Aesthetic Materials and Treatments
James R. Dunn DDS-
Aesthetic Dental Treatments
Patient requests for aesthetic treatments is driven by “Appearance Phenomenon”: the quest for
beauty. Dentistry is only following the Universal trend of “youth and beauty”. Programs like
“Extreme Makeover” have fueled this demand. Dentistry offers many treatments to enhance natural
beauty of a smile. Ethical concerns caution against over treatment. Conservation of natural tooth
structure is a high concern while meeting patient’s wants and needs. Remember the golden rule
and our Hippocratic oath—Do no harm!
Materials- Composites, Dentin Bonding Systems, Devices
Use Diamonds rather than carbides for tooth preparation. Air abrasion, Laser preparation-(no
biological or physical advantage), may allow more conservative preparations, diagnosing
(Diagnodent) and treating disease earlier with less tooth destruction. Hybrids are used for most
treatments-anterior/posterior; nanoofills for enamel like surface translucency and polish. New
translucent hybrids-”Natural shaded composites” (4 Seasons™, Supreme™, Vit-l-esence™,
Esthet-X Improved™, Renew™, Point 4™, Premise™, Miris™, Venus™ ,Simile™, Tetric
EvoCeram™, TPH3™, Gradia Direct™,Palfique Estelite ∑ ™, Artiste, Ceram X, etc.) promising.
No current validation for flexible, flowable composites. Current use as liners in posteriors promising
as stress relief and adaptation. New NanoComposites (Supreme™) have high surface gloss.
Apply with IPC, and brush. Finish with #12 blade, discs, rubber polishing cups. New micro-hybrids
have higher gloss with final use of diamond/rubber cups/brushes. Place Composite Surface
sealant on margins and surface after finishing. Multiple-bottle dentin bonding systems have more
testing (IE. SB-MP™, AB-2™, OptiBond FL™, AmalgamBond™) but new simplified systems more
convenient (IE. Single Bond™, Solo Plus™, One Step+™, P&B NT™, PermaQuik 1™, Bond 1™,
TM TM TM TM TM
Excite ™. Self etch--,SE Bond , Prompt L-Pop , I Bond , Touch N Bond , Solo Self etch ,
XENO IV , etc.). Question: is simplified better? Early tests raise questions of strength and
seal.Self Etch a concern for durability. Posterior composites use hybrids. Flowables, GI’s, may
reduce stress. “Heavy Body” in early clinical tests. Prep with Diamonds (Pedo and small pointed
shapes), wedge with spring rings (Bitine™, Composi-Tight™, Danville Contact™ ) and thin matrix.
At present, cure in layers, use VLC lights, cure after finishing. Pre-cured or quartz inserts, or plastic
cure/wedging devices not validated. Curing composites is either “Low and Slow” or “High and
Fast”. Best curing method not validated-from high output Quartz Tungsten Halogen lights
(Optilux™, XL3000™, Spectrum™) or (LED and PAC, and other high output sources, ramp or low
output curing). Amalgam bonding is benefit, but not magic. Dual cure DBS and metal primer
(PANAVIA F™,,Bistite II™) have high numbers In-Vitro testing, ()UniCem™ MaxCem™) have low.
Bonding Porcelain Veneers use DBS and clear, high viscosity Composites, Hurculite™ Incisal
Light, Esthet-X™ CE, Vitalesence™ Clears, Point 4™ trans.etc. Or light cure resin cements
(NEXUS™, Opal™, Calibra, Choice™, Variolink™. Unicem™, Permaflo hopeful.
Dentin/Enamel Bonding- Etch, Moist surface, Adequate surface coverage,
Prepare surface with diamonds, etch with 35-40% Phosphoric acid for 15-30 Sec. Wash until etch
color gone, leave surface moist without excess water layer or dessication. Use vacuum or blotting
to remove excess water. Apply enough primer or (combined primer/adhesive single bottle) so that
surface is glossy after solvent removal. Remove solvent with high volume vacuum or slow gentle
stir. Cure. Key to more predictable bond is visible glossy surface. “Self etching” adhesives do not
require phosphoric acid pre etching. May need to etch enamel. Apply composite. Use light cured
DBS for direct composite or PV’s , Dual cure for indirect posterior composite , crowns or Amalgam.
Bond to dentin/enamel is micro-mechanical, not chemical. Do not contaminate etched surface with
saliva, blood or other chemicals. Re-etching is not adequate after contamination, must re-prepare
surface. Desensitizers, ie. NaOCl, Gluma do not appear to effect bond.
Direct Composites- Class 5, 4, Diastema, Veneers
Class 5: Careful diagnosis, adjust occlusion on teeth with “abfraction” lesions. Retention is never
bad preparation design. Use pedo shape and pointed diamonds. Light cured GI for high caries risk
patients. Use Microfilled composites in layers Durafil™, Renamel Micro™, Amelogen™). Hybrids
may be too stiff. Polish carefully, do not abrade cementum. Soflex™ Discs, Optidiscs™ are flexible
and thin. Place composite surface sealer.
Class 4, Diastemas, Incisals: Prepare heavy chamfer margin around defect. Use micro-hybrid,
nanofilled composite for shape and strength, may use microfill on facial for polish. Can lengthen
anterior teeth with careful occlusion diagnosis. Rebuild Canine guidance. Warn patients of
potential gingival “black triangle”, with diastema closure. Placement depends on artistic skill of
dentist with color, translucency, New Natural Shade Composites.
Veneers: Benefit of composite veneer, conserves tooth. With diamonds, remove only enough
enamel for thickness of composite. Etch, bond, place thin layer of micro-hybrid, cure, layer of
microfill, nanofill, or new micro hygrids, using colors, natural anatomy. Brush surface for anatomical
detail. New “natural shade” composites give lifelike translucency. Cure, finish should only require
margin finishing, polishing, and sealing. Use diamond rubber finishing cups to retain surface
anatomy, yet high surface polish. Composite surface sealants. “Bleached” white shades available
in micro-hybrids, nanocomposites and microfills.
Posterior Composites- Preparation, Wedging/Matrix, DBS, Liners
Size comparable to Ag. Gingival margins in enamel. Use dentin, enamel shades. Use Diamonds or
air abrasion, prevent unsupported enamel margins. Place clear, pre-formed Mylar or “soft” SS
matrix segments. Use shortened wooden wedge. Use spring steel separating ring to separate
teeth. Burnish matrix. DBS, may use Glumma or HEMA desensitizing agents. HEMA based DBS
may have less post-Op sensitivity. May use flowable or GI as liner (not on occlusal margins) to
reduced effect of polymerization shrinkage stresses. Use microhybrid or “Heavy Body” composite in
layers, cure each from Facial, Lingual and Occlusal. Place final clear layer to correct anatomy.
Place composite surface sealant.
Crown Margins- Repair, Opaqers
Small class 5, roughen metal margin, etch dentin, DBS, PANAVIA OP™, on metal margins, thin
layer composite, layer PANAVIA OP™, or 3M ESPE Masking agent, final layer, composite. GI may
be opaque enough for many margin area.
Tooth whitening- Home, In Office, Light, Laser, Safety
No long term whitening effect advantage between accelerated bleaching ( high concentration
H2O2, light, PAC, laser, LED, Zoom AP™, BriteSmile™ Saphire™) from at-home, mouth guard
bleaching, using 10-15% carbamide peroxide. Least traumatic method; oral exam, custom tray
limiting CP to teeth, wearing tray 2-3 hours/day, recall by dentist. New “Tres White”, a self
contained disposable tray system interesting. Whitening is oxidizing organic stains with O2
molecules. 10-15% CP shown to be safe and effective when used as directed. Can use high
viscosity F+ for sensitivity. Potassium nitrate and F+ is desensitizing treatment. New amorphous Ca
and Po promising. Patient may want touch-up bleaching every 4-6 months. No reported adverse
effects with available H2O2 tested products. Transient tooth sensitivity greatest complaint. New
OTC products (Crest Whitestrips, Colgate, Rembrandt Plus) Shown to be effective and safe. For
patients wanting “whiter-than-white, “deep” bleaching may be helpful.
Porcelain Veneers- Preparation, Temporaries, Try-in, Cementation.
Diagnosis: Composite veneers more tooth conservative, but porcelain can be more aesthetic and
defect resistant. Use porcelain only where pt. understands more tooth must be removed! Bond to
enamel best and most conservative. Younger pts. may need direct composite. Remove only
enough tooth for porcelain thickness at correct morphology. Temporize with direct composite or
use thermoplastic splint, Temp Tab™, or PVS impression to make thin Triad™ or Acryl-Composite
temporary. Usually, do not cement. Only a cosmetic temporary. Ceramic artisan KEY to PV
success! Try in PV’s with water. Do not contaminate etched PV surface with resins. Check color,
use clear, high viscosity, cementing resin. Place resin on each PV, seat, remove excess, continue
with each PV until all are in place, floss with thin floss, place 10 micron mylar strips, make sure all
PV’s are seated completely, margins smooth, then cure for 20 secs. to hold, cure for 2 min. each
area, remove excess resin cement (#12 Scalpel blade, brush), Seal with composite surface
sealant. Adjust and polish occlusal interferences.
Indirect Posterior inlays/onlays- Diagnosis, Preparation, Temporization, Seating
Heavy occlusal forces can destroy tooth colored materials. Prepare adequate (>2mm) thickness
for porcelain/composite. >15 -18 draw, rounded angles. Concern with margins fracture in occlusal
contact .Porcelain more abrasive. Composite may be alternative. Onlays more durable. Use Temp
Tab™ or PVS impression as matrix for temporary. Triad™ or acryl-composite temporary material.
Try-in without testing occlusion. Cement with dual cure DBS and resin a concern. Light Cure best.
Adjust occlusion, seal margins. Waiting for validation of reinforced composite crowns/bridges.
Direct’s may be as good. CAD/CAM (CEREC) may be wave of future as tooth design software
improves to mill accurate, detailed anatomy.
Light Curing- Light Sources and Timing
LED lights dominating market, but high quality QTH lights (Demetron 501™) still excellent curing
sources. PAC and Laser diminishing in use. LED lights still heat dental interface. Select light for
ergonomics, intensity, wand tip size and ability to cure all light curing products used.
Be Conservative! Conserve tooth structure-think long term, teach patients advantage of long term
Ca(OH)2 only for physiologic direct pulp exposure. Only cover exposure. Seal with DBS or GI.
Dycal™ good temporary cement.
Use new “Natural” shaded composites, possible to closely resemble natural tooth shade of enamel
and dentin, a competitor for ceramics. New brands appearing. Very artistic, decreased
Follow manufactures instructions exactly, use commercial products (no home brew)
Find good DBS system and stick with it!
Use a small sandblaster. Clean, roughen, esp. metals.
Use metal bonding material (PANAVIA F, Rely-X Unicem™,MaxiCem™ , Meta Bond™, for post
Use magnification, higher the better!
Keep up! Read CRA Newsletter, Dental Advisor, Reality, etc.
Do not be first with materials or techniques, carefully evaluate anecdotal or testimonial statements,
find scientific validation, do not be last to give up old.
1. Why do patients want aesthetic Dentistry?
a. Through-out history people have always wanted to look younger.
b. Television, movies, magazines emphasize beauty and youthfulness.
c. Television programs (Extreme Makeover, the Swan, I want to look like …….,
Dr. 90210) show seemingly easy makeover.
d. Dentistry is “in” in aesthetics. ( Veneers, bleaching, orthodontics, gum
2. Do I have to provide extreme makeover to be an aesthetic dental practice?
a. Many less extreme procedures can give a more youthful appearance.
b. Bleaching, bonding, orthodontics and gum surgery can give very good dental
appearance without cutting down too much tooth.
3. What procedures are considered extreme makeover dentistry?
a. Porcelain veneers:
i. Requires much tooth removal
ii. Requires a high quality, aesthetic, laboratory procedure.
iii. Requires cementation
b. Posterior porcelain inlays/onlays, or crowns
i. Requires much tooth removal
ii. Requires a high quality, aesthetic laboratory procedure.
iii. Porcelain crown can break with heavy chewing
iv. Some teeth are sensitive after cementation.
c. Gum Surgery
i. Requires careful evaluation. Is plastic surgery of the gums. Can
make a difference in smile.
i. In office: (Zoom, Britesmile, Rembrandt)
1. Gives instant (one or more hours) white smile with many
2. Requires trays and gel for long lasting whiteness
3. Many patients have severe tooth pain for short time after
in office whitening
ii. Tray whitening
1. Still considered the most reliable method to whiten teeth.
2. Requires patience by dental staff and patient for best
whitening result. May take longer time than patient wants.
iii. Over the counter
1. Whitestrips are considered the best of the OTC.
2. Newer OTC products are being introduced and are under
e. Anterior Direct Composite
i. Most conservative way to repair diastemas, fractures, worn and
decayed anterior teeth. Requires artistic placement of new
f. Posterior Direct composite fillings.
i. One of the most popular fillings to enhance the smile.
ii. Most commonly used to replace amalgams.
iii. Requires a liner (Glass Ionomer or Flowable composite) to reduce
post treatment sensitivity.
iv. Requires spring rings and other devices to make a tight
v. Needs careful placement to make good anatomical detail to look
like natural teeth.
i. Conventional or Invisalign can give a straight and beautiful smile
ii. Dental office should work with Orthodontist in diagnosis and
treatment plan, especially if restorative work will be needed to give
the best result.
iii. Many patients require closing of spaces or repair of worn teeth after
orthodontic treatment is finished.
4. What are the problems with aesthetic dentistry?
a. Some patients have high expectations, sometimes higher than any dentist
b. Most aesthetic treatments have a higher failure than metal restorations.
c. No aesthetic materials will last forever. They all will fail with time. Many
patients do not realize that they are not permanent.
d. The rule is: Never over promise!
Bonding to Enamel and Dentin
1 Etch, Prime and Bond (Generation 4) (3 Step procedure)
e. Always 2 or more bottles plus Blue etching gel
f. Requires etching of enamel for 30 seconds and dentine for 15 seconds then
washing to remove all gel, gentle drying, then application of primer, then
adhesive then cure.
g. Why use? Long history, good bond, difficult to abuse technique.
h. Why not use? Multiple steps, etch, wash, dry. Tedious.
2 Etch, and combined Prime/Adhesive. (Generation 5) (2 Step procedure)
a. Usually 1 bottle plus blue etching gel.
b. Requires etching of enamel for 30 seconds and dentin for 15 seconds, then
washing to remove all gel, gentle drying then application of primer/adhesive,
c. Why use? Clinical history, good bond, easy to use.
d. Why not use? Requires etching, careful placement of resin/adhesive,
reports of post-treatment sensitivity, may hydrolyze with time.
3 Self etching (no separate etch), (Generation 6, 7) (2 or 1 Step procedure)
a. Can be 2 Bottles or a single bottle
b. With 2 Bottle systems, apply the primer, then apply the adhesive, then cure,
or if directed, mix the two bottle materials, then apply. If a single bottle,
apply for two 15 seconds applications, then gentle dry and cure. (Must
remove any residual water in adhesive before curing)
c. Why use? Very simple to use. No separate etch. Very little, if any post
d. Why Not Use? Some self-etch systems have not shown high bond strength,
and weaken rapidly in water (new evidence of rapid hydrolyzing in dentin
4 Which bonding system has shown longest clinical success?
5 What is the most popular reason for using a self etching bonding system?
Direct Composite Bonding
1. Which composites look the most natural?
a. Composites which (1) have good color with enamel like shades. (2) Will
polish to a high surface gloss and keep the shine for a long time. (Look like
b. Which composites meet the above criteria?
i. New Micro-hybrids
1. Tetric Evo Ceram (Vivadent)
2. Esthet-X (Caulk)
3. Venus (Kulzer)
4. TPH (Caulk)
5. Premise (Kerr)
6. Four Seasons (Vivadent)
7. Vit-l-esense (Ultradent)
8. Gradia Direct (GC)
9. Estelite ∑ (Tokuyama/J. Morita)
ii. “Nano” composites
1. Filtek Supreme (3M)
iii. “Microfilled composites
1. Durafil (Kulzer)
2. Renamel Micro (Cosmodent)
2. Is there a best composite?
a. Each composite has different shade or handling characteristics. Each of the
listed composites can give very aesthetic results. All require artistic
3. How do I choose a good composite?
a. Does the dentist want to be artistic or just fill a cavity or repair a broken
i. Artistic: Any of the listed composites can make beautiful
ii. Fill: Try Venus, TPH , Premise, Gradia or Estelite.
4. Which Composite is best for my practice?
5. Does my practice want to produce the highest aesthetic restorations possible? If so
what techniques will I use?
Porcelain Veneers, Porcelain inlays/Onlays
1. When are porcelain veneers indicated?
a. When less aggressive treatment cannot be done or patient refuses
b. When enamel is damaged or tooth arrangement is too
sever for composite bonding
c. When patients demand porcelain (dentist determines if they will treat)
2. When are porcelain veneers not indicated?
a. When less aggressive treatment meets the aesthetic and physical dental
c. When bonding is questionable. Dentin margins may leak and stain, bonding to
dentin may cause debonding of the veneer.
3. How much tooth should be removed?
a. Only as much as needed for the thickness of the porcelain veneer. Usually
less than .5 mm. If too much is removed, dentin is exposed and bonding
strength will be compromised.
b. The lab quality determines the thickness of the veneer and the final
4. How do we temporize veneer preparations?
a. No temporaries are best if the patient can tolerate the feel and appearance.
Need to seat as soon as possible.
b. The next best temporary is a removable stint. Use a vacuum stint with Bis-
Acryl temporary material, remove just before it is completely set, then continue to
try in and trim so that is will “snap on” without cement. The patient should treat it
as a “smile only” temporary.
c. Use the same type of temporary but with temporary cement. Patients should
also know this is a “smile only” temporary.
6. How do we cement Veneers?
a. Remove all temporary cement and clean prepared teeth with pumice and
either sodium hypochlorite or water.
b. Try in veneers with only water. Test for fit and shade.
c. If fit and shade are acceptable, dry veneers and place bonding agent on
inside of veneer. Thin but do not cure.
d. Isolate teeth and prepare for bonding. Cure bonding agent.
e. Place cement in a thin layer inside the veneer.
f. Apply the veneer gently and with vibration onto the tooth.
g. Continue vibrating pressure until the veneer is completely seated.
h. Remove excess cement around margins with explorer and brush with
composite surface sealant.
i. Hold veneer in place and cure for 40 to 60 seconds.
j. Use #12 scalpel blade to remove excess cured resin.
k. Try not to use high speed rotary finishing instruments.
7. When would we do porcelain inlays or onlays
a. When the cavity or defect is too large for a direct filling
b. When the patient wants porcelain looks.
8. When would we not do porcelain inlays or onlays.
a. Where concern for bonding or sealing of margins on dentin.
b. Where occlusal margins are in contact areas (margins are susceptible to
fracture in heavy bite.
c. Where the bite is very heavy and can fracture the porcelain.
d. Where cost is prohibitive. High lab cost.
9. What do the preparations look like?
a. Like gold inlay, onlays except with slightly tapered walls, and rounded
b. No sharp angles or parallel walls and no margin bevels
c. At least 2 mm of occlusal clearance. Occlusal thickness of porcelain needs
to be at least 2mm thick.
10. How do we temporize the preparations?
a. Take pre-impressions for a mold, then use to fabricate a temporary
11. How do we cement porcelain inlay/onlays
a. Clean the teeth with pumice and sodium hypochlorite or water.
b. Try the restorations in with water only (DO NOT CHECK BITE) Restorations
will break if occlusion is checked before cementing.
c. Place bonding agent on inside of onlay, thin with air, cure.
d. Place bonding agent on teeth, thin, cure.
e. Place cement on inside of onlay.
f. Seat onlay onto tooth with gentle, vibrating pressure.
g. Continue seating with gentle pressure until seated completely.
h. Clean margins with explorer and brush with composite surface sealant..
i. Cure, then clean excess cement with #12 scalpel blade.
220 or 330 diamonds(Pedo) Brasseler, Axis, Premier, SS White,etc.
201.3 F, needle shaped-Premier Two Striper
Fissurotomy –SS White Burs
SmartPrep burs-SS White Burs
All Bond 2—Bisco
One Step Plus-Bisco
Prime and Bond NT-Dentsply/Caulk
One Coat Bond—Coletene Whaledent
Gluma Comfort Bond-Heraeus Kulzer
6th, 7th Generation (Self Etch)
Clearfill S E Bond—Kuraray
Clearfil S3 ----Kuraray
Xeno IV---Dentsply Caulk
i Bond—Heraeus Kulzer
Optibond Solo Plus Self Etch—Kerr
One Up Bond F-J Morita
Tyrian Spe One Step—Bisco
Uni Bond—Den Mat
G Bond---GC America
All in One---Kerr
Bitine Ring and segmental matrices Dentsply/Caulk
Composi-tight Gold, Silver Plus Garrison Dental Solutions
Wedge Wand-Garrison Dental Solutions
Contact Matricies/Bands-Danville Materials
Hawe Adapt sectional matrices--Kerr/Hawe
Sycamore wedges—Premier Dental
Elastic margin seal----Danville
Fuji Liner LC—GC
Point 4 Flow—Kerr
Star Flow-Danville Materials
Filtek Flowable—3M ESPE
Tetric Flow—Ivoclar Vivadent
Microbands-Dental Innovations www.thinmatrix.com
Ivoclar Vivadent www.ivoclarvivadent.us.com
Contact Pro 1, 2 www.cejproducts.com
Heraeus Kulzer www.kulzer.com
Danville materials www.danvillematerials.com
Premier Dental Products www.premusa.com
Den Mat www.denmat.com
James R. Dunn DDS
3180 Bell Rd. Ste. 100
Auburn, CA 95603
Ph 530 888 9764
Fx 530 889 9946
Aesthetic Materials Handout 10 07
An Introduction to
Digital Dental Photography
James R. Dunn DDS
Dental Digital Photography is still Photography!
1. Principles of Photography apply to dental photography
Lighting-Most Important-quality, amount and direction
Use light to make subject appear most attractive
Composition-frame and isolate subject you want to photograph
Exclude unwanted or distracting items from the image.
Clarity-focus, depth of focus. Subject (all of subject) should be
sharp. Use large “f stop” for “long depth of field” -- Front to back
Color-Accurate, natural tooth, gingiva, and skin color
Depends on Camera, computer, monitor, printer, software
settings and capability. White balance, sensor quality,
(Resolution)-Number of pixels per image. Higher is better.
Maximum need in dentistry? Minimum approx. 8 Mp, Above 12 Mp
difficult to manage or use in dentistry. Sensor and pixel quality,
wide tonal range, high dynamic range. (visit glossary at
www.dpreview.com for explanations of terms)
Three Levels of Dental Digital Photography for dentistry
1. BASIC “Snapshots”, in-office, patient, Lab use
Simplified camera equipment
Simple image storage and organization
Simple printing and presentations primarily with prints
Snapshot portraits for patient identification
Auxiliaries take most photos
2. HIGH QUALITY-INTERMEDIATE marketing, web, portraits, diagnosis
Modified point-and-shoot cameras and introductory SLR’s
More sophisticated organization and manipulation image software
Presentation and manipulation software (Power Point and Thumbs
plus type software)
More sophisticated image quality, marketing quality
On camera lighting, mirrors, contractors
Higher quality portraits using small size lighting equipment and
Printing, higher quality, dye sublimation, copies to patients
Dentist and/or highly trained auxiliaries take photos
3. ADVANCED artistic professional quality, marketing, presentations
High resolution SLR for majority of images, modified P & S for
Equipment and software to meet higher image quality expectations
Image manipulation, enhancement, cropping, and corrections
Artistic quality images-lighting control, multiple flash, mirrors,
Patient photos organized in folders
Diagnosis, Treatment planning-full mouth photo series
Marketing with images-web sites, printed brochures
Digital radiographs-photos of radiographs or direct digital
Laboratory communications-prints, email, CD
Experience of imaging and photographic dental art
Specialty referrals-email or CD of photos to Doctors
Presentations to patients, service, educational and professional
Glamour portraits-external lighting and backgrounds
Accreditation, memberships, and presentations to high end dental
organizations. Dentist usually takes majority of photos
Digital Photos in Dentistry
1. Photos for Dentist use. Used to visually record, document, share and
communicate dental information to dentists, patients, laboratories,
specialists, insurance, peers and the public. Diagnosis and treatment
planning, lectures, publications, accreditations, competition. Use slide
shows or Power Point..
3. Photos for Patients. Any view patients see in normal environment.
Smiles-anterior, lateral, oblique, non-medical glamour, or attractive
portraits, Can print or burn photos to CD. Best marketing dental photos.
Modified consumer with PhotoMed flash/macro attachment.
Adequate quality for dentistry. 7-8 Mega-Pixel cameras. Will not take one
or two teeth, but adequate for portraits, smile, occlusal, quadrants.
Canon, Fuji, Olympus and Nikon. $1,200-2,000. Lens and flash attached
to camera, not changeable. Must use supplied close-up lens and flash
diffuser for dental close-up photos. Can be used with one hand and by
Imaging Equipment, cont’d…
Cameras-SLR-Professional or semi Professional camera bodies with
100mm macro lens and flash attached to the end of the lens. Similar to
35mm in use. Canon 30D, 40D, Canon Digital Rebel XTi, Nikon D40, Nikon
D300 systems $2,500 to 4,000.US Very high quality. Heavy-bulky
camera/lens. Canon, 5D, 1D Mark III, Nikon D300, Canon 1Ds Mark III-very
high quality, very expensive. Bodies from $4,000-8,000 have a questionable
need in dental use for highest end cameras. A macro lens and macro flash
must be attached to the camera body to take dental images. Requires two
hands and assistance. High image quality.
Image quality is determined by chip size, lack of chip artifacts and noise, pixel
size, number of pixels, quality and power of the Analog to digital processor.
The larger the chip, more pixels, larger pixels, and more powerful A-D
processor will give higher quality images. SLR’s inherently give better
JPEG files of high resolution adequate for dentistry (1-3 Mega bytes)-Will
need to decrease size to email. RAW files need processing to a working file
type (TIFF or JPEG). Discussion and differing opinions on need for RAW
image files in dental imaging. High quality JPEG files are adequate and save
processing time. RAW files required in AACD accreditation process.
To transfer the image to a computer, the camera can be connected directly
to a computer with a USB (or firewire) cable, or the camera’s memory card is
placed in a card reader connected to the USB port of the computer. Other
input devices are Scanners, CD’s or DVD’s and the internet. Images can be
transferred from the computer to viewing monitors, printers (ink jet, lasers or
dye sublimation), the internet, or to external storage, CD’s and DVD’s.
A Computer with adequate RAM memory (1 gigabyte minimum),
operating speed, hard drive capacity, CD and DVD writers,
Ethernet or wireless connection is a necessity for managing digital
images. It is recommended that dental images not be stored in the
office management systems. An external hard drive is useful to
store the large files digital images can create.
Software - Image Management software organizes and helps file the images
into named folders. $50-$130 range. Thumbs Plus7 Pro Cerious software,
ACDSee Pro 2, ACD software, Windows Explorer, Piscasa (Google).
Software - Image Manipulation allows alteration of the image (crop, rotate,
color correction, etc.). Most dental images can be managed by inexpensive
Photoshop Elements 5 (inexpensive yet has many features needed
Photoshiop CS3 (powerful and expensive with many features not
needed by dentist, used by professional photographers and graphic
Software - Designed for Dentistry includes the ability to create predictive
dentistry, commonly called “computer dentistry”. These programs also can
integrate with associated dental management systems. Dental
terminology is used in all image management. Most dental image management
programs degrade or permanently compress the image quality. If you want to
retain the original image quality, store the original images in separate
organizing software. (windows explorer, Thumbs Plus, ACDSee Pro 2).
Software - Power Point--Microsoft Office presentation software is used to
create patient diagnostic and treatment planning presentations, and
presentations to other groups.
Sterilizable cheek retractors (metal, or plastic), front surface mirrors,
contrastors (black tooth backgrounds) are needed for high quality intraoral
images. External strobes, diffusers essential for high quality portraits.
Sources: In Southern California-www.photomed.net
Flash diffusers and a background are needed for portraits. (Canon has a
flash system (430 EX and 580 EX series) for use with EX flash compatible
digital cameras—G series and D SLRs.
Techniques: Workshops or individual mentoring best
No detailed, technique books currently available.
Diagnostic Series-number and view depends on dentist
Anterior View-retracted lips. Cheek retractors
Occlusal-Maxillary and Mandibular. Cheek retractors, Occlusal contrastor
Quadrants-anterior or posterior-facial, lingual, Incisalocclusal. Retractors,
Portrait-(optional), X-Rays (optional).
AACD dental series required for accreditation
(see www.aacd.com for guidelines and digital protocol))
Simplified Dental Portrait-New dental style portraits are more artistic than
“medical” portraits. Requires external flash!
1. Lighting and background most important
2. External Flash with diffuser to soften light, reduce shadows, light
bounced to ceiling to highlight hair.
3. Black, non-reflecting background fabric attached to a foam board or
hanging from a wall or door.
4. Lap reflector. Brightens face by reducing shadows under nose and chin.
White board or Collapsible spring fabric. Reflects light bounced from
Modified Consumer (point and Shoot) Systems
Canon G7, G9 with PhotoMed flash 1. Light weight, Easy to use, 7
attachment.* (TTL Flash) with 7-10 megapixal
MP 2. Magnification: Portrait (without
attachment) macro .to approximately 5
430 EX and 580 EX Canon Flash with teeth. Uses zoom control for
Fong diffusers magnification selection.
ST E2 Canon speedlite Transmitter 3. Macro attachment gives soft, even
4. Video viewfinder-wide swivel-easy to
*Ideal modified P&S for dentistry at the see image from multiple positions.
moment. 5. Compact Flash Type I and II memory
(Earlier Canon “G” Series—Only a few cards (to 1 qigabyte)
available) 6 Allows off-camera TTL flash for
portraits or small object photography.
Olympus C-5060 with PhotoMed flash 1. Light weight, Easy to use, 5
attachment (TTL Flash) megapixal
2. Magnification: Portrait (without
attachment) to approximately 4 teeth
3. Macro attachment gives soft, even
5. C F, Smart Media, and xD memory
6. No accessory flash systems
7. Must use in-camera TTL flash for
Canon A620-640 with PhotoMed flash 1. Light weight, Easy to use, 7
attachment Megapixal2. Magnification: Portrait
(without attachment) to approximately 4
3. Macro flash attachment gives soft,
4. Video viewfinder-wide swivel-easy to
see image from multiple positions
5. S D and Multimedia memory card
6. No accessory flash systems
7. Must use in-camera TTL flash for
Fuji S9000 with PhotoMed Lighting 1. Between Point and Shoot and SLR
attachment and Macro Lens 2. 10x Optical zoom lens-can preset
lens for repeated same-size photos.
3. Uses standard batteries (can use
4. No TTL flash hot shoe-must use on-
camera flash for portraits
Kodak DX7590 kit 1. Light weight, accessory flash system
2. Kit includes close-up lens, and easy
share docking station for printing and
transfer to computer.
3. Uses “digital zoom” for close-up
Dentalfoto 80 4. Uses “distance guides” for
positioning camera to patient
1. Simplified lightweight camera
2. Kit uses add-on close-up lens.
3. Uses only in-camera flash
Canon SLR Semi-Pro Systems
EOS 30D* 40D (8.3 MP, 12 MP with 1. Moderate cost SLR digital body with
new Digic II (III) A-D processor) with high resolution and image sharpness.
100 mm macro lens and (1) MR 14EX Can use all EOS lens and flash.
Macro Ring Lite or (2) MT 24EX Macro 2. MR 14EX has 2-curved flash lamps,
Twin Lite with flash “diffusers” (Sigma use both as a ring light and one (either
“ring” flash for Canon now available) right or left) as a near point system.
Lighting effect similar to a ring light.
3. MT 24EX has 2-point lights
controlled as separate or dual lights.
Lighting effect similar to point source.
Must be used with diffusers on flash
*at this time an ideal digital camera head to light molars in occlusal views.
body for high quality, size and ease of 4. MR 14 EX and MT 24EX can be
use. used with 430EXand 580 EX for
Rebel XTi 10 MP good introduction multiple flash lighting.
SLR dental camera.
430 EX and 580 EX Canon Speedlite 3. Allows off-camera TTL flash for
Flash with Fong diffusers portraits or small object photography.
ST E2 Canon speedlite Transmitter Can use multiple speedlites for studio
Controls external Canon Speedlites in
TTL mode without a speedlite attached
to the EOS camera body.
Nikon Based SLR Semi-Pro Systems
Fuji S3 Pro with 105 Micro lens and 1. Built on Nikon N 80 film body
Sigma 140DG macro “ring” flash TTL. 2. Fuji film electronics
3. 6.1 MP Super CCD sensor, 12.1 MB
4. TTL flash with Sigma 140DG Macro
5. Heavy, Uses multiple batteries
6. High resolution
Nikon D 40x with 105 Micro lens and 1. Built on Nikon N 80 film body
Nikon R1 C1 flash (New Sigma EM 2. Manual flash exposure with Nikon
140DG macro “ring” flash only TTL SB 29s
flash with D50, D70) 3. 6.0 MP
NEW! D80-10 MP Not yet tested
SB 29s Nikon “ring” flash (Discontinued 1. TTL only with Fuji S2 Pro
by Nikon) 2. 2-point lights-use both or one (L or
3. Flash can be removed from front of
lens for portraits.
4. No Nikon external flash units for TTL
multiple flash portrait or small object
SLR Professional Systems
Canon EOS 1Ds Mk III (21 MP) (Full 1.Very expensive, heavy, high
frame sensor) with 100 macro and MR resolution (higher than film) (21MP),
14EX Macro Ring Lite or MT 24EX Professional color management
Macro Twin Lite with diffusers 2. Full frame CMOS chip (No mag.
(Canon EOS 1D Mark III—10 MP, 1.3 Ratio)
Mag. Ratio) 2. Used very little in Dentistry because
Fong diffuser with 580 EX for portraits of cost
3. TTL Flash with Canon flash system
Canon EOS 5D (12 MP) (Full frame 1. Expensive, high resolution full 35mm
sensor) with 100 macro lens and MR size sensor, no magnification ratio.
14 EX Macro Ring Lite or MT 24 EX 2. Higher resolution than 30D, and
Macro Twin Lite with diffusers slightly larger, lighter weight than 1Ds
Fong diffuser with 580 EX for portraits Mk II.
3. Very high quality image, and color
Nikon D300 (12 M P) with 105 Micro 1. Heavy Magnesium body, 12 MP CCD
lens and Nikon R1 flash, or Sigma Sensor
macro 140DG “ring” flash 2. TTL flash exposure with R 1 flash
3. New 105 VR micro lens and R1 TTL
twin flash just introduced.
(Pt. and shoot) vs. SLR in Dental Use.
Modified Consumer (pt. and shoot) SLR (Semi-Pro)
1. Light weight, easy to use, high 1. Heavy, large, requires two hands
resolution, shallow dept of focus to operate, highest resolution,
(f 8), lowest cost good depth of focus (f 32),
2. Technique easily learned (few expensive
settings and details) 2. Technique more difficult (multiple
3. Use Video screen for viewing settings and detail)
4. Magnification controlled by 3. Uses view finder for viewing
zoom 4. Magnification set on lens
5. Limited image repeatability 5. Easy image repeatability
6. Limited flash variability (except 6. Multiple flash options
Canon) 7. Interchangeable lens
7. Non-interchangeable lens
SLR Dental Cameras Lens and Accessory options.
Lens: Portraits, groups, buildings, Wide Angle Zoom: 24-105mm for wide
rooms, equipment, materials, to moderate telephoto view. “high
articulators, casts, nature. quality” Cameras with above 8 MP
need the manufacturers higher quality
lens. Designated as “L”, “ED”, or other
symbols. Normal lens may not record
camera’s high resolution image
Telephoto Zoom: 28-300mm, or 70-
200mm. High quality, used for distance
objects or magnification from a
Lens: Ultrawide zoom: 10-30mm, 16-
35mm. Used to record rooms in office
or any area where space is small or
difficult to record. May distort
perspective of image.
Lighting: portraits, groups, rooms, External flash systems: Canon 580
nature, table top, still life, nature. EX, 430 EX. Can be wireless TTL
controlled by external transmitter, or by
a 580 EX on the camera set to master
and the other flashes set to slave. Can
use multiple flashes for artistic lighting.
Used with diffusers for softer lighting.
Nikon has near equivalent systems SB
800 AF and Su-4 Wireless remote.
Nature close-up use dental
configuration. Twin light gives more
Lighting: Reflectors, Diffusers, Reflectors: reflect or absorb light.
Backgrounds: White or black foam board, collapsible
white, silver or black cloth. Used in
portraits to add light or fill shadows.
Absorb excess light or give black
Diffusers: Translucent material on
flash or near subject to soften light and
reduce shadows. Stofen Omi Bounce,
Fong Diffuser. Translucent Collapsible
Backgrounds: Portraits (Google search
on materials, colors patterns and
lighting) Dental: Non reflective Black or
White. Can use mirror with black
background as 3-D effect for crowns or
Point and Shoot Consumer Dental Cameras
Cameras: Use Dental point and Shoot cameras
without the close-up attachment as
multi use camera.
www.photomed.net Source for dental cameras, equipment, ancillary items, and
indefinite support with purchase.
ADA Technical report #1029 “Guide to Digital Dental Photography and
Imaging” available at www. ada.org
Wolfgang Bengel, Mastering Digital Dental Photography, Quintessence
Irfan Ahmd, Dental Photography, Quintessence Books, 2004
Robert Maher, Simple High Tech Case Presentation and Imaging
Photographic Documentation and Evaluation in Cosmetic Dentistry a
guide to Accreditation Photography, American Academy of Cosmetic
Thomas K. Hedge, Digital Dentisry, www.dentalhealthcenter.com
www.normankoren.com/Tutorials/. In depth source for mathematics of digital
www.dpreview.com Very good single source for camera reviews and
information on Digital Imaging
www.kodak.com/US/en/digital/dlc/index.jhtml General information on Digital
www.photomed.net Best source in Southern California for imaging systems
www.dinecorp.com Dental camera systems
www.clinpix-on-line.com Dental Camera Systems
www.normancamera.com Dental Camera Systems
www.xrite.com source for information on digital dental shade taking and
www.luminous-landscape.com/ Broad source of Information about digital
(Various Dental/Medical Photographic supply companies sell high end
digital camera equipment)
James R. Dunn DDS
3180 Bell Rd Ste 100
Auburn, CA 95603
Ph 530 888 9764
FAX 530 889 9946
E-mail jrdunndds@.gmail.com Dental Digital Photography 10 07