Selecting intraoral cameras

May 1, 2001
If your goal is to increase your case acceptance, and therefore profitability, showing patients really big pictures of their teeth beats showing patients unbelievably quick radiographs of those same teeth.

by Jeff Carter, DDS

If your goal is to increase your case acceptance, and therefore profitability, showing patients really big pictures of their teeth beats showing patients unbelievably quick radiographs of those same teeth.

High-tech guru (and all-around good guy) Dr. John Jameson passes along this information to us:

"For doctors who capture digital images of the patient, as well as 'befores and afters' of other cases for consultation purposes, we have seen an increase between 10 and 25 percent in case acceptance."

So, for those of you struggling to gain patient acceptance of high-quality comprehensive treatment, an intraoral camera is your best high-tech investment. That part is easy. Deciding which camera(s) to purchase, how to integrate them into your facility, and how to take full advantage of their wonderful attributes is a more of a challenge.

The "inside scoop"I wish I could take credit for gleaning this information on my own but most of it I "extracted" from Ted Takahashi, probably the industry's most knowledgeable intraoral camera expert. Ted and I work together on a daily basis to help doctors integrate the latest in high-tech and dental equipment into their offices.

Here is a little ammunition the next time you are feeling really "stupid" talking to an intraoral camera representative at a convention.

  • All internal intraoral camera parts are made by either Sony or Panasonic.
  • The optics distinguish a good intraoral camera from a not-so-good one. The best optic systems are created by placing the CCD chip at the end of the wand next to the lens. This is more expensive than placing the CCD chip in the middle of the wand. When the CCD chip is in the middle of the wand, an additional prism is used to direct the incoming image farther down the wand to the CCD chip. The addition of the prism degrades image quality.
  • Why do inexpensive intraoral cameras at conventions or trade shows often appear to produce an equivalent — or even superior — image quality when compared to higher-end cameras that may cost two the three times as much? Artifacts, artifacts, artifacts.

Internally, intraoral cameras have an adjustment for pre-shoot/over-shoot. This adjustment can electronically manipulate the video signal by boosting the peaks and valleys of the video signal wave pattern. These artificially manipulated images display whiter whites and blacker blacks and create an "illusion" of greater contrast, detail, and quality. White areas in the mouth that are wet will appear to have black or darkened areas surrounding them. These darkened areas are artifacts and do not exist. Fictitious black or darkened spots on white teeth can lead to misdiagnosis.

Analog intraoral cameras vs. "digital" intraoral cameras: If the word digital is anywhere near a product name or description it has to be better, right? If all other features are equal, the fact that an intraoral camera is "digital" has absolutely no advantage over an analog counterpart, with possibly one exception.

All intraoral cameras use incoming light to create an analog/video wave pattern signal through the CCD chip. There are no digital zeros and ones streaming through the air that you can intercept with your camera wand. What makes an intraoral camera digital is the location of the digitizing capture card. If it's in the camera rather than in the PCI or AGP slot in the back of your computer, it's digital.

If you compare pricing, digital intraoral cameras generally cost more than analog cameras plus capture card (e.g., ATI All in Wonder Pro, Viper capture card). The "digital" intraoral camera can connect to your computer through a USB port since the incoming data is already digitized. The USB connection would facilitate your intraoral camera's connection to a thin client that is, in turn, linked to an ASP (application service provider). If you are holding your breath waiting for all your dental software applications to be Internet-based, you better like the color blue.

So what does this mean?Your reaction at this point may be, "Jeff, cut out the 'technobabble' and just tell me what to buy!"

Buy the intraoral camera with the truest image depiction of what you actually see in the mouth. Ted's favorite intraoral camera (and mine) was the Reveal MLR that is no longer available. Vipercam (and the repackaged Dentrix version — same camera) is a very popular choice right now. I am also impressed with many of the features of the compuCam available through Dicom.

Final thoughtsSelecting an appropriate intraoral camera for your practice through an in-office demonstration is one more argument for investing in the technology infrastructure of your current or new facility first. With monitor(s) already mounted and cabled in the operatory, it is pretty darn easy for a intraoral camera salesman to hook up a new unit and show you some really big pictures of teeth.Key features to consider when purchasing an intraoral cameraQuality of construction: How does the camera dock with the light source? Does it appear capable of withstanding 2,000 insertions and detachments a year? Does the wand cord have strain relief or will it ultimately fray and create "water spots" on image displays and printouts?

Depth of field: As you move the wand inside the mouth, how much of the viewing area is in focus? Do you have to continually adjust the focus ring? Superior intraoral cameras require little or no focusing inside the mouth.

Artifacts: How much of what you see is actually there? The best way to judge an intraoral camera image is to have an in-office demonstration. Only then can you compare what you see in the mouth (under typical operatory lighting conditions) with what appears on the monitor display. You have no frame of reference on the convention floor to judge image quality and the presence or absence of artifacts.