Photography in orthodontics

1. DR.THABASSUM PARAKKAL
1ST YEAR P.G
DEPT. OF ORTHODONTICS
PHOTOGRAPHY
IN
ORTHODONTICS

2. 2
• CONTENTS:
• INTRODUCTION
• HISTORY
• EVOLUTION OF PHOTOGRAPHY
• HISTORY OF PHOTOGRAPHY IN
ORTHODONTICS
• PHOTOGRAPHY IN ORTHODONTICS
• DIGITAL PHOTOGRAPHY
• CAMERA BASICS
• THE SCIENCE OF PHOTOGRAPHY

3. • USING FLASH FOR INTRAORAL
PHOTOGRAPHY
• PRACTICAL TIPS IN ORTHODONTICS
• INTRA ORAL IMAGES
• FACIAL PHOTOGRAPHY
• ERRORS IN PHOTOGRAPHY
• SOFTWARES USED IN CLINICAL
PHOTOGRAPHY
• CONCLUSION

4. INTRODUCTION
The word photograph comes from the greek words ‘Phos’ and ‘Graphien’.
• Phos – light
• Graphien- To draw
• 1839,John Herschel coined “ Photography”.
• Photography is the process of making pictures by means of the action
of light.
4
Clinical Photography in Orthodontics, Sreesan NS et al.,Int J Oral Health Med Res,2016

5. • Light reflected from an object forms a picture on a material
sensitive to light.
• This picture is then chemically processed into a photograph; which
provides a representation of the object.
• Photography in medical science
• Microscopic picture of human bone
5
Clinical Photography in Orthodontics, Sreesan NS et al.,Int J Oral Health Med Res,2016.

6. HISTORY AND EVOLUTION
• 1st camera – Italy. ,1502 AD.
• ‘CAMERA OBSCURE’ (dark chamber).
• Huge box with a tiny opening on one
side.
• On the opposite side ,light form an
inverted image.
6
Nicéphore Niepcé’s first photography camera – made using a
silver chloride-coated piece of paper as the ‘Film’

7. 1816
• The person who took the first photograph
was Nicéphore Niepcé, a French inventor.
First photograph by Niepcé

8. First Publicly Available Photography
Process (Daguerreotype) – 1833
Louise Daguerre managed to figure out the world’s first
photographic process in 1833.

9. First Film Camera – 1859
• Thomas Sutton received a
patent for the first-ever
panoramic camera.
• Built using a wide-angle lens
consisting of a water-filled
glass sphere.

10. The “Kodak” by George Eastman – 1888
• used celluloid film
Groundbreaking camera by George Eastman– the “Kodak”

11. First Mass-Market Camera (The Brownie) –
1900
• Eastman was also responsible
for the next big step in
photography.
• introduced the Brownie
camera, the first mass-
marketed camera in the world.
Kodak’s brownie is the first mass-market camera.

12. First 35mm Film Camera – 1910
• The German engineer, Oskar
Barnack.
• Canon joined the market in
1936 as well, introducing their
Canon 35mm rangefinder.
The first-ever 35mm camera developed by Oskar Barnack

13. First Single-Lens Reflex Camera (SLR) –
Late 1920s.
• It was the elaborately named Franke
& Heidecke Rolleiflex medium format
TLR (Twin Lens Reflex).

14. Single-lens reflex cameras (SLR) – 1948
• First Single-Lens Reflex
camera (SLR) with an
instant return mirror is
the Gamma
Duflex (made in Hungary
Gamma Duflex is the first SLR camera with an instant return mirror –
1948

15. First polaroid Camera – 1948
First-ever polaroid – 1948
In 1948, Edwin Land introduced his Polaroid
camera, which allowed photographers to take a
photo and print it in mere minutes.

16. First Digital Camera System – 1975
• The first camera which used an image
sensor, instead of a film, was invented by a
Kodak engineer by the name Steven Sasson.

17. DSLRs and Smartphones Take Over –
21st Century

18. HISTORY OF PHOTOGRAPHY IN
ORTHODONTICS
• The history of dentistry and photography began in 1840
• when the first dental school was opened, and the world's first photographic
gallery was opened .
• Operated by a dentist turned photographer.
• Photography has become an integral part of a patient's record and treatment
plan. The specialty of orthodontics has led the way in this model of recording
patient data.
Galante, Donna. (2009). History and current use of clinical photography in orthodontics.. Journal of the
California Dental Association. 37. 173-4.

19. • 1980’s the most important invention in dentistry – DIGITAL
PHOTOGRAPHY.
• Digital photography combines the best of the three
photographic concepts: the quality of 35mm film, the speed
of instant photography, the computerized integration of
video.
• Dr. Edward Angle (Father of Orthodontics) was first known
orthodontist to photograph his patients as part of his
diagnostic workup.
19
DIGITAL PHOTOGRAPHY

20. IMPORTANCE OF PHOTOGRAPHY IN ORTHODONTICS
• Case records(photo documentation)
• Patient education
• Understand her/his condition
• Need for treatment
• Visualize potential improvements
• Improves confidence
• Evaluation of progress
• Interactive treatment planning
• Diagnostic aid
20

21. • Teaching
• Publication / Clinical research
• Communication with colleagues
• Record keeping
• Legal protection
21

22. Digital photography
• Checkable exposure accuracy
• No ageing of photos
• Dust and scratches are irrelevant
• Immediate viewing
• No film or processing costs
• Inexpensive storage
• Easy retrieval
• Duplication easy
• Transmission around the world in
seconds is entirely feasible.
Sharath Kumar Shetty et al , International Journal of Dental Research, (2017)

23. • Digital images made up picture elements
(pixels) of Red, Green and Blue light at levels
between 0 and 255.
•
23
Sandler J, Murray A. Digital photography in orthodontics. J Orthod. 2001 Sep;28(3):197-
201.
History of digital photography

24. 2.Professional cameras
JONATHAN SANDLER, ALISON MURRAY. Journal of Orthodontics, 2001
Basic price of Nikon/Kodak DCS
£10,495
24
1.Prosumer cameras
One type of digital camera (prosumer) falls into the
midrange price bracket £500–1500 and lies between
the consumer camera and the professional models.
They usually have a host of useful features including
macro-zoom lenses and potentially high image
quality.

25. Low pixel count results in poorer quality image Image required for orthodontics
25

26. 26
Slightly different technique used for occlusal shots with point flash shadows less but pixels wasted

27. Point flash intra-oral images are invariably inferior to ring flash due to shadowing and variable exposure.
27

28. Fuji Si FinePix Pro plus Nikon SB29 flash.
JONATHAN SANDLER, ALISON MURRAY. Journal of Orthodontics, 2001
28
Another digital camera recently released is the Fuji FinePix S1
Pro, which may be the perfect digital camera for orthodontics

29. 29
Top pictures with point flash and no TTL metering, bottom with FujiS1Pro.

30. JONATHAN SANDLER, ALISON MURRAY. Journal of Orthodontics, 2001
Kodak DX7590 -Dental Digital Photography System
30

31. Nikon - D100 digital SLR
JONATHAN SANDLER, ALISON MURRAY. Journal of Orthodontics, 2001 31

32. Nikon D200 digital SLR
32
The camera to be used in a busy
multiuser situation should be kept
easily accessible .
and capable of producing high quality
images over and over again, with few
camera adjustments required.

33. CAMERA BASICS
• DSLR camera
• SLR camera
• LENS

34. TYPES OF LENS
• STANDARD LENS
• WIDE ANGLE LENS
• TELEPHOTO LENS
• ZOOM LENS
• MACRO LENS
34

35. STANDARD LENSES
Similar to human field of vision
35

36. WIDE ANGLE LENSES
For landscapes..
36

37. TELEPHOTO LENSES
• To capture distant images
37

38. • ZOOM LENSES

39. • MACRO LENS
39

40. File formats
• JPEG
• RAW
• TIFF

41. DICOM
• Digital Imaging and Communications in Medicine
• a standard protocol for the management and transmission
of medical images and related data.

42. THE SCIENCE OF PHOTOGRAPHY

43. APERTURE
• It is a hole through which the light passes
from the subject to the film.
• Lower the number greater the aperture size
and vice-versa.
43

44. Aperture and Area of sharpness -
• SMALL aperture- little light- render
subject sharply.
• LARGE aperture- more light-
captures shallow plane clearly.
44

45. 1.4
8
4
22
45

46. • The aperture does this either by opening or
closing , and allowing more or less light to pass
through.
• Some lenses have a rotating ring on the lens
barrel called the aperture selection ring.
46

47. • The various sizes of the aperture are called ‘f’ stops or ‘f’ numbers.
• The f-stops start from 1.4 and go up to 32.
• Easy calculation:
1.4, 2, 2.8, 4, 5.6, 8, 11, 16, 22, 32
47

48. • the higher the number, the lesser the amount of light that is allowed to pass
through.
• For example
• If you ‘open up’ the setting from f/11 to f/8 the aperture admits twice as much light.
• If you ‘stop down’ from f/11 to f/16, the aperture admits half as much light.
48

49. SHUTTER SPEED
• The purpose of the shutter is to protect the film
from light until the chosen moment.
49

50. FILM SPEED/ISO
• 3rd factor which affects the exposure.
50

51. EXPOSURE
It is the total amount of light that reaches the film in the camera.
i.e. intensity of light x time.
Shutter speed + aperture
A(aperture priority)
S(Shutter priority)
M(Manual priority)
P(Programme mode)
51

52. DEPTH OF FIELD
52
Depth of field

53. The advantage of taking the intraoral views at
f/32 is the enormous depth of field, which
ensures that the maximum amount of the
area of interest is in crisp focus

54. PHOTOGRAPHY LIGHTINGS/FLASH
• POINT FLASH
• RING FLASH

55. POINT FLASH

56. RING LIGHT

57. POINT FLASH VS RING FLASH
57

58. PRACTICAL TIPS …
Holding a camera.
Flash less photography – 1/60s for 50mm lens
1/250 for 200mm lens
A major advantage of the digital camera is the ability to view the image immediately which
instantly allows an out of focus shot to be repeated.

59. • Working distance
• Magnification – Macro lens
• Proper aligning
• Consistency and colour

60. INTRA ORAL IMAGE

61. FRONTAL

62. Graber, Vanarsdall, ORTHODONTICS CURRENT PRINCIPLES AND TECHNIQUES, SIXTH EDITION. 62
The right buccal The left buccal
LATERAL VIEWS

63. 63
OCCLUSAL VIEWS
The maxillary occlusal The mandibular occlusal

64. It is important to…
• Instruct patients to tilt the head back as far as possible when
taking occlusal views .
• Just before the photograph is taken ask them to ‘open about
twice as wide’.

65. Tips to maximize quality of occlusal shots:
• Smallest end of small retractor pulled up, laterally and forwards.
• Long-handled, front-coated mirror.
• Warm the mirror.
• Patient to hold his/her breath.
• Use aspirator.
Clinical Photography in an Orthodontic Practice Environment Part 2., Jonathan Sandler, Alison Murray,
Orthodontic Update, 2010 65

66. • CHEEK RETRACTORS
• MIRRORS
• CONTRASTERS
OCCLUSAL
ANTERIOR
• LIP RETRACTORS
With all mirror shots, it is possible to reduce the problem of fogging by warming the mirror in hot
water just prior to use in the mouth.
ACCESSORIES FOR INTRA ORAL
PHOTOGRAPHY

67. Accessories
Lip rectractors Cheek retractors mirrors
Occlusal contrasters
Anterior contrasters

68. Occlusal contrasters with black background .
This view demonstrates micro aesthetic characteristics such as tooth shape, color, zeniths,
embrasures and connectors
Graber, Vanarsdall, ORTHODONTICS CURRENT PRINCIPLES AND TECHNIQUES, SIXTH EDITION. 68

69. 69
McKeown, Murray, Sandler. JO ( 2005)
The most important pieces of
equipment for securing high
quality clinical views, once the
correct camera has been selected,
are ..
Cheek retractors, which must be
used correctly to ensure success.

70. McKeown, Murray, Sandler. JO ( 2005)
70

71. Tips to maximize quality of intra-oral shots
• Correct retractors.
• Manual focusing;
• Quality camera with Flash/Lens combination allowing F32.
• Occlusal plane horizontal, front to back, as well as left to right;
• Use aspirator.
Clinical Photography in an Orthodontic Practice Environment Part 2., Jonathan Sandler, Alison Murray,
Orthodontic Update, 2010 71

72. EXTRA ORAL PHOTOGRAPHS/FACIAL
PHOTOGRAPHS
• Frontal view
with lips relaxed
smiling
• Profile view
• Oblique/three quarter view
• Smile .

73. FRONTAL
73
Frontal at rest Frontal dynamic (smile)

74. 74
A close-up image of the posed smile.

75. 75
PROFILE IMAGES
Profile at rest with lips relaxed Profile smile

76. 76
OBLIQUE (THREE-QUARTER, 45-DEGREE) VIEWS
Oblique at rest.
Oblique on smile

77. Oblique close-up smile

78. SUBMENTAL VIEW
78

79. Tips to maximize quality of extra-oral shots:
• Subject at same height as photographer.
• Patient’s hair behind his/her ears;
• Frankfurt plane horizontal;
• Non-reflective background and eliminate shadows.
• Focus on automatic, on nearest lower eyelid on all EO shots.
• Lips in repose and wide smiling.
Clinical Photography in an Orthodontic Practice Environment Part 2., Jonathan Sandler, Alison Murray,
Orthodontic Update, 2010 79

80. Important Points to Note……
• When Taking Extraoral Photographs
• Have different sized steps available, to get the photographer and
the subject at the same height.
• Have a non-reflective background behind the patient.
• Consider back lighting the patient to illuminate the background
using an accessory slave flash.

81. SOFTWARES USED IN CLINICAL
PHOTOGRAPHY
• Dolphin imaging
• Adobe photoshop
• Acdsee
• PS software photpgraph editor
• 3D system photomodeler

82. ERRORS IN CLINICAL PHOTOGRAPHY
82

83. Post processing digital image
• IMAGE EDITING
A rather disappointing photograph.
The image needs rotation and cropping
After rotation. Occlusal plane is now horizontal.
Demetrios et al., American Journal of Orthodontics and Dentofacial Orthopedics, 2000. 83

84. • After cropping, note that some areas of the image are white because cropping
included parts of the rotated image that were not present in the original.
Demetrios et al., American Journal of Orthodontics and Dentofacial Orthopedics, 2000. 84

85. McKeown, Murray, Sandler. JO ( 2005)
85
Ghost image from
glass mirror

86. Problems related to Digital Photography
1. Depth of field.
2. Auto focus.
3. Shadows.
4. Constructing symmetrical images.
5. Image storage.
McKeown, Murray, Sandler. JO ( 2005)
86

87. Depth of field problems
depth of field is distributed approximately one-third in front and two-thirds behind the focal plane
McKeown, Murray, Sandler. JO ( 2005)
87

88. Auto-focus problems
McKeown, Murray, Sandler. JO ( 2005)
88

89. Shadow
McKeown, Murray, Sandler. JO ( 2005) 89

90. Light box behind the patient eliminates shadows completely
‘Noise’ in the background detracts from the photograph
McKeown, Murray, Sandler. JO ( 2005)
90

91. McKeown, Murray, Sandler. JO ( 2005)
91

92. Card problems
McKeown, Murray, Sandler. JO ( 2005)
92

93. CCD problems
McKeown, Murray, Sandler. JO ( 2005)
93

94. Positioning errors
McKeown, Murray, Sandler. JO ( 2005)
94

95. McKeown, Murray, Sandler. JO ( 2005)
95

96. McKeown, Murray, Sandler. JO ( 2005)
96

97. Intra-oral photographs
McKeown, Murray, Sandler. JO ( 2005)

98. McKeown, Murray, Sandler. JO ( 2005)
98

99. Quality of clinical photographs taken by
orthodontists, professional photographers,
and orthodontic auxiliaries.
• Sandler J, Dwyer J, Kokich V, McKeown F, Murray A, McLaughlin R, O'Brien C, O'Malley P. Quality
of clinical photographs taken by orthodontists, professional photographers, and orthodontic
auxiliaries. Am J Orthod Dentofacial Orthop. 2009 May;135(5):657-62

100. Assessment of orthodontic treatment need: a
comparison of study models and facial
photographs.
• Sherlock JM, Cobourne MT, McDonald F. Assessment of orthodontic treatment need: a comparison of study
models and facial photographs. Community Dent Oral Epidemiol. 2008 Feb;36(1):21-6.

101. Accuracy of Dental Monitoring 3D digital
dental models using photograph and video
mode.
Morris RS, Hoye LN, Elnagar MH, Atsawasuwan P, Galang-Boquiren MT, Caplin J, Viana GC, Obrez A, Kusnoto B.
Accuracy of Dental Monitoring 3D digital dental models using photograph and video mode. Am J Orthod
Dentofacial Orthop. 2019 Sep;156(3):420-428

102. Diagnostic accuracy of intraoral photographic
orthodontic records.
• Jackson, T. H., Kirk, C. J., Phillips, C., & Koroluk, L. D. (2018). Diagnostic accuracy of
intraoral photographic orthodontic records. Journal of Esthetic and Restorative
Dentistry.

103. Quantification of maxillary dental midline
deviation in 2D photographs
• Alarabi AM, Revie GF, Bearn DR. Quantification of maxillary dental midline deviation in
2D photographs: Methodology trial. Int Orthod. 2019 Jun;17(2):312-323.

104. CONCLUSION

105. REFERENCES
• Orthodontics ,diagnosis management of mal occlusion and dentofacial deformities,3rd
edition,Om P Kharbanda
• Shadi samawi. Guide to clinical dental photography in orthodontics.2008.
• Orthodontic Pearls: A Selection of Practical Tips and Clinical Expertise; Eliakim Mizrahi.
(2004) Taylor & Francis. (Chapter 6: Orthodontic Samawi Photography, by PJ Sandler, AM
Murray)
• B, Sharath & Yethadka, Mahesh & Sreekumar, Chandrima. (2017). Digital photography in
orthodontics. International Journal of Dental Research. 5(2): 135.
• Galante DL. History and current use of clinical photography in orthodontics. J Calif Dent
Assoc. 2009 Mar;37(3):173-4.
• Palomo JM, Wolf GR, Hans MG. Use of digital photography in the Case orthodontic clinic.
Am J Orthod Dentofacial Orthop. 2004 Sep;126(3):381-5.
• Sandler J, Murray A. Digital photography in orthodontics. J Orthod. 2001 Sep;28(3):197-
201.
• Casaglia A, DE Dominicis P, Arcuri L, Gargari M, Ottria L. Dental photography today. Part 1:
basic concepts. Oral Implantol (Rome). 2016;8(4):122-129. Published 2016 Jul 23.

106. • Jackson, T. H., Kirk, C. J., Phillips, C., & Koroluk, L. D. (2018). Diagnostic accuracy of
intraoral photographic orthodontic records. Journal of Esthetic and Restorative
Dentistry.
• Sandler J, Dwyer J, Kokich V, McKeown F, Murray A, McLaughlin R, O'Brien C,
O'Malley P. Quality of clinical photographs taken by orthodontists, professional
photographers, and orthodontic auxiliaries. Am J Orthod Dentofacial Orthop. 2009
May;135(5):657-62.
• Sherlock JM, Cobourne MT, McDonald F. Assessment of orthodontic treatment
need: a comparison of study models and facial photographs. Community Dent Oral
Epidemiol. 2008 Feb;36(1):21-6.
• Morris RS, Hoye LN, Elnagar MH, Atsawasuwan P, Galang-Boquiren MT, Caplin J,
Viana GC, Obrez A, Kusnoto B. Accuracy of Dental Monitoring 3D digital dental
models using photograph and video mode. Am J Orthod Dentofacial Orthop. 2019
Sep;156(3):420-428.
• Alarabi AM, Revie GF, Bearn DR. Quantification of maxillary dental midline
deviation in 2D photographs: Methodology trial. Int Orthod. 2019 Jun;17(2):312-
323.

107. • Halazonetis DJ. Guidelines for preparing and submitting images for publication. Am J Orthod Dentofacial
Orthop. 2001 Oct;120(4):445-7. doi: 10.1067/mod.2001.119572. PMID: 11606971.
• Galante DL. History and current use of clinical photography in orthodontics. J Calif Dent Assoc. 2009
Mar;37(3):173-4. PMID: 19830981.
• McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod. 2005 Mar;32(1):43-
54.
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