Tishk International University

Dentistry Faculty
Dentistry Department
Dental photography

Lecture NO.3
3rd Grade- Spring Semester 2020-2021
Instructor: Dr.LANA BAHRAM
 CLINICAL DENTISTRY PHOTOGRAPHIC ACCESSORIES :

a) Cheek Retractors:
• Available in clear plastic or metal, it is used to retract the lips, labial and buccal mucosa.
• Retractors are either single or double-ended. Double-ended retractors provide both a
small and large curvature allowing adaptability.
• Single-ended plastic retractors have longer, tapered handles. The curved end is larger for
excellent lip retraction.
 TECHNIQUE FOR INSERTING RETRACTORS:
a) Moisten the retractors in warm water.
b) Ask the patient to relax the lips and open the mouth slightly.
c) Place the rim of the retractor onto the edge of the lower lip.
d) Rotate the handle of the retractor until it is parallel to the corner of the mouth.
e) Repeat this for the other side of the mouth if necessary.
f) Instruct the patient to bite down on the posterior teeth.
 Pull out the retractors laterally and slightly forward. Avoid pulling the retractor handles
toward the ears. This will cause the buccal mucosa to be pressed onto the buccal surfaces
of the teeth, as well as cause the patient discomfort when the retractor is pressed against
the gingiva and alveolar process.
B) Intraoral Mirrors:
• Intraoral mirrors are used to provide a reflected image when areas of difficult access
are photographed.
• Glass mirrors that have been rhodium plated on both sides create an excellent
reflective surface .
• Intraoral mirrors are available in several sizes for both adults and children.
• The large end of the mirror provides an excellent surface for capturing occlusal views,
and the smaller end can be placed for palatal and lingual views.
Types Of Retractors In Dentistry
 TECHNIQUE FOR INSERTING MIRRORS:
a) Place the mirror in warm water before use to prevent fogging. A small heating pad
could also be used to keep mirrors warm.
b) Insert the appropriate cheek retractors.
c) Select the mirror and the appropriate end for the desired view.
d) Place the mirror flat into the mouth. As you retract with your fingers, rotate the
mirror into position.
 Take care not to hit the teeth or press into the alveolar process, as this is annoying
and uncomfortable for the patient.
e) Hold the mirror securely at the opposite end while maintaining retraction.
A BLACK BACKGROUND
Is suitable for discrimination of dentin and enamel shades, analysis of shape, and
study of white and opalescence features. The absence of light inside the oral cavity
makes the mouth background black or similar to black. This is what we find most of
the time in dental photographs.
A White Background:
Allows differentiation between translucent masses and study of the amber( ;amber is a
yellow color), orange, and reddish properties of teeth. When maxillary incisors in
occlusion cover the mandibular incisors, the background turns white; this is a common
situation.
A Neutral Gray Background:
Promotes discrimination of tonality (Hue).

A red Background:
generally are used for artistic and graphic purposes; they do not have a true utility in the
study of color. The red background makes teeth appear bluer than they actually are.
 To view translucency, a useful tool is “the Dental Contraster”. This tool allows
either the maxillary anterior or mandibular anterior teeth to be easily isolated.
 GUIDELINES FOR CLINICAL PHOTOGRAPHY:
To achieve a good digital dental photograph, standardization is very important, i.e.
consistent lighting, exposure, patient positioning, perspective, depth of field and
background.
Preparation of the Patient
• The patient should be seated comfortably in the chair and explained about the procedure.
• Adjust the height of the chair so that the subjects head is lower than the photographer’s
head by asking his/her to turn or tilt their head.
• Surgical drape should be changed for every patient to avoid blood stained images. • If
patient helps in retraction, ask him to wear gloves.
Preparation of Background, Instruments and Intraoral Sites:
• Consistent background should be present behind the patient for pre-, mid- and post-
treatment photos.
• The area to be photographed should be clean of debris, excess saliva, blood, air bubbles,
impression material and cement, glove powder.
• Proper isolation should be done symmetrically with plastic retractors (cheek and
occlusal) to obtain unrestricted view.
• Use black spatula to prevent coverage of front teeth by lips with high quality mouth
mirrors to aid in better view.
• Mirrors necessary for lateral, palatal and occlusal views should be rhodium coated.
• Dip the mirror in hot water and dry it with cotton or tissue paper alternatively using
light stream of air from air syringe to avoid fogging.
• Black backgrounds allow better contrasts without compromising the translucency of
teeth and restorations to be displayed.
Preparation of Camera and Dentist
• Intraoral views should be shooted in landscape mode whereas in extraoral
photographs portrait mode is used.
• Use smallest aperture to maximize depth of field, with 1:1 magnification of lens.
• Photograph teeth in correct axial alignment (occlusal plane should be parallel to the
horizontal in photograph).
• Keep nose out of palatal view of maxillary incisors.
• Avoid beard hairs.
• Retract tongue with mirror/ask patient to move tongue posterior so as to attain a
proper background while photographing teeth.
• Proper cropping should be done to minimize confusion with mirror edges, fingers,
unreflected teeth.
• If the photographic conditions are standardized, it is easy to compare then even if
they were clicked by different photographers after long time intervals.
• Use manual focus, autofocus is unreliable for oral cavity.
• Eliminate poor quality and over or underexposed images, out of focus and poorly
oriented images.
All these parameters should be followed religiously by a dentist for obtaining an
excellent photograph.
Operatory Dental Light
• It should not be directly on the teeth
• Keep the light on the side of the cheek and out of the mouth.
• The light is only needed to give enough light to focus by
• When the dental light is bright or strong on the side of the arch that should have the
greatest contrast, it will kill the contrast produced by the flash.
TAKING CLINICAL PHOTOGRAPHES

Extra-oral Photographs :
• Face-frontal (lips relaxed).
• Face-frontal (smiling) .
• Profile (right side preferably – lips relaxed) .
• (45 °) Profile (also known as ¾ Profile – Smiling)

Intra-oral photographs:

 Frontal – in occlusion
 Right buccal - in occlusion .
 Left buccal – in occlusion .
 Upper occlusal .
 Lower occlusal
Face-frontal (Lips Relaxed) :
• outer canthus to superior attachment of the
ear (C-SA line)
• Interpupillary line .
• Encompassing area (crown to collarbone)
Head in NHP;(Natural head position)

Face-frontal (smiling):
 Same guidelines
 Smiling in a natural way with the teeth
visible.
 Aids in visualizing patients smile esthetics
and soft tissue properties
Profile (right side preferably – lips relaxed):
• canthus to superior attachment of ear
• encompassing area of crown to collarbone
• chin and neck should show, preferably up to the
clavicles
• Frankfort horizontal line to be sure that head is level
(45 °) Profile
• Social Interaction
• visible information about smile esthetics .
• Turn the head to right about ¾ of the way
• Teeth should be visible
 EXTRA-ORAL PHOTOGRAPHS
There are eight photographs in this
series. The photographs of the head
must be taken in a natural, posturally
correct position.

1. Portrait full-face frontal view with lips in repose (approximately 4.0 mm apart).

This is used to evaluate:

• Facial proportions/symmetry/skeletal-jaw relationship
• Interpupillary line relative to the horizon
• Length of upper lip
• Anterior tooth display
 2. Portrait full-face frontal view of the patient's maximum smile.

This is used to evaluate:

• Facial proportions/symmetry/skeletal jaw relationship
• Interpupillary line relative to horizon
• Relationship to face and horizon:
o Base of nose
o Upper and lower lips
o Incisal and occlusal planes of both arches
o Gingival display and level
• Tooth display, position, arrangement and proportion
• Lip dynamics
 3. Portrait full head sagittal view, right side in repose.

This is used to evaluate:

• Facial/skeletal jaw relationship
• Tooth display

4. Portrait full head sagittal view, right side in maximum smile.

This is used to evaluate:

• Facial/skeletal jaw relationship
• Tooth display, position, and inclination
 5. Frontal view (close-up, 1:2) of lips in repose.

This is used to evaluate:

• Anterior tooth display
• Incisal plane

6. Frontal view (close-up, 1:2) of patient maximum smile.

This is used to evaluate:

• Tooth display, position, arrangement, and
proportion
• Incisal and occlusal planes of both arches if
visible
• Gingival display/level
• Lip dynamics
 7. Three-quarter view (close-up, 1:2) of maximum smile right side.

This is used to evaluate:

• Tooth display and angulation
• Gingival display/level
• Incisal and occlusal planes of both arches if visible

8. Three-quarter view (close-up, 1:2) of maximum smile left side.

This is used to evaluate:

• Tooth display and angulation
• Gingival display/level
• Incisal and occlusal planes of both arches if visible
 INTRA-ORAL PHOTOGRAPHS
There are 10 photographs in this series taken close-up at approximately 1:2
magnification.

9. Frontal view with teeth in maximum intercuspation.

This is used to evaluate:

• Anterior overbite
• Tooth condition, position, arrangement, and
proportion
• Gingival condition, gingival, and papillae level
 10. Frontal view with anterior teeth separated by 2 to 4 mm.

This is used to evaluate:

• Tooth condition, position, arrangement and
proportion
• Incisal plane of both arches
• Occlusal plane of both arches
• Gingival condition and papillae levels

11. Buccal view, right lateral posterior with teeth in maximum intercuspation, taken into the
mirror.
This is used to evaluate:
• Tooth/jaw relationship
• Tooth condition, position, arrangement and
proportion
• Gingival condition, gingival and papillae levels left
lateral posterior
 12. Buccal view left lateral posterior with teeth in maximum intercuspation, taken into
the mirror.
This is used to evaluate:
• Tooth/jaw relationship
• Tooth condition, position, arrangement, and
proportion
• Gingival condition, gingival and papillae levels

13. Buccal view, right lateral posterior with teeth separated by 2 to 4 mm, taken into the
mirror.

This is used to evaluate:

• Incisal and occlusal planes
• Inclination of anterior teeth relative to occlusal plane
• Tooth condition, position, arrangement, and
proportion
• Gingival condition, gingival, and papillae levels
14. Buccal view, left lateral posterior with teeth separated by 2 to 4 mm, taken into the
mirror.
This is used to evaluate:
• Incisal and occlusal planes
• Inclination of anterior teeth relative to occlusal plane
• Tooth condition, position, arrangement and
proportion
• Gingival condition, gingival and papillae levels

15. Maxillary anterior teeth.

This is used to evaluate:

• Tooth condition, position, arrangement and proportion
• Incisal plane
• Gingival condition, gingival and papillae levels
 16. Mandibular anterior teeth.

This is used to evaluate:

• Tooth condition, position, arrangement, and
proportion
• Incisal plane
• Gingival condition, gingival and papillae
levels

17. Maxillary arch occlusal view taken into the mirror.

This is used to evaluate:

• Tooth condition, position and arrangement
• Arch form
18. Mandibular arch occlusal view taken into the mirror.

This is used to evaluate:

• Tooth condition, position and arrangement
• Arch form
ADDITIONAL PHOTOGRAPHS
• An additional photograph which is extremely valuable as a frontal portrait,
natural head posture, with the lips retracted and anterior teeth separated by
approximately 2.0 to 4.0 mm.

• In this one photograph, we can compare the interpupillary line with the incisal and
occlusal planes.
The composition of this photograph Tells us the Whole Story (Almost).”
• Another photos used to engage your patient in discussion about airway,
supplemental photographs which would be helpful.

1. Throat: tonsil area (use mirror to depress tongue)

 2. Tongue:
Tongue in resting position, and lingual frenum (place the tongue on the palate and then
have the patient open as wide as possible, keeping the tongue on the palate. Take the
photograph with the tongue in this position.
 3. Nose:

Nose basal view relaxed and with deep inspiration