Dental Imaging Software Compared From the IT Side: DEXIS, Carestream, Planmeca Romexis, Vatech and Dolphin

The sensor rep is coming back on Thursday with a quote, the panoramic unit is eleven years old, and someone has to decide whether the practice stays with the imaging program it has or moves to the one that comes with the new hardware. The demo looked great. Nobody in the demo asked what the software needs from your server, your network or your Windows licences, or whether it will still open a patient from your practice management system the morning after it is installed.

This guide gives you that comparison as one requirements matrix built from each vendor's own documents, dated as read on 30 October 2026, plus what each platform does to storage, which Windows and SQL Server versions are already past Microsoft's support dates, how bridges actually pass a patient, and a checklist of questions to put to the imaging rep before you sign. It is written for owners and office managers making the software decision (a startup choosing its first platform, a sensor replacement, a first CBCT unit or a newly acquired office), not for clinicians comparing image quality.

What does dental imaging software actually do on your network?

Dental imaging software captures images from sensors, panoramic and CBCT units, stores them in an image database or shared folder, and shows them on every computer that needs them. From IT's point of view it is a chain of six links, and the software you buy decides how each link is built and where it can break.

Most comparisons stop at the viewer. The viewer is the last link, and usually the least likely to cause a problem.

When something in this chain stops working, our guide on dental imaging integration troubleshooting maps each symptom to a link. Intraoral scanners follow a separate path to the lab and the CAD software; those are covered in our intraoral scanner network requirements guide.

Which dental imaging software do practices use?

Practices in the US commonly run DEXIS software (including DTX Studio Clinic), Carestream CS Imaging, Planmeca Romexis, Vatech EzDent-i and Ez3D-i, Dolphin Imaging, Sidexis and Schick from Dentsply Sirona, Apteryx XVWeb, and the imaging built into Dentrix and Dentrix Ascend. No reliable public market-share figures exist, so treat any ranking with care.

Short profiles, from the IT side only:

The IT requirements matrix: five imaging platforms side by side

Each vendor publishes its requirements differently, and some do not publish them at all. The matrix below puts what each vendor's own document says in one place, with the document and date. "Not published" means we could not find a public sheet on 30 October 2026; ask the vendor for it in writing.

Read across a row to see what one platform needs. Read down a column to see where they differ.

DEXIS cloud portal. The DEXIS IS Connect Agent, which links a workstation to DEXIS's online portal, lists a 2-core 2 GHz processor, 1 GB of RAM, 50 GB of disk and Windows 10 or higher, plus Chrome 104, Firefox 103 or Edge 103 or newer (DEXIS system requirements). For the older DEXIS Imaging Suite, we found no public requirement sheet on 30 October 2026, so ask the rep for one.

When you hand this matrix to a provider, the follow-on work is the same for every row: build the server to the sheet, keep the database on a supported version, and test the backup. Legend supports the IT environment behind each of the platforms above, and our software and imaging IT support page describes how.

Server and database: the hidden decision

Every on-premise platform in the matrix needs one computer that holds the image database, and most want it to be a real server operating system. DTX Studio Core's sheet explains why: Windows 10 and 11 Pro and Enterprise limit concurrent connections, so the vendor recommends them only for small set-ups. Carestream caps Windows 11 as a server at 20 stations.

Three practical rules follow:

• • Do not put the imaging database on a domain controller. Carestream says so directly, citing Microsoft's advice for SQL Server.
• • Give the imaging server room for growth. Planmeca recommends one machine as both application and database server, with mirrored disks.
• • Match the database version to Microsoft's dates, not only the vendor's list. The callout below shows why.

The dates come from Microsoft's lifecycle pages, for example SQL Server 2016 and Windows Server 2016, read 30 October 2026. A vendor keeping an old version on its list helps practices that cannot move yet. It is not a reason to install a new server on it. Our dental software system requirements guide covers the wider Windows and Windows Server calendar.

Storage: how fast imaging fills a disk

Image storage grows every working day and never shrinks, because radiographs are part of the patient record. Planmeca is one of the few vendors that publishes a per-image size: roughly 9 MB per 2D image, and 50 MB to 1 GB per 3D image depending on volume size and resolution.

The table works from those published figures. The image counts are examples to replace with your own; the arithmetic is the point.

Two things stand out. A practice that adds CBCT can multiply its yearly storage several times over, and the backup has to grow with it, because Carestream, Planmeca and DTX Studio all state that backing up the image data is the practice's responsibility. For CBCT folders that sit outside the main database, our guide on where endo images and CBCT scans land shows how to find them; the same audit applies to any specialty.

Network: why 3D needs gigabit

A 2D image is a few megabytes; a CBCT volume can be a gigabyte. Carestream sets 100 Mb/s as the floor for 2D and 1 Gb/s once 3D volumes are present, and DTX Studio Core asks for 1 Gbps wired Ethernet for 3D. In practice that means gigabit switches, cabling rated for gigabit to every room that opens 3D, and no imaging over Wi-Fi.

DTX Studio Core adds a rule that trips up office moves: Ethernet-connected imaging devices must sit on the same subnet as the server, and only IPv4 addresses are supported. If your network is segmented, plan the imaging network before the installer arrives.

Does Dentrix have imaging software?

Yes. On the comparison page we read on 30 October 2026, Henry Schein One describes Dentrix as having "Integrated imaging with Smart Image" and Ascend as having "Built-in imaging tools with AI diagnostics". Many Dentrix offices still bridge to a separate program such as DEXIS or Carestream, usually because it came with their sensors or CBCT.

The difference matters for IT. Built-in imaging keeps images in the practice management system's own storage, so one backup and one upgrade cover both. A bridged program keeps its own database, its own upgrade cycle and its own Windows requirements, so you plan two systems that must stay compatible. Henry Schein One's Dentrix or Dentrix Ascend page also notes that Dentrix keeps data on practice-managed local servers. For the PMS side of the choice, see our Dentrix IT support page.

Cloud imaging: what moves and what stays in the office?

Cloud imaging moves the image store and the viewer off your server, but image capture still happens on a local computer with the sensor plugged in. That computer still needs the right drivers, a supported Windows version and a working internet connection for images to reach the cloud on time.

Dentrix Ascend is a useful example. Its help center explains that an acquisition agent runs on the local PC or Mac, that the imaging module has an offline mode for when the internet is down, and that offline images sync once the connection returns, provided nobody exits the agent first (Acquiring Images in Offline Mode). Planmeca's Romexis Image Cloud sets 10 Mbps up and down for 2D and recommends 100 Mbps or better for 3D.

So the cloud question for imaging is not "do we still need IT?" It is "how much upload bandwidth, what happens when the line drops, and where does CBCT live?" Our comparison of dental server replacement vs cloud migration works through the server side of that decision.

Sensors and drivers: which part breaks?

Sensor compatibility is four things at once: the device, its driver, the Windows build and the imaging program version. A sensor that "works with" a program on a sales sheet can still fail if any one of the four drifts. TWAIN, the common capture interface, makes connection possible; it does not promise every feature.

Two dated examples show how driver support ends:

• • Schick. Open Dental's Schick sensor page notes that, as of 31 December 2024, Dentsply Sirona is discontinuing support for a list of older Schick drivers.
• • Dentsply Sirona and Windows 11. Dentsply Sirona's Windows 11 Security Package is a vendor-built Windows 11 disk image for a short list of CAD/CAM products, Primescan and CEREC among them; Dentsply Sirona states that Microsoft's own upgrade options cannot move those products to Windows 11. Its X-ray reconstruction computers ordered before September 2024 run a long-term Windows 10 edition that does not need to move yet.

Before buying a new program, ask for the driver support dates for the sensors you own. If a sensor has already stopped after an update, our dental software support vs IT support guide helps you decide who to call first.

How do imaging bridges to Dentrix, Eaglesoft and Open Dental work?

A bridge is a button in your practice management system that opens the same patient in the imaging program. It usually works by writing the patient's number and details to a small file and launching the imaging program with it. If the two systems disagree on the patient number, images end up on the wrong chart or a new one.

Open Dental publishes how its bridges work, which makes it the clearest public example:

Sources: Open Dental's program bridges list and its DEXIS, EzDent-i and Dolphin bridge pages, read 30 October 2026. Open Dental also says it does not recommend any particular brand of sensor or software, and that 2D imaging is built into Open Dental for practices on support. Dentrix and Eaglesoft bridges follow the same idea through their own set-up screens; confirm your exact PMS version is on the imaging vendor's bridge list before you buy. If Open Dental is your practice software, our Open Dental IT support page describes the IT work around its bridges.

Specialists: what changes for ortho, oral surgery, endo and pediatric offices?

Specialists add devices and data types that general offices rarely have: cephalometric images and photo series in orthodontics, CBCT for surgical planning in oral surgery, microscope video and small-field CBCT in endodontics. Each one adds storage, a capture computer and often a second imaging program next to the main one.

Questions to ask the imaging rep before you sign

The rep can answer most IT questions in writing before the purchase order, and the answers decide your server, network and backup budget. Use the checklist below in the demo or send it by email; anything the rep cannot answer becomes a condition of the sale.

The last three questions matter most for security. A vendor's remote support tool is a door into your network, so your IT provider should know when it is used and by whom.

Moving to new imaging software without losing old X-rays

Changing imaging software means moving years of images, and that is a separate project from moving your practice management data. Open Dental's conversion fee table, read 30 October 2026, lists X-ray image conversion as its own service with its own fee, separate from the data conversion, and notes that fees vary by software and data size.

Plan the move in this order: confirm the new program can import the old archive or that the old viewer stays available read-only; run a test conversion on a copy; check a sample of patients image by image; then switch the bridge and retire the old program on a set date. Our dental software migration checklist walks through the full sequence, including the downtime plan. Step zero is a backup you have actually restored from; our dental backup and disaster recovery checklist explains the restore test.

What to ask your IT provider about dental imaging software

Put these to your IT provider while the imaging quote is still open. Vague answers here usually show up later as slow images, missing scans or a broken bridge.

How Legend Networking can help

Every platform in the matrix is on Legend Networking's list of imaging systems supported (DEXIS, Vatech, Carestream, Planmeca/Romexis, Dolphin Imaging), and so are the practice systems they usually bridge into (Dentrix, Eaglesoft, Open Dental, Archy). Legend supports the IT environment these programs run on, while the imaging vendor keeps the application itself.

Ian Lynch, who has 22 years in dental IT, oversees the NOC, onsite dispatch and client technology roadmaps for Legend. The company has served over 3,500 practices since 2004 and holds a 4.8 rating from 173 Google reviews.