The upper and lower occlusal photographs rate as some of the most challenging along with buccal retracted images. The other side of the coin, is they are two of the most valuable of the images we take. They are at the top of my list of images I show to patients, as they express an overall view of the structure and health of the teeth. There are some ways to make getting these images more predictable. One of the most important pieces is that these images be taken using mirrors and not directly. Utilizing the occlusal mirrors with handles, eliminates the challenge of gloved fingers in every shot, and the difficulty in holding the mirror int he right position and angle.
If you haven’t yet discovered handles for your dental photography mirrors you are missing out. For many years I struggled to take mirror shots and hold the mirrors by hand. It was a combination of frustrations. I could never have enough control over the mirror to retract without having fingers in ever image. When I was first introduced to the handles I was a bit skeptical, but I would never take a mirror photograph without them today.
Taking photos with a digital camera is game changing in a dental practice. As the ultimate communication tool, they allow patient’s to “see” what their teeth look like and give us a way to talk with them more powerfully. Taking the photos requires the implementation of several systems one of which is storage of the images. Whether you are taking 4 or 18 photos once they are taken we have to be able to show them to the patient and refer back tot hem at future appointments.
One of my personal goals as a photographer is to take pictures of a high enough quality that I never open one on my computer and find it unusable. Whether for diagnostic purposes or as part of a patient presentation the exposure is a critical factor in the accuracy of a photograph. A critical factor in taking good photographs is displaying the histogram and being able to interpret what it is communicating about the exposure of the image. Different camera systems allow you to display the histogram along with the image on the back of the camera. Your owner’s manual or quick start guide should show you how to have the histogram display.
The Buccal retracted photograph is a critical image for treatment planning. It shows the upper and lower occlusal planes and relationship to the anterior teeth in the version with the teeth apart. The Image with teeth together allows us to evaluate intercuspal position and is used in the series of Invisalign photos to digitally occlude the models. The combination of retractors and mirror placement makes this one of the more challenging images to get. This video demonstrates a technique for placing the mirror and reliably capturing this photograph.
Click continue for the video.
Many years ago in a lecture by Dr. Frank Spear I learned about the six photos he takes on every hygiene patient and it transformed my practice. Over the years I have come to depend on the power of being able to see what I am describing as a way to engage my patients. Photography is the most powerful communication tool to allow people to see their teeth as we see them. It creates awareness, and all action begins with awareness. I no longer take the six I started with, but have it down to the magic four photos.
Some of the most challenging intra-oral photos to master are the mirror shots. The placement of the retractors and the mirror, controlling fog and then aiming and focusing are all part of what makes these photos my favorite to take. In some ways it feels like I am playing the game twister by the time I am ready to press the button and take the photo. With all of this when I then look at the photo and the exposure or color aren’t right I’m frustrated! One of the biggest problems that I have with my mirror shots, especially the occlusal, is that they come out with a bluish tint to them.
I had the opportunity this afternoon to begin the process of restoring a single maxillary central. Without question this is the most challenging thing I do in esthetics. One of the critical pieces of getting an exquisite match will be to mimic the surface morphology of the other central incisor. Surface morphology creates so many aspects of the appearance of the tooth. The primary interaction between surface morphology and our perception of the tooth has to do with light reflection. When light hits the tooth, some of it is reflected back to our eye, and the rest is reflected away. This light reflection is what our eye uses in determining the value of the tooth as well as the size and proportion, so it is critical when matching existing natural teeth.
Taking dental photographs in mirrors can be challenging enough, without having to worry about controlling the fog. Over the years I have tried and abandoned many techniques for warming the mirrors so that they don’t fog during photographs. The first technique I tried was placing the mirrors in a bowl of hot water. It warms them for sure, but I ran into several challenges. First getting water that is hot enough, then carrying it to the room without spilling it or tipping over the bowl once it was in the room. If this all worked, the last problem, was that once warmed the mirrors are wet and have to be dried prior to use. Since you don’t want to rub dental photography mirrors with paper towels or anything course, this required having sterile chamois in the room.
I abandoned this technique and tried warming the mirrors with a torch, using the same waving technique for warming wax for bite records. My challenge with this was getting the mirror evenly heated, not too cool which means it still fogs and not too warm or it burns the patient. I also found patients got a little skeptical watching all of this. When I finally burned my own fingers I gave up.