2. Basic Terms
3. Clinical Requirements for Photographic Records
4. Taking Clinical Photographs
5. “After Shot”-Post Processing your Digital Images
I. Why taking photographic records in
The basic orthodontic record taking is comprised of three man types of
a) STUDY MODELS
c) CLINICAL PHOTOGRAPHS
BENEFITS OF TAKING CLINICAL
• More and more emphasis from the orthodontic community on the
achievement of balanced facial harmony and smile esthetics of our
patients, in addition to the traditional orthodontic goals of a wellaligned and functional dentition.
• The need for proper clinical photographic records of the
orthodontic patients has become more obvious and essential for
proper treatment planning and follow up.
• Helps orthodontist to study the existing patient‟s soft tissue
patterns during treatment.
• To assess lip morphology, smile arc and smile esthetic.
• Helps to plan treatment without the presence of patients.
• Need of photographic records for research and publications,
lecturing and presentation.
• Medico legal cases cannot be over emphasized.
• The right choice in this digital age.
• Easy to use, eg- retake ,delete. Immidiate result.
• Cost effective-no more film, no more developing,.
• Easy to store,all u need is a generous memory card and
reasonable size hard disk.
• The main advantage is the ability to enhance ,or „post-process‟
the images.eg- rotation,color,brightness etc.
• It describes how much details an image can hold.
• Based on the pixel count and bit depth of each pixels.
• Each pixels displays one color, as the number of pixels
increases, the image details becomes sharper.
• A camera resolution is calculated by the number of
megapixels its digital image sensor is capable to capture.
• A display resolution is expressed in pixels per inch(ppi)
and a printers resolution in dots per inch(dpi).
• Minimum camera resolution for orthodontic purpose
would be 4 MP, can be more.
2) FOCAL LENGTH
• An important attribute of a lens than its quality, is its focal length.
• Its technically defined as the distance from the part of the optical path
where the light rays passing through onto the image plane or the digital
• This distance is usually measured in millimeters.
• Focal length can be thought of as the amount of magnification of the lens.
• The longer the focal length , the more the lens magnifies the scene.
• In addition with magnification, the focal length determines the prespective
and compression of the scene.
• It is a hole through which the light passes from the subject to the film.
• Various sizes of apertures are called
„f‟ STOPS or „f‟ NUMBERS.
• Size rages from 1.4-32
• These numbers are a measure of the size of the lens aperture, NOT the
diameter of the aperture.
• It is the number by which the focal length of the lens must be divided to yield
the aperture diameter.
• For Eg. 50mm lens is set to f/2 aperture, diameter of the aperture is 50/2 =
• „f‟ stands for focal length.
4) SHUTTER SPEED
• It reffers to the amount of time the shutter is open or the digital
image sensor is activated.
• The exposure of the image is determined by the combination of
shutter speed and the opening of the apeture.
• Shutter speed is displayed as fraction of a second,such as 1/8
CLINICAL REQUIREMENTS FOR PHOTOGRAPHIC
• Two main types of camera
• Point & Shoot digital camera
• DSLR ( Digital Single Lens Reflex )
• DSLRs are what professional photographers currently use as they allow
maximum flexibility and customization for the highest possible quality of digital
• There are many cameras from both spectrum that are suitable for orthodontic
record taking purposes, however ,this section will focus on their two most
important general requirements for any camera chosen; the ring flash and the
• Fish eye lens
• Wide-Angle lens
• Normal lens
• Telephoto lens
• Macro lens
• Macro photography refers to close up photography, the classic
definition that the image projected on the film plane is the same size
as the subject.
• Many point n& shoot cameras have a macro function; a function that
allows to take a close up shots of objects in good focus and depth of
• This is not entirely satisfactory for great and consistant results every
• But a dedicated macro lens attached to a DSLR camera provides
even better close up photos with high definition and better focus.
RING FLASH VS POINT FLASH
• The point flash may sometime produce fairly good
light distribution when used for clinical photographs.
• Detracting shadows ,which may also obstruct
important details ,which are often irreparable using
image editing software and will detract from the final
quality of the image.
• In contrast, the ring flash eliminates such shadows
by allowing a more and even thorough distribution of
light during extra oral and intra oral photographs, and
thus the quality of the image is enhanced.
• So its highly recommended to use a ring flash for
2) SPECIAL CHEEK RETRACTORS
• Recommended cheek retractors for best results in clinical photography is double ended
• Two types of double ended retractors- with regular and small size on either side.
- with narrow end and wide end.
• Smaller one piece orthodontic bonding retractors are generally not a good choice for
orthodontic purposes, especially for buccal and occlusal shots, as they have less
retraction potential and it can be painful experience.
• Its recommended to buy a good quality retractors to ensure durability and reliability, with
recurrent disinfection procedures.
3) DENTAL PHOTOGRAPHY MIRRORS
• Many types of mirrors have been used
ranging from front-silvered mirrors to
highly-polished stainless steel mirrors.
• Front-silvered mirrors offer the best quality
image and light distribution, no ghost
image or double layering.
• light reflection on front-silvered mirrors
brightens, bright image as an end result.
• Its also preferred to use „long handled‟ mirrors as
they allow better control and handling.
• There are different sizes for use with different
patients depending on the age
opening size. Medium size would fit with most
• Mirrors with out handle may be used successfully
but are more tricky to handle ,especially when
handling an expensive camera with the other
HOW MANY PHOTOGRAPHS DO WE
• There is no standard set that is universally approved as a rule of thumb.
• Based on many authorities opinions in this field –that a complete Clinical
photographic Set for any orthodontic patient at ant stage of treatment should include
a minimum of NINE photographs- FOUR Extra oral and FIVE Intraoral Photographs.
• Extra –oral clinical photographs are the easiest to take, only require proper
positioning of the patient and clinician, in addition of course to the digital camera
• Itra-oral photos require proper cheek retractors,dental photography mirror.
A) EXTRA-ORAL PHOTOGRAPHS
• Extra oral photos consists of four shots:
1) Face-Frontal ( lips relaxed).
2)Face –Frontal (smiling ).
3)Profile (Right side preferablylips relaxed).
4)Profile 45° ( oblique ).
• These four shots provide the clinician with informations about
patient‟s facial and soft tissue features,propotions and smile
1) FACE_FRONTAL(LIPS RELAXED)
• The first extra oral photo usually taken,
probably the easiest-however there are some
important guidelines that need to be taken.
• Framing of the shot
• Should encompass the whole of the patient‟s
face and neck
• Reasonable margin of space all around.
• Hold the camera lens in vertical position.
• Stand in a reasonable distance away from the
• The Patient should be made to stand with their head in the Natural
Head Position,with eyes looking straight in to the camera lens.
• The patient should hold their teeth and jaw in a relaxed position.
• Make sure patient‟s head is not tilted or their face rotated to either
side; the shot should be taken at 90° to the facial midline from the
• Ensure the patient‟s inter-pupillary line is level.
• Recommended to make the patient stand in a plain dark or white
2) FACE_FRONTAL (SMILING)
• Same guidelines as for the Face-frontal shot.
• Important thing that the patient should be Smiling in a natural way,
with the teeth visible.
• Helps in visualizing the patient‟s smile estheics and soft tissue
3) PROFILE ( RIGHT SIDE- LIPS RELAXED )
• The profile photo has a high diagnostic
value to the orthodontist.
• After taking frontal face photo, the
patient is asked to bodily turn to their
left,thus getting the right profile side .
• The head should be in the natural
• The wrong head position can make a
confusion regarding the patient‟s
actual skeletal pattern.
• Face clearly visible with
obstructions and use ring flash.
4) PROFILE 45º ( OBLIQUE )
• This shot conveys the patient as if in social interaction, and can
give valuable information about the smile esthetics changes pre
• From the profile photo position, the patient is asked to turn their
head slighty to their right,while keeping their body still in the
previous profile position.
B) INTRA – ORAL PHOTOGRAPHS
• This requires more attention to detail to produce good results.
• Use of special cheek retractors and dental mirrors are required .
• There are five required intra oral photographs:
1) Frontal ( In Occlusion )
2) Right Buccal ( In Occlusion )
3) Left Buccal ( In Occlusion )
4) Upper Occlusion
5) Lower occlusion
1) FRONTAL ( IN OCCLUSION )
• Patient seated comfortably and raised to the elbow level of the clinician.
• Using the retractors, patient‟s lips are retracted Sideways and away from
the gingiva, towards the clinician.
• Maximum visualization of the teeth and alveolar ridges.
• Photo taken 90º to the facial mid-line.
• High F value setting is recommended to attain maximum depth of the shot
with even the last visible molars are focused. F 28.
• Ring flash helps in light distribution of the image with out
shadows,especially in the deeper part of the oral cavity and buccal
2) RIGHT BUCCAL ( IN OCCLUSION )
• Flips the right retractor o the narrower
side,while the left retractor remains in
place as for the previous frontal shot.
• The right retractor is stretched to the
extend that the last molar is visible if
• 90º to the canine-premolar area for best
• Important in orthodontic assessment.
3) LEFT BUCCAL ( IN OCCLUSION )
• Similar to the right buccal shot.
• The left retractor is stretched maximum to the left with the
patient‟s head turned to right side.
4) UPPER OCCLUSAL
• Dental mirrors come into play.
• With the lip retractors the upper lip is retracted
sideways and away from the teeth.
• The mirror is inserted and pull it slightly downwards
to get the maximum visibility of the upper arch.
• The patient is asked to breath only through nose to
avoid fogging of mirror.
• The patient is instructed to lower the head slightly
and shot taken 90º to the plane of the mirror.it is
recommended that thee mid palatal raphe is used
as a guide for the orientation of the shot to get it
• Avoid finger visibility.
5) LOWER OCCLUSAL
• Lower lip is retracted sideways and away from teeth using lip
• Mirror is inserted and lifted upwards for maximum visibility.
• The patient is aske to roll back the tongue behind the mirror so that
it won‟t interfere the visibilty of any teeth.
• The direction of pull of the retractors is always sideways and
away from tissue,to get maximum visibility.
• Wetting the retractors before insertion eases positioning them
and reduce patient discomfort.
• Warming the mirror in warm water prior to insertion helps to
prevent Fogging of the mirrors which prevent clear image .
• Use saliva ejector to eliminate saliva prior to each photograph.
• Its recommended to take photographs before impression taking
to eliminate the possibility of material stuck between the teeth.
THE AFTER- SHOT: POST- PROCESSING YOUR
• Once all photographs taken, next step is to download it to the
computer for some minor editing and image correction.
• Create separate folders for each patients and store in the hard disk.
• Can use a dedicated database within a propietary orthodontic imaging
• Back-up the files( CD, DVD, Google Drive ) is a safe method to avoid
loosing of the datas, which can be restored when needed.
1) IMAGE EDITING
• Image editing can be done using suitable image editing
• The most popular one is Adobe Photoshop.
• Basic editing functions are enough for orthodontic purposes.
• Microsoft‟s Preview, Paint. Net (windows), Fast stone Image
viewer (windows), Preview and iphoto ( Apple Mac ).
EDITING WITH IMAGE EDITING SOFTWARE
• For orthodontic purposes, a few number of editing procedures
• Flipping( Mirroring ) and Derotation- vertically or
• Cropping- removing unnecessary image informations.
• Color, Brightness and Contrast
• Scratch removal
• Saving image files
FLIPPING AND DEROTATION
It should be the first step in editing images.
• Removes all unnecessary parts of the image like retractor, lips, fingers
COLOR, BRIGHTNESS AND CONTRAST
• Slight adjustments in color and brightness highlights the details.
• There is no specific adjustment here as the adjustment to be
made are variable depending on how the image is taken.
• Sometimes dust particles attached to the camera CCD sensor.
• Minor scratches on the mirror.
• Removed using scratch removal tool in image editing softwares.
• Healing tool and patch tool in Adobe Photoshop.
SAVING YOUR IMAGE
• Its done after all editing.
• Dedicated folders can be made for each patient.
• Labelled by date.
• There are many formats to save image.
• Two main formats used is:
• TIFF- Tagged Image File Format.
• JPEG- Joint Photographic Experts Group.
SAVING IMAGES FOR PUBLICATIONS AND ONSCREEN PRESENTATION
• In on-screen presentations very high resolution images are not
• Large file size increase loading time and slow perfomance.
• Recommended resolution is 72-96 DPI.
• For printing and publications, resolutions should be more.
• Range 150-300 DPI.