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Capturing High-Quality Oral Images with a Digital Camera

High quality photos that accurately capture your patient’s dentition and occlusion are an essential component of the treatment process. Submitting quality photos enables you to properly evaluate the impressions as well as to accurately set the initial bite for your treatment plan. The tools and materials you will need are: (1) a digital camera with a minimum of five megapixels as well as optical zoom, and preferably, macro focus capabilities; (2) cheek retractors, for use with the anterior and buccal photos; articulating paper; (3) a dental examination mirror; and (4) an occlusal photo mirror for the occlusal photos. Please note, if you are using a point-and-shoot digital camera, we recommend that you disable the digital zoom. Please refer to your camera’s user manual for further instructions.

There are two common types of external flashes used for the capture of dental images: ring flash and dual-point flash. Either flash system is appropriate for dental images, but there are a few differences. Ring flashes provide flat, uniform illumination with no shadows, but surface texture and characterization are not captured easily, and there may be reflection on facial surfaces. A dual-point flash is composed of two point flashes each positioned at the front of the lens barrel. One or both point flashes can be fired to produce a more three-dimensional topography and texture. With a dual-point flash, however, images of posterior teeth can be challenging to capture.2

Extra-oral Photos

Begin with the extra-oral images. Include frontal repose, frontal smiling and right profile photos, reminding the patient to keep her bite closed during this process. Position the patient approximately three feet in front of a non-distracting, neutral-colored background. When taking the frontal photos, position the patient so she is facing the camera. Fill the entire frame with the patient’s head and neck as shown (Figure 1). Then have the patient smile, and take the frontal smile photo (Figure 2). Turn the patient to the left to capture the right profile (Figure 3). If the patient has longer hair, have her pull her hair back to expose the entire jaw line. 

Intraoral Photos

There are five required intraoral images: frontal anterior, right buccal, left buccal, upper occlusal and lower occlusal. For all intraoral photos, make sure the patient is seated in the dental chair with her head resting on the headrest. Begin with the frontal anterior image. Place a check retractor in each side of the patient’s mouth, and have the patient hold them while biting down (Figure 4). Position the camera with the midline centered in the image so that the buccal surfaces of the molars are visible on both sides (Figure 5). 

The right buccal photo is next. With both cheek retractors in the mouth, have the patient bite down then pull back on the right retractor while relaxing the retractor on the opposite side (Figure 6). Assist the patient with retraction if needed. This will allow more of the molar region to show on the patient’s right side. Position the camera perpendicular to the buccal segment (Figure 7). (If there are issues exposing the second molars in the buccal photos, the use of narrow, more v-shaped retractors may be needed.) Repeat the same process for the left buccal photo. 

In preparation for the occlusal photos, submerge the occlusal mirror in warm water, to help prevent fogging.1 Before taking the occlusal photos, marking the occlusal with articulating paper is recommended. The visible contact points from the articulating paper with help your technician accurately set the initial bite on your treatment plan. Begin by drying the teeth thoroughly. Then, have the patient bite down on the articulating paper, making sure the paper is far enough back to mark the contact points on the molars. Repeat on the other side of the mouth. Inspect the occlusal surfaces to ensure that the marks are clearly visible before moving on to take the occlusal photos. Pull the upper lip away with retractors. After removing the mirror from the water and drying it, insert it with the widest portion toward the molars. If the patient’s mouth is too small for the mirror, turn it around and place the narrower portion back toward the molars. If the patient’s mouth is unusually large, it may be necessary to use a larger mirror.1 Position the occlusal mirror at the rear of the upper terminal molar, while the front rests on the lower incisors (Figure 8). Have the patient hold the retractors as shown, and position the camera at a 60-degree angle from the mirror’s surface before taking the photo (Figure 9). 

Repeat the same process on the lower arch. Insert the lower retractors (Figure 10). Position the occlusal mirror at the rear of the lower terminal molar while resting the front of the mirror on the upper incisors (Figure 11). Again, have the patient hold the retractors as shown. Position the camera at a 60-degree angle from the mirror’s surface. Compose the photo, and take the shot (Figure 12). Although it may be possible to see some of the mirror’s border or the side of the retractors in the images due to the shape of the patient’s head and mouth, an ideal image does not show more than is necessary.1

Best Practices

It is important to check the quality of each image before moving on to the next position. Reject any images that cast a shadow behind the patient. Any photos where the patient is tipping her head is unacceptable. Make sure the patient is looking straight ahead. When evaluating buccal photos, make sure that the relationship between the first and second molars are visible. Reject any images that do not show this relationship clearly. For buccal photos, the camera should be perpendicular to the buccal segment. You should see both the upper and lower first molars but little to none of the opposite, upper central incisor. Make sure the arch is completely visible and the mirror is fog-free before taking occlusal photos. Make sure all the images are clear and in focus before ending the photo session. 

References

1. Spear, F. The art of intra-oral photography. Seattle Inst for Adv Dent Ed 1999; 19, 21. 

2.  http://www.dentistrytoday.com/restorative/photography/8816-getting-the-right-shots-tips-and-tricks-for-consistent-photographic-excellence. Accessed October 22, 2014. 

 

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