Digital Photography Fundamentals

Filling in the Gaps Martin B. Goldstein DMD

According to Dr. Greg Lutke there are 5 dimensions of a digital photograph

Exposure; monitored by the histogram Tonal Range; adjusted in software post processing Color; controlled by white balance/color temperature setting of your camera Sharpness; influenced by camera shake and use of the unsharp mask in post processing Depth of Field; controlled by the F stop setting of the camera

The Good News:

Camera settings are pre-set on a one time basis (except for F stop) Software Post Processing is Simple

The Chip that makes it happen.

The cameras sensor is a Tiny Wonder And is supported by the cameras built in micro-processor

In dentistry we need a bigger bucket: Sensor Size

24 X 36 mm

Digital SLRs.

22.2 X 14.8 mm

Point and shoots.

7.8 X 5.32 mm

Digital Camera Sensors contain millions of photo-sites or diodes

Conventional photography uses chemical compounds to record light Digital photography uses tiny light-sensitive photosites to detect light Each Photo-site is responsible for a PIXEL
Pixels = picture elements

Portmanteau is a Lewis Carroll term for combining two words into a new word..Thus, the PIXEL (picture + element)

Pixels Make The Image

Resolution
Resolution refers to the number of pixels on a CCD
5 x 4 = 20 pixel CCD 10 x 8 = 80 pixel CCD

2272 X 1704 for a 4 megapixel camera

When you think resolution think file or image SIZE hold that thought..

Exposure Variables
Shutter Speed Aperture Setting Iso setting Light source Exposure Compensation White Balance

Shutter Speed=length of time the camera sensor is exposed to light

In dental photography the shutter speed is a constant We use the cameras flash synch speed The flash synch speed is the fastest shutter speed that can ordinarily be used to take a picture with an electronic flash. Typical value would be 1/200 of a second. (Rebel Xti) 1/250 for a 40D. The faster the better so as to reduce the effects of camera shake We set it and forget it!

Our chief variable is altering the size of the aperture.

Aperture Priority

Whats an FF-Stop?? OrHow Aperture Effects Image Focus

Depth of Field Is Critical to Our Efforts

F stop settings hint:

Think high number=more depth of field=more image clarity (F22-F32) Thing low number=less depth of field=less image clarity (F5.6-F8.0)

ISO=International Organization for Standardization

ISO is the yardstick for sensitivity to light The higher the ISO, the faster the speed of the camera with respect to image recording Digital SLRs now feature ISOs up to 3200 and up useful for low (light photography:VELscope) In dental digital photography (flash-based) we set it and forget it at 100. This keeps noise out of the picture

Light Sources
Flash photography; Ring flash, Point Source, Dual Point Source; Combined point source and ring flash Can be controlled by TTL or ETTL: Evaluative Through the lens metering; The camera tells the flash when to turn off! This is how WE DO IT. We are using automatic exposure controls vs manual exposure controls

What is a Histogram?
The histogram is simply a graph that allows you to judge the brightness of an image. You can think of the area under the graph as comprising all the pixels in your captured digital image. The left side of the histogram depicts how many "dark" pixels you have captured; the right side, how many "bright" pixels you have captured.

Histograms: They can guide us in setting the Exposure Compensation Value as well as onthe-fly aperture setting adjustments

Image too dark

Image just right With peak just left of center

Image too light

What is Exposure Compensation?

A pre-determined exposure adjustment matched to the cameras system components; It adjusts the Exposure Value It over-rides what the camera initially tells the flash and adjusts the flash output up or down Typically +1 in the Canon systems

White Balance
Influences color temperature of image; warm (gold/yellow) to cold (bluish) Can be pre-set to Kelvin value (5000-5700); Canon allows setting variables in 100 degree increments Can be pre-set to daylight setting or flash setting Can be pre-set using Custom white balance Photomed presets this value in cameras shipped in kit form.

A word about Custom White Balance

Macbeth Mini Color Checker Chart

Color Calibration for your monitor

Typical SLR settings for dental photography shooting in Aperture Priority Mode Av
Shutter Speed: Flash Synch Speed of 1/200 of a second to 1/250 F Stops: 22-32 for close ups, 5.6-6.7 for portraits ISO = 100 Quality setting to highest offered by camera (may include simultaneous RAW recording) Flash set to ETTL for automatic exposure control Color temperature: 5000 to 5700 Kelvin or daylight Exposure Compensation +1 All values (except F stop) are pre-set by Photomed before shipped to you; not to worry

Photomeds Quick Start Guides Worth the price of admission

Image Quality is pre-determined by format capture selection: JPEG vs RAW

The concept of compression factors in! Compression happens in the camera but can happen in software applications as well

With Respect to Image Quality Settings: Image Size (resolution) and Quality are options that you choose when you set up your camera for the first time Canon and Nikon Settings Combine both

File Formats: JPEG vs RAW

JPEG = Selectable Compression JPEG = A lossy format JPEG = Most compatible format JPEG = less room on memory cards JPEG = can reduce file size by a factor or 20 or more JPEG = in camera and out of camera selectable compression

In the RAW; All you need to know

RAW is the broad term applied to all the proprietary formats created by each digital camera manufacturer RAW is not compressed; Sensors native resolution RAW eliminates camera pre-sets such as white balance, sharpness, color saturation, exposure, etc You fix em up after the image is captured RAW is your digital negative; archive them AACD submissions are done in RAW Shoot with your cameras JPEG+RAW option A 12 megapixel camera can save 132 JPEG FINE+RAW image pairs on a 4 GB card Most popular 3rd party converter: Adobe Camera Raw supplied with Photoshop Elements and Photoshop CS Canon RAW = CR2 or CRW Nikon RAW = NEF

ADOBE RAW as found in Adobe PhotoShop Elements

Whats a magnification ratio?

The magnification ratio is the ratio of the size of the image projected on the sensor compared to the actual size of the object. A magnification ratio of 1:10 means that the image on the sensor is 1/10 of life size. magnification ratio of 1:1 indicates a life size image on the sensor. The more an image is magnified, the larger it is projected on the sensor which results in a larger image seen on the view screen.

Magnification Ratios

1:1 = actual size of imaging media In the case of XSi: 9/10s inch which = about 3 teeth 1:2 = about 8 teeth (1.8 inches imaged) 1:3 = full anterior retracted (just under 3 inches imaged)

1:1 magnification

1:3 magnification

Focusing Options: Manual focus vs Autofocus

What is Autofocus and when should you use it?

In Manual Focus mode, using the magnifcation ratio scale will guarantee consistent image sizes and illumination. Auto-focus is fast but will yield varying sizes and illumination as your distance from the subject will vary.you can be in focus anywhere.

Magnification Ratios on a Canon lens

Digital Film

USB cable

Digital Film Reader

Image Tranfer Options

Eye-Fi Card PC

USB port

Post Processing Classification

Global Editing: cropping, sharpening, brightening, darkening, changing contrast, etc Spot Editing: similar to above but involves limited areas in your image, ie brightening a smile Focal editing: changing content at the pixel level as in using the clone tool to remove an uwanted spot

Post Imaging Processing Made Easy for JPEG images the ADOBE way
Straightening; use the straightening tool Cropping Levels Adjustment Ctrl L Unsharp Mask

Saving

This can all be done in Adobe Photoshop Elements 7.0

Enhancing your imagess tonal range with the histogram

Courtesy of Dr. Greg Lutke of Plano, Texas

 The Schmutz tool..(Clone Tool) The Healing Brush works as well.

The Alt key marks the spot that will clone to whats under your brush

Folder Management and More Move it, Save it, Fix it, Re-Save it

Summary of Post Processing in ADOBE PhotoShop Elements

Straighten tool used to level the shot Cropping Tool to create a 4X6 format Levels tool to expand tonal range : left carrot moved to beginning of graph; right carrot to clip of the right side (Ctrl L) Unsharp Mask to sharpen the image : Amount: 100, Radius: 3 pixels, Threshold: 0% Save as jpeg to desired size; I use 750 KB to 1 MB via the quality prompt when saving in Adobe Photoshop Elements

Digital SLR Outfits and accessories

The Latest and Greatest

SLR Pros
See what the lens sees (nearly 95% of life size!) Easy to focus Ultra close images made easy Extremely high depth of field possible Faster to operate

SLR Cons

More expensive Heavier and take up more counter space Requires extra sets of batteries for flash unit

Latest SLR outfit Price Points

Canon Rebel Xs and Xsi Canon 50D Nikon D90 Nikon D300 and D700 (Starting at $1800) (Starting at $2500) (Starting at $2200) (Starting 1t $2900)

Includes basic components in Kit form: camera body, macro lens and ring flash as well as needed accessories. (case, battery charger, Quick Start guide, flash memory); Photomed Pricing

SLR outfits are best sold as kits

Flash Unit Options

Sigmas EM-140 DG

Canons MR-14 EX

Nikon SLR with Nikon wireless flash and Photomed flash bracket
Nikon R1 and R1C1 macro flashes as well as standard flashes

Next to lens for deep intraoral close-ups

Away from lens for anterior shots

Canon MT-24EX Twin Light Macro Flash

Split flash Nikon vs Ring Flash Canon

Split Flash with Nikon

Ring Flash with Canon

The Most Popular Mirror Shapes.

Top shelf Mirrors

Ultra-bright coating Photomed mirror handle with Titanium mirror

Doctorseyes occlusal mirror www.jlblosser.com

Printer Heaven.Weve arrived What do you need in your office?

The Canon Pixma series / HP Photosmart series

What makes a stand-alone?

Ink Vending Machines.

More colors for more accurate: six colors as a minimum

The All-In-One Printer

Sweet Spot Printer of the month

The HP Photosmart C7280 with Premium Plus Photo Paper; Soft Gloss, 50 pack Features printer, copier, fax, film card reader, six ink colors and is wireless (estimated street cost: under $250)

Epson Notables
Stylus Photo R1900 with Ultrachrome Hi Gloss pigment ink; 13 X 19 format printer Artisan 800 All In One with Claria Six color ink and hi-tech touch panel screen PictureMate Dash or Zoom

A Suitable Combo A mini ink jet in your operatories An All In One in a private office where a PC is located for full size prints and text

Photographic Documentation
AACD Accreditation Photography

Our model, Sandy

Full Face, Frontal View 1:15 magnification, non-retracted

Horizontal only with chin near the lower border Full natural smile, relaxed facial muscles Patients nose is the center point Use the interpupillary line and vertical midline of face to orient the camera. Use a uniform non-distracting, non-reflective background Take the photo straight on, avoiding angulations

Full Smile, Frontal View 1:3 magnification, non-retracted

Document the maximum amount of teeth and gingiva shown during a broad smile The vertical center is the philtrum of the upper lip The incisal plane of the upper teeth should be the horizontal midline of the photo Capture any cants or midline discrepancies Focus on the centrals and laterals

Full Smile 1:3 magnification Right and Left Lateral Views, Non-Retracted
The vertical midline should be the lateral incisor The horizontal midline should be the incisal plane, perpendicular to the vertical midline. Focus on the lateral incisor Some background maybe visible on the contra-lateral side Not a sagital view; contralateral central should be in view

Upper and Lower Teeth, Frontal View 1:3 magnification, Retracted View

Upper and lower teeth slightly parted Show as much gingiva as possible Minimize appearance of lips and retractors Vertical midline: midline of face Horizontal midline: incisal plane of uppers Camera 90 degrees to the subject, avoid tilting

Upper and Lower Teeth Right and Left Lateral View, 1:3 Retracted
Upper and lower teeth slightly parted, incisal edges visible Show as much gingiva as possible Minimize retractors and lips from shot Vertical midline: lateral incisor Horizontal midline: incisal plane This is not sagital; the contralateral central (and more) should be visible

Maxillary Anterior View 1:1.5 Magnification; Retracted View

Vertical Reference: midline and frenum Horizontal Reference: midline of photo should bisect the central incisors No retractors visible; contraster optional 90 degrees 4 to 6 teeth in the frame

Close Up with Contraster

Contrasters From Photomed

Maxillary Anterior View, Retracted Right and Left Lateral View, 1:1.5,

The lateral incisor is centered to bisect the view vertically Horizontal reference: the midline bisects the lateral incisor No retractors or opposing teeth visible Photo at 90 degrees to the facial of the lateral 4 to 6 teeth in the frame

Maxillary Arch; Occlusal View 1:3 Magnification, Retracted with mirror

Taken with mirror and retractors The facial surfaces of the centrals should be visible near the edge of the photo Minimize mirror edges and lips. Patients nose should be excluded Photo should extend from the central incisors to the mesial of the second molars Can be taken in front of or behind patient

Mandibular Arch; Occlusal View 1:3 Magnification, Retracted with mirror

Taken with mirror and retractors The facial surfaces of the centrals should be visible near the edge of the photo Minimize mirror edges and lips. Photo should extend from the central incisors to the mesial of the second molars The patients tongue should not hide the teeth Can be taken in front of or behind patient

Non Retracted Views

Retracted Views

The 12 AACD Required Views

AACD image submissions

http://www.aacd.com/index.php?module=cms&page=141

Shot Taking for the Rest of Us

1:15 Frontal Full Face Smiling (The Portrait) 1:3 Frontal Smile 1:3 Front Retracted, teeth in occlusion 1:3 Maxillary Occlusal View 1:3 Mandibular Occlusal View

The Basic Exam Set

Cheek Retraction

Frontal Retracted

Full Smile

Upper Occlusal

45 degrees

Lower Occlusal Shot

Up/Down and Away Occlusal Shots

Occlusal Shot Tips

Retract the cheeks up and out / down and out Hold the mirror against the opposing arch Have patient reclined about 30 degrees back Use 1:3 magnification If the tongue is problematic on the lower, ask patient to move their tongue behind the mirror Air to defog the mirror Wide end of mirror first As close to perpendicular to mirror as possible (45 degrees closer to reality) Mirrored shots need to be flipped vertically in software

Occlusal Image Considerations

If shooting in front of the patient, flip image to vertical mirror image to obtain proper perspective: Thumbs Plus will do this in one step with the vertical flip tool.

Ideal Occlusal shots

Quadrant Shots are useful when there is difficulty getting an adequate occlusal shot

Buccal Shots are simply obtuse retracted shots.

Shade Taking Shots

1:3 magnification Taken with two closest shade tabs (one lighter and one darker) In same verticle plane as teeth you are matching Wet with water or glaze liquid

Some Bonus Photo Tips

Brace yourself against the chair when taking photos.this will steady you Vaseline to lips or retractors will ease retractor placement For occlusal shots, the mirror is at least 45 degrees to arch, focusing on bicuspids (closer to perpendicular the better) Turn the patients head towards you to facilitate the imaging. Use Quadrant shots when wishing to zoom in on a particular area of interest Wear Glasses when using an LCD if you normally do Peripheral lighting only from your overhead light; excess light will confuse the flash sensor

Portraiture
Two Varieties 1. Clinical as in the AACD horizontal Full Face Frontal View (landscape mode) 2. Enhanced Vertically Oriented Portrait: Suitable for Simulation.

Summary of Tips for Effective Portraits

Distance: 6 to 8 feet from patient: zoom in F 5.6-6.7 or portrait mode Camera turned vertically Lens perpendicular to the nose Focus on the teeth; lock focus Recompose to fill LCD with face Have patient say hiiiieeeeeee Steady as she goes: count 1.1000 after shutter release Check for little white focus points

Distance is key

The message: Back up and zoom in

Portrait Enhancements A set of useful tools

Portable Portrait Photo Enhancement Device The PPPED

My Photo Studio

Photomeds Portrait Kit

Just click on the facial landmarks as prompted

Portrait Professional 8.0

The Five Crimes of Digital Dental Photographers

The Crime of Proximity.

The Shaky Hand.

Wasted Pixels.(now you know what they are)

The same crime when shooting teeth

The Wrong Angle

Horizontal Misfires.
Stopobserve plane.shoot ..for better results

FogAREA!!

The Worst Offense..

Not taking the camera out of the box once you get it in your office.

Putting your camera to work

Fight the battle on two fronts: Anterior Dentistry Posterior Dentistry

Cosmetic Simulation As A Marketing Tool Getting Patients to Accept Treatment

And so the courtship begins - with a simulation-

Two approaches to smile simulations. Option 1: Do It Yourself

Kodaks KDI with the cosmetic suite Digital Dentist Tutorial Package Snap Instant Dental Imaging

But what is your time worth?

Accuracy issues Drop In Smiles from Smile Library Time Consuming and potentially frustrating

Option 2 Cosmetic Imaging with Smile-Vision

www.smile-vision.net
Just send them a portrait and theyll return you a newly designed smile

Web Based Interaction from Smile Vision; why I like it!

Convenienceno need to phone Access from anywhere with a password Easy to check status of imaging order Economicalprint your own if you like Easy for staff to interact with Calls for HIGH SPEED CONNECTION

Ready to Print? Remember.. Smile Vision will send prints or Do it yourself

Simulation Strategies
Patient Categories

New Patient Cosmetic Consulation

The $50 cosmetic dentistry screen; Reappoint to discuss simulation

New Patient: Full mouth restorative with potential for anterior dentistry

The $50 cosmetic dentistry screen

No fee for the simulation; focused marketing

Patients of record that already trust you!

No fee, mailed simulations with letter; patient to call if interested

Lorin Library Interactive Smile Style Guide

www.digident.com

$149

Select the shape of the 4 incisors There are 6 choices for all 3 canine types.

Centrals- Square Laterals - Square

CentralsSquare/round Laterals Square/round

Centrals- Square Laterals - Square /round

CentralsSquare/round Laterals Round

Centrals- Square Laterals - Round

CentralsRound Laterals Round

In Office Finance Programs Care Credit!! www.carecredit.com

A Recent Study from the Academy of Dental CPAs Practices enrolled in CareCredit increased their gross annual production by 25%
vs 4% for practices without a patient financing program: an average of $126,000 more per year for those offering CareCredit Accounts receivable Aging decreased 38% vs 4%

Bottom Line..
Once youve delivered a convincing, quality simulation. You can stop selling.

Premiers ALFA Triple Tray

This is all you need to get the ball rolling..

Bite record and Bite Jig for a vertical reference

Coltene Whaledent Monobody and a triple tray

Resin Replica

Hard Soft Templates

Temporary Veneers

Finished Case

The Finished Casevery much in synch with the mock up and simulation

The old way.Siltek Putty Matrix to translate Resin Replica to final restoration

A new approach: Milled Empress

The Resin Replica, aka Wax Up is scanned and coronal shapes milled

Remarkable similarities between wax up and machined restorations

The Beauty of a System Predictability Comfort Zone A consistent Routine. Make it an always procedure

Digital Imaging to Validate Your Diagnosis and Treatment Recommendations of Fractured Teeth Just what the doctor ordered.

Especially helpful for third party reimbursement

The digital camera as it emulates a microscope.

Epson PictureMate Series

What Patients Are Shown

www.ecdentalsolutions.com www.photomed.net

Schedule a Diagnostic Restoration Removal An hour appointment (or more) Arrange to replace adjacent alloys of similar vintage to the one being explored Prepare for the possibility of indirect restoration Start with the tooth in question Have your digital camera handy for on the spot demonstration of what youve uncovered

Upgrade Your View: Class III or Class IV Loupes preferably with a light

Laser Loupe from Orascoptic.

Filter in the carrier lens is made of high index polycarbonate

Filter in the telescope is made of glass and is significantly clearer than the carrier lens

Magnification and laser eye protection in a single product. Laser filters are in BOTH the telescopes and the carrier lenses.

Hands On Exercises
Meet Your Camera.

The Backside

Film Slot

Most Important Buttons XTi

Main dial for F stop settings Shutter Release Display sensor Zoom buttons

Playback button Menu button Cross Keys for Erase button advancing images in Mode dial AV:Aperture priority playback mode

Display Made Simple

F stop Shutter speed

Mode

Image Quality

Exposure count remaining

The Sigma Flash

Should see ETTL when in use

Turns on focus lamp

Ready light

The Sigma Macro Lens: Manual vs Autofocus

Magnification Ratios

Focus toggle for lens M/AF

Basic Camera Settings

Rebel XTi Close ups: F22 (Set with Main dial) Portraits: F5.6 to 6.7 Mode Selector in AV mode Exposure compensation is preset to +1 by Photomed. See Quick Start guide for info on how to alter this setting.

The AACD 12 Views

Natural Full Face (1:15) Full Natural Smile: frontal, right lateral, left lateral (1:3) Retracted upper and lower, slightly parted: frontal, right lateral, left lateral (1:3) Retracted maxillary anterior only: frontal, right lateral, left lateral (1: 1.5) Retracted occlusal views: maxillary, mandibular, mirrored (1:3)

Non Retracted Views

Retracted Views

Take These Shots

Additional Shots to take

Vertical Portrait

Contrasted maxillary anterior shot if contrasters available

Contact Info
martyg924@cox.net to reach Dr. Goldstein www.drgoldsteinspeaks.com for Dr. Goldsteins web site; to download a photo release form for your patients www.smilevision.net for Smile Vision 800-634-3480 (Dr. Larry Brooks) www.photomed.net for Photomed 800-998-7765 (Mike Mckenna or Sean Chappel) www.orascoptic.com for upgrading your vision www.carecredit.com for setting up a credit program www.ecdentalsolutions.com for What the Eyes Cant See booklet www.digident.com for the Smile Style Guide www.jlblosser.com for Doctors Eyes mirrors www.portraitprofessional.com for Portrait Professional 8.0 www.adobe.com for PhotoShop Elements 7.0