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Digital Photography

High upfront cost

Low residual cost
High quality
Easy storage
Dr. Doug Depew

Camera Focusing Camera Positioning

Easy to use, yet

provides quality
Better quality
cameras tend to be Horizontal
more complicated Line up occlusal
Know your camera plane
well Vertical
standard distance
Line up midline of
focus manually or
automatically face
focus by pushing a
button, turning a dial,
or physically moving
camera in or out

Picture Order Common Photographs

Pictures must be Extraoral

taken in a certain Frontal - serious
order to be
downloaded Frontal - smiling
properly Profile - lips at rest
The order depends Intraoral
on: Frontal 2161 Cedarcrest Rd.

the doctor
Suite #115
Right lateral Acworth, GA 30101
770-428-8891
www.trapezio.com

the camera Left lateral

the imaging system
being used Maxillary occlusal
Mandibular occlusal

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When to Take Photos Initial Exam

Initial Exam Important for

Before Treatment Begins (if delayed) reviewing with
Progress Records patient/parent
Presurgical Records
Helps establish
Recall Observation relationship
Phase II Records
Finals (at the completion of treatment) Send them home
with printouts

The Treatment Coordinator Initial Records

Should Look for and Discuss When Treatment Begins
- Arch form
Delayed start
- Malocclusion
- Crowding Dentitions change
- Spacing Adults-restorative
- Curve of Spee work
- Crossbites
- Overjet
- Overbite
- Midlines
- Deficient/protrusive
profile

Progress Photos Presurgical Records

Planning the
Single or full set surgery
Progress or Permanent record
problems Great before/afters
Review with
patients/parents

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Recall Observation Phase II Records

Demonstrates New treatment plan

changes Updated photos
- overjet worse
- lost 4 primary teeth
- poor hygiene
developing
Ready recall-
anticipate beginning
treatment

Final Records Orthodontic Photography

I am Finished!

Compare befores
and afters
Get parents involved
Print out and send
home

Cheek Retractors

in addition to the camera

Cheek Retractors
This will vary from doctor to doctor
hold the lips and
cheeks out of the
way

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Buccal View Center View

Upper Occlusal View Lower Occlusal View

Upper Occlusal View Lower Occlusal View

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Mirrors Buccal View

Mirrors
Produce a
mirror image
Need to be
flipped with
softwear

Occlusal View Occlusal View

What Are Doctors Looking For? Picture Groupings

Standard Guidelines

All team members

taking photos need to
learn what is acceptable
and what is not, and .

When a photo must be 2161 Cedarcrest Rd.

Suite #115
Acworth, GA 30101
retaken 770-428-8891
www.trapezio.com

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Frontal - Serious Frontal - Smile

Head fills the frame Head fills the frame

Looking straight Looking straight
ahead ahead
The head is level The head is level
Lips resting naturally Full, natural smile

Profile Center

Head fills the frame

Should see all
Looking straight
teeth
ahead
Plane of
The head is level
occlusion level
(Frankfort Horizontal)
Midline
Lips resting naturally
centered
Shoulders are
Minimize
square
cheeks, lip
(perpendicular to the
retractors, etc.
background)

Center Retractor Positioning Right and Left Lateral

As many teeth as
possible
Occlusal plane
level
Avoid tilting
Minimize cheeks,
lips, retractors

Pull retractor apart and forward

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Buccal Retractor Positioning Right Buccal Positioning

Turn the patient in the chair
Use the long lateral cheek retractor on
the right side
Use the shorter, wider double ended
retractor on the left side
Rest the retractor on the left and
stretch back on the right
Move the camera around

Left Buccal Positioning Buccal Mirror Positioning

Turn the patient in the chair
Use the long lateral cheek retractor on
the left side
Use the shorter, wider double ended
retractor on the right side
Rest the retractor on the right and
stretch back on the left
Move the camera around

Buccal Mirror Positioning Mirror vs. Retractor Shots

Similar except you use the mirror to
retract
Insert the narrow part of the mirror
Tip the front portion of the mirror
outwards
Mirror is level and the face is not
angled
Shoot directly into the mirror at the
teeth

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Mirror Position - Buccal Mirror Position - Buccal

Mirror Position - Buccal Mirror Position - Buccal

Upper and Lower Occlusal Awesome Occlusal Photos

Teeth should fill

frame
Include all teeth if
possible
Shot taken 90
degrees to teeth
See edges and
back of incisors
Minimize tongue,
cheeks, etc.

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Occlusal Mirror Positioning
Upper Arch
Occlusal Mirror Positioning
Lower Arch
Upper Occlusal Positioning
Retract upper lips with retractors
Place mirror (shiny side) toward the
nose
Patients head tilted as needed
Mirror should be heated
Position view with midline centered
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Patient and Camera Position
Upper Arch
Patient and Camera Position
Lower Arch
Lower Occlusal Positioning
Retract lower lip with retractors
Place mirror with shiny side toward the
chin
Patients head tilted back
Heated mirror
Tongue behind the mirror
Position view with midline centered
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Occlusal Positioning Hints
Mirrors placed against
the opposite arch
Push the tongue back
gently to the back of the
mouth with the mirror
Lay mirror just past the
last teeth to pry mouth
open
Tongue Position
Extra-Oral Guidelines
General
1) Patient should sit up straight and look
straight forward
2) Smile should be genuine. Rest position
should be relaxed
3) Head should be level
4) Shoulders should be level and square
5) Head should fill majority of the frame
6) Long hair should be pulled back so ears
show
7) Glasses should be removed
8) Clearnot blurry
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Occlusal Picture Tip
Upper- patient is best sitting part-way
upright to look directly into the mirror
Lower- lean the chair further back
letting more room light into the mouth
In the viewfinder you should see the
edge of the anterior teeth (but not their
front) and at least to the distal of the
first molars.
The lip should not be hanging over the
edge of the front teeth
Short Lingual Frenum
Intra-Oral Guidelines
General
1) Occlusal plane should be level
2) Patient bite all the way together
3) Side shots are taken from a 45 degree angle
and include at least the canines to molars
4) Occlusal shots should be taken at 90 degrees
5) Occlusal shots should include incisal edges
and distal of the molars
6) Leave out cheeks, tongue, retractors, face
7) Hold cheeks and lips out firmly but gently!
8) Sterilize retractors and mirrors
9) Warm mirrors to prevent fog
10) Clearnot blurry
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Profile

Determines the jaw relationship

The jaw line changes if the head is
tipped up or down

Frontal - Serious Frontal - Smile

Looking for facial symmetry
Lip incompetence
How much teeth show when smiling
Excessive gumminess or lack of
Narrowness
Midlines
Arch shape
This picture can have a direct effect on
your treatment recommendation

Buccals Center

Overjet Overbite/Deepbite
Molar relationship Midlines
Gingival recession Frenum
Gingival recession

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Occlusals

Arch shape
Tooth position
Measure spacing
Measure crowding
Rotations
Primary teeth present

Head Is Tilted Head is Turned

Head is Too Small Shoulders are Turned

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Shoulders not squared Patient Looking Down

Improper Retraction Too Much Skin

Not Enough Teeth

Photography Issues

Lips Covering Teeth Double Images

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Teeth Too High in Frame Missing Molars

Not Level And too much lips and retractor

Shadow Over Molar Not Biting Properly

Taken at an angle Foggy Mirror

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Missing Molars Lips are folded over incisors

Not Close Enough

Slightly out of focus View of Front of Incisors

Excessive Lips and Cheeks Tongue Obstructing View

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Frontal - Serious
When the patient turns from the profile
position to face the camera, they often
will step back somewhat. If this
happens, the head will not fill the frame
equally in the three facial shots. Be
aware of this and move slightly closer
or zoom in with the camera.
Buccal Views
Photographer assist the patient in
holding the retractor
Turn the head in the opposite direction
90 degree angle (retractor)
45 degree angle (mirror)
Turn the chair
Focus on the canine
How to avoid shadows
Beware of bite shifting
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Profile
Ask the patient to look straight ahead
If you can see the very tips of the left
eyelashes, the head should not be
turned
The patient should be biting all the way
down on their back teeth, lips relaxed
Frontal - Smile
Sometimes getting a patient to smile is
difficult. If you explain the extreme
importance of this picture for treatment
recommendation, they may try to help
you out. Be careful not to mistake a
grimace as opposed to a genuine smile.
Would you do me a favor and just fake
it?
Center View
Hold Retractors Out and Forward
Like a fish
Cross Lines in the Camera Centered
Frenum in clear view
Overbite in clear view
Midlines in clear view
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Occlusal Views Occlusal View

Mirror placement on the back molars In the viewfinder you should see the
How to obtain clear focus on molars edge of the anterior teeth (but not their
Tongue position front) and at least to the distal of the
Foggy mirrors first molars.
-warm water The lip should not be hanging over the
-heating pad edge of the front teeth
-defog spray
If none of these are available, have your
patient breathe through their nose to
minimize fog

Profile

Blunder Beauty

Frontal Smile Buccal

Blunder Beauty Blunder Beauty

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Buccal Center

Blunder Beauty Blunder Beauty

Center Upper Occlusal

Blunder Beauty Blunder Beauty

Upper Occlusal Upper Occlusal

Blunder Beauty Blunder Beauty

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Lower Occlusal Lower Occlusal

Blunder Beauty Blunder Beauty

Lower Occlusal

Blunder Beauty

Flip-Rotate-Crop Flip-Rotate-Crop

Flip
Horizontal
Vertical
Rotate
Crop
Brightness
and Contrast

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Adjusting Brightness/Contrast Younger Patients

Younger Patients

Photos are not only important

for diagnostic purposes.
Here are some examples

Send to Referring General Dentist Send to Specialists

Send initial photos Send photos with

with Dr. summary referral
letter Mark specifically
Send Finals what needs to be
evaluated
Set yourself apart

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Internet Consultations Before and After Book

Parents
General dentists
Specialists

Photos
Before and after
Exam room
Reception area

Similar Cases Is Phase II Treatment Necessary?

Half finished
Effective selling tool Her teeth look fine
Similar treatment Phase I extremely
plan successful
Great result Utilize as exam
photos

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Final Photos Presentations

Treatment Complete

External Marketing
Schools
Various business
associations/clubs
Framed photos or
PowerPoint at local
events
Doctor study clubs

Quality Photos for a Quality Practice Finish # 1

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