Introduction to Digital Dental Photography Prepared by Todd R. Schoenbaum, DDS & Richard G. Stevenson, DDS with support from the UCLA Division of Restorative Dentistry and the Academy of Operative Dentistry Founder’s Fund

Welcome to the world of Digital Dental Photography All information is accurate and current as of 2012. Future developments in photography will require revision of the information contained within.

What is Dental photography good for?

Patient Communication Patients understand their needs and complications much better when they can see a picture of their own pathology

Lab Communication Particularly for treatment in the aesthetic zone, technicians need more information than just a single shade tab. Photography greatly simplifies the shade taking process; providing the ceramist with a “palate” of shades rather than trying to match a single shade.

Interdisciplinary Communication Photography greatly enhances the ability to communicate between disciplines for complex treatment.

Diagnosis and Treatment Planning Even with radiographs, charting and mounted models, there is much diagnostic information to be gained by including photography to comprehensive treatment planning.

Basic Armamentarium

There are 3 camera types for dental photography Intraoral dSLR Point & Shoot

There are 3 camera types for dental photography Intraoral Advantages: - no mirrors needed - small and lightweight - simple Disadvantages: - subpar image quality

There are 3 camera types for dental photography Point & Shoot Advantages: - small and lightweight - lower cost Disadvantages: - not upgradeable - inconsistent magnification

There are 3 camera types for dental photography Advantages: - highest image quality - upgradeable - various lighting options Disadvantages: - heavy - expensive dSLR

There are 3 components of a dSLR for dental photography Although intimidating, once properly calibrated the dSLR is the most popular and versatile choice for dental photography. dSLR There are 3 components of a dSLR for dental photography Camera Body Macro Lens Macro Flash

The models and specifications of camera bodies changes very rapidly. Camera Body The models and specifications of camera bodies changes very rapidly. A dSLR body for Dental Photography should at a minimum have the following requirements: - 10 MP resolution - APS-C sensor - 3” LCD screen More expensive models may have many extra features, most of which are of little use in dental photography

Macro Lens The lens needed for dental photography is a Macro (or Micro) specific lens with a focal length of 85-105mm. This is not the lens that comes on the camera when purchased as a kit at a consumer store. It cannot be a zoom lens. It must have magnification marking on the lens.

Ring Flash Dual-point Flash - Easier to use - Smaller - More consistent lighting - Not very good at showing incisal translucency or line angles - More difficult to use - More flexible lighting options (i.e. diffusers) - Difficult to use for mirror shots - Best option for aesthetic dental work and shade photography - Works best with a special mounting bracket for dentistry Dual-point Flash

Photography accessories

Intraoral Photography Mirrors Front surface coated to avoid double images Occlusal mirror is used for the maxillary and mandibular occlusal images Buccal mirror is used for quadrant, buccal, and lingual images must be handled with extreme care to minimize scratches Buccal #1 Wide Occlusal XL Tips: - keep mirror warm to avoid fogging (i.e. water bath, heat pad, coffee cup warmer) - use the biggest mirror possible - never place mirrors on or near metal instruments

Cheek Retractors Used to hold the cheeks off the buccal tooth surfaces and allow more light into the mouth Usually positioned by the doctor, and held by the patient Available in different sizes and made of metal or plastic They should not be visible in the photo

Anterior Contraster (optional) Used in anterior shots to “black out” the background Enhances the ability to see translucency Used in conjunction with retractors

dSLR Camera Settings Shutter Speed: 60-250 Aperture: f/8 for full face f/32 for intraoral Shutter Speed: 60-250 White Balance: Flash or Custom Image size: Large JPEG or RAW ISO: 100-400

dSLR Camera Settings Exposure Mode: “M” Manual or “Av” Aperture Priority (Usually set on the dial on top of the camera) Flash Mode: eTTL This is an automatic mode that works well for beginners. Advanced users may choose to experiment with manual flash exposure settings. Focus Mode: “MF” Manual Focus Not to be confused with the exposure mode set above. This prevents the autofocus from changing the magnification setting. Focus will be achieved by moving the camera. This may initially seem more complex, but the mouth is generally too dark for autofocus to work properly.

Magnification Rotate to change magnification Magnification: - Controlled by turning the lens barrel - Macro specific lenses have magnification markings on them - The magnification is set on the lens - Do NOT spin the lens to focus (it will change the magnification) - We will be using three magnification settings: - 1:15 for full face image - 1:3 for most intraoral images - 1:1.5 for closeup images Rotate to change magnification

What images to take?

Basic Diagnostic Image Series 4. Retracted 1:3 - insert retractors, dry teeth - teeth should be slightly separated - retractors need to be pulled out and forward 1. Full Face smiling - stand approx. 2 meters away - use autofocus for this image only - patient’s head should be vertical Magnification 1:15; Aperture f/8 Magnification 1:3; Aperture f/32 2. Lips in Repose (“M” position) - turn off autofocus; set magnification to 1:3 and aperture to f/32 - Instruct pt to say “emma” - used to determine incisal display at rest 5. Maxillary Occlusal - place patient in a fully supine position - insert retractors; dry teeth - insert occlusal mirror - shoot from 12 o’clock position Magnification 1:3; Aperture f/32 Magnification 1:3; Aperture f/32 6. Mandibular Occlusal - place patient in a fully supine position - insert retractors; dry teeth - insert occlusal mirror under tongue 3. Maximum Gingival Display (“E” position) - instruct patient to say “eeee” - used to determine lip mobility and gingival display Magnification 1:3; Aperture f/32 Magnification 1:3; Aperture f/32

Posterior Restoration Image Series 1. Shade Image - taken before preparation or rubber dam - best to shoot in RAW format for color fidelity - position shade tabs as close as possible to teeth to be matched - use one tab for occlusal, one tab for gingival - use the appropriate shade guide for the porcelain to be used Magnification 1:3; Aperture f/32 2. Pre-operative Occlusal - Use buccal mirror - Teeth and rubber dam should be clean and dry - If not using a rubber dam, use the cheek retractors Magnification 1:3; Aperture f/32 3. Post-operative Occlusal - Use buccal mirror - Teeth and rubber dam should be clean and dry - If not using a rubber dam, use the cheek retractors Magnification 1:3; Aperture f/32

Anterior Restoration Image Series 1. Full Face smiling - stand approx. 2 meters away - use autofocus for this image only - patient’s head should be vertical 4. Retracted 1:3 - insert retractors, dry teeth - teeth should be slightly separated - retractors need to be pulled out and forward Magnification 1:15; Aperture f/8 Magnification 1:3; Aperture f/32 2. Shade image - set magnification to 1:1.5 - use retractors - clean and dry teeth - make note of shade tabs if labels cannot be seen in the image 5. Preparation - set magnification to 1:1.5 - use retractors - clean and dry teeth - use contraster to better capture translucency Magnification 1:1.5; Aperture f/32 Magnification 1:1.5; Aperture f/32 3. Pre-operative Close up - set magnification to 1:1.5 - use retractors - clean and dry teeth - use contraster to better capture translucency 6. Post-operative - set magnification to 1:3 - use retractors - clean and dry teeth - use contraster to better capture translucency Magnification 1:3; Aperture f/32 Magnification 1:1.5; Aperture f/32

Comprehensive Diagnostic Image Series #2 #3 #4 #5 #6 #7 #1 1. Full face smiling 2. “M” (Lips in repose) 3. “E” (max. gingival display) 4. “F” (A-P relation) 5. Right smile 6. Center smile 7. Left smile 8. Pre-Operative shade image 9. Right retracted 10. Center retracted 11. Left retracted 12. Right close-up 13. Center close-up 14. Left close-up 15. Maxillary occlusal 16. Mandibular occlusal #9 #10 #11 #8 #12 #13 #14 #15 #16

This will take practice and dedication to master Like any new skill… This will take practice and dedication to master Prepared by Todd R. Schoenbaum, DDS & Richard G. Stevenson, DDS with support from the UCLA Division of Restorative Dentistry and the Academy of Operative Dentistry Founder’s Fund