orthodontics

1. PHOTOGRAPHY
IN
ORTHODONTICS

2. CONTENTS
• INTRODUCTION
• EVOLUTION OF PHOTOGRAPHY
• HISTORY OF PHOTOGRAPHY IN ORTHODONTICS
• IMPORTANCE OF PHOTOGRAPHY IN ORTHODONTICS
• ALL ABOUT DIGITAL PHOTOGRAPHY
• CAMERA EXPOSURE
• DIGITAL PHOTOGRAPHY (CLINICAL SCENARIO)
• PHOTOGRAPHY LIGHTINGS
• PHOTOGRAPHY AREA/SETUP
• SOFTWARES USED IN CLINICAL PHOTGRAPHY
• CONCLUSION

3. • It is often stated that Photography is the magic by which light is transformed in
colour, space and time
• The three facets of the visual experience:
colour : a three dimensional entity consisting of hue, value,chroma
space : defines the depth, transparency, size, shape/form and texture
time : indicates movement, flicker, sparkle (vitality), fluctuation and glitter

4. Photographs are an essential part of clinical documentation.
Current ‘the best practice’ is a full set of extra and intra-oral
photographs, both at the start and completion of orthodontic
treatment and ideally, some mid-treatment photographs
showing key-stages in treatment.
Jonathan Sandler and Alison Murray
Journal of Orthodontics, Vol. 28, No. 3, 197-202, September 2001

5. EVOLUTION OF PHOTOGRAPHY

6. Camera obscura
an image of a scene at the other
side of a screen is projected
through a small hole in that screen
as a reversed and inverted image
on a surface opposite to the
opening.

7. Joseph Niépce (1822)
• the inventor of photography and
a pioneer in that field.
• developed heliography, a technique he
used to create the world's oldest
surviving product of a photographic
process.

8. Louis-Jaques-Mandé Daguerre (1837)
• daguerreotypy
Title pages of Daguerre's 1839 manual, published
soon after Arago's lecture to meet the intense public
demand for more information about the photography.

9. Hercules Florence silver-salt-based paper process(1832)
Photographie

10. William Henry Fox Talbot
salted paper and calotype processes
photography pioneer
The Pencil of Nature

11. George Eastman(1885)
Marketed the first flexible roll film.

12. Color Photography
Autochrome, the first commercially successful color process,
was introduced by the Lumière brothers in 1907.

13. Digital Photography
the first consumer camera (1981)
digital single lens reflex camera (1991)

14. Digital imaging is a highly manipulative medium. It permits
different communicative potentials and applications.

15. HISTORY OF PHOTOGRAPHY IN
ORTHODONTICS

16. The history of dentistry and photography began in 1840
First dental school was opened
world's first photographic
gallery was opened

17. Dr. Edward Angle (Father of Orthodontics) was first known orthodontist to
photograph his patients as part of his diagnostic workup

18. 1960’s to 1970’s
A limitation of 35mm film based photography became
clear.
Invention of INSTANT film cameras.
• while not the quality of 35mm film, offered the
ability to take a photograph and see results within a
couple of minutes. Film was processed inside the
camera.
Lester Dine modified and affixed lenses and a flash
creating the dental world’s first instant photographic
system

19. 1980’s
the most important invention in dentistry - DIGITAL PHOTOGRAPHY
Digital photography combines the best of all the three of the previous
photographic concepts:
the quality of 35mm film
the speed of instant photography
the computerized integration of video

20. Why go digital in
orthodontics?

21. • No waiting time
• Ability to enhance images
• Can see images immediately
• Allows immediate retakes
• Can make exact duplicates
• Images can be easily stored
• Can be instantly forwarded or transmitted to patients, labs,
colleagues etc
• Cost effective

24. Why take orthodontic photographic
records?

25.  Case records (photo documentation)
 Complement other orthodontic records
 Important clinical and legal role
 From a diagnostic point of view
 Case presentations to study clubs and other groups

26.  Academic research
 Training of staff and students
 Publications
 Patient education
 Presurical planning, and post operative analysis

27. All about digital
photography

29. 0-255

31. CCD allows to view photographs
on the spot, eliminating film and
development costs, image
manipulation and editing
capabilites.
Digital Photography in Orthodontics; Journal of Orthodontics/Vol. 28/2001/197–201

32. 1990s – typical CCD would comprise 640x480 pixels
1999 – first ‘Mega-pixel’ cameras ( over 1,000,000 pixels
per image)

33. The conventional 35mm slide is
thought to contain the
equivalent of 20-30 million
pixels of information.

34. Prosumer cameras
• Image preview facility
• Problems –
– point flash(built-in) : shadows on most images
– Not powerful enough to allow the photos to be taken
on very small aperture (f32)
– Live display on LCD is inaccurate and are very power
hungry
– Focusing system is problematic
– Macro settings also sometimes gives disappointing
results
Digital Photography in Orthodontics; Journal of Orthodontics/Vol. 28/2001/197–201

36. Professional camera

37. Parts of a typical
digital camera

39. • Standard lens
a camera lens giving a field of view similar to that of the naked
eye.

41. • Wide angle lens
wide-angle lens refers to a lens whose focal length is
substantially smaller than the focal length of a normal lens.

43. • Telephoto lens
Telephoto lenses are especially handy when you can’t get
physically close to your subject

45. • Macro lens
A macro lens is one which allows you to take sharp, detailed,
close-up photos of small subject

47. • Fisheye lens
A fisheye lens is an ultra
wide-angle lens that produces
strong visual distortion
intended to create a wide
panoramic image

49. APS-C sensor
• Advanced Photo System type-C (APS-C)
is an image sensor format
• APS-C variants are considerably smaller
than 35 mm standard film.
• Because of this, devices with APS-C
sensors are known as "cropped frame"

50. CCD
• CCD image sensor is an analog
device ( passive-pixel sensor)
• CCDs is a more mature technology
• Prone to Blooming effect
CMOS
• CMOS imaging chip is a type of Active
pixel sensor made using CMOS
semiconductor process
• CMOS has fever components, use less
power, provide faster readouts
• CMOS sensors are less expensive to
manufacture
• Can combine the image sensor function
and image processing functions within
the same integrated circuit

51. CROP FACTOR
• Most digital camera sensors are smaller
than film, so any image you see from
those cameras is created from a smaller
area than film
• If a photo is made with the same lens, but
a smaller sensor, it shows a smaller area.
• The smaller sensor is cropping the len’s
image compared to a 35mm film frame

52. • JPG/JPEG (joint photographic experts group)
most common file format used in digital photography
less compression=less data thrown away=larger file size
• RAW
actual data taken directly from a digital camera’s image
sensor
unprocessed image, purest image file possible
need specific software
• TIFF (tagged image file format)
larger size, good quality photographs
can be compressed and uncompressed
IMAGE FORMATS

53. Camera Exposure

54. • Determines how light or dark an image will appear when it's been
captured by your camera
• Determined by just three camera settings:
aperture
ISO Exposure triangle
shutter speed

56. Shutter speed
• Length of time during which the shutter is open
• Expressed as a fraction of a second (.. 1/60 , 1/125 , 1/200, .. , 1/500..)
• 1/4000 is a faster shutter speed
• Faster shutter speed freeze the action
• Good photography requires a balance between shutter speed and aperture

57. Shutter Speed Typical Examples
1 - 30+ seconds
Specialty night and low-light photos
on a tripod
2 - 1/2 second
To add a silky look to flowing water
Landscape photos on a tripod for
enhanced depth of field
1/2 to 1/30 second
To add motion blur to the background
of a moving subject
Carefully taken hand-held photos with
stabilization
1/50 - 1/100 second
Typical hand-held photos without
substantial zoom
1/250 - 1/500 second
To freeze everyday sports/action
subject movement
Hand-held photos with substantial
zoom (telephoto lens)
1/1000 - 1/4000 second
To freeze extremely fast, up-close
subject motion

59. Aperture setting
• The opening that controls the amount of
light entering the lens.
• Aperture size is measured in “f-numbers”.
• Every time the f-stop value halves, the
light-collecting area quadruples.

61. Depth of field
• A camera's aperture setting is what determines a photo's depth of field
• the range of distance over which objects appear in sharp focus.
Wide Aperture
f/2.0 - low f-stop number shallow depth of
field
Narrow Aperture
f/16 - high f-stop number large depth
of field

64. ISO SPEED
• The ISO speed determines how sensitive the camera is to incoming light.
• A lower ISO speed is almost always desirable, since higher ISO speeds
dramatically increase image noise.

65. Clinical scenario

66. Two main types of digital cameras
• Point & Shoot
Advantages:
- small and lightweight
- lower cost
Disadvantages:
- not upgradeable
- inconsistent
magnification
Recent Photography Trends in Orthodontics, TurkJOrthod.2016

67. Advantages:
- highest image quality
- upgradeable
- various lighting
options
Disadvantages:
- heavy
- expensive
• DSLR CAMERA

68. • An DSLR allows manual focus and can accommodate a variety of lenses
• Virtually any digital SLR can produce excellent photographs.
• Satisfactory depth of field + good illumination = high quality intra-oral
photos

69. The lens needed for dental photography is a Macro lens with a
focal length of 85-105mm

70. Recommended camera settings
• Digital cameras automatically calculate exposures
• To take the best possible shot, however, you may need to
control the settings manually
• Shutter speed – 1/125
• ISO – 100
• Mode – M
• Aperture for Extra-oral – f-8 to f-11
• Aperture for intra oral – f-32
• Aperture for mirror view – f-19 to f-16
Digital dental photograph;British Dental Journal 207, 63 - 69 (2009)

71. Exposure Mode: “M” Manual or “Av” Aperture Priority
(Usually set on the dial on top of the camera)
Flash Mode: ETTL
This is an automatic mode that works well for beginners.
Advanced users may choose to experiment with manual
flash exposure settings.

72. Focus Mode: “MF” Manual Focus Not to be
confused with the exposure mode set above. This
prevents the autofocus from changing the
magnification setting. Focus will be achieved by
moving the camera. This may initially seem more
complex, but the mouth is generally too dark for
autofocus to work properly.

73. Bister et al,
Ten current digital single lens reflex (SLR) cameras were tested for use in
intra- and extra-oral photography as used in orthodontics.
• Canon350D Canon20D Fujifilm S3Pro Konica -Minolta7D
• Nikon D100 Nikon D70 NikonD50 Olympus E1
• Olympus E300 Pentax DS
No camera took acceptable images in factory default settings

74. over exposure, aperture and flash adjustment needed,
good color fidelity
over exposure, once adjusted, were able to take intra-
and extra-oral photographs without the need to change
settings
poor DOF and aperture adjustment needed .
largest and brightest viewfinders
Nikon and Fujifilm
Olympus
Canon, Konica-Minolta
and Pentax
Konica-Minolta and
Pentax
Comparison of 10 digital SLR cameras for orthodontic photography; Journal of Orthodontics, Vol. 33, 2006, 223–230

75. Photography lighting
There was one huge road block to taking dental pictures. There was no
clear way to get light from the camera’s flash inside the dark cavern
that is the mouth
1952

76. • Universal flash system for general macro photography
• A circular flash that attached to the end of the camera’s lens
• Ability to pinpoint light directly into patient’s mouth
• Providing full illumination from external anterior to posterior intra-
oral quadrant pictures

77. To improve portrait photography, an additional flash called a “point
light” was added to the ring flash system
Two distinct flashes - Ring for intra oral
- Point for facials

78. Point flash
• Single strobe-light source mounted on one side of the camera lens
• Flash can be moved around the lens to provide directional
lighting from different angles
• Placed at 12, 9 , and 3 o’clock position for frontal, right lateral
and left lateral views respectively
• Requires considerable experience and additional setup time
before each exposure

79. Twin flash

80. LED flash

81. Armamentarium
A

82. Cheek retractors
• Larger end of the large retractors are
used
• Assistant should hold both retractors
pulling them both laterally, and forward
• By pulling the lips forwards, towards
the photographer it makes it easier for
the patient to bite together in occlusion
and pulls the soft tissue away from the
teeth
For anterior intra-oral shots

83. • Use the smaller end of the larger retractor
on the side of interest
• The photographer should hold it themselves
and pull it an extra 4-5mm both distally and
away from the teeth to ensure at least the
distal of first molar is captured
• The assistant passively holds the large end
of the larger retractor on the opposite side
For the Buccal intra-oral shots

84. Mirrors
• Long-handled, front-silvered,
glass mirrors are ideal
• Long handles are held by the
photographer to allow complete
control of the picture and keep
assistants fingers out of the shot.

86. • reflection from the glass surface occurs when the silvering is on the back
surface
• Prior to taking photographs the mirror should be either be warmed to
prevent misting of the mirror when it is inserted into the patient’s mouth,
or the patient should be instructed to hold their breath for 10 seconds or so
• During occlusal photography light is never reflected 100% and there is a
tendency to be slightly underexposed.

88. What images to take

89. Extraoral
Intraoral

90. Frontal view
At rest

91. With the teeth in maximal intercuspation and the lips closed

92. Dynamic smile

93. Close-up image of the natural smile

94. OBLIQUE VIEW (THREE-FOURTH , 45º)
At rest

95. At smile

96. Close-up smile

97. Profile view
At rest

98. At smile

99. Anterior view

101. Buccal view

102. Occlusal mirror view

103. Positioning the camera
• The distance from the camera to subject will be determined by the focal
length of the lens
• Best way to standardize facial portraits is to keep focal length of the lens
same ( ideally 100mm or 105mm) and maintain consistent subject-to-
camera distance
• A line from the middle of the lens to the eye is parallel to the horizontal
plane. If the camera is too high, the head will appear to have a forward
tilt; if the camera is too low, the head will seem to tilt backward.
• Focus on the patient’s lower eyelid

104. Gage et al,
To compare the facial morphometric analysis using CBCT volumetric
rendering and digital photography
3-D CBCT derived images were more accurate than 2-D photometric analysis
when measuring upper and lower lip lengths in frontal view. Clinicians of
different training backgrounds show higher consistency and accuracy in
measuring the lower facial third from the frontal aspect with 3-D CBCT
derived images than with 2-Dphotographs.
Comparison of facial morphometric analysis using CBCT volumetric rendering and digital photography;
JOral Maxillofac Surg Med Pathol (2015)

105. Photography area

106. • A dedicated photography room can be as small as about 13x20 ft,
with a 13ft ceiling
• Enough space between the patient and the background
• White background - painted flat wall free of distractions
- custom-sized, motorized, light blocking
shade or a white roll-up screen
• Sunlight from a window should be shaded
• light can be diffused with either a Soft box or an Umbrella light

107. • Key light – used to highlight the form and dimension of the subject
• Fill light – may be used to reduce the contrast of a scene and provide
some illumination for the areas of the image that are in shadow
• Fill flash – a photographic technique used to brighten the deep shadow
areas, particularly in backlit subjects
• Back light – the process of illuminating the subject from the back

109. Dolphin imaging featuring 3D
• Helps visualization and analysis of craniofacial anatomy
from data produced by cone beam computed
tomography(CBCT), MRI, medical CT and 3D facial
camera systems
• Features tools for onscreen manipulation and analysis of
volumetric datasets
• Measurements and digitization can be performed in both
3D and traditional 2D

110. • 3D image capturing system for facial profile
• 3D system – Photomodeler
• Photomodeler system measurements can be used to assess linear
distances and angles
• Adobe Photoshop CS6
• Adobe Photoshop lightroom 4
-Image editing , organizing and sharing

111. Sandler et al,
To assess the quality of photographs taken by orthodontists to see whether those
taken by orthodontic auxiliaries and clinical photographers are of comparable
quality.
Extraoral photographs showed no significant differences between the 3 groups.
The results for intraoral photographs showed that, orthodontists produced
significantly more good-quality intraoral photographs.
Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic
auxiliaries; Am J Orthod Dentofacial Orthop 2009;135:657-62

112. Conclusion
Clinical photography has been greatly improved with the advent of digital
cameras, especially digital SLRs. To obtain high-quality, consistent
photographs, the orthodontist must select an SLR that meets clinical
requirements.
It provides a diagnostic information that is easily recognized and understood
by both professionals and laypersons
In order to get the full diagnostic value out of digital photography, a
systematic method and regimentation of clinical images must be adopted

113. References
• Eder, J.M (1945) [1932]. History of Photography, 4th. Edition
• Comparison of 10 digital SLR cameras for orthodontic photography;
Journal of Orthodontics, Vol. 33, 2006, 223–230
• Digital dental photograph;British Dental Journal 207, 63 - 69 (2009)
• Quality of clinical photographs taken by orthodontists, professional
photographers, and orthodontic auxiliaries; Am J Orthod Dentofacial
Orthop 2009;135:657-62
• Jonathan Sandler and Alison Murray Journal of Orthodontics, Vol. 28, No.
3, 197-202, September 2001
• How to avoid common errors in clinical photography; Journal of
Orthodontics, Vol. 32, 2005, 43–54