Are you getting the right shots?
This summary is based on the article by Drs. Jason Goodchild and Mark Donaldson published in the Dentistry Today magazine: Getting the Right Shots! Tips and Tricks for Consistent Photographic Excellence (March 2013)
Dr. Jason H. Goodchild is Clinical Associate Professor in the Department of Oral Medicine at the University of Pennsylvania School of Dental Medicine and Clinical Assistant Professor in the Division of Oral Diagnosis in the Department of Diagnostic Sciences at the New Jersey Dental school
Dr. Mark Donaldson is Director of Pharmaceutical Services at the Kalispell Regional Medical Center, is Clinical Professor in the Department of Pharmacy at the University of Montana, and is Clinical Associate professor in the School of Dentistry at the Oregon Health and Sciences University
Digital imaging in current dental practice is commonplace, including radiographs, impression taking, and intraoral and extraoral photography.
Dental practitioners utilize patient images for many reasons, including patient education, medicolegal documentation, communication with other practitioners or laboratory technicians, and marketing.
Each particular patient or clinical circumstance may dictate the need for a specific intraoral or extraoral image. In general, practitioners should capture 8 basic views to record a patient’s clinical condition during the initial patient visit. Additional views may be captured as needed based on the patient’s clinical findings or treatment provided. The 8 basic views include:
- Full-face—smiling
- Full-face—profile
- Full-smile
- Anterior (frontal) view—retracted
- Right buccal—retracted
- Left buccal—retracted
- Maxillary occlusal
- Mandibular occlusal
Purpose of the article
- Present tips and tricks to help capture these 8 basic views with a focus on the use of point-and-shoot and DSLR cameras.
- Describe the techniques and patient positioning required to capture the images.
Exact camera settings will vary by type or camera used. Knowing how to capture each image consistently and predictably will help practitioners increase efficiency and reduce wasted chair time.
Getting the Shots
- Full Face—Smiling
- Should be taken directly in front of the patient, against a solid-color, nondistracting background (eg, white, gray, or black).
- The operator and patient should be at the same height so that the resulting picture is not taken from below or above the patient’s eye level.
- Full Face—Profile
- Accomplished similarly to the full-face shot, except with the patient turned 90°.
- Same relative heights of the operator and patient.
- Same camera settings.
- The point of focus should be the patient’s eyebrows. The patient’s nose should be the horizontal midline of the photo.
- The patient’s lips should remain at rest with an additional view of the patient's profile.
- Full-Smile
- A point-and-shoot camera should be switched to macro mode
- DSLR macro lenses should be used at approximately 1:2 magnification.
- Attempt to take the photo from directly in front of the patient, avoiding a downward or upward angle of view.
- The patient should exhibit a natural smile, with framing of the photo extending from the right to left corner of the mouth.
- Point of focus for this shot is on the central or lateral incisors.
- The horizontal midline should be the incisal plane; the vertical midline should be the anatomic midline. Camera should not be tilted to compensate for a canted incisal plane.
- Anterior (Frontal) View—Retracted
- The patient should ideally be seated in the dental chair with the operator standing in front of the patient.
- Cheek retractors must be used with the lips retracted outward, away from the teeth.
- Minimize the appearance of the cheek retractors in the image.
- Clear plastic retractors are typically used because they are nondistracting and may be seen in the photograph, although they are more breakable with repeated use and sterilization; metal retractors may be more distracting but will last longer.
- A common error during retraction is pulling the lips outward and backward; this results in the buccal soft tissue resting against the teeth and preventing adequate visualization of the buccal corridors.
- Use the largest set of retractors that the patient can comfortably tolerate to avoid the center of the upper and lower lip from showing in the photograph.
- The horizontal midline should be the occlusal plane and the vertical midline should be the anatomic midline.
- Air-dry the teeth to minimize the appearance of saliva and to better capture the gingival appearance.
- The teeth should be together in maximum intercuspation, although a complimentary image with the teeth slightly apart may help in recording the appearance of incisal edges.
- Right and Left Buccal Views
- Use the same patient and operator position and same camera settings as the frontal view. They can either be achieved using a direct view with retractors or a reflected view with a buccal mirror.
- The direct method
- Place both cheek retractors and shift the retraction to the side being photographed.
- Standard adult cheek retractors may be used; however, it is helpful to use buccal retractors to more easily capture all the teeth in the image.
- The teeth should be in maximum intercuspation; the horizontal midline should be the occlusal plane. The vertical midline should be the canine, but may be variable based on the angle of view and number of teeth captured.
- Practitioners may choose to take an additional photo of the teeth slightly apart to view incisal edge position.
- Reflected view with a buccal mirror
- A single cheek retractor is used for the contralateral side and a buccal mirror is used to both retract the tissue and visualize the teeth on the side being photographed.
- Eliminate excess moisture from the mirror before capturing the image.
- Insert the cheek retractor and ask your patient to open so that the mirror can be inserted.
- Once the mirror is outside the teeth, ask the patient to bring the teeth together.
- Advance the mirror so it is resting on buccal tissue behind the most distal tooth.
- The mirror should be pulled outward so the end is not resting on the teeth and rotated to visualize the arch.
- The point of focus is the premolars, and the occlusal plane should be the horizontal midline.
- It is sometimes useful to take an additional photo with the teeth slightly apart.
- Maxillary Occlusal View
- Shot is always taken with both retractors and an occlusal mirror.
- Camera settings are identical to the anterior retracted shot, although patient and operator positioning are different and ultimately critical to success.
- The patient should be reclined to approximately 45° and asked to raise his or her chin.
- The operator should be in front of the patient.
- Cheek retractors should be placed so that the lips can be pulled upward and outward; in some cases the medial corners of the cheek retractors will touch at the middle of the upper lip.
- The mirror should be inserted so that the edge extends behind the most posterior tooth.
- Rotate the mirror downward so that the back side is touching the lower incisor teeth.
- Eliminate excess moisture from the mirror before capturing the image.
- The vertical midline should be the anatomic midline of the patient, and the point of focus should be the premolars.
- Mandibular Occlusal View
- Accomplished with the same camera settings, and similar positioning of the patient and operator as the maxillary occlusal.
- The patient should be reclined at a minimum of 45°and should raise the chin as far as possible (neck extended maximally).
- Standard retractors (or a fork retractor) should always be used to keep soft tissue and lips off of the teeth.
- Insert the mirror so that the end rests on soft tissue behind the most posterior teeth, making sure that it is not touching the teeth.
- Rotate the mirror upward so that the back of the mirror is resting against the maxillary incisor teeth; the image should be taken at approximately 45° to the mirror.
- The vertical midline is the anatomic midline of the patient.
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