Clinical photography in Orthodontics
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Clinical photography in Orthodontics
- 2. Learning Outcomes …….. 1. Why photographs in orthodontics are important? 2. What are clinical requirements for photographic records? 3. How many photographs we need in orthodontics? 4. How to take them? What are the techniques? 5. What are the common errors and their correction? 6. Once taken, how to improve their quality (image editing)? 7. How to analyse the photographs? 8. What are the alternatives of photographs?
- 4. • Patient care • Diagnostic records • Treatment planning • Treatment outcome Reference: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS • Wolfgang Bengel’s Mastering digital dental photography
- 5. • Academics • Examinations • Research and publication • Lecturing Reference: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS • Wolfgang Bengel’s Mastering digital dental photography
- 6. • Records for medico-legal reasons Reference: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS • Wolfgang Bengel’s Mastering digital dental photography
- 7. Photographic Technique • Requirements for clinical / orthodontic purpose • How to take photographs / basic photography Photographic Analysis
- 10. 1.The Digital Camera 2.The Lens 3.The Flash 4.The Retractors 5.Dental Photography Mirrors 6.Background Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 11. A. Camera DSLR Cameras are highly recommended for taking orthodontic photographic records. Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 12. B. Lens The lens required is dependent on the views necessary¹: 90mm, 100mm or 105mm macro lens extreme close-up, up to 2 teeth 85mm macro lens up to a quadrant 60mm macro lens no smaller than a full mouth Reference: 1. Camera Recommendation for Dental Photography, January 2014, Bauer Seminars, University of Toronto, Faculty of Dentistry 2. Dan Lazar, Sanda Cimpian, Stefan-Ioan Stratul, An introduction to dental photography, TMJ 2011, Vol. 61, No. 1 - 2 The 100mm and 105mm macro lenses are best suited for dental photography.²
- 13. B. Lens Reference: • Eduardo Mahn, Clinical digital photography, Part 1: Equipment and basic Documentation, International Dentistry – African edition Vol. 3, No. 1 VS. Sigma 105mm f/2.8 EX DG macro micro Nikkor AF-S 105mm f: 2.8 ED, NC, VR “Buy a normal camera but buy an excellent lens..”
- 14. C. Flash Recommended: Reference: • Shadi S. Samawi, Clinical Digital Photography in Orthodontics: Professional Photographic Records in Daily Practice., Jordan Dental Journal, Vol. 18, No. 1, 2012 • Eduardo Mahn, Clinical digital photography, Part 1: Equipment and basic Documentation, International Dentistry – African edition Vol. 3, No. 1 Ring flash R1 flash (macro lateral or twin flash Light) Ring flash VS.
- 15. D. Retractors Image courtesy: dentalaegis.com
- 16. E. Mirrors VS. Metal Mirrors Glass Mirrors
- 17. E. Mirrors Long-handled, front-silvered, glass mirrors are the ideal tool for clinical photography. Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 18. F. Background Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS Dark Blue
- 19. Extra-oral Photographs Varies according to different authors.. Intra-oral Photographs (5) 1. Frontal - In Occlusion 2. Right Buccal - In Occlusion 3. Left Buccal - In Occlusion 4. Upper Occlusal 5. Lower Occlusal Special Shots 1. Submental (Asymmetry)
- 20. Contemporary orthodontics Minimum set is three photographs 1. Frontal at rest 2. Frontal at smile 3. Profile at rest Additional: Oblique smile Contemporary Orthodontics by William R. Proffit; 4th edition A Short Guide to Clinical Digital Photography in Orthodontics Extra-oral photos consist of the following four shots: 1. Face-Frontal (lips relaxed). 2. Face-Frontal (Smiling). 3. Profile (Right side preferably - Lips relaxed). 4. (45 °) Profile (also known as 3/4 Profile - Smiling). A Short Guide to Clinical Digital Photography in Orthodontics- 2nd edition Clinical photography in orthodontics 1. Full face 2. Full face smiling 3. Right profile 4. Three quarter views Sandler PJ, Murray AM. Clinical photography in orthodontics. J Clin Orthod 1997;XXXI:729-39.
- 21. Orthodontic current principles and techniques Extra Oral / Facial Photographs 1. Frontal: i. Frontal at rest ii. Frontal view with the teeth in maximal intercuspation, with the lips closed, even if this strains the patient iii. Frontal dynamic (smile) iv. A close-up image of the posed smile 2. Oblique (three-quarter, 45-degree): i. Oblique at rest ii. Oblique on smile iii. Oblique close-up smile 3. Profile i. Profile at rest. ii. Profile smile. 4. An optional submental view Orthodontics current principles and techniques; Grabber; 5th edition
- 23. Background: Texture: Plain background Colour: Blue Camera position: Potrait mode ( vertical position ) At the same eye level if possible Patient position: Standing, Natural head position Distance: 4-5 feet away from the patient Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 24. Guidelines: • Frame • Camera position • Patient position • Distance Technique: • The patient should hold their teeth and jaw in a relaxed position, with the lips in contact (if possible). • The shot should be taken at 90° to the facial mid-line from the front. • Ensuring the patient’s inter-pupillary line is leveled. Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 25. Proper framing Pupil line levelled Mid facial line centered
- 26. • Same as Face-Front (lips relaxed) photograph • Natural smile with teeth visible This photo greatly aids in visualizing the patient’s smile esthetics and soft tissue proportions during smiling. Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 27. Superior border: slightly above the top of the head. Inferior border: slightly above the scapula, at the base of neck. Right border: slightly ahead of the nasal tip.¹ The whole of the right side of the face should be clearly visible with no obstructions such as hair, hats or scarfs.² Reference: 1. Orthodontics current principles and techniques; Grabber, 5th edition 2. A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 28. • The patient is asked to turn their heads slightly to their right about 3/4 of the way while keeping their body still in the previous “Profile Shot” position. (45°) Profile or (3/4 Profile) - Smiling Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 29. Look into the camera² (45°) Profile or (3/4 Profile) - Smiling Reference: 1. Orthodontics current principles and techniques; Grabber, 5th edition 2. A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS Look 45° to the camera¹ What should be the position of Eyes in 45° Oblique facial photograph ?
- 30. Reference: “Sandler et al. Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries. AJO-DO May 2009; Vol 135, Number 5”
- 31. Reference: “Sandler et al. Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries. AJO-DO May 2009; Vol 135, Number 5”
- 32. Excessive tilting of the head forwards or backwards results in misrepresentation of the soft tissue morphology or skeletal pattern. Reference:“McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 33. Camera position: Landscape mode ( horizontal position ) Patient position: Patient sitting comfortably in the dental chair and raised to elbow-level of the clinician. Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 34. Technique: • The photo should be taken 90° to the facial mid-line & central incisors. • Large retractors are used. • Assistant should be at the back of the patient. Retractors pulled laterally and towards the photographer. Reference: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS • “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 35. Why not dental midline?
- 36. ERRORS: Example 1 ERRORS: Example 2 Occlusal plane tipping dowwards (more upward shot) Occlusal plane tipping upwards (more downward shot) Occlusal plane horizontal (prependicular shot)
- 37. Technique: • The shot is taken 90° to the canine premolar area. • The patient is asked to turn their head slightly to their left so their right side will be facing the clinician. • At least the distal of the first molars is captured.* Reference: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS • *“McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 38. ERRORS: Example 1 Occlusal plane tipping upwards Occlusal plane horizontal Occlusal plane tipping downwards
- 39. ERRORS: Example 2 Distal 1st molar not visible Improper retractionImproper occlusion Occlusal plane tipping upwardsOcclusal plane tipping downwards
- 40. Technique: • The shot is taken at 90° to the canine- premolar area. • The patient turns their head slightly to their right so their left side will be facing the clinician. • At least the distal of the first molars is captured.* Reference: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS • *“McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 41. Technique: • Smaller retractor are used. • Mirror with its wider end inward. • The whole upper arch should be visible to the last present molar. • The shot should be taken 90° to the plane of the mirror for best visibility. • Use the mid-palatal raphe as a guide to get the shot leveled. Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 42. Technique: • Smaller retractors are used. • The patient is asked to “lift their chin up” slightly. • The shot should be taken 90° to the plane of the mirror, with the last molar present visible. • Tongue should be “rolled back” and behind the mirror. Reference: A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS
- 43. Proper cropping not possible ERRORS: Example 1 Proper cropping possible
- 44. Tongue obstructing field of view ERRORS: Example 2 Saliva obstructing field of view
- 45. Reference: “Sandler et al. Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries. AJO-DO May 2009; Vol 135, Number 5”
- 46. • The direction of pull of the retractors is always sideways and slightly forward, away from the gingival tissues i.e towards the operator. • In occlusal “Mirror” shots, warming the mirror in warm water prevent “Fogging” of the mirrors. the patient should be instructed to hold their breath for 10 seconds or so. alternatively, triple air syringe can be used. • A saliva ejector can be used to eliminate saliva prior to taking each photograph. • All photographic records be taken before impression-taking. Helpful Tips for Successful Photographs
- 47. Patients hair should be brushed back to reveal area of interest Helpful Tips for Successful Photographs Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 48. “ It was suggested that the gold standard for orthodontic photographs should be that the need for retaking photographs because of poor quality is less than 10%. “ “Rowland H, Atack N, Mitchell N. The quality of clinical photographs. British Orthodontic Society Clinical Effectiveness Bulletin 2004; No. 17 p.16.” Helpful Tips for Successful Photographs “ Four important variables directly affect the quality of photographs. These include: 1. training in photography, 2. photographic experience, 3. amount of time available to take the photographs, 4. and the camera and accessory equipment. “ “Jonathan Sandler, Joe Dwyer, Vincent Kokich, Fiona McKeown, Alison Murray, Richard McLaughlin, Catherine O’Brien, and Paul O’Malleyh. Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries. AJO-DO May 2009; Vol 135, Number 5.”
- 49. An optional to evaluate mandibular asymmetries Adapted from; Orthodontics current principles and techniques; Grabber, 5th edition
- 50. • Technical errors: a) Camera 1. Depth of field 2. Auto focus 3. Shadows b)Background • Positioning errors: a) Patient positioning b)Doctor positioning
- 51. The depth of field represents the amount of the image that is in sharp focus, and is dependant upon magnification and the aperture selected. Technical errors: Camera: Depth of field problems:
- 52. Large aperture, Focus lost distal to canines Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 53. Small aperture (F32) allows central incisors to molar tubes in focus Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 54. Light never reflected 100%; therefore, aperture compensation required. Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 55. Technical errors: Camera: 2. Auto-focus problems: Frustrating attempts to get auto-focus to work Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 56. Manual Focus Camera can moved until image is sharp Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 57. Focus on the patients lower eyelid to ensure from the tip of the nose to the ear of the patient falls within the depth of field on the front, three-quarter and profile extra oral views. Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 58. Technical errors: Camera: 3. Shadow: Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 59. Adjustment of flash or camera position to throw shadow behind subject. Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 60. Technical errors: Background: ‘Noise’ in the background detracts from the photograph Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 61. Give clear and concise instructions to the patient Instructions taken too literally Technical errors: Background: Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 62. B. Positioning errors • Patient position • Clinician position
- 63. B. Positioning errors: Height difference between the patient and the clinician? Reference: “McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54”
- 64. The main procedures include: 1. Flipping (Mirroring) and De-rotation. 2. Cropping unnecessary image. 3. Color, brightness and contrast enhancement. 4. Selective “Scratch Removal”. Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 65. 1. Flipping (Mirroring) : The purpose is to re-orient the image properly vertically and horizontally. Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 66. 2. De-Rotation : Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 67. Choosing area to crop Cropped image 3. Cropping; removing unnecessary image “information”
- 68. Images may require slight adjustments in their brightness/contrast values to make them more defined and in conformity with the rest of the images of the photo set. 4. Color, Brightness, Contrast Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 69. Dust particles become attached to the camera sensor, or minor scratches occur on the mirrors used for occlusal shots, will appear on the final image as a “scratch” or dark blemishes scattered around the image. 5. Selective “Scratch Removal: Reference: “A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition, Shadi S. Samawi BDS, MMedSci,MOrthRCS”
- 70. Digital video technology Recent emphasis
- 71. Digital Video Technology in Orthodontic Records Mumper Digital video clips can be a useful adjunct in smile evaluation. Adapted from; Orthodontics current principles and techniques; Grabber, 5th edition
- 72. REFERENCES: Articles: • McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32:43-54 • Jonathan Sandler, Joe Dwyer, Vincent Kokich, Fiona McKeown, Alison Murray, Richard McLaughlin, Catherine O’Brien, and Paul O’Malleyh. Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries. AJO-DO May 2009; Vol 135, Number 5 • Dan Lazar, Sanda Cimpian, Stefan-Ioan Stratul, An introduction to dental photography, TMJ 2011, Vol. 61, No. 1 - 2 • Eduardo Mahn, Clinical digital photography, Part 1: Equipment and basic Documentation, International Dentistry – African edition Vol. 3, No. 1 Books: • A Short Guide to Clinical Digital Photography in Orthodontics, Second Edition Shadi S. Samawi BDS, MMedSci,MOrthRCS • Contemporary Orthodontics by William R. Proffit; 4th edition • Orthodontics current principles and techniques; Grabber, 5th edition
- 73. REFERENCES: Guidelines: • ALD 2010 Recommended Guidelines for Clinical Photography Academy of Laser Dentistry’s 17th Annual Conference, April 14-17, 2010, Miami, Florida • Camera Recommendation for Dental Photography, January 2014, Bauer Seminars, University of Toronto, Faculty of Dentistry Websites: • Macro lens a key for dental photos (http://www.dentaleconomics.com/articles/print/volume-95/issue-7/columns/the- world-of-digital-dentistry/macro-lens-a-key-for-dental-photos.html) • How to Buy a Camera, Flash & Lens for Clinical Dental Photography (http://dentalphotography.blogspot.com/2012/03/what-camera-should-i-buy-for- dental.html) • Getting the Right Shots! Tips and Tricks for Consistent Photographic Excellence (http://www.dentistrytoday.com/restorative/photography/8816-getting-the-right-shots- tips-and-tricks-for-consistent-photographic-excellence)
- 74. Dr Abbas Naseem abbas_naseem@yahoo.com Dated: September 1st, 2014 Like any new skill… This will take practice and dedication to master
Notes de l'éditeur
- In this presentation we will learn…
- Clinical photographs are not only a useful diagnostic tool, but also are essential for accurate record keeping, case evaluation, and monitoring treatment progress. They are also useful for exchanging information between clinicians and for educational and medical legal purposes.
- Clinical photographs are not only a useful diagnostic tool, but also are essential for accurate record keeping, case evaluation, and monitoring treatment progress. They are also useful for exchanging information between clinicians and for educational and medical legal purposes.
- Clinical photographs are not only a useful diagnostic tool, but also are essential for accurate record keeping, case evaluation, and monitoring treatment progress. They are also useful for exchanging information between clinicians and for educational and medical legal purposes.
- DSLR (Digital Single Lens Reflex), Point and Shoot compact cameras(limited manual control, smaller ISO range, shutter lag), fixed lens zoom cameras (low resolution lcd screen, shutter lag (0.5sec), poor high-ISO noise reduction) D5300 Image source: http://www.expertreviews.co.uk/digital-cameras/1304890/nikon-d5300 Ideal Requirements: camera with a macro-facility (ability to produce 1 : 1 images) a ring flash an appropriate background suitable lighting and well trained assistants.
- “Buy a normal camera but buy an excellent lens” Purpose of lens: The purpose of the flash is to throw light on whatever it is you are photographing. Once light has bounced off a subject, it has to be channeled to the camera’s sensor to capture the image. This is the job of the lens, to channel the light. The lens can do other things, too. Macrolens: Macro lens type is designed to take closeup views of small objects such as flowers, insects, and teeth. For dentistry, the ability to focus closely on small objects is essential. The 100mm length allows us to be eight to 20 inches from a patient yet still take a closeup view, such as a single incisor. Reference: “http://www.dentaleconomics.com/articles/print/volume-95/issue-7/columns/the-world-of-digital-dentistry/macro-lens-a-key-for-dental-photos.html” The old standby for Nikon was the Nikkor 105mm "micro" (only Nikkor uses the term "micro" instead of macro) Reference: “http://dentalphotography.blogspot.com/2012/03/what-camera-should-i-buy-for-dental.html” The magnification factor represents the magnifying power of the lens. For example, a lens with a magnification factor of 1:1 forms the image on the film (sensor) with the same size as the photographed object. So, true macro lenses have a magnification factor of 1:1, and they have fixed focal lengths, of 50mm, 60mm, 90mm, 100mm, 105mm or 200mm. The 100mm and 105mm macro lenses are best suited for dental photography. Reference: “Dan Lazar, Sanda Cimpian, Stefan-Ioan Stratul, An introduction to dental photography, TMJ 2011, Vol. 61, No. 1 - 2 “
- Nikon has the R1 flash You could adapt the R1 to your Canon, but you would need the R1C1 which includes the commander module to make them fire, which increases the size and the price by $250. The R1C1, by definition is the R1 PLUS the proper commander module. The 5100 requires it. You see, the flashes are wide which gives you great shadows. Why do we like shadows? They give us ideal surface texture, embrasures and nuances of what we're shooting. Wanna destroy all of that? Use a ring flash. --------------- The ring flash light is the favourite amongst inexperienced dental photographers and it is considered the universal flash system for general macro photography. On the one hand, it is true that the greater the distance between the ring flash and the subject, the flatter, less texturised and refined the photos are, while a twin flash generates pictures with more texture, contrast and that look more alive. The macro lateral flash shows more variability in light direction, allowing certain details to be highlighted. The overall hue of colour, cracks and also transitions are best captured with the macro lateral flash. Probably the only drawback, besides its higher cost, is when photographing posterior regions, where access and space is limited. Reference: “Eduardo Mahn, Clinical digital photography, Part 1: Equipment and basic Documentation, International Dentistry – African edition Vol. 3, No. 1”
- Two sizes of double-ended retractor re prerequisite to obtaining a set of high quality intra-oral photographs.
- Glass mirrors produce a far superior photograph compared to polished metal mirrors as there is much greater reflection of the light and they are more resistant to scratching. Silvering on the front side of the mirror prevents double images, which occur due to a second reflection from the glass surface when the silvering is on the back surface. These mirrors differ from ordinary mirrors in that the image reflection is made at the surface of the mirror, right on the reflecting surface. Classical mirrors have the reflecting layer covered by protective glass, so two images are created, one reflected by the reflecting metallic layer, and the other reflected by the glass surface. The reflecting surfaces of older special photographic mirrors were made of highly polished surgical stainless steel, modern photographic mirrors are made of Rhodium or Titanium.
- Glass mirrors produce a far superior photograph compared to polished metal mirrors as there is much greater reflection of the light and they are more resistant to scratching. Silvering on the front side of the mirror prevents double images, which occur due to a second reflection from the glass surface when the silvering is on the back surface. These mirrors differ from ordinary mirrors in that the image reflection is made at the surface of the mirror, right on the reflecting surface. Classical mirrors have the reflecting layer covered by protective glass, so two images are created, one reflected by the reflecting metallic layer, and the other reflected by the glass surface. The reflecting surfaces of older special photographic mirrors were made of highly polished surgical stainless steel, modern photographic mirrors are made of Rhodium or Titanium.
- An appropriate and consistent background should be selected, such as a blue non-reflective material, or alternatively to eliminate shadows completely a light box.
- Frontal Rest Lip together picture is recommended in pts who have lip incompetence (documentation of lip strain and its esthetic effect) Smiling picture demonstrates: amount of incisor show on smile (%age of max incisor display on smile) & any excessive gingival display Close up image of posed smile for careful analysis of smile relationships. 2. Oblique Oblique at rest: midface deformities (especially nasal), chin-neck area, prominence of gonial angle, length & defination of border of mandible, focus on lip fullness and vermilion display. Oblique smile: to see incisor flare & occlusal plane orientation
- Make sure the patient’s head is not tilted or their face rotated to either side;
- Make sure the patient’s head is not tilted or their face rotated to either side;
- Most common method for positioning pt. properly: is to have pt. look in a mirror, orienting the head on the visual axis. - Profile photographs should be taken in NHP(Grabber), not frankfort horizontal?
- They are then instructed to look into the camera, and then smile. This shot conveys the patient as if in “social interaction”, and can give valuable information about the smile esthetics’ changes pre- and post treatment. Note: It is essential that the patient’s teeth show clearly when smiling, otherwise the photograph would be of minimum benefit.
- Profile shots: Usually only one profile (the patients right profile to match up with the lateral cephalogram and tracing) is taken. However, for patients with facial asymmetries both right and left profiles should be taken. The face should fill the frame extending to above the top of the head, in front of the nose and below the chin. The patient’s Frankfort plane should be horizontal. The dental light, if required, should be directed so that the patient’s shadow is thrown behind the patient and the camera’s flash, where possible, should be adjusted for similar effect. Subjects with long hair should always be asked to tuck it behind their ears so that the Frankfort plane may be assessed accurately and the area of interest is fully exposed.
- The dental mid-lines are not as reliable for this purpose as they can be shifted to one side or the other depending on the malocclusion present. This is important to allow maximum visualization of all teeth and alveolar ridges, and also to minimize discomfort for the patient from retractor edges impinging on the gingivae. The full extension of the sulci is paramount for full visualization and clarity, and the high F value setting e.g. F32 is required to attain maximum depth of field of the shot with even the last visible molars fully in focus.
- The dental mid-lines are not as reliable for this purpose as they can be shifted to one side or the other depending on the malocclusion present. This is important to allow maximum visualization of all teeth and alveolar ridges, and also to minimize discomfort for the patient from retractor edges impinging on the gingivae. The full extension of the sulci is paramount for full visualization and clarity, and the high F value setting e.g. F32 is required to attain maximum depth of field of the shot with even the last visible molars fully in focus.
- The assistant flips the right retractor to the narrower side, while the left retractor remains in place as for the previous frontal shot. A useful tip would be for the clinician to fully stretch the right retractor just before taking the shot to minimize any discomfort for the patient, and achieve maximum visibility of the last present molar, if possible.
- The assistant now switches the retractors with the narrow end on the photo side (patient’s left) and the wide end on the other (patient’s right).
- Sources of errors in clinical photography: Technical errors: The first group comprises errors due to inappropriate choice or use of equipment including the camera, lens, flash, retractors, mirrors or suction, or a lack of understanding of the digital technology resulting in inadequate or inappropriate images. Positioning errors: The second group of errors relates to any recording medium and involves inappropriate positioning of the subjects.
- As the magnification increases and as the aperture through which the picture is taken widens the depth of field reduces. Intra-oral photographs should be taken with the smallest aperture possible to maximize the depth of field.
- Many mid-range digital cameras that bridge the gap between consumer and professional models, (known as ‘Prosumer’ cameras, e.g. Nikon Cool Pix 990/4500) will only allow the aperture to be reduced to about F11. This disadvantage of small depth of field with pictures taken with larger apertures can be minimized (but not avoided completely) by focusing on the distal surface of the lateral incisors to at least get central incisors to canines in focus. When taking intra-oral photographs with these mid-range cameras the depth of field will be relatively small and on the anterior intra-oral photograph part of the picture will inevitably be out of focus.
- With buccal shots and occlusal shots, provided the subject is correctly positioned and retractors are appropriately used, all the area of interest is on one plane; therefore, depth of field should not be an issue. With professional digital cameras, e.g. Fuji S1 Fine- Pix Pro, combined with the powerful Nikon SB29 flash, which allows through the lens metering a perfect exposure is possible on F32. This tiny aperture allows sufficient depth of field to include both incisor brackets and second premolar brackets in sharp focus provided the focal plane is positioned correctly, i.e. on the mesial of the canines (Figure 11).
- During occlusal photography light is never reflected 100%, and there is a tendency for mirror photographs to be slightly underexposed. It is therefore worth using an aperture compensation of +1 F-stop, to ensure good illumination of mirror shots.
- Because of the lack of sharply contrasting lines in the area of interest many of the digital cameras have difficulty focusing using the auto-focus setting for intraoral photographs. Digital cameras often allow the choice between auto-focus or manual focus. Manual focus is by far the preferred option for the following reasons. With Prosumer cameras focusing has to be on the lateral incisors and with top end cameras on the canines, whilst still maintaining a centred photograph. The result of this is attempt after attempt to get the camera focus light (usually flashing green) to stop flashing, indicating that the shot is in focus. This often proves fruitless despite repeatedly moving the camera slightly between attempts at focusing. All this is occurring whilst the assistant and the clinician are heaving on the retractors to get maximum retraction of the soft tissues and some patients may find this a little uncomfortable (Figure 12).
- Twenty centimetres is a good distance to start testing the cameras ability to take sharp anterior intra-oral photographs on manual setting. Appropriate distance between the patient and the camera until area of interest is sharp.
- Focus on lower eyelid whilst keeping subject centred. Using the dental light to illuminate the patient, not only helps to reduce red-eye, but also greatly aids focusing in poorly lit surgeries.
- Problems involving shadowing are almost inevitable with use a point flash. Figure: (a,b) (left and middle) Shadow thrown in front of or below subject because of flash position problems of shadowing on extraoral lateral shots can also be overcome by either switching off the part of the ring flash, which throws the shadow in front of the subject if this is an option, or rotating the camera through 180u to ensure the flash throws the shadow behind the patients outline
- Alternatives for shadow correction: illuminated screen as the backdrop to the patients or use a dark non-reflective background (preferably velvet) to maximize the quality of the image.
- Soap containers, light switches, door handles and edges of notice boards add ‘noise’ to the view and detract from the overall quality of the final Picture.
- Occasionally, when asked to stand in front of the background, patients will take the instructions too literally and turn their back to the photographer, highlighting the need for explicit patient instructions.
- This problem can be solvgetting the patient or the clinicianed by, which ever is appropriate, to stand on a platform to raise them to the same height.
- Figure: (a,b) Height difference between the patient and the clinician. Both the patient and the clinician need to be positioned correctly, in a standardized manner, to produce consistent photographs. This problem can be solvgetting the patient or the clinicianed by, which ever is appropriate, to stand on a platform to raise them to the same height.
- 2. Cropping; removing unnecessary image “information”. Regardless of the software you choose to use, there are only a few number of editing procedures to follow to obtain the best possible end-result in most cases. Post processing your digital images Cropping of images Enhancing the images Exposure Brightness / contrast Colour
- The purpose is to re-orient the image properly vertically and horizontally, and relative to the occlusal plane or midlines of the jaws. Frontal and buccal intra-oral shots should be level with the occlusal plane of the teeth. Upper and lower occlusal shots should have a leveled mid-sagital plane. e.g. The mid-palatal raphe should be in the midline of the image Upper and lower occlusal shots (Mirror) shots usually require vertical, then horizontal flipping to correct their orientation, followed by a degree of de-rotation to level the midline of the palate if needed. These planes should be leveled ideally when taking the photos, but a small amount of correction usually remains needed.
- For even quicker adjustments, the “Exposure” and “Shadows/Highlights” controls may be used, depending on the image-editing software being used. These controls can help minimize or even eliminate some dark shadows and the “dull” appearance of images. The “Gamma” control is also a good alternative for both the “Brightness/contrast” controls combined. There are no specific adjustment recommendations here as the adjustments to be made are very subjective and variable depending on how the original image has been captured, and the operator’s preference and/or requirements.
- These will appear on the final image as a “scratch” or dark blemishes scattered around the image and detract from the final quality of the the image. These can optionally be “removed” using the “scratch removal” tool that is found in some image editing software tools. This tool is sometimes called the “Healing” tool. The “Cloning” tool in certain software suites can also do a reasonable job of removing blemishes and dust shadows from images.
- In standard photography, the image represents an approximate 1/125 - second exposure of a patient’s smile. The image is taken somewhere in this dynamic process and may not represent the patient’s consistent and repeatable smile. Digital video and computer technology currently enable the clinician to record anterior tooth display during speech and smiling at the equivalent of 30 frames per second. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- In recording a smile for subsequent analysis, the subject is asked to smile and the picture is snapped. The problem in this process lies in the knowledge that the lips start the smile process at rest and animate over a very short time period. In practical terms, the image may be taken halfway into the smile or halfway to the end of the smile and may not represent the smile the patient uses consistently. Certainly almost all practicing clinicians have had the frustrating experience of looking at the patient’s smile image during treatment planning and having the subject show a forced smile or smiling without their teeth showing. (particularly 12-year-old boys!). Digital video and computer technology currently enable the clinician to record anterior tooth display during speech and smiling at the equivalent of 30 frames per second. With video clips of this type, one can review the video clip on a computer screen for repeated playback or set up a printout sequence that reflects the “smile curve,” which is a series of frames chosen to reflect the animation of the smile from start to finish (Figure 2-7). This gives the clinician an opportunity to both visualize the smile from start to finish in dynamic viewing and see the individual frames in sequence to visualize the sustained smile—the smile with the most consistent lip incisor position during the smile.
- “Do not seek praise. Seek criticism.” - Chinese Proverb