Hindawi

International Journal of Dentistry

Volume 2022, Article ID 2811684, 5 pages
https://doi.org/10.1155/2022/2811684

Review Article
Technique for Orthodontic Clinical Photographs
Using a Smartphone

Al Imran Shahrul ,1,2 Nabilla Shukor ,2 and Noraina Hafizan Norman 2

1
Centre for Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
2
Centre of Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh 4700,
Selangor, Malaysia

Correspondence should be addressed to Noraina Hafizan Norman; [email protected]

Received 17 July 2021; Accepted 8 January 2022; Published 22 January 2022

Academic Editor: Boonlert Kukiattrakoon

Copyright © 2022 Al Imran Shahrul et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Smartphone cameras have advanced at a rapid rate. With this advancement, it is possible to take high quality orthodontic clinical
photographs using a smartphone. The aim of this article is to describe the technique to take orthodontic clinical photographs using
a smartphone.

1. Introduction Taking personal photographs using a smartphone is rela-

tively simple, but capturing high-quality orthodontic clinical
Within the field of orthodontics, high-quality clinical photographs is harder. To produce acceptable orthodontic
photographs are essential as a diagnostic tool, to monitor photographs that meet the standards of clinical records
treatment progress, and for educational and medicolegal requires the dentist to have the proper equipment and use
purposes. Orthodontic clinical photographs consist of proper techniques.
extraoral and intraoral photographs [1]. Orthodontic clinical The purpose of this article is to explain and illustrate the
photographs may be taken by a professional medical pho- technique of taking orthodontic clinical photographs using a
tographer, orthodontist, or dental assistant [2]. smartphone.
Smartphones have become one of the most essential
pieces of equipment in our daily lives. The latest smart-
phones are packed with features that make them much more
2. Techniques
than devices for making calls. In orthodontics, smartphones 2.1. Camera Settings
are known to be used for remote monitoring of treatment
progress, cephalometric analysis, and taking orthodontic 2.1.1. General Settings. In the preinstalled camera applica-
clinical photographs [3–7]. tion (app), select the manual shooting mode. If the
The current gold standard equipment for taking or- smartphone does not have a manual mode, a third-party app
thodontic clinical photographs is a DSLR (digital single-lens such as Adobe Lightroom Mobile can be installed which
reflex) camera with a 100 mm macro lens and macro ring allows the camera to use manual mode (Figure 2). The
flash [8, 9] (Figure 1). The high cost and large size of a DSLR dentist should select the JPEG format picture quality if it is
camera and its lenses might deter certain dentists from using available. The larger RAW file type should only be selected if
this equipment, and they might instead opt to use their the dentist wishes to edit the photo. In the settings, the white
smartphone camera [10]. Compared to a DSLR camera, a balance setting should be set to Auto. The camera will then
smartphone has the advantages of being smaller, lighter, select the best white balance for the photo depending on the
cheaper, more user-friendly, and able to perform more tasks. lighting conditions.
2 International Journal of Dentistry

Select the highest aperture value possible in the camera.

A higher aperture number increases the depth of field. Most
smartphones have shorter focal lengths. The shorter focal
length results in the operator being closer to the patient,
thereby reducing the depth of field. Hence, a higher aperture
setting is required in smartphones.
The ISO should be set at the lowest value available in the
camera. Once all the camera settings have been made, the
dentist can preview the exposure of the photograph. If the
exposure is deemed too dark, the author suggests that the
dentist first increase the light intensity of the continuous
light. If the maximum intensity has been reached and the
photograph is still underexposed, only then should the
dentist increase the ISO value. Increasing the ISO is the last
method to increase the exposure, because increasing its value
will produce a noisier photograph.

Figure 1: DSLR camera, macro lens and ring flash.

2.2. Patient Positioning. The extraoral view is taken either in
the standing or seated position [1, 11]. As a reference, the
Flash setting author uses the patient’s interpupillary plane for the frontal
Picture format
view and the Frankfort plane in the profile and three-quarter
view [12]. The plane should be parallel to the floor for every
view. The intraoral view is taken in the dental chair. The
patient is seated in a 45-degree angle for the anterior and
buccal views, whereas the occlusal picture is taken in the
supine position.
Modern smartphones are equipped with multiple lenses
with different focal lengths. The author recommends that the
dentist select the telephoto lens with the greatest focal length.
Once the telephoto lens is selected, the author walks closer to
the patient until the patient’s image fills the frame. It is best
to avoid zooming, if possible, as zooming will significantly
Shutter speed White balance reduce the quality of the photograph. If the camera is too
close to the patient, only then will the author use the zoom
Exposure compensation Autofocus feature of the camera until an acceptable distance from the
patient is achieved.
Mode selection
Telephoto lens
setting selection
2.3. Environment, Background, Lighting, and Accessory
Figure 2: Example of manual settings. Equipment. The environment where the photograph is
taken plays a huge role in the quality of the image produced
The author uses autofocus to achieve focus. While the [13]. Extraoral photographs are best taken in a well-lit room
settings provide an option to use manual focus, in the author’s with many windows and a daylight colour temperature light
experience, the current manual focus feature in a smartphone is (5000 K–6500 K) [14]. The brighter the environment, the less
not as accurate as autofocus, increasing the chances of out-of- additional external lighting is required.
focus photographs. The focusing point for extraoral photos A plain, nondistracting white or black background is
should be the eye, and for intraoral photos, the canine tooth. typically used in orthodontic clinical photography [1]. Be-
Finally, the exposure compensation should be set to zero. cause of the limitations of mobile dental photography, the
author does not recommend a white background due to the
presence of shadows, especially in profile or three-quarter
2.1.2. Shutter Speed, Aperture, and ISO. The author rec- view. Instead, a darker background should be used to hide
ommends a shutter speed faster than 1/100 second and shadows.
suggests two methods to reduce the occurrence of camera One of the trickiest components of mobile dental
shake, which may produce a blurred image (Figure 3). First, photography is lighting. One method to overcome this
hold the smartphone with both hands as close to your body shortcoming is to use a continuous light source [14]. The
as possible. Next, tuck in your arms. This will turn your body author recommends an affordable portable LED ring or box
into a stable platform like a tripod. The author finds this light (Figure 4). For intraoral photographs, the author uses a
method to be effective in reducing camera shake. dedicated LED light to illuminate the teeth.
International Journal of Dentistry 3

Figure 3: Methods of holding a smartphone.

(a) (b)

Figure 4: LED ring light (a) and intraoral LED light (b).

Accessory equipment such as a cheek retractor and to an average model, can capture quality orthodontic photos
mirror is essential for intraoral photography (Figure 5). with the proper technique (Figure 6). The author strongly
Various sizes of retractors and mirrors are available on the believes that a photo taken with a smartphone is better than
market. The size should be selected according to the patient. no photo at all.
A transparent retractor and a mirror with a handle are The author would like to emphasize the importance of
recommended. data privacy when taking clinical photos with a smartphone
[15]. Due to the connectivity of smartphones to the internet,
3. Discussion the possibility of the picture being leaked online is signifi-
cantly higher. The author recommends that clinical photos
In the hands of an experienced dentist, the picture quality of should not be kept together with personal photos. Using a
a DSLR camera system is far superior to that of a smart- separate phone or folder for clinical photos is best. To ensure
phone. Furthermore, there are certain technical differences that unauthorized personnel do not gain access to the photos,
between taking a picture with a smartphone and a DSLR. the folder should be password protected. Sharing of photos via
These differences are summarised in Table 1. Hence, for a messenger or social media is prohibited without the consent
dentist who uses a DSLR daily, there is a need to get of the patient. The connectivity of smartphones does provide
refamiliarized with the new settings. However, the inferior an advantage. Photos stored on the phone can be transferred
picture quality of smartphones does not mean that photo- immediately to a computer or cloud storage. This ensures that,
graphs taken with a smartphone are unacceptable for an in the unfortunate event of a lost phone or SD card failure,
orthodontic clinical record. Based on the author’s experi- there is a backup file available. Finally, when a smartphone is
ence, any modern-day smartphone, from the top-of-the-line no longer being used, its memory should be erased.
4 International Journal of Dentistry

Figure 5: Intraoral mirrors and cheek retractors.

Table 1: Summary of the technical differences between a DSLR and a smartphone in taking orthodontic photographs.
DSLR Smartphone
Picture format JPEG/RAW JPEG/RAW
Depends on the smartphone manufacturer (select the longest focal
Lens focal length 100 mm focal length lens with macrocapabilities
length lens)
Additional A macro ring or twin flash attached to the
External continuous LED light
lighting camera hot shoe
Extraoral: F8 Depends on the smartphone manufacturer (select the highest
Aperture
Intraoral: F22 aperture number possible)
ISO 100 100 or lowest possible
Shutter speed 1/100 per second 1/100 per second
White balance Neutral Auto
Autofocus
Manual focus Autofocus
settings

(a)

(b)

Figure 6: Photos taken (a) without the proper technique and (b) with the proper technique.
International Journal of Dentistry 5

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Conflicts of Interest [17] S. Saccomanno, V. Quinzi, S. Sarhan, D. Laganà, and
G. Marzo, “Perspectives of tele-orthodontics in the COVID-
The authors declare that there are no conflicts of interest 19 emergency and as a future tool in daily practice,” European
regarding the publication of this study. Journal of Paediatric Dentistry, vol. 21, no. 2, pp. 157–162,
2020.

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