A research about dental photography was done by me ( Laith Tahir Al Radi) when I was a fifth year student as a graduation project for operative department in Baghdad university/ dentistry College and supervised by dr. Noor Salman.

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Dental photography
INTRODUCTION
Why should one understand and use dental digital photography?
The answer to that is actually quite simple.
Because esthetic dentistry is a visual art, form, therefore displaying, communicating,
and educating, about the process accurately, efficiently, and professionally is
essential for success. What better tool to accomplish this than the digital camera?
Patients easily forget what they looked like before they started treatment. When
anything to do with the appearance is affected, not using a camera puts the
practitioner at substantial legal risk.
Unfortunately, human memory is terribly short, and patients’ recollection of how
their teeth appeared before treatment is often quite hazy, which leads to the potential
for dispute. Even for something as straightforward as tooth whitening, patients may
feel that their teeth have not responded to treatment and thus may seek a refund of
fees. If this occurs, showing them pretreatment and post-treatment clinical
photographs of how the teeth responded to the whitening process should clear things
up.
The patient has simply become accustomed to the new appearance of the teeth very
quickly. Thus photography has a role in things as simple as bleaching and as complex
as extensive rehabilitation; this makes the camera as essential an instrument as dental
loupes, handpieces, and other basic tools in performing esthetic dentistry.
In addition, all practitioners learn by seeing clinical photographs in books and
journals. Viewing their own patients in this same way frequently improves their
diagnostic abilities and ensures that potentially important aspects of the treatment
are not overlooked.
Once one has identified the needs and wants for incorporating digital photography
into their practice, there are important questions that must be asked and answered:
*how do we choose the right digital camera?
*how do we take or capture our digital photographs correctly?

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HISTORICAL REVIEW:
Dental photography has always been an important potential adjunct to dental
records. However, before the advent of recent esthetic procedures, the dental camera
could have been considered a dispensable item. With today's technologic advances
and the proliferation of new procedures, yesterday's luxury item, the digital camera,
has become part of today's indispensable armamentarium.
HISTORY OF CONVENTIONAL PHOTOGRAPHY
In the early half of the twentieth century, dental photography was limited to the
professional photographer's studio.
Before the early 1960s, dental photography was impractical because of a lack of
proper through-the-lens viewing, lighting complications, exposure difficulties, and
affordability.
The major advance in dental photography centers on the shift from film-based to
digital imaging. Film was a great step forward when introduced over a century ago.
Clinically, however, it was not a useful or efficient tool, as it was impossible to
analyze the images immediately and check whether the desired views had been
obtained. Pictures were taken as slides because slide films were considered best for
color reproduction. However, the film had to be sent out to commercial laboratories
for processing.
Due to the specialized processing needed, there was always a delay in return of the
photographs, often 1 to 2 weeks. Showing patients their own teeth was inconvenient
owing to the need to project the images. Copying images when required was an
added inconvenience, as it was very difficult to achieve consistent quality and color
accuracy in duplication.
It was very difficult to show the pictures to patients at the chairside; thus, for most
practitioners, excepting those taking post-graduate examinations or clinicians on the
lecture circuit, photography was not considered a routine practice.
Digital photography has been around for some time, but it was only in 2003-2004
that a good-quality digital single-lens reflex (SLR)–type camera become affordable
for most practitioners.These cameras, which incorporate a mirror and a prism, allow
the photographer to see the same image that the lens is "viewing". Non-SLR cameras

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(called rangefinder cameras) use a viewing window located 3 to 4 inches above the
film plane. This means that the image the viewer sees and the image the film exposes
are not identical. This problem is referred to as parallax, and it makes accurate
closeup dental photography impossible.
Figure 1 A single lens reflex (SLR) camera with the mirror in the view-finding position. In this position the mirror and prism
mechanism allows the viewer to see the exact same image as the camera lens.
Figure 2 The parallax problem of range finder (any non-SLR) cameras.

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USES OF DIGITAL AND CONVENTIONAL DENTAL
PHOTOGRAPHY
1-Quality Control
Dental photography can be an effective quality control measure. The magnified
image in a dental photograph often highlights imperfections that the clinician may
have overlooked; such feedback is an excellent learning device.
2-Patient Records
Photographs are an effective treatment planning adjunct. With a thorough medical
history, intraoral charting, study models, radiographs, and intraoral and extra oral
photographs, the treatment planning may be accomplished almost as if the patient
were present. In addition, attaching a photograph to the outside of the patient's record
facilitates instant recall of that patient by all staff members.
3-Case Presentation
Photographs of the patient's current condition enhance the patient's understanding of
a proposed treatment plan, especially when accompanied by a portfolio of before
and after photographs of similar, successfully treated cases. In addition, the
acceptance of treatment plans may increase through this approach. Digital
photographs combined with the proper software can even be used to predict clinical
results.
4-Treatment Documentation
Before and after photographs provide accurate visual documentation.
Photography also improves the quality of referrals. If a general practitioner sees a
suspicious red lesion under a patient’s tongue, it is quite easy to take a picture of it,
put that into a referral letter or attach it to an email, and send it to the oral medicine
specialist. A complex restorative referral can be made much easier for the
practitioner receiving the referral if photographs can be included along with
radiographs and the referral letter as it allows the treatment planning process to begin
even before the patient visits the prosthodontist’s office. Not only does this allow
the dentist to document what is being done, but it helps in caring for patients more
comprehensively and more efficiently. (11)

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5-Laboratory Communication
A color photograph or slide of the restorative case facilitates communication with
the laboratory. Photographing the shade tab adjacent to the teeth to be restored makes
the chances of success higher.
6-Education
Photography can be used for conferring with a colleague or for lecturing at dental
meetings or study clubs, or in table clinics. It can be used in publications or, as
mentioned above, in patient consultation. Again.
7-Community Service
Presentation to local organizations raises the dental health consciousness of the
community, improves the image of the profession, and expands the dentist's future
patient base by creating a greater awareness of advances in dentistry.
8-Marketing
Photography has a tremendous capacity to help any dental practice grow more
effectively through internal and external marketing.
DIGITAL CAMERAS
2 types available, point and shoot and digital SLR cameras.
The modified point-and-shoot cameras have
an important place in clinical photography.
The early consumer-level digital SLRs were
more expensive than some practitioners
could afford.
The point-and-shoot cameras have the
advantage of being compact, light, and (at
that time) relatively less expensive. Their
disadvantages relate to their distinct
operational and a long learning curve, the
need for a substantial degree of practice and
familiarity with the setup to get the best
images. . Figure 3 Modified point-and-shoot camera

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With digital photography, there is the
advantage of immediately verifying that the
desired image has been captured. It is very easy
to look at the picture on the camera’s screen,
identify what is not right, and retake it
immediately. There is no need for processing,
so images can be viewed immediately, and they
can be shared with patients right away.
Digital photography has both advantages and
disadvantages.
Some of the advantages are:
• Instant photographs are produced.
• The need to develop film is eliminated.
• Images can be previewed before the picture is taken.
• Only desired images are printed.
• Instant image duplication is possible without degradation of images.
• Images can be manipulated by computer.
• Images can be transmitted over telephone lines.
• Images can be placed on the Internet.
• Waste is reduced because poor images can be deleted.
Some of the disadvantages are:
• A significant learning curve is involved.
• Startup costs are higher than conventional photography.
• Additional time is required for the operator to print pictures.
• The risk of data loss is greater because no hard copy exists unless a printed copy is
produced.
• The resolution is lower than with standard film.
Despite its disadvantages, digital photography is increasing in popularity.
Figure 4 DSLR camera

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There are two types of digital cameras available today for taking dental digital
photography:
*single lens reflex SLR digital cameras
*point-and-shoot digital cameras
SLR Point-and-shoot
Actual image viewed is what is captured Image captured is computer generated
Large charge-couple device CCD or
complimentary metal-oxide semiconductor
CMOS chip, resulting in a more true-to-
life-size image therefore you see what you
see
Smaller CCD or CMOS chip, therefore
the image is computer extrapolated
Interchangeable lenses Fixed lens
Automatic and manual control Limited manual control
More expensive Less expensive
Depth of field easily controlled Limited depth of field control
Ideal for all views of dental photography Limited views captured therefore
images must be digitally enhanced
Steeper learning curve Relatively simple to use
Dental photography requires ring/point
flash
Dental photography requires special
modifications like lens adapters and
flash diffusers
SUMMARY
Optimal photographs can be produced if the clinician has a proper understanding of
the equipment and the mechanisms of photography. Correct exposure, depth of field,
and composition are essential.
When a flash is used as a light source, the process is significantly simplified because
most other variables cannot be altered; exposure is controlled only by the aperture
setting, depth of field is automatically determined by the chosen focus point, and
composition and magnification are determined by personal preference. Attention to
these easily controlled variables makes dental photography simple and satisfying.(12,
14, 15, 20)

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SMILE LITE & SMILE CAPTURE
A revolutionary tool that
boosts the iPhone macro
capabilities to transform it into
a complete dental photography
system. Is not only a cover that
allows the Smile Lite to be
fitted to your iPhone, but as
well a concept of professional
dental photography where the
images are obtained in a very
similar way than is done with
the DSLR cameras. Smile Lite
is a revolutionary tool which
brings you RELIABILITY,
SIMPLICITY and
EFFICIENCY it allows you to
drastically reduce the risk of
mistakes during shade-taking.
Equipped with 5500°K
Figure 5
Figure 6

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(daylight) calibrated L.E.D. (Light Emitting Diodes), Smile Lite provides natural
and neutral light, stable and reliable regardless of the time of the day or the weather
outside (sunny or cloudy). Smile Lite is equipped with a special polarizing filter that
produces near to zero light interference easily adaptable to Smile Lite. This
«magical» filter amazingly annihilates light reflection (specular and diffuse) and
allows the user to observe the teeth in a totally new way: easier appreciation of color,
better understanding of the depth and transparencies, enhancement of the tiniest
details and characterizations.
Smile Lite is selling worldwide because of the versatility between natural light and
polarized light, because of its size, design, long lasting battery and many other
convenient features as the universal USB charger that can be plugged in the
computer, wall plug and any other device with a USB port.
Having a very narrow camera, and thus a very small diaphragm, the depth of field
given by the iSight camera is more than ideal. The lightning given by the 6 LED
form the Smile Lite enhances the texture of teeth, and gives a very accurate color in
every shot. The big display of the iPhone allows the user to capture what they see
through the screen and the ability to perceive many details before the actual pictures
is taken.
Why on iPhone?
It was clear that having
a compact device as the
Smile Lite, it was
necessary to have a
compact device to
capture the digital
media.
The choice of iPhone
was determined in an
early stage for having at
the moment the only
camera that was able to focus from close distances, that is, a true macro mode
without zoom.
Camera definition, processor speed, screen resolution were among other features an
important reason for which iPhone was selected as the ideal device for this goal.
Figure 7

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BASIC ARMAMENTARIUM
The basic equipment required for proper dental photography is digital camera, a
macro lens, a flash unit, and accessories such as mirrors and lip retractors.
1-Digital SLR Camera Body
The camera body's only function is to
hold the sensor and to trip the shutter
for the proper amount of time. Because
the shutter speed for flash photography
is predetermined by the manufacturer,
the camera body's function is greatly
simplified compared with nondental
photography. For these reasons, the
operator need not make a large
expenditure on this part of the system.
The main consideration is that the
camera body must be compatible with
the macro lens chosen. To achieve this compatibility, most manufacturers make
bodies with interchangeable mounts.
2-Macro Lens
Macro refers to the closeup focusing
capability of the macro lenses.
Several reliable macro lenses are on
the market that perform well in
dentistry. They commonly have a
focal length range of 90 to 120 mm.
These lenses produce less distortion
and allow more comfortable working
lengths than lenses with shorter or
longer focal lengths. At least one
manufacturer sells a 55-mm lens.
This focal length works well for
most dental purposes, although the
working distance for closeup views
Figure 8 DSLR camera body
Figure 9 macro lens

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is short and full face views are distorted.
Magnification capability is the second important factor in choosing a lens. Many
good macro lenses achieve a 1:1 magnification without additional converters or
extenders to expand the magnification range. Some older models produce only 1:2
magnification and require extenders to achieve 1:1 magnification.
In dental photography the following reproduction ratios are important
(approximate):
1:10 portrait photography.
1:2 image of a set of teeth.
1:1.2 whole set of anterior teeth.
1:1 anterior teeth with partial canines or premolars and molars filling the format.
2:1 two maxillary anterior teeth.
3-Flash
To obtain proper lighting effects in intraoral photographs, the light must be mounted
on the end of the lens barrel; otherwise the lips will cause harsh shadows. The choice
for proper lighting is either a point or a ring flash, depending on the operator's needs
and preferences.
Figure 10 Flashgun

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Both units can be incorporated into the same system, allowing for personal
preference in each situation; the added expense of having both types of flash units is
minimal.
4-Proper lip and cheek retractors are made of
clear plastic. The clear plastic allows the tissue
to be seen through the retractor (reducing visual
distraction), and the double end allows
versatility because the two ends can be different
sizes. Plastic retractors can be reshaped with an
acrylic bur to any size the operator finds useful.
Sometimes metal retractors can be used in
combination with buccal mirrors (long slender
mirrors that reflect buccal views and fit between the zygomatic arch and the lower
border of the mandible).
Figure 11 DSLR camera with dual point flash Figure 12 DSLR camera with ring flash
Figure 13 cheek retractor

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Front surface glass mirrors
perform best because they
produce a clearer single image
view, compared with the
double (shadowed) view of
back surface mirrors. Chrome
plated mirrors also perform
well but require a larger
aperture setting for proper
exposure because they do not
reflect light as brightly as glass
mirrors.
Two differently shaped
mirrors are required, one for full occlusal views and one for buccal and lingual
views. The clinician with a practice composed of all age groups probably needs at
least two sizes of each.
5-Film
Digital photography does not use film; "film speed" is a function of the CCD light
sensor or CMOS chip.
SUMMARY
The best combination is therefore an SLR camera, a macro lens, and a ring flash.
The camera sits assembled in the operatory, ready to be picked up and pointed at the
patient. In addition, any practitioner taking photographs will need cheek retractors
and mirrors. The more sophisticated practitioner may prefer visual contrast and can
use black-out sticks in close-up shots to eliminate the out-of-focus background of
the mouth. This is an issue of personal preference but improves the final picture
significantly.
Figure 14 set of mirrors

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BASIC FUNCTIONS CAMERA SETTING
There are four exposure settings or modes in the majority of DSLR cameras and all
employ a through-the-lens-metering system:
Aperture priority
The aperture is the lens opening. So the aperture
control allows the photographer to control how far
the lens is opened when a picture is taken. The
farther the lens is opened, the greater the amount of
light that is allowed into the camera and the lighter
the exposure. Once the aperture value has been
selected, the camera automatically selects the
correct shutter speed to produce an acceptable
exposure. By setting the aperture value, the
photographer decides on the depth of field (the
plane of sharp focus) in the image. One can select
a small aperture value (a high f-number) for a larger
plane of sharp focus and a large aperture value (a
small f-number) for a narrow plane.
A depth of field problem is that the entire dentition can only be photographed
completely in sharp focus if the focal plane is positioned carefully. Therefore, do not
focus on the anterior teeth. For a frontal view, the point of focus should be around
the canines.
Shutter priority
The shutter speed controls the amount of light that enters the lens when the picture
is taken. The more light desired, the slower the photographer should set the shutter
speed. Once the shutter speed has been selected, the camera automatically selects
the correct aperture value to produce an acceptable exposure. This mode is not used
for the purpose of intra-oral photography.
Program
The camera automatically selects both the aperture and shutter speed based on a
built-in-program.
Figure 15

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Manual
The photographer selects both the aperture and shutter speed, but the camera’s built-
in-meter can still be used to calculate the correct exposure.
For dental photography, it is important to be in control of the exposure features.
Therefore, either the aperture priority or manual exposure settings are preferable.
RECOMMENDED DIGITAL SLR CAMERAS AND THEIR
SETTINGS FOR INTRA-ORAL PHOTOGRAPHY:
Camera Nikon DSLR Canon DSLR Nikon DSLR
Flash Nikon R1C1 flash Sigma ring flash or
canon ring flash
Sigma ring flash
Power setting TTL eTTL ¼
Aperture value F22 F25 F25
Shutter speed 1/160 1/125 1/160
INTRAORAL TECHNIQUE
The post treatment photograph can be
repeated at any time, but the
pretreatment photograph can never be
reproduced.
Some photographs may require only the
patient's assistance, whereas others
require assistance from the patient, the
photographer and one or even two staff
members.
Figure 16

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ANTERIOR (FRONTAL) VIEW
Figure 17 anterior view
The anterior or frontal view is the most common view used in dental photography.
It ranges from a single tooth to a full face view.
Clinical Technique
1. Seat the patient semi-upright with the head turned toward the photographer.
2. Place retractors at the corners of the mouth and pull gently outward and forward
so that the buccal tissue is away from the teeth.
3. If a point light is used, it should be at the 3 o'clock or 9 o'clock position to create
a sense of depth with shadows.
4. Hold the camera so that the occlusal plane is perpendicular and centered
horizontally to the plane of the sensor (CCD or CMOS).
5. Align the patient's midline with the center of the frame. Adjust the magnification
(usually 1:2).Compose the photograph to include all relevant teeth and soft tissue.
6. Focus the camera while correcting the magnification.

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MAXILLARY OCCLUSAL VIEW
The maxillary occlusal view is the most difficult view to obtain and requires
patience. This photograph usually requires assistance from two staff members.
Clinical Technique
1. Seat the patient in a semi-upright position with the head turned toward the
photographer.
2. Instruct one of the assistants to gently rotate the retractors upward and outward.
3. Instruct the other assistant to rest a full-arch mirror on the maxillary tuberosity,
not on the teeth. The mirror should diverge from the occlusal plane as much as
possible so that the camera can be held 90 degrees to the plane of the mirror.
4. If a point light is used, it should be at the 9 o'clock or 3 o'clock position.
5. Hold the camera so that the plane of the sensor (CCD or CMOS) is parallel to the
full arch in view.
6. Align the midline of the palate with the center of the frame and adjust the
magnification (usually 1: 2). Compose the photograph to include all relevant teeth
and soft tissue.
7. Focus on the premolar area while correcting the magnification.
Figure 18 maxillary occlusal view

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MANDIBULAR OCCLUSAL VIEW
Figure 19 mandibular occlusal view
The mandibular occlusal view is the reverse of the maxillary occlusal view.
Clinical Technique
1. Seat the patient in the supine position, parallel to the floor.
2. Tip the patient's head back slightly and turn it toward the photographer so that the
occlusal plane is parallel to the floor.
3. Rotate the retractors gently downward toward the mandible and outward.
4. Rest a full-arch mirror on the retromolar pad not on the teeth.
5. The mirror should diverge from the occlusal plane as much as possible so that the
camera can be held 90 degrees off the plane of the mirror.
6. If a point light is used, it should be at the 9 o'clock or 3 o'clock position.
7. Hold the camera so that the plane of the sensor (CCD or CMOS) is parallel to the
full arch in view.
8. Align the midline of the tongue with the center of the frame and adjust the
magnification (usually 1:2). Compose the photograph to include all relevant teeth
and soft tissues.
9. Focus on the premolar area while correcting the magnification.

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BUCCAL VIEW
Figure 20 buccal view
Buccal views are ideal for photographing the patient's centric occlusion.
Clinical Technique
1. Seat the patient in a semi-upright position with the head facing straight for left
buccal views and toward the photographer for right buccal views (reverse for left-
handed dental units).
2. Place a buccal mirror distal to the last tooth in the arch. Move it as laterally as
possible while at the same time retracting the lip. The mirror also serves as a
retractor.
3. If a mirror is used, passively hold a single retractor on the side opposite the mirror.
4. If no mirror is used, pull the retractor on the side being photographed as distally
as comfortably possible for the patient. Passively hold the retractor on the side that
is not being photographed.
5. If a point source light is used, place it on the same side of the camera as the mirror.
6. Hold the camera so that the plane of the sensor (CCD or CMOS) is as
perpendicular to the mirror as possible.
7. Set the magnification (usually 1:1.5 to 1:2). Compose the photograph to include
from the distal area of the canine to the most posterior tooth, with the plane of
occlusion parallel to the film plane and in the middle of the frame.
8. Focus the camera on the premolar area while correcting the magnification.

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LINGUAL VIEW
Figure 21 lingual view
Lingual views of the maxilla or the mandible are obtained similarly.
1. Position the patient semi-upright with the head facing straight for right views and
toward the photographer for left views (reverse for left-handed dental units).
2. Place retractors at the corners of the mouth, rotated toward the photographed arch
and passive on the opposite side.
3. For a mandibular photograph, place a mirror between the tongue and the quadrant
being photographed, distal to the terminal tooth, parallel to the long axis of the teeth,
and pushed laterally as much as possible. For a maxillary photograph, place the
mirror against the palate in the midline, distal to the terminal tooth, parallel to the
long axis of the teeth, and pushed as laterally as much as possible.
4. If a point source light is used, place it on the same side of the camera as the mirror.
5. Hold the camera so that the plane of the sensor (CCD or CMOS) is as
perpendicular to the mirror as possible.
6. Set the magnification (usually 1:1.5 to 1:1.2). Compose the photograph to include
from the distal area of the canine to the most posterior tooth, with the plane of
occlusion parallel with the film plane and in the middle of the frame.
7. Focus the camera on the distal side of the canine while correcting the
magnification.

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OTHER VIEWS
Any of the above views can be modified to meet the needs of the user. Usually only
changes in magnification and composition are necessary to suit specific needs. For
example, if only an occlusal view of a quadrant is necessary, the buccal or lingual
mirror can be used in a similar manner as that described for the full-arch occlusal
view, along with a modification in the magnification. For a view of only the
premaxilla, only the necessary portion of a full-arch mirror is used and the
magnification is adjusted (1:1.2). The creativity of the photographer can allow for
any other specific views that are needed.
Figure 22 anterior view showing only maxillary teeth
Figure 23 lateral smile view

22. 22
EXTRAORAL TECHNIQUE
Good, finished full face and profile photographs require a pleasant colored
background. An art store can furnish art paper in a number of suitable colors. The
best usually is a pastel color that contrasts with normal hair color and skin tones. A
soft blue is the best overall. This paper can be taped to the wall in the operatory and
removed as needed.
FULL FACE VIEW
Clinical Technique
1. Position the patient approximately 18 to 24 inches in front of the background to
help minimize shadows.
2. Position the head such that a line from the ala of the nose to the tragus of the ear
is parallel to the floor.
3. If a point source light is used, place it at the 12 o'clock position.
4. Position the camera vertically at the level of the patient's eyes.
5. Set the magnification (usually 1:10). Compose the photograph to include from the
inferior border of the hyoid to above the top of the head.
6. Focus the camera on the patient's eyes while correcting the magnification.
Figure 24 full face view

23. 23
PROFILE VIEW
Clinical Technique
1. Position the patient approximately 18 to 24 inches in front of the background to
help minimize shadows.
2. Position the head such that a line from the ala of the nose to the tragus of the ear
is parallel to the floor. The teeth should be in occlusion.
3. If a point source light is used, place it on the side of the camera that the patient is
facing. The camera should be in a vertical position at the level of the patient's eyes.
4. Set the magnification (usually 1:10). Compose the photograph so that the profile
dominates the center of the frame, with the area just behind the ear visible.
5. Focus the camera on the patient's eyes while correcting the magnification.
Figure 25 profile view

24. 24
TREATMENT PLANNING
A number of years ago the American Academy of Cosmetic Dentistry (AACD)
recommended a standard set of 12 pictures for its accreditation examination, which
represented a good starting point for planning and documentation over a wide range
of situations. The views required were reflective of the limitations of film-based
photography, in which it was very difficult to magnify selected parts of an image.
The first picture should be a full-face picture, taken with the patient looking straight
into the camera, with the interpupillary line parallel to the lower border of the frame,
and the facial midline parallel to the vertical border of the fame.
Framing should include from just below the chin to just above the hairline.
All the other photographs are taken at a fixed magnification ratio of 1: 3 (the
equivalent of a 1: 2 on 35-mm film and full frame digital SLR cameras) and an
aperture of f/22 or higher to provide acceptable depth of field.
The next pictures are a series of three pictures of the patient smiling. The frontal
view has the central incisors in the middle of the picture parallel to the lower border
of the frame and the facial midline parallel to the vertical border. It is important to
note that it should be the facial midline, not the dental midline. Any discrepancy
between the dental and the facial midline will be reproduced in the photograph and
noted. After this, right and then left lateral smile views are taken, with the upper
lateral incisor just above the middle of the picture and the occlusal view parallel to
the lower border. The frontal view will allow the dentist to assess the lip line, the
smile line, the midline, the relationship between the incisor levels, and the lips. The
lateral views also show the teeth on their respective side plus the emergence profile
of the teeth on the contralateral side.
At this point a set of cheek retractors is placed into the patient’s mouth, and then
frontal and left and right lateral photos are taken first with the teeth in occlusion and
then slightly parted. As with the frontal smile view, the central incisors are typically
in the middle of the picture and the facial midline is parallel to the vertical border of
the frame. The occlusal plane is parallel to the lower border of the frame. Lateral
views also have the lateral incisor in the middle of the frame and the occlusal plane
parallel to the lower border of the shot.Finally, some occlusal images are taken using
an occlusal mirror. Patients should open very wide so the mirror can be inserted and
the occlusal surface of all the teeth in an arch can be photographed, from second
molars to incisors. The mouth should be opened wide enough that the interproximal

25. 25
embrasures of the anterior teeth are visible, but only a small area of the labial
surfaces are shown. This can sometimes be difficult in the lower jaw. The assistant
may need to position the retractors very precisely to allow the dentist to move the
mirror for the perfect picture. For the lower picture it may also be helpful to have
the patient curl their tongue to the back of the mouth.
These 12 images form a set of pictures that can be used almost universally for most
treatment plans. It is wise to take them at an initial consultation; this permits the
dentist to discuss the treatment plan with the patient immediately. Alternatively, if
the treatment plan is complex and requires the dentist to further analyze the dentition
before presenting treatment, the practitioner can see the patient’s entire mouth
without having to schedule an added appointment. 13, 16, 17, 18, 19, 21
Additional
photographs, such as close-up views of the anterior teeth or posterior quadrants and
lateral images of the face can be taken if appropriate to the patient’s condition or if
required for examination purposes.
Figure 26

26. 26
CLINICAL TIPS
*To determine the type of mirror, place an explorer directly onto the mirror's surface.
On a front surface mirror, the "tips" will meet. On a back surface mirror, a space will
be seen between the tips, which represents the distance between the glass and the
reflecting surface on the back.
*A commonly encountered problem is mirror fogging caused by the patient's breath.
This can be eliminated either by soaking the mirrors in warm water or by having the
assistant gently blow air from the syringe onto the mirror while it is in use.
*If saliva comes in contact with the mirror's surface, the mirror must be removed
and cleaned to avoid a significant distraction on the finished photograph.
*The dental camera should be readily available, stored either in a wall-mounted
bracket or on a counter near the work area. If the camera is not readily available, it
will not be used. It is not advisable for the dental camera to double as a recreational
camera, because it probably will be at home when needed.
*The single most common beginner's error is incorrect choice of magnification. A
typical magnification error involves including the nose and chin in a frontal view of
the oral cavity. This extraneous information is distracting for the viewer. The
photographer must decide what the photograph should contain and choose the
magnification that eliminates everything else.
*Good intraoral photographs should appear as if the camera were aimed directly at
the desired subject regardless of whether mirrors were used. The photographs should
be devoid of mirror edges, fingers or thumbs, fog, saliva, lip retractors, or any
elements other than the desired aspect of the oral cavity.
*Lip retractors are not always easily eliminated, but clear retractors are an excellent
compromise.
*A more relaxed or casual view without lip retractors is useful and appropriate for
esthetic dentistry, especially when designed for patient viewing. Never show patients
with lips retracted when illustrating esthetic dentistry for patient viewing.
*To achieve maximum sharpness of the image, focus the camera on the canines, not
the central incisors while photographing the anterior view of the patient.

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*A standard set of retractors can be modified by removing the flange on one side of
the retractor, such that when the retractor is rotated toward the desired arch, no
interference comes between the mirror and the retractor.
*When photographing the mandibular occlusal view, use the same altered lip
retractors described for the maxillary view.
*Buccal views can be taken without mirrors if a view of the distal end of the terminal
molar is not required.
*The head should be turned slightly toward the photographer so that the off-side
eyelash is just visible. This avoids the appearance of the patient looking away from
the camera.
*Many cameras feature a "red eye" reduction flash. Pulsating the flash before taking
the photograph causes the subject's iris to contract, thus eliminating the reflection of
light off the retina and minimizing the "red eye" effect seen in some photographs.

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REFRENCES
1. George A. Freedman: Contemporary esthetic dentistry, 2012, by Mosby, Inc.
2. Kenneth W Aschheim and Mark P King: esthetic dentistry, a clinical approach
to techniques and materials, Mosby, Inc., 2001.
3. Swift EJ Jr, Quiroz L, Hall SA: An introduction to clinical photography,
Wolfgang Bengel: mastering digital dental photography, Quintessence
Publishing Co, Ltd, 2006.
4. www.styleitaliano.org, smile lite and smile capture, Aesthetic and restorative
dentistry; 2015.