Digital Dental Photography

Digital Photography and Workflow for Dentists

Extraoral Photography

A Ring Flash Technique for Tooth Shade Matching

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In response to a question on DentalTown regarding how to get rid of the excessive flash on the central incisors when taking a shade for lab restorations, my colleague Dr. David Cook responded with this trick to solve the problem.  The description and photos are both courtesy of him.

One solution when you get too much perpendicular flash returning directly towards your lens is to alter the angle of your lens to the flat facial surfaces as others have advised.

Another solution is to still shoot perpendicular to the flat facial surfaces, but remove the ring flash from the front of your lens, hold it on top of your lens and angle it down 30-45 degrees. The flash is the same distance from the teeth, but the light angling down will not give you as much reflective washed out areas.

This image, the lens is perpendicular to the flat facial surface and the attached flash is perpendicular. Note the large reflected washed out facial areas on the centrals.


This image, the lens is still perpendicular, but I removed the ring flash, held it above the lens and angled it down 30-45 degrees. There are still highlights, but not the large washed out areas. You can also see the incisal translucency better and characterizations when the flash is taken off and angled down.

As others pointed out, another option is to use a twin-lite flash, such as the Canon MT-24EX TTL Macro Twin Lite or the Nikon R1C1 Wireless Closeup Speedlight system.  These are generally more difficult to use for anything except the anterior teeth unless you are very experienced.

8 Uses for Dental Photography

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Patients often ask why we take photos, and especially why we take so many.  So for a quick summary of why you, as a dentist, should use digital photography in your practice, here you go:

1. Dental Insurance – it’s hard for an insurance adjuster to deny a claim of a tooth with a big hole in it from doing the endo, or showing the huge cavity, etc.

2. Case Presentation – whether using the iPad, PowerPoint, or whatever, you want an easy way to show patients what is going on in their mouths, whether it’s a single cracked tooth, periodontitis, bruxism, etc.

3. Diagnosis – it is IMO impossible to properly diagnose and treatment plan complex cases without good photography.

4. CYA – it’s unfortunate that I had to do so, but I have avoided several problems with the NC Board regarding patient complaints because I had a case thoroughly documented start-to-finish, thereby eliminating the patient’s ability to say I did poor dentistry.

5. Tracking Your Work Over Time – with keyword tagging, you can label your pictures and later do searches based on them to follow the success (hopefully!) of your treatment over years and decades.

6. Self-Improvement – it’s kind of tough to hide from yourself when the pictures are on a 24″ HD monitor or bigger.  Pictures don’t lie, and I know that I am motivated to do better when I take a picture and find some fault (however nitpicky) that I didn’t see before dismissing the patient.

7. Lab Communication – it’s a LOT easier to communicate with a lab about shade, contour, etc. using high-quality photographs than trying to draw it out on paper.

8. Showcase Your Work to Patients – it’s far more effective to show patients considering some treatment photos of YOUR work than of someone else’s, especially on the Web.

Important adapter for new Canon 100mm Macro

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I confess, I did not bother learning much about the new Canon 100mm f/2.8L IS macro lens that was introduced early in 2010 due to the significantly greater cost and the minimal increase in usefulness for dental macro photography.

Recently, however, I learned from Mike McKenna at Photomed.net, that the new 100mm macro does NOT have the little “lip” at the end to allow the Canon MR14-EX ring flash or the Canon MT-24EX Twin Lite flash to be added.  Why?  I have no idea, as such flashes are an integral part of many macro photographer’s gear.  In fact, I think it’s pretty stupid, but hey, I guess it’s just another way for Canon to squeeze a few more dollars out of you, because now you have to buy the Macrolite 67 adapter (see below) for another $32 or so if you do choose to buy the new version of the 100mm macro.

RAW or JPEG for dental photography?

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Here’s another thought that popped to mind this evening as I was playing with my new Canon 7D (oh god, how I love this thing already!), and it relates to 2 questions many colleagues ask:

1) Should I shoot in RAW or JPEG?
Simple answer to a complex question: UNLESS you are taking pictures that you need in RAW because you’re aiming for accreditation with the American Academy of Cosmetic Dentistry or a similar organization, I recommend you shoot in JPEG.  Why?  Well, there are no PMS (practice management software) programs of which I know that can handle RAW files; you need much bigger memory cards if taking a lot of pictures; RAW files do take longer to download; you need a lot more HD memory to store a large number of RAW files.  As a comparison:
     My work PC has roughly 44,000 pictures of patients that I’ve taken with all my digital cameras going back to 2002 (my first was an Olympus C2500L), and the My Pictures folder is approx. 130GB.  My home PC has approximately 20,000 pictures in the My Pictures folder, but because I shoot all my personal stuff in RAW, that folder is about 300GB!  So only 1/2 the pictures, but more than double the memory required.  And with the new 7D having RAW files of about 24MB each, that will increase fast!

While JPEG files do degrade slightly over time when opened and closed many many many times, with the current resolution of images, the likelihood that such degradation will be visible in your entire lifetime is practically zilch.  Ain’t gonna happen.  No need to worry about it.

If you ARE aiming for accreditation, why is it therefore important to shoot in RAW?  For a very simple reason: the RAW file is equivalent to a digital negative, and it is ALWAYS that equivalent.  Even if you edit it, the original is always there and can be recovered, so it’s impossible to “fake” pictures by editing them.  That way the examiners can be 100% positive that no-one is trying to sneak something by that was really Photoshopped.

2) OK, so I shoot in JPEG for intraoral/extraoral photography, what level of resolution should I choose?
Since JPEGs can be handled pretty easily by virtually any computer these days, and you can get a lot more pictures onto a card and HD, it makes sense IMO to shoot at the largest resolution (the “L” with the smooth curve next to it, not the steps).   Sure, you could shoot much smaller files, but what’s the point?  At some time you will probably regret having a lower-quality image that you can’t improve/upsize……but it’s easy and fast to take a bigger-than needed picture and downsize it.