Dr. Carlos Boudet, DDS

	After many years of sharing information with my colleagues I have noticed that the majority of dentists take very few photographs and don’t take time to document their work-even the interesting cases-with photographic records. In today’s economic and business environment, it has become a necessity to adequately promote your business, and I consider photography a very important part of that.

	With this article, I would like to introduce a simple but effective way of documenting your cases with dental photography that will help you in many ways with your practice.


	Dental photography has two parts. Intraoral and extraoral photography, and you need some basic tools as follows:

	1. A camera that allows you to take both full face or profile pictures and also intraoral close-up shots.
	2. Two sets of intraoral photographic mirrors and two sets of retractors. There should be one occlusal mirror and one lateral mirror in each set.

	I have adopted a simple standard set of dental photographs in my office to document my cases. I take one set of pre-operative pictures, and I take another set to document the final results post-operatively. A simple before and after picture of your work (Figs. 1, 2) may help patients visualize and accept the work they need.3 If I think that I might make a presentation, I take additional photos of the procedural steps.


	The required views for clinical case submission to the American Academy of Cosmetic Dentistry (AACD) are 12 pre-operative views and 12 post-operative views.2 My standard set  consists of the following:

	1. Extraoral photos (3): Two frontal views of the face, one in repose and one smiling, and one profile shot. Additional examples of these photographs can be found in the online version of this article at dentalproductsreport.com.
	2. Intraoral photos (5): Five Retracted views, an anterior view, a right view and a left view. Two mirror occlusal shots, one of the mandible and one of the maxilla.
	3. For cosmetic cases, an anterior retracted view with the teeth apart is very helpful and that makes for six intraoral photos instead of five.


	Let’s talk about the camera. Undoubtedly, the best camera system is a SLR digital camera like a Cannon T3i or a Nikon D90, using a dedicated 100 mm macro lens and a ring flash.1
	In this basic tutorial, however, we will use a point and shoot camera. It’s simpler to use because there are no settings to change and focusing is automatic. This simple system was chosen because of  the different levels of expertise exhibited by the dentists attending our courses and the need for a camera that could take the use and abuse.

	We chose the Pentax Optio W90 for its simple-to-use instructions as well as for its shockproof and waterproof characteristics. This 12-megapixel camera allows you to take great face shots and intraoral views without changing settings in the camera.


	Basically you can take the necessary pictures with the chair in two positions: Completely horizontal, and at 45° from horizontal (Figs. 3, 4).

	With the chair at an inclination of about 45° we can take the anterior, right and left retracted views, as well as the three head shots. For nicer looking pictures, you can take the three headshots with the patient standing in front of a contrasting background.

	With the chair completely horizontal, you can take the maxillary and mandibular occlusal mirror views.

		Standardize the photographs by taking them at the same distance from the subject every time, that way they will be easier to compare before and after shots.

		Do not change the “P” or program mode in the Pentax Optio W-90. This will standardize your exposure settings. The camera will adjust the focus and the exposure for you automatically, and the lighting shouldn’t change in the operatory.

		Proper position of the camera avoids the errors associated with canting and taking the shots at angles that are “too high” or “too low” from the front.

		Reposition the head of the patient slightly instead of leaning over him or her.

		Use a background for head shots for a better picture. Do not place the patient too close to the background as this may create shadows.

		Try to take the occlusal views looking down the incisal edges of the anteriors.

		Use the interpupillary line and the vertical midline to orient the camera.

		Finally, try to remove anything that would make the picture look bad, such as excess saliva, blood and food.

	For those who have Decals on their lenses, the full face shots should be at about a 1:10 magnification, all the other frontal, lateral and occlusal retracted views should be at a 1:2 magnification. For the Optio W90 camera, when you are taking head shots you place the camera about 5 feet from the face and zoom in or out to frame the head on the screen. For the intraoral shots, the retracted frontal and lateral views are taken about one foot away from the face at maximum optical zoom, and about two feet away for the occlusals.

 
	A photo editing program is a very useful tool when working with digital pictures. There are a lot of good ones in the market, from free applications such as Gimp, Picasa and Photoscape, to those geared toward the professional such as Adobe PhotoShop. Others, to name a few, include Adobe LightRoom, Adobe Elements, Corel Paintshop Pro and Arcsoft Photo Studio.

	These programs will let you tweak your photos by doing things like cropping, rotating, and adjusting exposure  so they look great even if you are not the greatest photographer. As a final note, make sure that your patients sign a simple photography release form that gives you permission to show their pictures.

	This brief tutorial was written with the hope that it may encourage more of us to document cases with photography. This will increase your cosmetic and implant case acceptance, and will lead to patients asking you about doing their dental work. It will benefit your marketing efforts, as well as
	make you a more humble and a better dentist in the process.  
	
	 

References
	1. Goldstein, Martin B. Digital Photography update: 2011. Dentistry Today, May 2011, (138-142)
	2. Photographic Documentation and Evaluation in Cosmetic Dentistry – A Guide to Accreditation Photography, by the American Academy of Cosmetic Dentistry.
	3. Maher, Robert .Practical Dental Photography & High Tech Case Presentation. 2005
	4. Soileau, Tony. Dental Digital Photography Columns in Dental Economics Magazine.
	5. Terry, Douglas A. Contemporary Dental

Articles

 After many years of sharing information with my colleagues I have noticed that the majority of dentists take very few photographs and don’t take time to document their work-even the interesting cases-with photographic records. In today’s economic and business environment, it has become a necessity to adequately promote your business, and I consider photography a very important part of that.