[Oradlist] Intraoral radiographic technique: beam-guiding instruments or free-hand (tabs, biteblocks)?

[Brooks, Sharon]

A situation has arisen at my institution regarding the quality of
radiographs taken by our dental hygiene students when they cannot use the
Rinn XCP system.

A little background: for years and years and years here the culture was to
use only the foam biteblocks for periapicals and tabs for bitewings. No one
would have dreamed of using a beam-guiding instrument of any kind because it
is a crutch, not needed, etc. We do use a rectangular collimator and
sometimes the images were less than stellar.

A number of years ago we instituted the use of the Rinn system and the image
quality shot way up. The students also generally like using them. For those
that say that they don't need them, I counter with the argument that using
them allows images taken over time or by different operators to be much more
similar than images made free-hand, which is good for following lesions over
time. 

We do teach the block and tab system and they do use it on their manikin
exercises (and occasional patient where the rings are too difficult), but we
encourage them to use the rings.

We also encourage our dental hygiene students to talk to their new employers
about getting the rings when they get out into the real world.

However, the reality is that since the system has not been part of the
culture of this state, many (most?) dentists will not buy them for their
staff and then they complain about the quality of the radiographs!

So, I guess my question is how much emphasis should we be putting on doing
radiographs free-hand, given the situation in the private offices? I know
that in some parts of the country, the rings (or similar system) have been
used for so many years that it is a given that they will be used in the
offices, but that is not true here.

I feel that it is a step backwards to leave a proven system that allows
students to take good quality radiographs the first time, but on the other
hand I don't want to handicap them for when they leave here.

I would be interested in hearing what others do about this situation - or
whether it is unique to my location.

Thanks

Sharon

*****************************
Sharon L. Brooks, DDS, MS
Diplomate, American Board of Oral and Maxillofacial Radiology
University of Michigan School of Dentistry
Department of Periodontics and Oral Medicine
Ann Arbor, MI 48109-1078 USA
Tel: +1 734-764-1595   Fax +1-734-764-2469
slbrooks at umich.edu