DC-Air™ Video Library: The Wireless Sensor in Action

Problem number one: the wire. Every year there are over 500 million intraoral X-rays performed, and this wire has been a hassle and a complaint from the dental community for the last 30 years.

Now, the problem with traditional sensors is, one, it has glass inside of this encapsulation, and the glass optic plate breaks easily. The second area was the image quality — it's based on what we call indirect conversion, and you get an inherently fuzzy image. Because we go from X-rays to light, light to digital imaging — that's indirect conversion of X-rays to digital imaging — then you have to use sharpening algorithms to improve the clarity of that image, and the sharpening algorithms are actually removing information.

Thirdly, the cord is the worst thing on a sensor there is, from the comfort standpoint and from the cost with the breakage. It tugs on the sensor inside the mouth, pulling it in various ways, thus causing pain. And the comfort of the patient is the most important, so we wanted to make something better for dental professionals — make it truly better. Enter our product, the DC-Air.

What's really exciting about the DC-Air wireless sensor is we cut the cord. What we offer to the market is replacing this bundle of wires with this product here. The evolution of both chip technology and battery technology have allowed us to improve the customer and patient experience and bring a really cutting-edge sensor to the marketplace.

Number one: it is the only product in the market that does not use indirect conversion. We use low-energy Bluetooth transmission, and what allows us to do that is the fact that we're using direct conversion. Number two: because it's direct conversion, it doesn't have the glass optic plate, which means that because we have a homogeneous construction inside, this product is far more robust and durable than the wired sensor. Third: direct-conversion image is inherently sharp because the photons are going directly to the pixels on the sensor. That's why our sensor has the highest MTF — modulation transfer function — of any sensor on the market, and MTF is the true measurement of image quality.

The first thing I noticed when I started looking at the DCR images versus the corded images: you could see PDLs clearly, you could see bone levels clearly, incipient decay finally wasn't an artifact — it was really what it was supposed to be. We are not talking about an incremental improvement in performance here. This is a quantum leap, the likes of which have not been seen since the transition from film to digital 30 years ago.

Patients love it because it's more comfortable. Staff love it as well because it's so easy to use. And the doctors love it because the image quality is amazing.

Hello, I'm Dr. Robert Sachs, and I am the Chief Clinical Officer of Freedom Technologies Group. Today I'm going to show you how easy it is to use the DC-Air wireless sensor and get outstanding images for your patients.

It's as simple as pressing the Acquire button — the TWAIN will pop up, telling you it's in the docking station, so it's ready to be picked up and paired, and you're ready to go. The DC-Air includes five different holder, or bite block, types. Let's look at how each is assembled, disassembled, and used to acquire various types of images.

First, let's review the bitewing holder. It includes two sensor attachment points. Most often the sensor's battery adapts into the attachment point closer to the distal aspect of the bite surface — the smaller, curved portion marked with the letter D. The mesial aspect of the bite surface is marked with the letter M. The sensor should be divided symmetrically behind the bite surface and should fit snugly across the attachment points. It's also possible to attach the sensor's battery into the attachment point closer to the mesial portion of the bite surface — this is ideal for achieving better anterior coverage, such as the distal aspect of the canines, or for achieving better comfort with premolar bitewings for patients with smaller mouths or anterior tori. The wider M side of the bitewing holder always exits the front of the patient's mouth, while the D side sits comfortably toward the back of the patient's arch. The wireless sensor can be oriented either way in the holder, depending on the desired shot.

Where the sensor needs to be removed from the bitewing holder, apply direct pressure on the back of the sensor toward the bite surface — don't twist the sensor to break it free, as this is more difficult and can apply torque to the holder itself. To attach the positioning bar and ring, simply place the angled end of the bar into the bitewing holder until it snaps into place. The aiming ring slides onto the bar with the alignment tabs facing away from the holder. To disconnect the positioning bar and ring, slide the ring off the bar, then pinch the bar's attachment to the holder to release it and pull to remove.

With the bitewing holder set up, place it into the patient's mouth along the bite surface, slide the aiming ring as close to the patient's cheek as possible, and position your X-ray source through the ring, also as close to the cheek as possible.

The anterior Zero Profile holder is used for acquiring both upper and lower anterior PAs. It has a single attachment point for the sensor's battery and an attachment point for the alignment bar; the alignment ring slides onto the bar with the tabs facing away from the holder. On the front of the bite block there's a vertical line to help with centering it across the desired area, usually the patient's midline. To remove the sensor, apply pressure between the sensor and the tab on the back of the holder.

To acquire a lower anterior PA, have the sensor oriented downward and at a slight angle toward the patient, and have the patient close slowly as the sensor is positioned behind the lower incisors. Bring the ring and X-ray source as close to the face as possible for optimal results. To get an upper anterior PA, simply flip the direction of the holder — no need to reorient the sensor. Oftentimes the longer, medium bar length is used with the anterior bite block to ensure adequate clearance of the nose and chin. The anterior holder can also acquire vertical periapicals of premolars by offsetting the bite block distally to position the sensor's face behind the desired area.

The posterior holder includes two sensor attachment points as well as two alignment-bar slots for versatile coverage. Most often the alignment bar is used in the upper slot, marked U, with the sensor connected more-curved-side toward the back of the patient's arch. It's sometimes beneficial to use the lower slot, marked L, for lower posterior PAs — this helps extend the image below the apices of the molars if the patient's anatomy makes the standard configuration difficult. The sensor can also be used curved-end-forward if more anterior coverage or comfort is desired.

To remove the sensor from the posterior holder, apply pressure between the sensor and the tab on the back. Use two hands to position the holder, take a slight angle to slide the sensor into place, and have the patient start to close slowly, using one finger to gently push back the commissure. Slide the ring as close to the cheek as possible and position your X-ray source through it. For patients with small mouths or tenderness, a cotton roll between the bite block and the arch can maximize comfort.

The endodontic (endo) holder is perhaps the most versatile of the Zero Profile holders — the sensor can adapt to it in four different directions to position it exactly how and where you need it. It features a textured handle for the patient or assistant, and the sensor is removed by applying pressure between the sensor and the ring on the back of the holder. Oriented vertically, it's typically ideal for anterior teeth, using the bisecting-angle technique with your X-ray source and minimizing distance from the skin. Oriented horizontally, it's great for posterior teeth, especially third molars. Oriented perpendicular to the holder, it's great for capturing vertical bitewings as well as vertical periapicals.

Finally, the Zero Profile occlusal holder is a plastic sleeve that protects the sensor while acquiring occlusal radiographs. Insert the sensor battery-side first, and slide it out to remove. The sleeve is inserted perpendicular to the patient's midline; have the patient close slowly on it and position your X-ray source below or above the sensor's face.

Now let's review the imaging workflow. It begins by docking the sensor in the room you want to use it in. In your imaging software, select the desired layout or template and ensure DC-Air is your imaging source. Once activated, the TWAIN opens and shows the sensor status: blue means the sensor is on the docking station and ready to be picked up; yellow means it's initializing; green means it's ready. Place the sensor in the holder and position it for the desired image. When the image is acquired, you'll see a downloading-image notification and progress, a preview image while final processing completes, and then the image returns into the template. In most imaging programs the DCR TWAIN automatically reopens with the sensor ready for the next image. To end an acquisition early, use Save and Exit in the TWAIN.

A few of the many features in the DCR TWAIN: to resize the TWAIN window, right-click the sensor icon in your system tray and choose an option under GUI modality. At the bottom of the TWAIN window is the sensor status bar (blue docked, yellow initializing or warning, green ready), plus battery and signal-strength indicators.

The top of the TWAIN window has five feature buttons. The Endo button activates the sensor's endodontic mode, which turns off the automatic sleep/battery-save feature so the sensor stays active for longer procedures — toggling it requires the sensor to be in the docking station. The sensor-icon button changes the sensor's orientation on the fly (this can also be set in back-end settings). Download Last Image recalls the last image acquired from the sensor's onboard memory.

The gear icon opens the DCR TWAIN back-end settings, which let you customize the sensor's operation: Power Off Timeout adjusts how long the sensor can sit off the dock before sleeping to preserve battery; HDR adjusts contrast and sharpening; Gauss value adjusts smoothing; histogram width and center adjust contrast and brightness respectively. There are also options for default image orientation and single- or batch-capture modes. Use Save to apply settings, or Save and Exit to close the TWAIN.

"I'm Dr. Scottville. I've been using the DC-Air sensor for about four months now, and it's been a game changer. One thing I always hated about a regular digital sensor was it did not look like film, and I knew we were missing stuff. Now with the DC-Air, it looks like film, and we're capturing things and finding things that we would have missed with a regular digital sensor. It's great — I tell everyone, get it.

"We really love these new sensors because they're wireless, and they're small and easy in the patient's mouth. I know that I'm able to diagnose interproximal lesions at a more accurate rate than I was with my previous sensor — much more diagnostic images than anything we've seen in the past. It's much more compact, the cordless technology is awesome and very convenient for the patients, and I think it's a massive win for us. Taking X-rays is fun again, to be honest with you, and it's super easy to use — basically, we just love it.

"It's so easy, the image quality is so much better, and my biggest worry was losing it — and I haven't lost it. You'd worry about that, but it's just been automatically put right back. I always love anything that's wireless — it's super easy, it all just comes together so that it's easy to use and I have good image quality, and it makes me happy to use it. I am very happy using it."

"I actually really like it — I think it's much more convenient. It seems to be a little easier on patients, and it seems to be a smooth transition, very easy to use. So I know here at Keystone Dentistry we really enjoy it. I'm going to say the image quality is excellent — I don't have to work really hard and then get poor image quality. It just all comes together so that it's easy to use, and I have good image quality, and it makes me happy to use it. I am very happy.

"First of all, it's so much easier than the wired one, because those fit on nobody — I mean, this is much smaller, much more adaptable in the mouth. Since the wired sensors were generally uncomfortable and got in the way, this is a lot more comfortable and smaller compared to what you've seen previously. It's a lot better, for sure — you can see a lot more detail.

"Do you feel like it's better for the staff, the patient, and the doctor? All three, for sure. My biggest worry was losing it, and I haven't lost it — you're not going to worry about that, because it's automatic, you put it right back on the sensor. It's been great. I also want to say part of the reason I decided to invest in the sensor is because I have confidence in Dental TI to help me make the transition, and you guys have been great in making that happen. I really appreciate it."

"So I'm going to go ahead and magnify this — tell me what you see here."

"Well, I'm seeing a lot more than the other ones, that's for sure. I'm definitely got some concern now about that area, with that little — I don't know what you want to call that little lip area there — right, I mean, just apical to that there's clearly some darkness there, you can see like a line there above that, where it looks like some type of carious line, or something — there's some delineation between that darker area and the area above it. So this would definitely be — I'm now saying, hey, I'm actually concerned about this, versus what I was seeing in the previous images."

"Yeah, and you can definitely kind of see it — there's clearly an area of darkness there, and it looks almost like a — I'm seeing a couple of little — I got something in the middle there, and it sort of dips down a little bit toward one end and up toward the other — you know, it looks almost like a genie's lamp sitting on top of it. But you can clearly see where that potential lesion is. I mean, obviously clinical judgment is going to decide, but yeah, there's enough here that I would say, hey, I want to do a much closer look at that, versus the other ones, which I'm not sure what I'm looking at."

"So I'm here with Dr. Kitcoff, and he's been using the DC-Air, and he was just commenting on it a little bit, so I wanted to ask you, Dr. Kitcoff — what's been your experience with this technology versus all the other sensors you've used in the past?"

"I love it. This technology in particular gives us the clearest X-rays that we've had — much more diagnostic images than anything we've seen in the past. It's much more compact, the cordless technology is awesome and very convenient for the patients, and I think it's a massive win for us."

"That's excellent. Are you getting good comments from your patients about the comfort?"

"Yes, they're much happier with the smaller sensor size and not having to drag that cord around — it's much more tolerable for both our patients and our staff, so I think it's just an awesome technology."

"That's great — well, thank you, Dr. Kitcoff, we appreciate the time today, and we're glad you're a happy user of the DC-Air force."