The dental profession has been warned for over two decades in peer reviewed literature of the ability and ease to manipulate digital dental radiographs. Violators may have nefarious purposes. Possibilities include deceptions and misrepresentations to the insurance industry, dental patients, Medicaid third party administrators (TPAs), state dental regulatory boards, as well as civil, criminal, and administrative law proceedings.
Alterations of digital x-rays may go far beyond adjustments in image contrast for enhanced diagnostics, or removal of artifacts for educational purposes. Radiographs may be modified and reworked with utilization of a variety of software products such as Adobe Photoshop to fabricate inauthentic images. Digital images may be artificially transformed to indicate dental caries, missing tooth structure (e.g., cusps and incisal angles), periapical radiolucent lesions, falsified endodontic obturations, fractures, misrepresentations in crestal bone levels, etc.
The only limitations are seemingly the creativity of the perpetrator.
Apparently, dental image manipulations were not much of an issue, as so few if any cases had been discovered and adjudicated.
Reality hit hard with a January 13, 2021, ruling in US District Court for the Court of New Mexico, in William C. Gardner, DDS vs. Charles Schumacher, DDS, et al.