• Medium resolution-Image display of around 1,280 x
1,024 (1.3 million) to 2160x1440 (3.1 million) pixels will
produce good consumer prints, but not good enough for
the professional photographer.
• High resolution-Image display of around 4096x4096
(about 16 million) pixels are available and are for
professional use.
 Color Management of
Graphics
Bit-depth color intensity in each pixel.
• Bit depth is the number of bits used to describe each
pixel. The greater the number of bits per pixel, the
better the image.
• Bit-Short for binary digit. The smallest unit of
information a computer can hold.  The value of a bit is
1 or 0. A pixel that has one bit is black and white only.
• A 2 bit image 2x2=4 shades.  This pixel will have
4 levels black and white and thus begins to show
shades of gray.
• A 3 bit image 2x2x2 =8 shades.  This pixel will have 8
levels of black and white (or color) and therefore can
have more shades of gray.  16 colors is 4 bit.
• An 8 bit image is 2x2x2x2x2x2x2x2= 256 shades of
gray or colors (indexed or palletized color). 
 Color Management of
Graphics
Bit-depth 
• X-rays show grayscale only and therefore 8-
16 bit processing is sufficient.  The human eye
can perceive from 25-40 shades of gray, while
the computer can differentiate 256.
• High color has 65,000 colors and is 16 bit.
While True color (RGB color) has 16.7 million
colors and is 24 bit. There is also 32 bit which
is over 4 billion colors.
• Colors, bit-depth and screen resolution
adjustment is located in the control panel.
 Color Management of
Graphics
Image size
• It is best to display images in their true
resolution and size to obtain best results. 
 Image size is directly related to dpi and refers
to the physical height and width of the image. 
A 2 x 2 inch image if scaled up to 4 x 4
requires the addition of more dots to fill in
missing ones and, if it is scaled down, will
require removal of dots.  
• As you increase the color, the resolution will
decrease unless you have a good graphics
card with lots of memory. Your monitor and
graphics card determine the maximum number
of colors that can appear on your monitor.
 Color Management of
Graphics
Image size
• If the computer is set for 16 bit color, using 24 bit color
images will not create clearer colors.  The computer
will throw away some of the color.  Best to check at
different color settings to determine best settings.
• Computer monitor resolution is measured by the
number of pixels and scan lines. Scan lines are used
to designate resolution in a TV or video monitor.   They
are a horizontal line of pixels generated by a single
horizontal sweep of the beam from a monitor's electron
gun. The number of scan lines that make up a frame is
the vertical resolution. The TV will have around 400-
525 scan lines on a screen. HDTV  has a resolution
over 1000 scan lines.
 Color Management for Input
and Output Devices
• Dental digital x-rays have an 8-16 bit depth
--gray scale.
• An intra-oral (wand) camera usually has 24 bit
RGB image.
• A scanner has a variety of settings as
determined when scanning.
• For output to a printer use the 24 bit setting to
print to a RGB (red, green, blue) or a CMYK (32
bit) printer.
 Color Management for Input
and Output Devices
• You can convert a 24 bit color image to
grayscale (8 bit, 256 shades) and decrease the
file size.
• You may also convert a 24 bit image to a smaller
file size, 256 colors--8 bit image. This results in a
loss of some color intensity.    For such
conversions CorelPaint™ and Photoshop
(Elements)™   can be used.
 Color Management for Input
and Output Devices
This example is taken
from CorelPaint™
and shows the
conversion of a 24
bit image to 8 bit,
256 color image.  If
it is done without a
process called
dithering, poorer
results are obtained.
 Color Management for Input
and Output Devices
With dithering that is
ordered or using
error diffusion, a
better result is
observed
 Color Management for Input
and Output Devices
• Dithering is created by averaging the
depth of adjacent  pixels when pixels
(resolution) are  up-scaled or down-scaled
to create a homogeneous appearance of
colors or shades of gray. Image Dithering
is a method of enhancing the appearance
of photographic images when the
original color palette is changed.
The Three Components Needed for
Obtaining Digital Images
1.   Detector or sensors- A device to capture
incoming light, as in an introral camera (video
camera) or a digital still cameras, or an x-ray
beam, and converting either of these energy
sources to an electronic signal.  
2.   Computer- This serves as the method to
control image acquisition, storage, processing,
retrieval and display of the digital image.
3.   Software to convert analog image into a digital
one.
 Detectors
• The most common type of
image detector is the charged-
coupled device (CCD),
complementary metal-oxide
semiconductor (CMOS) or
charge induction device (CID).  
This is made of silicon and
when light or x-rays hit it, an
electrical charge is created.
This analog signal is converted
to a standard video signal which
is digitized to create the digital
image (ADC).
 Scanners

• A flatbed

• Film scanner

A scanner's bit depth indicates

how many bits it uses to
define the color of each dot of
an image.  A 24-bit scanner is
the most commonly used.
Difference between Optical and
Interpolated Resolution
• Optical resolution is what the scanner can see.
Interpolated resolution is what it can guess at.
Ignore interpolated resolution when making a
purchase decision.
• Optical resolution is usually given as two
numbers"600x1, 200dpi."
-The first number describes the scanner's
optical resolution-- the density of the coupled
device (CCD) sensor or complementary
metallic oxide semiconductor sensors (CMOS)
array.
-The second number is the vertical resolution.
 Scanner Resolutions

  Use      Scan resolution Format

On-screen (Web, e-mail, 72 to 300 dpi, 8-24 GIF-JPEG (small

fax) bit files)

Optical character
recognition (OCR)* 300 dpi, 8bit TIF

TIF
Print small photo. 600 dpi, 24bit (uncompresse
d)
Enlarge or print large Use maximum TIF
photo. Slides using resolution, 48 (uncompresse
flatbed bit. d)
 The Output for the Acquired
Image 
• To a monitor:
Save as a gif or jpg file type with a resolution of 72 
to 92 dpi is good.
• To e-mail:
 Same as for monitor.
• To a printer:
– Some have slots for SmartMedia, CompactFlash,
Secure Digital and Memory Stick to print without
using your computer. 
– 600x 600 dpi is a good resolution for BW printing
and 1200 x 1200 dpi when printing in color. 
– Since the size usually wanted in the dental office
is 4x6 or 5x7, a 10 MB file can be compressed
when sent to a good quality printer. This will
produce a good printed graphic.