role of photography in dentistry

1. SUBMITTED BY –
DR. NEHA MAHESHWARI
MDS Ist YEAR (2012-13)
DEPARTMENT OF
ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS
Photography in orthodontics

2. CONTENTS
 Introduction
 Benefits of taking clinical photographs
 Use of digital photographs
 Why go digital
 Basic terms
 Digital cameras classification
 Photographic requirements

3.  How many photographs do we need
 Requirements of extra & intraoral
photography
 Instructions for extra & intraoral
photography
 Gold standard
 Common errors in clinical photography
 After shot: post processing of images
 Conclusion references

4. INTRODUCTION
 Photography is an art and science.
 Digital photography has been generally available
since 1981.
 In 1991 ‘Autotrader’ were the first mass market
publication to move completely to digital recording of
images.
 Dr.B.W.Weinberger says “ Today modern
orthodontia requires not only knowledge of dentistry,
but of art, anatomy, anthropology, biology,
embryology, endocrinology, pediatrics, physical
diagnosis, psychology, photography, radiography,
nutrition and many other branches of medicine and

5.  Photographic facial reproductions are placed next in
importance to the written record by Dr. B.E.Lischer in
his review of the requirements of orthodontic
diagnosis.
 Photographs of the face made to scale are placed
next in importance to denture reproduction by Dr.
Samuel J. Lewis in his summary of the physical
equipments for orthodontic diagnosis.
 Photographs are an essential part of clinical
documentation. Current ‘best practice’ is a full set of
extra- and intraoral photographs, both at the start and
completion of a course of orthodontic treatment and,
ideally, some midtreatment photographs showing key-

6. BENEFITS OF TAKING CLINICAL
PHOTOGRAPHS
 Clinical photographs allow the orthodontist to
carefully study the patient’s soft tissue patterns
during the treatment planning stage. we can
assess lip morphology and tonicity, the smile arc
and smile esthetics from various angles.
 We can also assess the degree of incisal show
upon smiling. Thus, they allow us to study the
patient in a so called social setting.
 Such informations greatly aids the orthodontist in
formulating the best possible treatment plan for
each patient and for monitoring in subsequent
follow up.

7. USE OF DIGITAL
PHOTOGRAPHS
 Unreliable memories
 Medicolegal requirements
 Teaching needs
 Treatment evaluations

8. WHY GO DIGITAL

9. RESOLUTION
 It describes how much detail an image can hold.
Resolution of an image is nothing but the number
of pixels recorded in the image i.e.determined by
image’s pixel count and the bit depth of each
pixel.
 Resolution is expressed in pixels per inch (ppi)
 A high number of pixels not only increase the
quality and detail of image, but also increases the
size of file in which the image is saved.

10. There are two types of
sensors -
 CCD’S (charged
coupled device)
 CMOS
(complementary
metal-oxide semi-
conductor)

11. HOW THEY WORK
 Digital images are
made up of picture
elements (pixels)
comprising red, green
and blue light, each
set at level between 0
and 255.
 If all colours are set at
255, white colour is
the result, while if they
are set at 0 black
colour is the result.

12.  There are 256 gray shades that result on all three
colours being set in the same plane (number),
varying colours of each of 3 colours result in 16.7
million colours. Numerical value of these is stored
in CCD-charged couple device.
 The image is formed into the image sensor and the
light is gathered by tiny elements (pixels). Each of
these tiny sensors detects the amount of light falling
on them as if filtered by an over mask, which is of a
particular colour.
 This colour information is then processed by the
electronics in the camera, so that colour values
gathered from all the locations on sensor are
organized precisely, creating a map indicating

13. FOCAL LENGTH
 Focal length is the attribute of
the camera that identifies
angle of view of the lens – in
other words “how much the
camera sees”.
 Focal length is technically
defined as “the distance from
the optical path where the
light rays converge to a point
where the light rays passing
through the lens are focused
on to the image plane or the
digital image sensor.” This

14. SHUTTER SPEED
 It refers to the amount of time the shutter is open
or the digital image sensor is activated. Exposure
of the image is determined by combination of
shutter speed and the opening of aperture.

15. BURST
 Also called sequential shooting should be a part
of the package. These are devised to overcome
the shutter lag by capturing a series of images.

16. EXPOSURE
 Exposure is amount of light required to take a
photo. If there is too much light then picture will
appear washed out and with too little light the
picture appears dark.

17. EXPOSURE
COMPENSATION
 Exposure compensation serves to adjust how
metering evaluates the subject.
 It is a very simple system that serves to shift
where the metering assumes the perfect
exposure point to be, by moving it slightly towards
a brighter or darker image.

18. WHITE BALANCE
 Digital cameras to keep colour as natural as
possible in the picture basically use white
balance. To do so camera analyses the scene to
determine which area is truly white and adjusts
itself to rest of scene accordingly.
 If level of one color (red) is too high, on white
part, the camera will adjust naturally to remove
red colour and make the picture as white as
possible.

19. ZOOM
 As the name suggest zoom can take you closer to
without physically moving closer.
 Zoom lens is a must on any digital camera as they
help capture more on the subject that will be the main
focus of your snapshot.
 There are two main types of zoom –
 Optical Zoom
 Digital Zoom
 Optical zoom can bring the object closer much like a
telescope can; digital zoom is merely a cropping tool.

21. APERTURE SETTING
 This indicates the amount of light entering the
camera and striking the sensor.

22. DEPTH OF FIELD
 The areas ahead and
behind the area in
focus indicate the
depth of the field.
Depth of field
depends on aperture
and magnification.
 In normal
photography
approximately one
third of the overall
depth of field in front
of this and two third

23. AUTO FOCUS
 In clinical photography this autofocus function
should be turned off and focusing should be done
manually.
 Reasoning for switching off autofocus mode is the
fact that autofocus focusing point is in the centre
of the viewfinder in most cameras. Thus it would
not be possible to have the entire set of teeth in
acceptable focus.

24. RING FLASH
 flash may sometimes
produce fairly good light
distribution when used
for clinical
photographs.however,
frequently, distracting
shadows, which may also
obstruct important details
do occur. These are often
irrepairable using image
editing software, and will
detract from the final
quality of image and
possibly the information
gained from it .

25. MACRO LENS
 Macro photography
refers to close up
photography; the
classical definition
that the image
projected on the film
plane is the same size
as the subject.
 Normal lengths of
macro lenses are
50mm, 60mm, 90mm,
100mm, 105mm, and
200mm; the 100 or
105mm lens is best

26. FOCUSSING SCREEN
 The focusing screen is
part of the focusing
system. The mirror
projects the image onto
the screen; this image is
flipped horizontally and
vertically by the
pentaprism so that it is
the right way up and
corrected for left-to-right
reversal, allowing us to
view the image through
the viewfinder.

27. DIGITAL CAMERAS
CLASSIFICATION
They are classified
into – according to
use
 Consumer
 Prosumer
 Professional
 According To Cost -
 Inexpensive
 Entry level
 Mid range
 High range
 Professional

28. PHOTOGRAPHIC
REQUIREMENTS
 A camera should be reliable and simple.
 For high quality clinical photographs, include camera
with macrofacility, ideally a ring flash, an appropriate
background, suitable lighting and well trained assistants.
 Extraoral photographs taken in portrait mode.
 Intraoral photographs taken in landscape mode.
 Minimal adjustment should be done when changing
from intraoral to extraoral shots.
 To allow direct comparision of photographs taken at
different times consistent magnification of images is
required.the magnification will therefore be provided for
intraoral , mirror, extraoral shots.
 Mirrors an cheek retractors are available in many

29. CHEEK RETRACTORS
There are 2 sets of
double ended
retractors –
 Regular and small size
either end – used for
intraoral occlusal
shots.
 Narrow end on one
side and wide end on
the other – used for
intraoral, frontal and
buccal shots.

30. DENTAL PHOTOGRAPHIC
MIRRORS
 Mirrors are available in different sizes for use with
different patients depending on the age and mouth
opening size.
 Long handled front silvered glass mirrors are the
ideal tool for clinical photography although
significantly more expensive than rear silvered or metal
mirrors.
 In front silvered mirrors there is much greater reflection
of the light and they are more resistant to stretching.
 In front silvered mirrors – no ghost image or double
image occurs.
 In rear coated silver mirrors ghost image can severely

32. HOW MANY PHOTOGRAPHS DO WE
NEED
 There is no standard set that is universally
approved as a rule of thumb. However a
complete “clinical photographic set” should
include minimum of 9 photograph i.e. 4 extraoral
and 5 intraoral photographs.

33. REQUIREMENTS FOR EXTRAORAL
PHOTOGRAPHY
 Quality, standardized facial photographs either in black and
white or color
 Patient head oriented accurately in all three planes of
space and in Frankfort horizontal plane
 One lateral view, facing to the right; serious expression lips
closed tightly to reveal muscle imbalance and disharmony
 One anterior view serious expression
 Optional one lateral view and or one anterior view with lips
apart
 Optional one anterior view, smiling
 Background free distractions
 Quality lighting revealing with no shadows in background
 Ear exposed for purpose of orientation
 Eye open and looking straight ahead: glasses removed.

34. REQUIREMENTS FOR INTRAORAL
PHOTOGRAPHY
 Quality, standardized intra oral prints in color
 Patient dentition oriented accurately in all three
planes of space
 One frontal view in maximum intercuspation.
 Two lateral view right and left.
 Optional two occlusal view maxillary and mandibular
 Free of distraction - check retractors, labels and
fingers
 Quality lighting revealing anatomical contours and
free of shadows.
 Tongue retracted
 Free of saliva and / or bubbles
 Dentition clean.

35.  True representation of the malocclusion depends
upon correct camera positioning

36.  Vertical position also important to get
reproducible and representative photographs

37. EXTRAORAL
PHOTOGRAPHS
Consists of the following 4 shots as –
 Face frontal (lips relaxed)
 Face frontal (smiling)
 Profile (lips relaxed – right side preferably)
 3/4th profile (smiling)

42. INTRAORAL
PHOTOGRAPHS
There are 5 required intraoral photographs as –
 Frontal (in occlusion)
 Right buccal (in occlusion)
 Left buccal (in occlusion)
 Upper occlusal (mirror shot)
 Lower occlusal (mirror shot)

47. POSITION OF RETRACTORS FOR
UPPER AND LOWER OCCLUSAL
SHOTS

48. GOLD STANDARD
 Nine pre-treatment and nine post-treatment
images should be considered an absolute
minimum for each and every orthodontic patient.

49. COMMON ERRORS IN CLINICAL
PHOTOGRAPHY
 The first group comprises errors due to
inappropriate choice or use of equipment
including the camera, lens, flash, retractors,
mirrors or suction, or a lack of understanding of
the digital technology resulting in inadequate or
inappropriate images.
 The second group of errors relates to any
recording medium and involves inappropriate
positioning of the subjects.

50. Correct camera orientation is important
 Extra-oral photographs taken in portrait mode
 Intra-oral photographs taken in landscape
mode

51. Problems Related Exclusively To Digital
Photography:
 Depth of field
 Auto Focus
 Shadows
 Constructing Symmetrical images
 Image Storage
 Digital image—fit for purpose

53.  Dark right buccal corridor as cheek prevents
light from left mounted flash

54. MISREPRESENTATION OF
SKELETAL PATTERN
 A.Head tilted
forward,
exaggerating
mandibular
retrognathia.
 B. Head tilted
backward, giving
Class III
appearance.

55. Differing skeletal pattern purely due to patient positioning errors

56. Common errors include canted occlusal planes, inappropriate selection
and use of cheek retractors

57. A. Sagittal discrepancy misrepresented in shot with
inadequate retraction and poor camera position.
B. Shot repeated perpendicular to posterior segment with
proper retraction

58. POST PROCESSING OF DENTAL
IMAGES
 Downloading to computer
 Flipping
 cropping
 Enhancing
 Scratch removal
 Saving images

61. CONCLUSION
The ideal features of a compact digital camera can be
summarized as follows:
 Lens system with a high focal length and a powerful zoom,
allowing intraoral photography with at least a magnification
comparable to the 1:2 lens of 35mm cameras.
 Optical resolution of at least 500,000 pixels.
 Clinically useful resolution of at least 400,000 pixels (depending
on the two previous criteria).
 Both auto and manual focus.
 Ability to use a ring flash.
 Optical reflex viewfinder, or LCD with a high refresh rate.
 Capability of reviewing the recorded image on the viewfinder
screen.
 Ability to manually tune exposition parameters.
 Rechargeable batteries and AC connection.
 External memory that will store an adequate number of images
and speed up file transfer to the computer.

62. REFERENCES
 Digital Photography in the Orthodontic Practice
GIORGIO FIORELLI, MD, DDS, ENRICO PUPILLI, DDS, BIAGIO PATANÈ , MD,
DDS, JCO-2003
 How to avoid common errors in clinical photography
H. F. MCKEOWN, A. M. MURRAY, P. J. SANDLER, JOURNAL OF
ORTHODONTICS 2005
 Digital Photography in Orthodontics
JONATHAN SANDLER, ALISON MURRAY, journal of orthodontics 2001
 Clinical Photography in Orthodontics
JONATHAN SANDLER, BDS(Hons), MSC, FDS RCPS, MOrth RCS, ALISON
MURRAY, BDS, MSC, FDS RCPS, MOrth RCS jco 1997
 The cutting edge JAMES MAH, DDS, MS, DMS jco 2002
 A short guide to clinical digital photography by SHADI S. SAMAWI BDS M.ORTHO
RCS
 The manual of photography by JACOBSON AND RAY.

63. THANK YOU