Article and Clinical Photos by Carlos A. Boudet, DDS, DICOI
After many years of sharing information with colleagues, I have noticed that
the majority of dentists do not take the time to document their work – even
the interesting cases – with photographic records. In today's economic and
business environment, it has become increasingly necessary to adequately
promote your practice, and I consider taking photographs to be a very important
part of that.
With this article, I would like to introduce a simple, but effective way of
documenting your cases with dental photography. Following these guidelines
will help your practice in many ways.
PHOTO DOCUMENTATION
Dental photography has two parts: intraoral and extraoral
photography. Here are some basic tools you will need:
1. A camera that allows you to take both full-face and profile
pictures, as well as intraoral close-up shots.
2. Two sets of intraoral photographic mirrors and two sets
of retractors. There should be one occlusal mirror and
one lateral mirror in each set.
I have adopted a simple series of standard dental photographs
to document my cases. I take one set of preoperative
pictures, and I take another postoperative set to document
the final results. Simple before-and-after pictures of your
work can help patients visualize and accept the work they
need done
(Figs. 1, 2). If I think I might make a presentation
of the case, I take additional photos of the procedural steps.
STANDARD PHOTOS
The required views for clinical case submission to the
American Academy of Cosmetic Dentistry are 12 preoperative
views and 12 postoperative views. My standard set of
photographs consists of the following:
1. Three extraoral photos: Two frontal views of the face
(one in repose and one smiling) and one profile shot
2. Five intraoral photos: Five retracted views, including
an anterior view, a right view and a left view, and two
mirror occlusal shots (one of the mandible and one of
the maxilla)
3. For cosmetic cases, an anterior retracted view with the
teeth apart is very helpful. This makes for six intraoral
photos instead of five.
CAMERA CHOICES
Now let's talk about cameras. Undoubtedly, the best camera
system is an SLR digital camera like a Canon T3i or a Nikon
D90, with a dedicated 100 mm macro lens and a ring flash.
In this basic tutorial, however, we use a point-and-shoot
camera. It's simpler to use because there are no settings to
change and focusing is automatic. This simple system was
chosen because of the different levels of expertise exhibited
by the dentists attending our courses, as well as the need
for a camera that could take the use and abuse.
PATIENT POSITIONING
You can take the necessary pictures with the chair in two
positions: completely horizontal and at 45 degrees from
horizontal
(Figs. 3, 4). With the chair at an inclination of
about 45 degrees, you can take the anterior, right and left
retracted views, as well as the three headshots. For nicer
looking pictures, you can take the three headshots with the
patient standing in front of a contrasting background.
TIPS FOR BETTER PHOTOS
• Standardize the photographs by taking them at the same
distance from the subject every time. That way, it will be
easier to compare "before" and "after" shots.
• Do not change the "P" or program mode in the Pentax
Optio W90. This will standardize your exposure settings
because the camera's default setting will adjust the focus
and the exposure for you automatically, and the lighting
should not change in the operatory.
• Proper positioning of the camera avoids the errors associated
with canting and taking the shots at angles that are
"too high" or "too low."
• Reposition the patient's head slightly instead of leaning
over the patient.
• For better headshot photographs, use a background. Do
not place the patient too close to the background as this
can create shadows.
• Try to take the occlusal views looking down the incisal
edges of the anteriors.
• Use the interpupillary line and the vertical midline to
orient the camera.
• Finally, try to remove anything that would make the
picture look bad, such as excess saliva, blood and food.
The full-face shots should be at about a 1:10 magnification,
while all the other frontal, lateral and occlusal retracted
views should be at a 1:2 magnification. When you are taking
headshots with the Optio W90 camera, be sure to place
the camera about five feet from the patient's face and zoom
in or out to frame the patient's head on the screen. For
the intraoral shots, the retracted frontal and lateral views
should be taken about one foot away from the patient's
face at maximum optical zoom, and about two feet away for
the occlusals.
Figures
5a, 5b, 5c, 6a, 6b, 7a, 7b, 8, 9a, 9b illustrate the series of standard photographs
previously described.
PHOTO EDITING
A photo editing program is a very useful tool when working
with digital pictures. There are a lot of good ones on the
market, from free applications such as GIMP, Picasa and
Photoscape, to those geared toward the professional such
as Adobe Photoshop. Other programs include Adobe
Photoshop Lightroom, Adobe Photoshop Elements, Corel
PaintShop Pro and ArcSoft PhotoStudio.
These programs will let you tweak your photos by cropping,
rotating and adjusting exposure so they look great,
even if you are not the greatest photographer. As a final
note, make sure that your patients sign a simple photography
release form that gives you permission to show their
pictures.
This brief tutorial was written in the hope that it will
encourage more dentists to document their cases with
photography. This will increase your cosmetic and implant
case acceptance, and lead to patients inquiring about having
you do their dental work. It will also benefit your marketing
efforts, while making you a more humble and better dentist
in the process.
