Microbial contamination and decontamination of reusable digital intraoral imaging equipment: a narrative review

Digital intraoral radiography relies on reusable solid-state sensors and photostimulable phosphor (PSP) plates that cannot be heat-sterilized, so infection control depends largely on single-use barriers and on disinfectants the equipment can tolerate. This narrative review synthesizes laboratory and clinical evidence on microbial contamination of reusable digital intraoral imaging equipment, the mechanisms by which barriers fail, and the balance between antimicrobial efficacy and device compatibility. Across the available clinical studies of barrier-protected PSP plates, contamination was reported in roughly 17% to 73% of plates and was frequently associated with handling-related factors, including perforation, incomplete sealing and non-aseptic removal, rather than with the barrier material alone. The exterior of intact envelopes becomes heavily contaminated during brief intraoral use, identifying removal technique as a distinct contamination route; these findings are integrated into a proposed six-stage contamination pathway. Evidence for solid-state sensors is largely limited to barrier-perforation testing, and data on cables, scanner internals and computer peripherals remain sparse. Studies of lead aprons and thyroid shields, mostly from non-dental settings and therefore contextual, report frequent contamination, now alongside 2023–2024 guidance recommending against routine shielding. Laboratory studies indicate that antimicrobial efficacy and plate compatibility vary independently across agents and plate brands, so the two must be evaluated together. Contamination indicates a plausible transmission pathway but does not demonstrate patient infection, and no study identified in this review has linked imaging equipment to a documented infection. The review concludes with an evidence-gap matrix and outlines emerging approaches to objective contamination surveillance.