This presentation will provide you with basic knowledge to take clinical photographs in dentistry, with any digital camera like point and shoot or a DSLR camera..

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2. Dr. Onkar B. Khot
PG (Orthodontics)
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3.  Introduction
 Why take orthodontic photographic
records
 Why go DIGITAL
 Basic terms
 Resolution
 Focal Depth
 Shutter speed
 Macro function / lens
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4.  Clinical requirements for photographic records
 Digital camera setup / ring flash / Macro Lens
 Special cheek retractors
 Dental mirrors
 Taking clinical photographs
 Extra-oral
 Patient positioning
 Clinician positioning
 Intra-oral
 Patient positioning
 Clinician / Assistant positioning
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5.  Post processing your digital images
 Cropping of images
 Enhancing the images
 Exposure
 Brightness / contrast
 Color
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6.  Study models, properly trimmed, dental stone – cast
moulds
 Radiographs, usually OPG and Lateral cephalogram
 Clinical photographs – a luxury..??
 Time has changed – emphasis on achieving balanced
facial harmony
 Carefully study existing patients soft tissue pattern
 Lip morphology and tonicity, smile arc & smile
esthetics
 In absence of patient
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7.  Ease of use of digital cameras
 Ability to repeat / delete unsuitable images
 No need to wait till the film is developed
 Cost effective
 A one time investment
 VTO
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8.  Resolution
 How much detail an image can hold
 Pixel count and bit depth of each pixel
 As the number of pixels increases, the image’s detail
becomes sharper
 Number of megapixels – camera’s resolution
 Display’s resolution – expressed in pixels per inch (ppi)
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9.  Focal length
 Lens’s magnification power
 Longer the focal length – more the magnification power
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10.  Macro photography – close-up photography
 Reproduction ratio of life size i.e. 1 : 1
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11.  Shutter speed
 Amount of time the shutter is open or digital image
sensor is activated
 Displayed as fraction of a second, such as 1/8 0r 1/250
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12.  Aperture
 A hole in the lens through which light passes on its way
from subject to the film
 DOF – depth of field
 To make one object stand out of a wide view
 Reduce aperture size
Increase in depth in a picture
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13.  How much picture comes out sharply and how much
doesn’t
 This zone of sharpness is called as depth of field
 Can be controlled by 3 main factors –
 Aperture – smaller the aperture more extensive the DOF
 Focal length – shorter the focal length, greater the DOF
 Camera to subject distance – greater the distance,
deeper the DOF
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14.  Shallow depth of field
 Greater depth of field
 1/30th of a second
 1.5 second exposure
exposure
 f 3.5 aperture value
 f 22 aperture value
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15.  Digital camera setup
 Point & shoot
 DSLRs
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16.  Ring flash eliminates shadows
 Allows more even and thorough
distribution of light
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17.  A dedicated macro lens that can be attached to the
cameras and adjusted as needed is by far a superior
choice
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18.  Double ended retractors
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20.  Extra-oral Photographs
 Face-frontal (lips relaxed)
 Face-frontal (smiling)
 Profile (right side preferably – lips relaxed)
 (45 °) Profile (also known as ¾ Profile – Smiling)
 Intra-oral photographs
 Frontal – in occlusion
 Right buccal - in occlusion
 Left buccal – in occlusion
 Upper occlusal
 Lower occlusal
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21.  Face-frontal (lips relaxed)
 outer canthus to superior attachment of the ear (C-SA
line)
 Interpupillary line
 Encompassing area (crown to collarbone)
 Head in NHP
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22.  Face-frontal (smiling)
 Same guidelines
 Smiling in a natural way with the teeth visible
 Aids in visualizing patients smile esthetics and soft
tissue properties
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23.  Profile (right side preferably – lips relaxed)
 canthus to superior attachment of ear
 encompassing area of crown to collarbone
 chin and neck should show, preferably up to
the clavicles
 Frankfort horizontal line to
be sure that head is level
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25.  (45 °) Profile
 Social interaction
 Visible information about smile esthetics
 Turn the head to right about ¾ of the way
 Teeth should be visible
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26.  The position of the patient is important to the camera
view and to the operator’s ease in making the view
 For most straight anterior views, the patient should be
in a semi upright position with a slight tilt backwards
 In a contour chair, the patient must turn his head to
the side so that the operator does not have to lean
sideways over the chair and patient.
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27.  It should not be directly on the teeth
 Keep the light on the side of the cheek and out of the
mouth
 The light is only needed to give enough light to focus
by
 When the dental light is bright or strong on the side of
the arch that should have the greatest contrast, it will
kill the contrast produced by the flash.
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28.  Frontal – in occlusion
 Patient in dental chair, raised to clinicians elbow level
 Assistant standing behind the patient
 Retract patients lips sideways
 90° to facial midline using upper frenum as a guide
 Full extension of sulci
 High “f” value for maximum depth of field
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29.  Right buccal - in occlusion
 Flip the right retractor to the narrower side
 Patient is asked to turn their head to left
 Clinician then holds the right side retractor and pulls it
to visualize the last erupted molar as much as possible
 90° to canine-premolar area
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30.  Left buccal – in occlusion
 Similar to that of the right buccal
 Switch the larger retractor to patients right and narrow
end to patients left
 Patient turns head slightly towards their right
 90° to canine-premolar area
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31.  Upper occlusal
 Retractors are inserted in “V” shape to retract upper lip
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sideways and away from the teeth
Mirror with wider end inside the mouth
Patient is instructed to lower the head slightly
Shot can be taken 90° to the plane of the mirror
Mid-palatal raphe as a guide for orientation
Minimum retractor show
No fingers should be seen
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32.  Lower occlusal
 Retractors in reverse “V” shape
 Clinician holds the mirror upwards to visualize lower
arch
 Patient is asked to lift the chin up
 And also asked to roll back the tongue
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33. UPPER OCCLUSAL SHOT
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34. LOWER OCCLUSAL SHOT
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38.  Direction of pull of retractors is always sideways and
slightly forward, away from gingival tissue
 Wetting the retractors just before insertion eases the
process of positioning them with minimum patient
discomfort
 Taking occlusal mirror shots, slightly warming the
mirror in warm water prior to insertion helps prevent
fogging of the mirror
 Saliva ejector can be used to eliminate saliva prior to
taking each photograph
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39.  During occlusal mirror shots, instruct the patient to
open wide just prior to pressing the camera button.
This helps in obtaining maximum mouth opening at
the right moment, and minimizes patient’s fatigue
during the procedure
 It is recommended that all photographic records to be
taken before impression making, to eliminate the
possibility of impression material being stuck between
the teeth or the face during the procedure
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40.  Minimum camera resolution for orthodontic purpose
would be around 3-4 megapixels
 DSLR cameras are highly recommended for taking
orthodontic photographic records
 Patient should be standing in front of a plain white
background when taking extra-oral shots
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41.  Immediate back-up ensures a complete back-up of all
the original, unprocessed image files
 Flipping – relative to occlusal plane and mid line
 De-rotation
 Cropping
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42.  Clinical photography in dentistry ; Matrishva B. Vyas ;
Jaypee publication
 A Short Guide to Clinical Digital Photography in
Orthodontics ; Shadi S. Samawi
 Orthodontics Current Principles Techniques ; Graber,
Vanarsdall, Vig ; 4th Edt
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