1GooD MorninG..!!

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Dr. Onkar B. KhotPG (Orthodontics)

Clinical Photography

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Points to ponder…Introduction

Why take orthodontic photographic records

Why go DIGITALBasic terms

ResolutionFocal DepthShutter speedMacro function / lens

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Clinical requirements for photographic recordsDigital camera setup / ring flash / Macro

LensSpecial cheek retractorsDental mirrors

Taking clinical photographsExtra-oral

Patient positioningClinician positioning

Intra-oralPatient positioningClinician / Assistant positioning

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Post processing your digital imagesCropping of imagesEnhancing the images

ExposureBrightness / contrastColor

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Study models, properly trimmed, dental stone – cast moulds

Radiographs, usually OPG and Lateral cephalogram

Clinical photographs – a luxury..??

Time has changed – emphasis on achieving balanced facial harmony

Carefully study existing patients soft tissue pattern

Lip morphology and tonicity, smile arc & smile esthetics

In absence of patient

Why take orthodontic photographic records..??

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Ease of use of digital camerasAbility to repeat / delete unsuitable imagesNo need to wait till the film is developedCost effectiveA one time investmentVTO

Why go digital..??

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ResolutionHow much detail an image can holdPixel count and bit depth of each pixelAs the number of pixels increases, the image’s

detail becomes sharperNumber of megapixels – camera’s resolutionDisplay’s resolution – expressed in pixels per

inch (ppi)

Basic terms

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Focal lengthLens’s magnification powerLonger the focal length – more the

magnification power

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Macro photography – close-up photographyReproduction ratio of life size i.e. 1 : 1

Macro function / lens

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Shutter speedAmount of time the shutter is open or digital

image sensor is activatedDisplayed as fraction of a second, such as 1/8

0r 1/250

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ApertureA hole in the lens through which light passes

on its way from subject to the filmDOF – depth of fieldTo make one object stand out of a wide viewReduce aperture size

Increase in depth in a picture

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How much picture comes out sharply and how much doesn’t

This zone of sharpness is called as depth of field

Can be controlled by 3 main factors –Aperture – smaller the aperture more extensive

the DOFFocal length – shorter the focal length, greater

the DOFCamera to subject distance – greater the

distance, deeper the DOF

Depth of field (DOF)

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Shallow depth of field

1/30th of a second exposure

f 3.5 aperture value

Greater depth of field

1.5 second exposuref 22 aperture value

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Digital camera setupPoint & shootDSLRs

Clinical requirements for photographic records

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Ring flash eliminates shadowsAllows more even and thoroughdistribution of light

Ring flash Vs Point flash

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A dedicated macro lens that can be attached to the cameras and adjusted as needed is by far a superior choice

Macro lens Vs macro function

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Double ended retractors

Special cheek retractors

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Dental photography mirrors

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Extra-oral PhotographsFace-frontal (lips relaxed)Face-frontal (smiling)Profile (right side preferably – lips relaxed)(45 °) Profile (also known as ¾ Profile –

Smiling)

Intra-oral photographsFrontal – in occlusionRight buccal - in occlusionLeft buccal – in occlusionUpper occlusalLower occlusal

Taking clinical photographs

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Face-frontal (lips relaxed)outer canthus to superior attachment of the ear

(C-SA line)Interpupillary lineEncompassing area (crown to collarbone)Head in NHP

Extra-oral photographs

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Face-frontal (smiling)Same guidelinesSmiling in a natural way with the teeth visibleAids in visualizing patients smile esthetics and

soft tissue properties

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Profile (right side preferably – lips relaxed)

canthus to superior attachment of earencompassing area of crown to

collarbonechin and neck should show, preferably

up to the claviclesFrankfort horizontal line tobe sure that head is level

Camera position for lateral view

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(45 °) ProfileSocial interactionVisible information about smile estheticsTurn the head to right about ¾ of the wayTeeth should be visible

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POSITIONING THE PATIENT The position of the patient is important to

the camera view and to the operator’s ease in making the view

For most straight anterior views, the patient should be in a semi upright position with a slight tilt backwards

In a contour chair, the patient must turn his head to the side so that the operator does not have to lean sideways over the chair and patient.

OPERATORY DENTAL LIGHTIt should not be directly on the teeth

Keep the light on the side of the cheek and out of the mouth

The light is only needed to give enough light to focus by

When the dental light is bright or strong on the side of the arch that should have the greatest contrast, it will kill the contrast produced by the flash.

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Frontal – in occlusionPatient in dental chair, raised to clinicians

elbow levelAssistant standing behind the patientRetract patients lips sideways90° to facial midline using upper frenum as a

guideFull extension of sulciHigh “f” value for maximum depth of field

Intra-oral photographs

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Right buccal - in occlusionFlip the right retractor to the narrower sidePatient is asked to turn their head to leftClinician then holds the right side retractor

and pulls it to visualize the last erupted molar as much as possible

90° to canine-premolar area

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Left buccal – in occlusionSimilar to that of the right buccalSwitch the larger retractor to patients right

and narrow end to patients leftPatient turns head slightly towards their right90° to canine-premolar area

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Upper occlusalRetractors are inserted in “V” shape to retract

upper lip sideways and away from the teethMirror with wider end inside the mouthPatient is instructed to lower the head slightlyShot can be taken 90° to the plane of the

mirrorMid-palatal raphe as a guide for orientationMinimum retractor showNo fingers should be seen

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Lower occlusalRetractors in reverse “V” shapeClinician holds the mirror upwards to visualize

lower archPatient is asked to lift the chin upAnd also asked to roll back the tongue

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UPPER OCCLUSAL SHOT

34LOWER OCCLUSAL SHOT

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Direction of pull of retractors is always sideways and slightly forward, away from gingival tissue

Wetting the retractors just before insertion eases the process of positioning them with minimum patient discomfort

Taking occlusal mirror shots, slightly warming the mirror in warm water prior to insertion helps prevent fogging of the mirror

Saliva ejector can be used to eliminate saliva prior to taking each photograph

Helpful tips

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During occlusal mirror shots, instruct the patient to open wide just prior to pressing the camera button. This helps in obtaining maximum mouth opening at the right moment, and minimizes patient’s fatigue during the procedure

It is recommended that all photographic records to be taken before impression making, to eliminate the possibility of impression material being stuck between the teeth or the face during the procedure

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Minimum camera resolution for orthodontic purpose would be around 3-4 megapixels

DSLR cameras are highly recommended for taking orthodontic photographic records

Patient should be standing in front of a plain white background when taking extra-oral shots

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Immediate back-up ensures a complete back-up of all the original, unprocessed image files

Flipping – relative to occlusal plane and mid line

De-rotationCropping

Post processing your digital images

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Clinical photography in dentistry ; Matrishva B. Vyas ; Jaypee publication

A Short Guide to Clinical Digital Photography in Orthodontics ; Shadi S. Samawi

Orthodontics Current Principles Techniques ; Graber, Vanarsdall, Vig ; 4th Edt

REFERENCES…

43THANK YOU…!!!