This document discusses the importance and proper techniques of clinical photography in orthodontics. It begins by outlining the key reasons for clinical photography, including documentation, diagnosis, comparing pre- and post-treatment results, and patient education. It then provides details on the basic requirements for clinical photography, including using a DSLR camera, macro lens, ring flash, and fast shutter speed. The document also explains the different types of extraoral and intraoral photos needed, such as frontal, profile, and occlusal views. For each photo, it describes the proper positioning of the patient, camera, mirrors, and retractors to optimize image quality.

1. Dr.Shah MD.Shafiul Mahboob(shahroj)
Internee doctor (IS-34)
Sapporo Dental College & Hospital.
Clinical
Photography in
Orthodontics

2. Topics
01. Importance & basics
of clinical photography
03. Extra oral
photography
02. Requirements for
clinical photography
04. Intra oral photography

3. Importance of Clinical
Photography
oDocumentation of records for legal reasons.
oUseful in diagnosis
oTo compare pretreatment and post treatment results.
oTo use data in clinical practice for patient information and
motivation
oIt greatly aids the orthodontist in formulating the best
possible treatment plan for each patient, and monitoring
them in subsequent follow-ups
oFor obtaining data to make presentations and teaching
students3 ADD A FOOTER

4. BASICS OF
PHOTOGRAPHIC
CAPTURE
A clinical photograph should have the following properties:
1.Subject should be captured optimally, with nothing excess that may divert
attention from the subject, yet no part of the subject should be left out.
2.All parts of the subject should be in sharp focus with no blurring
3.All parts of the subject should be in good light.
4.Shadows should not obliterate any part of the subject
5.Subject should be centered in the photograph
6.Subject should be well isolated
7.Alignment of the subject should be pleasing and easily interpretable.
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5. Clinical
Requirements For
Photography
1. The Camera
2.The Retractors
3.The Dental Photography Mirrors
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6. The Camera
A professional DSLR camera is
recommended for clinical photography
The Lens The Flash The Shutter
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7. The lens
Macro lens is recommended as,
These lenses work from infinity to a
close-up of 3- 4 inches. 100-105mm
macro lenses are generally used for
dental photography. These are much
sharper than zoom lenses because of
fixed focal ability.
Fig : canon Macro lens 100mm MM.DD.20XX

8. The Flash
A dedicated Ring Flash is recommended
as,
. It eliminates almost all shadows
by providing a more even
distribution of light during extra
and intra-oral photographs and
thus the quality of the image is
enhanced due to overall better
illuminationFig :Photography using ring flash MM.DD.20XX

9. The Shutter
Recommended shutter speed is 1/80 of a
second for intraoral and 1/100 of a second for
extra oral pictures.
.
Fig :Shutter MM.DD.20XX
•If the shutter has a fast speed, it lets in less
amount of light (darker image) but gives a
crisp and sharp image.
•If the shutter has a slow speed, it lets in
more amount of light (brighter image), but
the image may be soft or blurred

10. The retractors
The recommended cheek retractors to be used
for best results in clinical photography are two
pairs of variable-size double-ended retractors
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11. The Dental
Photography Mirrors
Many types of mirrors may be used for clinical
photography, ranging from front-silvered
mirrors to highly polished Stainless Steel mirrors
of various shapes and sizes.
It is generally preferred to use long-handled
mirrors as they allow better control
and handling by the clinician during the occlusal
shots.
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12. Extra oral
photograph.
oFace-Frontal (lips relaxed).
oFace-Frontal (Smiling).
oProfile (Right side preferably – Lips
relaxed).
o(45 °) Profile (also known as ¾ Profile -
Smiling).
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13. Frontal view (lip
relaxed )
1.Camera should be positioned in front of patient’s head – on
the same level as the patient
2.There should not be any tilt in the camera position.
3.The patient should stand with their head in the Natural
Head Position, with eyes looking straight into the camera lens.
4.The patient should hold their teeth and jaw in a
relaxed (Rest) position, with the lips in contact (if
possible) and in a relaxed position.
5.Ensuring the patient’s inter-pupillary line is
leveled is also very important.
6. If lip incompetence is present, the lips
should be in repose and the mandible in
rest position.
Fig :Shutter MM.DD.20XX

14. Method for taking a frontal photo of the
patients
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15. Frontal view (smiling)
1.A patient who is smiling for a
photograph tends not to elevate the
lip as extensively as a laughing
patient.
2.The smiling picture demonstrates the
amount of incisor show on smile
(percentage of maxillary incisor
display on smile), as well as any
excessive gingival display
Fig :Shutter MM.DD.20XX

16. Profile (Right Side -
Lips
Relaxed)
1.The patient is asked to bodily turn to their left, thus having their
right profile side facing the clinician.
2.The head should be in the Natural Head Position, with their
eyes fixed horizontally (preferably at a specific point at eye-level,
or at the reflection of their own pupils in a mirror).
3.The wrong head posture can result in confusion regarding the
patient’s actual skeletal pattern.
4. Ideally, the whole of the right side of the face should be clearly
visible with no obstructions such as hair, hats or scarfs. The
inferior border be slightly above the scapula, at the base of the
neck.
6.This position permits visualization of the contours of the chin
and neck area.
7.The superior border should be only slightly above the top of
the head, and the right border slightly ahead of the nasal tip.
Fig :Shutter MM.DD.20XX

17. Profile smile
The profile smile image allows one to see
the angulations of the maxillary incisors, an
important aesthetic factor that patients see
clearly and orthodontists tend to miss
because the inclination noted on
cephalometric radiographs may not
represent what one sees on direct
examination.
Fig :Shutter MM.DD.20XX

18. Oblique (three-quarter,
45-degree)
Patient in natural head position looking
45 degrees to the camera. Three views are
useful
oOblique at rest.
oOblique on smile.
oOblique close-up smile
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19. Oblique at rest
•This view can be useful for examination of the mid face
and is particularly informative of mid face deformities,
including nasal deformity.
This view also reveals anatomic characteristics that are
difficult to quantify but are important aesthetic factors,
such as the chin-neck area, the prominence of the gonial
angle, and the length and definition of the border of the
mandible.
This view also permits focus on lip fullness and vermilion
display.
For a patient with obvious facial asymmetry, oblique
views of both sides are recommendedFig :Shutter MM.DD.20XX

20. Oblique on
smile.
Can give valuable information about the
smile esthetics’ changes in pre and post
treatment. From the Profile photo position,
the patient is asked to turn their heads
slightly to their right (about 3/4 of the way -
hence the name), while keeping their body
still in the “Profile Shot” position i.e. Facing
forward. They are then instructed to look
into the camera, and then smile. It is
essential that the patient’s teeth show clearly
when smiling, otherwise the photograph
would be of minimum benefit
Fig :Shutter MM.DD.20XX

21. Oblique close-
up smile
This view allows a more
precise evaluation of the lip
relationships to the teeth and
jaws than is possible using the
full oblique view.
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22. INTRA ORAL
PHOTOGRAPHS
oFrontal - in occlusion
oRight Buccal - in occlusion
oLeft Buccal - in occlusion
oUpper Occlusal (using mirror)
oLower Occlusal (using mirror)
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23. Frontal
(in occlusion)
With the patient sitting comfortably in the dental
chair and raised to elbow-level of the clinician, the
assistant stands behind the patient and uses the first
larger set of retractors from the wide ends to retract
the patient’s lips sideways and away from the teeth
and gingiva & slightly towards the clinician.
This is important to allow maximum visualization
of all teeth and alveolar ridges, and also to
minimize discomfort for the patient from retractor
edges impinging on the gingiva.
The photo should be taken 90° to the facial
midline & central incisors
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24. Right buccal
(in occlusion)
The assistant flips the right retractor to the narrower side, while
the left retractor remains in place as for the previous frontal shot.
The patient is asked to turn their head slightly to their left so
their right side will be facing the clinician.
The clinician holds the right retractor and stretches it to the
extent that the last present molar is visible if possible, while the
assistant maintains hold of the left retractor, without undue
stretching.
Again, the shot is taken 90° to the canine premolar area for
best visualization of the buccal segment relationship, as this is
very important in orthodontic assessment.
A useful tip would be for the clinician to fully stretch the right
retractor just before taking the shot to minimize any discomfort
for the patient, and achieve maximum visibility of the last present
molar, if possible.
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25. Left buccal (in
occlusion)
The assistant now switches the retractors
with the narrow end on the photo side
(patient’s left) and the wide end on the
other (patient’s right). Again, the shot is
taken at 90° to the canine premolar area,
and to ensure this and the clinician should
move their body slightly to the right while
holding the retractor on the photo side,
while the patient turns their head slightly to
their right. MM.DD.20XX

26. Upper occlusal
The assistant now switches to the smaller retractor set and with
the patient’s mouth held open, the retractors are inserted in a “V”
shape to retract the upper lips sideways and away from the
teeth.
The clinician inserts the mirror with its wider end inwards to
capture maximum width of the arch posteriorly, and pulls it
slightly downwards so that the whole upper arch is visible to the
last present molar.
The patient is instructed to lower their head slightly so that the
shot can be taken 90° to the plane of the mirror for best visibility.
Use the mid-palatal raphe as a guide to get the shot leveled.
Minimum retractor show in the image is recommended, and
no fingers should be visible at any time MM.DD.20XX

27. Position Of Retractors For Upper
Occlusal Shot
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28. Upper Occlusal Shot
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29. Lower occlusal
•The assistant would now lower the smaller retractors into a
Reverse “V” shape to retract the lower lips sideways and away
form the teeth.
The clinician would now lift the mirror upwards so he/she may
visualize the reflection of the lower arch, while the patient is be
asked to “lift their chin up” slightly.
Ideally, the shot should be taken 90° to the plane of the mirror,
with the last molar present visible.
An important issue here would be the tongue position of the
patient while taking the photo.
It is best to ask the patient to “roll back” their tongue behind
the mirror so that it won’t interfere with the visibility of any teeth,
particularly in the posterior area. MM.DD.20XX

30. Position Of Retractors For
Lower Occlusal Shot
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31. Lower Occlusal Shot
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32. Thak you
Thank You
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