Using DEXIS Platinum digital sensors and DEXIS CariVu

This comprehensive group practice consists of brothers Drs. Lester, Stuart and Joel Appell, and their nephew, Dr. Aaron Appell. Each of these dentists understands the importance and the benefits of operating a digital practice

Dr. Lester Appell shares this overview of digital imaging by using DEXIS™ Platinum digital sensors and DEXIS™ CariVu™.

We feel that being a modern dentist today means running a digital practice. Appell Dental Group bought three DEXIS Platinum sensors and a CariVu after evaluating numerous sensors over the last few years. While we were building our new office, we tested many sensors on each other and our staff. We were completely sold on the size and the comfort of the DEXIS sensor. All of us agreed that the others were absolutely intolerable. Also, the DEXIS software is so easily integrated into our practice management software, and it works well with different diagnostic devices.

Related reading: Inside Look: Diagnostics, efficiency, patient care at its best

Additionally, we are very excited about the CariVu caries detection device. In conjunction with DEXIS digital radiographs and intraoral photographs, we can give our patients a complete picture of their dentition. Our youngest patients are already getting great benefits from CariVu. We start seeing children at three years old, and their mouths are either too small for radiographs, or they cannot sit still long enough for X-rays. Generally, we don’t start taking X-rays until the child is five or six years old. We have always felt that exams were not as thorough as we wanted without taking radiographs if the teeth had touching contacts. CariVu has helped us to fill this gap. With CariVu, we are finding proximal carious lesions that do not show up in X-rays -- often very large cavities. We can do our exams with confidence and ease as the children tolerate this with absolutely no discomfort. Their parents are equally thrilled because a majority of parents are against exposing their children to [ionizing] radiation, especially at these early ages.

Because it uses transillumination technology rather than [ionizing] radiation, patients who are hesitant to be exposed to radiation feel safer. We explain that CariVu imaging is only one part of our diagnostic process, but for those patients whose medical histories preclude radiation or for pregnant women, it certainly gives us a far greater diagnostic capability.

CariVu shines in both diagnostics and presentation. Every operatory in my office has two viewers, one screen behind the patient for me and one on the wall for the patient to see. Patients love the fact that without any radiation, we can give them this level of visually explanatory diagnostics. A CariVu picture is worth a thousand words.

DEXIS X-ray and caries detection devices are comfortable, easy to use and produce consistently clear images. These are all invaluable to our modern digital office. In my opinion, DEXIS imaging systems are the finest in the market.

With CariVu, the fact that we can often detect caries that may not otherwise be found on an X-ray really creates that “wow factor” with the patients. When they can visually see caries on the CariVu image, it makes them want to take action to fix the problem. I can see tooth fractures, and actually show the patient the fracture that is the reason for my suggesting a crown. The image is very explanatory. With an intraoral camera image, many times I am pointing at lines I am not sure that they can see -- but with the CariVu, they can see the fracture or the cracks in the teeth. And even better, we are achieving all of this without radiation. If the average patient today sees technology working in a positive manner, they get excited about it.

More more on DEXIS imaging, read: The benefits of the DEXIS Platinum Intraoral Digital Imaging System

Regarding our recent implementation of DEXIS digital X-ray, we are amazed to hear patients’ positive comments about having digital bitewings taken instead of film radiographs. Because of the smooth, rounded shape, they find sensor more comfortable. We are not getting any complaints at all.

Dr. Joel Appell gets to the root of using digital imaging for endodontics and cosmetic dentistry.

Using digital X-ray when performing endodontic procedures improves my efficiency. Within seconds, I can see exactly what I have done, and I have gotten to the point where I don’t remove the sensor until I have seen the X-ray in case I have to adjust something and change files with the sensor in place -- it saves a lot of time.  

Dr. Stuart Appell, senior partner and dentist for 46 years, adds his thoughts on imaging in restorative/ prosthetics in the practice.

We are seeing incredible detail on DEXIS digital radiographs. We can find issues, such as root decay, with a clarity that we never saw on film radiographs. On traditional film X-rays, often all that we saw was a shadow, and now we

clearly see demarcation of decay. Sometimes, I have seen decay on the digital X-ray and thought, “Holy Cow, look at that!” Then, I go back through the chart and look through the old films, and it isn’t there. This works for decay that must be addressed immediately and also decay that I must watch and check again next time.

Digital imaging is great for patient education. Our office is designed in an open-office concept with six treatment rooms along a hallway. Patients face away from us, and there is a big screen on the wall behind them and in front of them. The clarity of X-ray is not only integral to my diagnosis, but also helps in co-diagnosis. Patients appreciate the fact that we are seeing more. In their perception, we have invested in the best technology for their best treatment. That translates to treatment plan acceptance.

Dr. Aaron Appell uses digital imaging for the youngest patients in the practice.

Often the toughest patients to treat in a practice are the little kiddos. With digital radiography, I am able to blow up images, see densities, and catch cavities before they get to the point where they enter the nerve. Especially with pediatric teeth, there is not as much room between the enamel and the dentin before the nerve. Also, I can enhance the image and really see between the enamel and the dentin line. So, with children who are on a six-month visit schedule, if a cavity exists that isn’t found, we are much more likely to end up with a pulpotomy, some other nerve-related issue, or even an extraction. Because the images are better, we can be a little more aggressive on when to start treating issues that we may have not seen in the past, but in the same vein, we are able to do more conservative dentistry because we catch these issues earlier.

CariVu is a great adjunct to digital imaging. On kids where I cannot get a bitewing because of the cooperation of the child, the CariVu is an easier device to use, and I can find decay.  Even if we were unable to obtain an X-ray, I can still properly treat and diagnose caries or know to watch the area.

Digital X-rays are very helpful in education. Parents want to see what we are explaining, and DEXIS tools make it easier to do this. Dentists have years of training to read X-rays. Showing a parent who is not trained in radiology a

film X-ray and trying to point out certain small areas of concern, unless the image is very big, most parents won’t see or understand what I am talking about. With CariVu, if I am taking an occlusal view picture, it is much easier to see a dark or black spot on a picture that I can blow up larger. With digital X-ray, I can use digital tools within the DEXIS software -- I can either invert the image, or use a highlighting circle where I am actually able to enhance the image and make a clearer image with the highlight over the cavity or the decay I am trying to show the parent.
DEXIS digital imaging and CariVu have become an integral part of our practice, and I could not imagine treating pediatric patients in our practice without either of the two.  CariVu is a really nice adjunct for patient education and another great tool in our armamentarium to educate and teach patients about their children’s on-going oral health. 

About the practice

Appell Dental Group combines the expertise of Drs. Stuart Appell, Lester Appell, Joel Appell and Aaron Appell into a comprehensive general dental practice in Arlington Heights, Illinois. It is a third-generation practice started by their father, Seymoure in 1939. They practice in one location all working together and enjoying their work, their patients and each other. The Drs. Appell have no financial interest in DEXIS.

More on CariVu™

DEXIS CariVu™ is a compact, portable caries detection device that uses patented transillumination technology to support the identification of occlusal, interproximal and recurrent carious lesions and cracks. By hugging the tooth and bathing it in safe, near-infrared light, CariVu makes enamel appear transparent while porous lesions trap and absorb light. This allows the clinician to see through the tooth exposing its structure and the actual structure of any carious lesions with very high accuracy.