Dental photography:

This is how to take great portrait,

lab-work and intraoral picture!
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Dental photography: This is how to take great
portrait, lab-work and intraoral picture!
I Portrait photography

General information
• For an effective clinical documentation, we recommend taking
preoperative and postoperative pictures of the patient. In other
words, take a portrait picture of your patient before and after the
treatment.
• Objective: to give an overall impression (without showing the teeth
in detail)

Picture background
• Choose a smooth and plain background that does not distracted
from the face.
• A bright background looks friendlier than a dark one. A white
wall will do for the purpose of creating a photographic record; however it may look somewhat boring.

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Tips:
–
Use a light and blurred structure in the background (e.g. walls that protrude into the picture, cabinets, doors, window frames, etc.).
–
The distance between the patient and the background should be as large as possible.

Patient
• It is advisable for the patient to wear a natural smile, not too forced.
• The patient should be in a refreshed, rested state for the final portrait (e.g. before a follow-up examination, but preferably not
immediately after a taxing treatment session).
• The patient should have an opportunity to come prepared to the photo shooting session (e.g. make-up, styling, etc.).

Camera settings
• If possible, shoot the pictures in manual mode, or possibly in portrait mode, to achieve consistent results.
• Choose a wide aperture, e.g. f5.6 (depending on the lens) to get as much of a blurred background as possible.
• Adjust the shutter speed and ISO settings to the aperture size to ensure that the background is well illuminated.
• Depending on the lens, the shutter speed should be no longer than approximately 1/125 second to ensure that the image is not blurred
(e.g. due to camera movement).

Flash settings
• Once you have set the camera to the correct values (see above), check whether the face is well illuminated on the viewfinder or histogram.
• If the face is not sufficiently lit, use a flash to achieve a brighter result.

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Tip:
–
Either use the built-in flash on your camera (if available) or a detachable external flash. Ring and twin flashes are not suitable for this
purpose.

Selecting the lens

• If there is sufficient space, us a long focal length (from approx. 80 mm at full size). You can achieve this with a zoom lens or possibly with
the macro lens of the camera.
• Focusing can be done with the auto-focusing feature.
• Make sure that the focus is on the eyes of the patient.
II Lab-work photography

General information
• If possible, set up your own workspace for shooting pictures of
your lab work.
• Mount your camera on a tripod so that the pictures of the indi-
vidual stages of your work are always taken from the same angle.

Background colour
• Select the background colour (light or dark) before you start
shooting, depending on the intended use of the photographs.

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Tips:
–
If possible use velvet material for a black backdrop.
–
Leave some space between the workpiece and the backdrop to avoid shadows.

Camera settings
• If possible, always work in manual mode in order to achieve good consistent photographs.
• Choose a narrow aperture, e.g. f/22 or f/32 (depending on the lens). A narrow aperture increases the depth on a larger area (depth of
field).
• Choose a short shutter speed, e.g. 1/125 second to prevent possible ambient light from affecting your images too strongly.
• The ISO value should be as low as possible for optimum quality – about 100 ISO, depending on your camera.
• Use manual focusing to get the focus. If you want to show a specific area of your workpiece, focus on that area. If you want to achieve
a sharp focus of the entire workpiece, focus on the first third.

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Tip:
–
If the depth of field is too shallow, focus rather on the front or take a picture of the dental subject in a smaller size and then create
a cut-out.

Flash settings
Once you have set up the camera as described above,
• sadjust the flash so that the picture will be correctly illuminated;
Check the exposure of the image in the viewfinder or histogram.

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Tip:
–
You can adjust the lighting effect with twin-point flashes.

Lens
• Use a macro lens if possible.

Prevent dust formation

Dust that enters your camera and settles on the sensor will create dark dots on every image. The dust load is high in dental laboratories
where sanding and grinding is performed.

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Tips:
–
Store your camera in a dust-free environment (cabinet, camera bag).
–
Never leave your SLR camera without a lens or body cap.
–
Change the lens speedily and in a dust-free area.
III Intraoral photography

General information
Intraoral photography is particularly tricky because many details
have to be considered when shooting the images. Intraoral photo-
graphy requires
• a knowledgeable photographer or practitioner,
• a trained assistant, and
• a compliant patient.
Even something like using a rubber dam can result in a change of
the light situation - and thus create deviations in the colour tem-
perature and brightness compared with the initial situation. That
is why manual fine-tuning is essential when shooting intraoral
pictures. Specifically, this means that the exposure parameters and
possibly the white balance may require adjusting.

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Tip:
–
If possible, choose a rubber dam in a dark blue colour. This colour will lead to a strong contrast and is less prone to affect the colour
perception, unlike for instance a green or purple rubber dam. Light rubber dam colours (e.g. light blue, pink, semi-transparent) do
not create a good contrast. They result in the images looking “boring”.

Step-by-step sequence (general)

General information
You should plan and prepare especially carefully when taking intraoral images.

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Tips:
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Before you begin with the shooting session, prepare a list of all the required set-ups, which you then can systematically carry out.
Otherwise, it may happen that you forget to take certain pictures that you will not be able to rearrange later.
–
Use long-handled oral mirrors for taking these shots. They provide easy access to the working area and do not affect the access of
light.

General conditions
• Alignment with the horizontal and vertical axis and the centre of the image depend on the anatomic situation of the patient.
• Make sure interfering surrounding features (e.g. beard hairs, cheek retractors) are not included in the image.
• Adjust the image area so that the dental subject is adequately shown (“single-tooth” composition).
• Make sure that the teeth are isolated well - there should be no saliva on the tooth surfaces and gingival tissues.
• Avoid accretions.
• Make sure the gingiva looks healthy.
• Create a “tidy” treatment field (no blood, no dentin debris, etc.).
• Make sure that the adjacent teeth are properly restored or in good condition.
• Use a clean mirror.
• Small aperture value will get you sufficiently large depth of field.
• Place focus on the front third of the desired depth of field.
Step-by-step sequence (posterior area)
Single teeth
• For a set of single-teeth images, a 1:1 to 1:1.5 imaging scale is appropriate, depending on the dimensions of the tooth. This way, at least
half of the neighbouring teeth will be included in the images for easier reference of the viewer.
• The centre of the image should be aligned with the centre of the tooth being treated.
• Align the horizontal midline of the image with the curve of the tooth row in the dental arch where the tooth being photographed is located.
• Adjust the focus in such a way that the tips of the cusps and the gingival margins are included in depth of field.
• Keep all the settings as consistent as possible across the entire set of shots.
• Shoot the pictures from the reflected image of the tooth on the oral mirror. Mirrors with an elongated shape and long handle are best
suited for this purpose.
• Retract the corner of the mouth with a one-sided cheek retractor.
• Then, place the mirror in the retracted corner of the mouth with the greatest possible distance to the tooth row and gently push it as far
as possible into the buccal area.
• Tilt the mirror in such a way that the teeth are reflected perpendicularly.

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Tips:
–
Prepare a bullet point list of the sequence of images that you would like to shoot.
–
Inform your member of staff about the desired sequence of shots. In addition to handling a mirror or cheek retractor, your member of
staff may need to hold other instruments against the tooth to be photographed without obstructing the access of light or creating
a reflection of the instrument on the image.

A step-by-step sequence of images for an adhesively bonded restoration should include shots of the following procedural steps:
• preoperative situation showing the decayed area or defective filling;
• prepared tooth;
• prepared cavity/isolation;
• conditioning/priming/bonding;
• application of the restorative material or placement of the restoration (here you may show details of additional steps, e.g. a specific
layering technique);
• if applicable, completely layered restoration;
• if applicable, polishing;
• completed restoration directly after insertion and
• restoration after having been in situ for some time.
You may add or remove individual steps from this list depending on the purpose and objective of the documentation.

Multiple teeth
• For multiple-unit prosthetic work, increase the image area accordingly.
• Make sure to include at least half of the adjacent tooth structures or teeth to allow the viewer to quickly locate the position of the work.
• Once selected, stick to your image area, even when you capture images of individual working steps, which you may perform only on one
of the teeth being treated. Consistency in the selection of the composition ensures a clear and smooth sequence of images and will help
viewers find their way through the pictures.

Guidelines on image composition

• Basically, the same guidelines as for capturing single teeth apply.
• The view should be perpendicular to the occlusal surfaces.
• The horizontal midline of the image should be positioned centrally and parallel with the midline of the tooth row.
• The centre of the image should be aligned with the centre of the planned restoration.

The following guidelines apply to indirect restorations:

• Fake extraoral pictures, for example of impressions, models or the completed restoration at the same magnification and from the same
direction as the intraoral pictures.

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Tip:
–
Since intraoral pictures are taken indirectly (as reflection on the mirror), you will need to mirror the image later on the computer so
that the intraoral shots match the images that you have taken without using a mirror.
Step-by-step sequence (anterior area)
General information
The same guidelines apply to the anterior sequence of images as for the posterior sequence. However, the anterior images are easier to
accomplish because you normally do not need to use a mirror to shoot them.
• Always select the same composition.
• Make sure that at least half of the adjacent teeth are included on the image.
• If possible, always choose the optical axis radially to the dental arch.
• Either include the entire anterior segment from the left to the right lateral incisor and centre the image on the dental midline or centre
the image on the tooth that is being treated.
• Important: Maintain a consistent view across the entire sequence.
• If oral views of the anterior teeth are necessary, please make sure that no interfering structures are depicted in the background.

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Tips:
–
Interference can be prevented by using a careful retraction technique and by ensuring that the optical axis is positioned as near
perpendicular to the palatal or lingual surfaces as possible.
–
It may be helpful to use again a narrow oral mirror to ensure that the images are shot at an appropriate angle when creating a palatal
or lingual view of the anterior teeth.

Often, when taking pictures of the maxillary anterior segment, the views are positioned too far down because the patient is usually seated
in a reclined position. This leads to the incisal edge line showing as “negative” curve, leading to pictures that look “unesthetic”.

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Tip:
–
Position the view as near perpendicular to the labial surface as possible. For the before-and-after shots, it is advisable to use a central
anterior view as a panorama picture and a view of the segment as additional presentation.

Shots of the following procedural steps are useful for documenting adhesively bonded anterior restorations:
• preoperative situation with the decayed area or defective filling (panorama picture and close-up);
• prepared cavity/isolation;
• conditioning/priming/bonding;
• application of the restorative material or seating of the restoration (here you may show details of additional procedural steps,
e.g. a layering technique with a variety of opaque materials: dentin, enamel, clear);
• If applicable, completely layered restoration;
• if applicable, polishing;
• completed restoration immediately after insertion;
• restoration after having been in situ for some time (this is particularly important for anterior restorations to document the final integration
of the restoration after the surrounding tooth structure has become rehydrated) and
• final situation in a similar panorama view as the pre-operative picture.
Special photography
Transillumination
• You can create a photographic documentation of discolourations, cracks, caries or the translucency of restorations by using a fibre-optic
system to transilluminate the teeth.
• As these systems tend to emit a very low light intensity, you should select a wide aperture or use a tripod. If necessary, increase the film
speed.
• Position the light source in the oral cavity according to the characteristic that you want to show on the image and direct the light either
directly from the oral side towards the teeth or more towards a palatal direction.

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Tip:
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Intraoral illumination of the palate enables you to capture opalescent effects.

Fluorescence
Fluorescence is the radiation produced from solid bodies, liquids and gases as a result of radiation with light, X-rays or other electro-
magnetic radiation. This light is re-emitted in the same or in longer wavelengths as the light absorbed. Natural teeth have the property to
emit visible light when exposed to UV radiation. This phenomenon is not easy to capture on clinical pictures.
• You will need an UV light source to show fluorescence in the dentition.
• When procuring a UV light source, make sure that the specified wavelength range of the light source is not harmful to the eyes.
• Position the UV light source slightly above the patient.
• Set up the camera in manual mode.
• In most cases, you will need to select a longer shutter speed (2 seconds with a tripod) and increased film speed to be able to use an
aperture value of >f11.

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Tip:
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Another possibility to capture the fluorescent effect is to use a fluorescent plaque disclosing agent. The fluorescent disclosing agent
only becomes visible when illuminated with the blue light of a light-curing device. In addition, it does not cause any unsightly staining
on the teeth of the patient when exposed to daylight.
If you use a curing light that features a high light intensity, you will be able to capture the fluorescent effect without a tripod as long
as you select an increased film speed, an aperture of >f11 and a short shutter speed. The light should be positioned at adequate
position from the teeth being photographed to ensure a homogeneous illumination of the entire composition. Make sure to protect
the eyes of the patient.
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