Digital Photography in Dentistry: Tools and Techniques to Help Your Patients and Improve Your Practice

Digital photography can have many impacts on your dental practice: Photos can educate patients and improve case acceptance, communicate shade to the dental lab, and improve patient confidence after treatment. In this article, Ben Ross, DMD, FACP, illustrates the different types of photos you need to take for each of these lenses, and explains the tools you’ll need to take them.

At present, if you don’t have a digital camera (whether compact camera, single lens DSLR [DSLR], or even a smartphone), you may be living in an alternate universe. The days of cinema are pretty much over, and the desire for an instant photographic review is almost ubiquitous (see: selfies). This is also true in dentistry, from an instant review of the x-rays on the screen for the dentist to showing existing or potential patients how their teeth look from our perspective, whether in the dental room. operation or in the consulting room to help them better understand what is great. dentistry can do it for them.

In my prosthodontic practice I use a digital SLR camera (Nikon D600), a macro lens (Micro Nikkor 105-mm) and either a ring flash (Nissin MF18) or a dual source flash system (Nikon R1C1) with a support (PhotoMed) for almost all photos (figures 1 and 2). The flash I use depends on what I’m trying to convey and who my audience is. I normally keep the camera on its manual setting and adjust the f-stop to vary the depth of field and focus. Wi-Fi enabled Secure Digital (SD) cards can send photos directly and instantly to a viewing device, such as a tablet or Wi-Fi enabled computer monitor in your operating room, so you can show off to your patients what you see in real time (figure 3).


Figure 1:
Nikon DSLR D600, Micro Nikkor 105mm lens, Nikon R1C1 dual flash with PhotoMed mount


Figure 2:
The same body and the same lens with the Nissin MF18 ring flash


Figure 3:
Wi-Fi enabled SD cards that can instantly transmit a photo to a device for patient viewing (images courtesy of Eye-Fi and Toshiba)

I won’t go into too much detail on dental and macro photography as there have been many books published on the subject, but one resource I highly recommend is Photography in Dentistry: Theory and Techniques of Modern Documentationby Pasquale Loiacono and Luca Pascoletti.

I will say, however, that digital photography in the dental office can have a huge impact in many ways. While there are many uses, I will focus on what I have found to make the most of my time and also to have the greatest impact on my practice and the oral health of my patients.

Intra-oral and occlusal photographs to educate the patient

If I have a questionable patient who has a restoration that needs to be replaced or has recurring decay, a crisp and clear picture of the problem area can convince them of the need for treatment. For these photographs, I generally recommend a ring flash for ease of use, a 14-26 aperture, and an available helper to hold the retractors (plastic or metal will work well, depending on your personal preference). A hot water bath or a heating pad for the mirrors will decrease the fogging of the patient’s breath. Having your hand or the hands of your assistant in the photo reduces the emphasis on the teeth. That’s why I highly recommend using mirrors with handles (PhotoMed) or long and elongated mirrors. They have become something that I cannot live without for this reason (Figure 4).


Figure 4:
Mirrors with handles from PhotoMed

When taking an intraoral mirror image from the lateral perspective, I always try to get the patient to separate their teeth so that the entire tooth and what I am showing is easily visible (Figures 5-6). It is the same for the retracted frontal planes; you can see much more when the teeth are apart than when they are together, in most cases (Figures 7-8).


Figure 5:
With a closed side view, Patient A may not see what we know to be there.


Figure 6:
For patient education, it is just as effective to show the teeth separated as they are together in lateral views, especially in cases of wear.


Image 7:
A closed, retracted frontal view of Patient A


Figure 8:
A slightly open frontal view of Patient A shows destruction which might not otherwise be appreciable.


Figure 9:
In an occlusal view of Patient A, extreme wear and erosion is now very visible on almost all teeth, a powerful image for patients who cannot see it on their own.


Figure 10:
Patient B presented with aesthetic problems concerning the two plants. I always take a photo with the lips framing the smile; this comes into play after the completion of dentistry (figure 12).


Figure 11:
Patient B had a shade photograph taken with a dual flash setup and at least two shade tabs. You should also take a shade of the underlying tooth structure if ceramic crowns are to be used.


Figure 12:
Patient B after Central Incisor Restoration: Often the patient’s lip line will rise higher as a result of cosmetic improvement. Showing potential patients this type of photo – with lips – has a bigger impact than a retracted photo.

Shadow communication with the dental laboratory

Unless you have a lab in your dental office, you are likely communicating with your lab using photos. I always advise the dialogue between the dentist and the laboratory on how to effectively communicate the shade; labs usually have a specific set of photos that they prefer the dental office to provide. If you are unsure, I recommend the following:

  • Use a two-point flash (Figure 1) to decrease the amount of direct reflection. Position the flashes three to four inches to the left and three to four inches to the right of the lens, and point them 30 to 45 degrees toward the focal points of the image. Take a few pictures this way and you’ll notice the translucency you get with this flash setup, which doesn’t happen as well with the ring flash.
  • Always have more than one shade tab in the photo for reference and place the edge of the shade tab over the edge of the restored tooth, reflecting its image, depth of field, and angle to the lens (figure 11; figures 14-15). Some shading tabs look different, depending on how and where you hold them. Again, have this discussion with your lab in advance if possible.


Figure 13:
Patient C: Using a black background or contrast better illustrates translucency near the incisal edges.


Image 14:
Patient C: Using multiple shade tabs gives the ceramist more information, so they can compare spectral differences that may not be apparent with a photo that has only one shade tab.


Figure 15:
Patient C: Having tabs specific to the range of ceramics used by your lab is also helpful when communicating difficult shade matches.

“Before” and “After” portraits

What says a lot about patients is how they see themselves after treatment. Did you make a difference in their smiles? How can you tell without photographs what they looked like before you start? You (and your patients) just can’t.

For portrait photography, I recommend that you have a standard DSLR camera with a standard 35-70mm lens and two separate remote flashes with diffusers. (The R1C1 system can work for this as well, or you can purchase additional flashes to use specifically for this.) I like to sit the patient in a stool or chair that swings away from the wall as it creates too much direct reflection and shadows. . Take these photos capturing the lower neck just above the head in the following poses:


Image 16:
A gentle smile: the average smile patients present


Figure 17:
A lively smile with slightly narrowed eyes: notice how she lifts her cheeks and upper lips to show more teeth. People can often distinguish a genuine smile from a calm smile by looking into the eyes.


Figure 18:
The 45 degree shot to the right, smiling: I call this ‘the round table conversation view’ because it illustrates how others see us smiling and speaking from different angles.


Illustration 19:
Notice how the eyes show the difference in the genuine smile.


Image 20:
The shot to the left at 45 degrees, smiling: again, this helps us see what is visible in group conversations.


Image 21:
Open-mouth rest: Have the patient pronounce an “m” word, such as “Emma”, without moving the lower jaw after saying the word, as this helps show the incisal length at rest and any changes you may have. bring there.


Figure 22:
Compare this type of photo with the type shown in Figure 21 and assess the mobility of the lips during the smile, both before and after the treatment. Patients will notice the change more when it is framed by the lips.

At the end of the treatment, we take a few of those photos back and do a side-by-side comparison using a PowerPoint or Keynote slideshow to show the patient the improvements we’ve made together, making the patient an integral part. of the process as possible. We then give the patient cropped “before” and “after” portraits on a US letter size piece of photographic paper, so that he or she can see the new person behind the different smile.

These are just a few of the ways I incorporate digital photography into my practice to influence and impress patients. This has a huge impact on treatments that take months to complete and reminds the patient (and the dental team) that what was done was worth the wait!

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Editor’s Note: This article first appeared in Pearls for Your Practice: The Product Navigator. Click here to subscribe. Click here to submit an article on products to consider.
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Ben B. Ross, DMD, FACP, is a certified prosthodontist who has a private practice in Charlottesville, Virginia. After graduating from Tufts University School of Dental Medicine, he joined the US Army Dental Corps where he obtained his certificate in prosthodontics and was deployed to Iraq in 2010 on active duty. He continues to serve his country today in the Army Reserves. He is very active in his local dental society and is currently president of the Virginia chapter of the American College of Prosthodontics.

About Debra D. Johnson

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