Sreesan NS et al.

: Clinical Photography in Orthodontics REVIEW ARTICLE

Clinical Photography in Orthodontics

Sreesan N. S.1, Binu Purushothaman2, Rahul. C. S3, Shafanath T4, Fawaz V5
1-Sr Lec, Department Of Orthodontics, K.M.C.T Dental College, Calicut, Kerala. 2-Professor Correspondence to:
And Head, Department Of Orthodontics, K.M.C.T Dental College, Calicut, Kerala. 3,4,5-Post Dr. Sreesan N. S., Sr Lec, Department Of Orthodontics,
Graduate student, Department Of Orthodontics, K.M.C.T Dental College, Calicut, Kerala. K.M.C.T Dental College, Calicut, Kerala.
Contact Us: www.ijohmr.com

ABSTRACT
Clinical Photography has evolved as an important aid to become a very important aid and requirement for better clinical
diagnosis, treatment planning and case documentation in modern Orthodontics and General Dentistry. The application
of photography in dental practice is simple, quick and particularly useful in documenting of work, assisting in patient
education and helping in clinical investigations, thus benefits dentists and patients. Its widespread application include
self-checking of one’s own results, illustration of lectures and publications, marketing and accomplishing electronic tele
dental systems. This paperwork aims to assist practitioners to capitalize on the domain of digital dental photography in
everyday practise thus making better quality treatment possible. This article attempts to give an overview of importance
of clinical digital photography in day-to-day orthodontic practice, a moderate description of main equipment, present an
outline of essentials and best-practices for maintaining high quality photographic records in a clinical setup.
KEYWORDS: Dental Photography, Digital Documentation, Clinical Photography, Photography In Orthodontics
AA
INTRODUCTION
aaaasasa sss

The word photography comes from Greek word meaning planes of space
“to write or draw with light.” The word "photography"  One frontal view in maximum intercuspation.
was coined by Sir John Herschel in 1839.1Photography is  Two lateral view right and left.
the process of making pictures by means of the action of  Optional two occlusal view maxillary and
light. Light reflected from an object forms a picture upon mandibular
a material sensitive to light. This picture is then  Free of distraction - check retractors, labels, and
chemically processed into a photograph; which provides a fingers
representation of the object.  Quality lighting which reveals anatomical contours
Photography has played a significant role in medicine and makes image free of shadows.
from the very beginning. One of the first photographs  Tongue retracted
taken over 150 yrs ago was a microscopic picture of  Free of saliva and bubbles
human bone. Digital photographic technique has been  Clean dentition.
available since 1981. Photography also plays a major role
in orthodontics. The aims of dental photographs are GUIDELINES
documentation and evaluation of craniofacial and dental
relationship, Assessment of soft tissue profile,  It is important to get permission from the patient
Monitoring of treatment progress etc. 2 before taking photograph
 Patient should be seated, leaning back slightly in the
PHOTOGRAPHS IN chair.
 Height of chair should be adjusted such that the
ORTHODONTIC CLINICS patient’s head is lower to that of photographer’s
Intra-Oral Photographs: The major purpose of intra-  All standard views should be done in horizontal
oral photograph is to enable the orthodontist3: frame
 To review the hard and soft tissue at clinical  A stable position of photographer is mandatory
examinations. (since camera is handled and not placed on a tripod)
 To record hard and soft tissue condition as they exist  The upper arm held against upper part of body with
before treatment the left hand supporting front of lens
 The eye is not pressed against the eyecup but slightly
(Patient with white spot lesions of enamel, hyperplastic
in back of it. The other eye to be open
areas and gingival cleft are essential to document)
 Photographer leg should be supported by outside
American Board of Orthodontics Requirements for edge of the patient chair in order to find secure,
Intra Oral Photographs are4:- comfortable position.
 Quality, standardized intra oral prints in color  Select magnification ratio according to the desired
 Patient dentition oriented accurately in all three frame and focus by moving camera back and forth.
How to cite this article:
Sreesan NS, Purushothaman B, Rahul CS, Shafanath T, Fawaz V. Clinical Photography in Orthodontics. Int J Oral Health Med Res 2016;3(2):71-75.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY-AUGUST 2016 | VOL 3 | ISSUE 2 71
 Sreesan NS et al.: Clinical Photography in Orthodontics REVIEW ARTICLE

 20 cm is a good distance to start testing a camera’s  The centre of photograph and focus point are around
ability to take sharp anterior intra oral photographs second premolars or first molars, depending upon
on the manual setting. framing of the image.
 In reproduction ratio of 1:1, side edges of photograph
DIFFERENT VIEWS mesial to the first premolar and distal to the second
molar.
Frontal View (Fig. 1)
 If canine to be photographed reproduction ratio of
 The frontal view is important as it details the 1:2 selected.
appearance of teeth as seen by patient, parent and
general public.
 This view is preferable in particular for general
purpose and orthodontics; this is taken in landscape
orientation with the teeth in occlusion filling the
frame with the occlusal frame horizontal and
bisecting the picture.
 Large ends of larger retractor should be used
 Assistant should hold both retractors, pulling all the
soft tissue laterally and forward; this makes it easier
for the patient to bite together in occlusion and pulls
the soft tissue away from the teeth.
 The midlines if they are should be at the centre of
frame
 The dental light should always be shown directly into
Figure 2. Right buccal
the patients mouth, adequate depth of field is
required, so it is important to focus on lateral incisor
or mesial of canine to ensure that maximum number
of teeth are in focus.
 The center of the image is the contact point of the
upper central incisors.
 The reproduction ratio is about 1:1.8
 The edges of the photograph are in vestibular oris.

Figure 3. Right buccal

Occlusal View Maxillary (Fig.4)

 Importance - assessing space requirement
 In the absence of study models, photographs can be
taken to carry out detailed and accurate space
analysis.
 Image should extend from just in front of incisors to
Figure 1. Frontal at least distal surface of first molars and ideally to
Buccal Views (Fig.2, 3) include all erupted teeth. There should be no direct
 Importance - useful in giving functional detail of view of incisor
malocclusion  Patient position - head tilted backward so that the
 Patient told to close in maximum intercuspation photographer does not have to twist excessively,
 Occlusal plane should be horizontal instruct patient fully open mouth.
 Mirror is always required. A sufficient wide lateral  Palatal mirror - rests on distal aspect of the last
mirror is inserted distal to last tooth turned outside as molars and turned down until it touches the incisors.
far as lips and check will stretch should not rest on  Small end of small retractors under the respective
the gingiva. Patient can be asked to hold the mirror. lips and rotates towards midline pulling forward and
 Assistant should hold large end of large retractor laterally. The pull is away from the teeth and in an
 Angle of the camera should be adjusted so that lens upward direction.5
is perpendicular to the buccal surface of posterior  Centre of the photograph is a cross-section of the
teeth. sagittal plane with the connection line between

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY-AUGUST 2016 | VOL 3 | ISSUE 2 72
 Sreesan NS et al.: Clinical Photography in Orthodontics REVIEW ARTICLE

second premolars running horizontally in the middle  Patient head oriented accurately in all three planes of
of the image. space and in Frankfort horizontal plane
 Focus on fissure of side teeth.  One lateral view, facing to the right; serious
 Reproduction ratio is 1:2 expression lips closed tightly to reveal muscle
imbalance and disharmony
 One anterior view serious expression
 Optional one lateral view and or one anterior view
with lips apart
 Optional one anterior view, smiling
 Background free of distractions
 Quality lighting revealing no shadows in the
background
 Ear exposed for purpose of orientation
 Eyes open and looking straight ahead, glasses
removed.
Positioning of Patient6
Both patient and the clinician need to be positioned
correctly in a standardized manner. If there is a height
Figure 4. Maxillary occlusal
difference between patient and the clinician any one of
Occlusal View Mandibular (Fig.5) them can stand on a platform to raise them to appropriate
 Palatal mirror inserted with the broader end so that level camera level at the middle of the face.
mirror rests on distal aspects of last molars, it is In extra-oral photography, attempt should be made to
turned upward with the mouth wide open until it focus on the patient’s lower eyelid to ensure from tip of
touches the incisal edges of upper incisors. The nose to ear of patient falls within the depth of field.
patient is advised to raise the tongue and breathe
through the nose. Frontal View
 The pull of retractor is away from the teeth and in a  Portrait view with the frame extending to just above
down ward direction. the top of head and lower frame line around the
 Centre of the image should be at the intersection of larynx.
the sagittal plane with the line crossing second  Photograph should be symmetrical with the inter-
premolars, positioned horizontal in the centre of pupillary line parallel to floor7
image.  A focusing screen with grid is very useful
 Optimum focus is on side teeth  Patient assumes a natural head position and looks
 Reproduction ratio - 1:2 straight ahead into the camera.
 Photograph taken with mirror require aperture  Camera position middle of the face and in portrait
compensation of +1 to allow more light input. format.
 Space should be left on all sides of the photograph.
 Light should come diagonally from the front, leaving
the patient shadow out of view of the camera. Three
types of frontal photographs are usually taken.
Frontal at Rest (Fig.6)
Teeth in maximal inter-cuspation with the lips closed

Figure 5. Mandibular occlusal

Extra- Oral Photographs

As For The American Board Of Orthodontics
Requirement Are:
 Quality, standardized facial photographs either in
black and white or color Figure 6. Frontal at rest

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY-AUGUST 2016 | VOL 3 | ISSUE 2 73
 Sreesan NS et al.: Clinical Photography in Orthodontics REVIEW ARTICLE

even if this strains the patient in case of lip incompetence.  Light should always fall on the patient profile (light
This photograph serves as clear documentation of lip always from point of nose) advantage: clearly
strain and its esthetic affect. showing mandibular margin and keeping patient
shadow out of picture
Frontal Dynamic Smile (Fig.7)
Smiling picture demonstrates the amount of incisor smile  If portrait is lit from back of head the angle of jaw is
(percentage of maxillary incisor display on smile) as well not shown clearly, and the nasal labial line will be
as excessive gingival display. unflatteringly lit (pouchy cheek)
Importance: Profile can change during orthodontic
treatment. Therefore, it is very important to have profile
views both before and after treatment.
Three Quarter Profile (Fig.9)
Useful in examination of midface deformities, in surgery
of jaw, prosthetics:
 Portraits should be taken in such a way that the
sagittal plane of the patient and optical axis of the
camera are approximately 45o to each other.
 Recommended that the patient turns his or her head
away from the camera until the contour of eye
furthest away from the camera appears to touch the
lateral visible contour of orbit.

Figure 7. Frontal smile

A close image of posed smile: A close-up image of the

posed smile is recommended now as a standard
photograph for careful analysis of smile relationship.
Profile View (Fig.8)
Usually only one profile (right profile matching up with
lateral cephalogram) is taken.
 For a patient with facial asymmetries both right and
left profile should be taken.
 Frame extending to above the top of the head in front
of the nose and below the chin.
 Back of head is not necessarily required, the Figure 9. Three quarter profile
remaining free space should be in front of profile
 Patient assumes a natural head position and look Submental View (Fig.10)
straight ahead in a relaxed manner keeping jaws It is an optional view taken especially to document
closed, and lips also relaxed. mandibular asymmetries. A self-made angled mirror (two
 Subjects with long hair should always be asked to folding mirrors with wooden frames), can be used which
tuck them behind the ear, so that Frankfort horizontal allows both frontal and lateral view to be photographed
line can be assessed accurately. separately.

Figure 8. Right profile Figure 10. Submental

 Frank fort plane is horizontal and parallel to the Disadvantage: It takes, longer to set up the mirror than it
horizontal frame of the photograph. does to make three separate exposures.

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY-AUGUST 2016 | VOL 3 | ISSUE 2 74
 Sreesan NS et al.: Clinical Photography in Orthodontics REVIEW ARTICLE

Mladenović. "Importance of digital dental photography in

CONCLUSION the practice of dentistry." Acta Facultatis Medicae
Naissensis 27.2 (2010): 75-79.
Digital photography assumes importance for diagnostic
3. A Short Guide to Clinical Digital Photography in
and treatment planning procedures as it is low cost and Orthodontics ShadiS Samawi BDS, MMedSci, MOrthRCS
less technique sensitive when compared to 4. www.americanboardortho.com
cephalometry8. Though photography cannot be an 5. Manjunath, S. G., et al. "Photography in clinical dentistry-a
alternative for cephalometry in orthodontic diagnosis, the review."International Journal of Dental Clinics 3.2 (2011).
paradigm shift towards soft tissue has elevated the status 6. McKeown HF, Murray AM, Sandler PJ. How to avoid
of photography in treatment planning. Photographs can common errors in clinical photography. Journal of
be used advantageously for epidemiology, screening, Orthodontics. 2005 Mar 1; 32(1):43-54.
initial consultations and also cases where irradiation to 7. Samawi, S. "Clinical Digital Photography in Orthodontics:
Professional Photographic Records in Daily
the patient is not recommended.
Practice." Jordan Dental Journal 18.1 (2012): 25-8.
8. Sandler, Jonathan, and Alison Murray. "Digital
REFERENCES photography in orthodontics." Journal of orthodontics
(2014).
1. Orthodontic Pearls: A Selection of Practical Tips and
Clinical Expertise; Eliakim Mizrahi. (2004) Taylor &
Francis Group. (Chapter 4: Orthodontic Samawi
Photography, by PJ Sandler, AM Murray). Source of Support: Nil
2. Mladenović, Dragan, Lidija Mladenović, and Sanja Conflict of Interest: Nil

International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JULY-AUGUST 2016 | VOL 3 | ISSUE 2 75