Clinical Photography In Orthodontics

Good clinical photography is the cornerstone of advanced case planning. A picture speaks a thousand words and are a powerful tool when communicating with patients, dental labs and to support your clinical records. Clinical photography is also an excellent way for you to build your own portfolio of cases, publish your work on social media and elevate your clinical work.

Key Takeaways:

What photographs are needed and what makes them good?

- Know which photographs to take for orthodontic treatment

- Understand landmarks and patient positioning for orthodontic photographs

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Extraoral photographs

Frontal photographs

Here are the two necessary frontal views. 

With these photographs, orthodontists will be looking at facial symmetry, smile aesthetics, lip line and lip competency.  All of which can impact decisions about orthodontic treatment.

Positioning:

• You’ll want to position the patient at eye level in front of the camera, capturing one with a full, beaming smile and the other relaxed and expressionless.
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• It’s best to capture a patient’s natural smile. Patients will often not show any teeth or grimace. If this is the case, do try your best dad joke to get them to produce a natural smile.
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• A good quality frontal photograph captures the top of the patient’s head, below their chin (shoulder level) and both ears (asking the patient to tuck their hair back if needed).

Pro Tip: If your patient is taller or shorter than the photographer, in order to get eye level- you can have the patient sit upright in a chair with feet planted or have the photographer stand on a stool.

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Profile photographs

The same expressions are captured in the profile view (always the patient’s right profile view). 

The smiling profile shot is important in the absence of a lateral ceph radiograph to give some sense of the proclination of the upper incisors. Additionally, these photographs will provide insight into a patient's profile and how you may (or may not) want orthodontic treatment to impact the profile.

Positioning:

• Patients tend to tilt their chin up or down when you ask for a profile view rather than looking straight ahead. This can mask the underlying skeletal pattern and means that the photo is not truly reflective of the patient’s presentation.
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• Ask patients to maintain a neutral posture and look far beyond the objects in close proximity (ie. down a hallway). Don’t be afraid to inform them to tip their chin up or down.
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• Similar to frontal views, you want to see the patient’s ear. If needed, ask them to tuck hair behind their ears so the jawline and ear are visible.

Pro Tip: For each of the extraoral photos, the F stop was set at 8 and the autofocus used with flash settings appropriate for the level of ambient lighting.

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Intraoral photographs

Buccal photographs

The three core intraoral photos that are needed in max ICP are as seen here.

The goal is to be able to focus on the incisor, canine and molar relationships. As well as, determine if any significant midline deviations.

Positioning:

• It is important that the patient is biting into their most comfortable biting position on their back teeth in each photograph.
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•  For the buccal photographs, you want to aim for capturing at least the first molars. Using two cheek retractors can assist in getting the ideal field of view: one stretching the side you are capturing and the other relaxed but retracting the soft tissue on the contralateral side.
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• For the straight view, lining up with the patient’s upper midline (or frenum if there is a midline deviation) can ensure you’re not at too much of an angle.

Pro Tip: Try to ensure that the occlusal plane is level and that the photograph is taken from a direction that is on the same plane. Here is an example of an angled occlusal plane:

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Occlusal Photographs

The last two intraoral photographs needed are occlusal views of the upper and lower.

These photographs provide insight into arch diagnoses such as; the level of crowding or spacing present and arch form.

Occlusal photographs can be particularly challenging as we must factor in how to deliver a reasonable patient experience. First of all, ALWAYS explain what you are going to do as it can be a complex manoeuvre and you might need a hand from your patient.

Positioning:

• When taking the image, you will need to ask the patient to open as wide as they possibly can, if only for a fleeting second while you get the shot. Aim to take photos at a 60 degree angle to the mirror.
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• You can ask your assistant to retract the lips with gloved fingers but the best way is to ask your patient to pull the lips clear of the incisal edges using retractors. It is recommended that you use small individual cheek retractors for this purpose rather than self-retaining retractors. The retractors should be located at approximately 10 and 2 on the clock-face for the upper lip or 4 and 8 for the lower lip.
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• These photographs should capture the full arch (up to the second molars if possible) without any soft tissue interference.

Pro Tips: For intraoral views manual focus is recommended with a lens magnification ratio of 1:3 and high f stop, usually between 22 and 32. Additionally, always warm occlusal mirrors beforehand to avoid fogging – you can use warm water or a heating pad. 

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Conclusion

We hope that you have found these hints and tips useful! Practice clinical photography with members of your team to get slick and make this a part of your day-to-day practice. Repetition will make the experience more comfortable for patients and improve the quality of the photos in your portfolio.