Unfortunately, most orthodontists weren't given a great education about capturing exceptional clinical images and this weakness is translated into their assistants' skill. So, when the pictures are taken, they naturally try their best to get all of the teeth in the arch. As a result, without exceptional use of the retractors and mirrors, the image needs to be captured from the front. What one gets is a misrepresentation of the Angle's classification, and it's an misrepresentation.
Note that I am not calling anyone a liar or a cheat. Instead, I am merely pointing out that an image taken from the front shows an untruthful representation of the patient's classification.
Look at the differences in the following two images:
The first one shows the patient's "real" occlusion. The lines drawn down the cuspid and mesial buccal cusp of the first molar show that the patient is essentially in a class II end-on relationship.
But, if the image is taken from the mesial (as we see most of the time), the patient magically becomes a class I relationship. Same patient. Same camera, mirror and retractors. Same moment in time.
How do we correct this problem?
The first thing we need to do is understand how to properly evaluate our images. The easiest way to do that is to figure out what we're looking at. In a lateral arch image, the bicuspids and molars should be parallel to our camera (or 90 degrees to the lens, depending on the way you see it). Look at the following image and notice that the yellow shaded area is directly facing the camera.
The fact that I'm looking straight at the molars and bicuspids tells me that the image is an accurate representation of the arch, as if I was looking straight on at an articulator. However, when it's misrepresented, one will most commonly be looking straight on at the cuspid and lateral, as in the following picture.
Notice how the molars and bicuspids are "trailing away" in the image. That's a sure sign that the Angle's classification isn't being properly shown.
So, how does one avoid this problem?
First, learn how to properly use mirrors and retractors. I know, it's easier said than done. There's a reason I traveled 120,000 miles a year teaching clinical photography. Most schools don't teach it enough or properly. There are also a ton of Youtube videos that simply show awful techniques with a ton of mistakes that I've tried to undo at a lot of offices. Taking great images should be really easy and I've got some simple suggestions:
(Note: I am recommending products from a company I own. While I developed these products as a result of working with tens of thousands of dentists in hands on presentations, if you have mirrors and retractors that are giving you exceptional images, then stay with them. I offer the following suggestions only because when I teach clinical photography, everyone asks me which mirrors and retractors I use and how they can be trained in clinical photography.)
1. Use the right mirrors. Rhodium coated has been the standard for decades and while other coatings have come along, none has displaced rhodium. There's a reason that companies give away stainless steel mirrors for free when you buy a camera. They're really low quality and also scratch really easily. If you invest in a good set of rhodium mirrors, they'll last you for years. HERE is a set I've produced.
2. Use the right retractors. Don't try and do direct shots. If you don't involve a mirror, you'll never get exceptional images on a consistent basis. You'll also need certain sizes for certain shots (like the lateral and occlusal images) so don't just buy a set of retractors hoping they'll fit all instances. The set I've created HERE has all of the sizes you'll ever need.
3. Learn how to use the mirrors and retractors. Yes, I know it sounds self serving, but until I can find a better option, I would suggest the DVD that I made which essentially follows me in clinic while taking a full set of images using mirrors and retractors, Yes, it's 10 years old, but I can promise you that if you use it, and have your assistants use it, their images will look awesome. You can buy it HERE.
If you but the mirrors and retractors from my site, the DVD will show you how to use them. Trust me when I tell you that overhead will keep me from getting rich off of mirrors and retractors, but until I can find a company making the shapes and sizes I've created, I'll keep recommending them.
Last, but not least, learn how to grade your images and make sure that you do so periodically. My previous post on how to evaluate images can be found HERE.
Don't get frustrated with clinical photography. It really is very easy to get great images and all you need to do is take the time to learn. Proper training and the right mirrors and retractors, along with proper practice will give you images like you never thought you could capture.
Wishing you an amazing day,
If you want to come to learn more about an amazing business meeting for orthodontists, simply visit OP2018.com . We’ve got a world-class lineup of speakers, amazing food and an ambiance that will make you want to come back year after year. You can always email me at Glenn@OrthopreneursRD.com or message me on Facebook. I’m here to help.