Clinical Dental Photography

Sorry for the break....

2011-11-08T23:56:00.000-08:00

Hi Eveeryone.

First off, I am so very sorry for the time away. Yes, I know it's been a while, but I have been so focused, (no pun intended) on lecturing and coming up with new ideas that I simply let the blog go away.

I now have a new video blog at our redesigned website www.kriegercontinuum.com

I promise that I will do everything within my power to answer your questions in a timely fashion and help clear up a lot of the myths that are circulating today about clinical photography and its proper use.

Stay tuned and thanks for your patience. I'll make the wait worthwhile...

Glenn

New Mirrors Retractors are Finally Here!!!

2007-12-31T00:37:00.000-08:00

Well, with some help of CAD/CAM, my new mirrors and retractors have finally gotten to a place where I think they work exceptionally well. I have used them exclusively for the last several weeks and am thrilled with the results.

So, what makes them different?

Well, I changed the widths a bit so that they are easier to see into by being slightly bigger, but I have also gotten rid of a lot of the "end" bulk, which makes them easier to fit into the mouth.

Additionally, I have made both sides and both ends of the lateral mirrors the same, so it's as if you have 4 of the same mirror for every one you buy. If an end gets scratched up, there are 3 other ends using both sides.

The maxillary and mandibular mirrors are also longer, so there's more places to put your hand without getting them in the way.

Of course, the unique retractors that I use have also been finished and I credit their shape and size to a lot of the detail that I capture in my images. I don't know how I ever practiced without them.

If you're interested in ordering them, please contact me through my website at www.betterdentalimages.com

Have a great day!!!

Glenn

How to get perfect intra-oral shots, with particular reference to mirror use

2007-11-22T22:27:00.001-08:00

I've been asked by a reader to cover this topic.

I have to start by apologizing. My main purpose in this blog is to help viewers get as much out of their clinical photography as possible, however, this topic is one that simply cannot be mastered in words alone. Sure, I can give tips about how to get that perfect lateral or occlusal shot, but until you get a chance to have the mirror properly aligned or camera angle corrected, all the reading in the world won't get you there.

Let me try my best, though. In this post, I'll cover the lateral arch shots, and deal with the occlusals some time in the near future.

I'll start with the criteria that I think best define what I like to look for when I take a "great" lateral image. I want to capture every tooth in that side of the arch from the second molar to the contra-lateral central incisor. Additionally, I would like to see the plane of occlusion run right down the center of the horizontal axis of the image. It's also important that the lens be angled such that we aren't looking up or down on the arch. Last, but most importantly (at least in my humble opinion), I would like to see the arch perfectly perpendicular to the viewer; I have to be able to see the Angle's Classification properly. Unfortunately, it is this last criteria that is often the most underachieved. Open any dental journal today, and I will guarantee you that you will see lateral arch shot after lateral arch shot where the teeth are not even close to perpendicular. This gives a false sense of the Angle's classification which is a critical factor for proper treatment planning.

As my previous post mentioned, I believe that current mirror design has a lot to do with the difficulty in achieving a better image. Nonetheless, I think that human error plays a bigger role. I say this because I can almost always get a great image with the current mirrors, however, my students have found that there is a rather decent learning curve.

The keys for operators achieving successful images lies in the positioning of the mirrors and retractors. It is vital that the mirror be placed as far distally as possible and the distal end be pulled away from the second molars before pivoting the mesial end facially. This keeps it from hurting the patient.

The contra-lateral retractor should be released to the mid-line as much as possible to get rid of as much tension as possible not related to the side you are capturing.

Last, but not least, don't be afraid to really stretch that mesial end of the mirror until a perfect image appears. Collagen is our friend and will allow us to capture a perfect image on almost everyone. Don't be afraid of "stretching" the patient, as you can go pretty far without hurting them. Sure, it's going to be a weird experience for them, but it won't be painful, unless of course, you don't pull the mirror away from the distal-most aspect as you pivot it.

By far, the most common mistake that I see from my students is the fear of pivoting that mirror to where it needs to be. All "newbies" are afraid to really stretch the patient. In my courses, when a student tells me that they have a patient stretched as far as possible but still can't get that great shot, I gently assist them in moving the mirror even farther to get what is needed. Afterwards, patients remark that it didn't hurt at all.

There are time, though, where anatomy just won't allow a "perfect" shot. In times like these, I would rather miss the second molar altogether and get a true Angle's classification, rather than capture the second molar, but not get a fair evaluation of the occlusal relationship.

Remember, this particular type of image requires hands on instruction and lots of practice to get it perfect. I look at it like driving a car; You can read about it as long as you like, but until you get behind the wheel, shift the car into "Drive" and step on the accelerator, you just don't truly understand what you've gotten yourself into and how to overcome unexpected issues.

I hope this helps, and I welcome any feedback.

Have fun shooting images. It will change your practice forever.

New Mirrors on the Way

2007-11-21T21:06:00.000-08:00

Great news!!!

Having taught literally thousands of dentists over the last several years, I have found that many dentists have a hard time capturing great lateral and occlusal images, This is, in part, because of the shapes of many of the common mirror designs on the market today. They are too wide at the ends, so they don't allow the mirror to go back far enough, and often put pressure where it doesn't belong.

So, over the last few months I have been working on prototypes of mirror designs that get rid of a lot of the problems that the current designs cause.

I've switched to using them exclusively and am almost done with the 5 basic shapes that I believe work best.

As soon as they're ready for mass production, I will let you see an image of what they look like and will offer links to find out more.

I know, I'm a geek for working on this stuff, but after hearing hundreds of complaints about current mirror design from my students, I felt that I had to do something.

Happy Thanksgiving!!!

Tricks for Great Smile Shots

2007-10-16T22:00:00.000-07:00

Well, with Halloween just around the corner, I thought that I would provide a treat in the form of a trick to capturing awesome smile shots.

The most common issue that I see with regard to smile shots is the fact that they are either off center or aren't angled correctly in a vertical dimension. By this I mean that they look as if they are either being shot from above or below.

Here is an example of an image that was taken from below. It's the most common mistake, and far more common than the error of being taken from above. Why is that the case?

Most dentists and assistants make the mistake of taking the image of the smile with the patient reclined far too much in the dental chair. As a result, just from a postural position, one must either get the patient to lower their chin a great amount, or have the dentist stand on some device (not recommended due to danger of falling) to capture the proper 90 degree shot. Lowering the chair is usually not an option as most individuals aren't tall enough to get a great angle even when the chair is at its lowest position.

If the chair is upright so that the patient is nearly upright, then there is minimal adjustment necessary. It's also important to observe your body position while shooting the image. You should be standing on the side of the patient at around the anterior/posterior level of their wrist and have the patient turn towards you. A lot of dentists lean out over the patient and that's a sure way to a tweaked back.

Last, but not least, look through your viewfinder and compose the image perfectly while asking the patient to smile. Once you've properly framed it, ask the patient to relax, all the while trying to keep you focus on the smile that will appear. Count down from 3 and then ask the patient to smile. Capturing the image immediately will ensure a natural smile shot.

Here is the same image from above, except taken at the proper angle.

Good luck, and please contact me if you have any questions or topics that you would like to see discussed.

Best Wishes,

Glenn

TTL vs. Non-TTL, Which is Better?

2007-08-28T20:26:00.000-07:00

A few years ago, I was told that there were a lot of dental photography experts who were suggesting that dentists use "TTL" (Through The Lens) metering for their cameras. I was not a fan of TTL to begin with because I felt that it left too many decisions up to the camera, so I continued shooting and teaching non-TTL, histogram based dental photography.

The primary perceived value of TTL is that it's easy to use. In my opinion, based upon my experience and side by side comparisons, nothing could be farther from the truth. You see, SLR cameras weren't specifically designed for the very rigid demands of dental photography. We shoot images from about 1 foot away with the majority of the image being white and pink. Because our use is so far outside of the normal macro photography, the metering system just doesn't work right in the TTL mode. As a matter of fact, after learning how to properly use histogram based capture, most students have an "AHA!" moment related to a variety of close up images that they previously couldn't capture using TTL.

It doesn't seem to matter what camera system is being used, or whether one is using "E"TTL or "i"TTL. In either case, the images just don't compare to the beauty and sophistication of non-TTL photography.

When I changed from Nikon D-100 cameras to D-200 cameras, I figured that I would give the newest Nikon TTL system a chance. For over 2 months I actually tried everything in my power to give TTL a chance. Unfortunately, I could rarely capture an image that was even close to what I was getting with the non-TTL shots. To this day, I look back at the images I took during that period and cringe.

If you think that your camera and TTL are different, please feel free to look at the histogram. I virtually guarantee you that changing to a non-TTL image capture workflow will give you a far better result.

Have a fun time capturing some great images!!!

The Facts about Dental Camera Purchases

2007-08-05T03:43:00.000-07:00

Now, I know that this particular topic may not make me a lot of friends at some camera stores, but there's a lot of information that consumers should understand before buying a camera. I just want to share some of what I've learned, with the hope that you won't make the same mistakes that many new camera buyers make.

When buying a new camera for dental use, I would strongly recommend a Single Lens Reflex (SLR) camera. These are the type of cameras that have interchangeable lenses and generally do not show an image on the screen before you shoot an image. You need to look through the viewfinder. What distinguishes them from the standard "point & shoot" cameras is their incredible adaptability for the very specific task of taking high quality dental images. The ability to use specific lenses and flashes designed for up close (macro) photography makes SLRs a far better choice than "point & shoot" cameras, which need oddly designed accoutrements in order to adapt them for up close shooting, something they were never designed to do. There are several major dental photogrpahy companies tuting their latest and greatest "point & shoot" cameras as being as good as SLRs. Head to head comparisons just don't show this to be the case, so please do not be fooled.

(Above) An example of an SLR camera with a macro lens and flash setup. What you are looking at is a state of the art camera system for exquisite dental photography. Approximate cost for this system is around $2000 and is as good as any setup currently on the market. Sure, there's some instruction necessary, but that will be the case regardless of the camera type you choose, and the reward will be far greater with an SLR versus a "point & shoot".

(Above) An example of a "point & shoot" camera. Special additional adaptors are necessary to make this camera appropriate for dental use. The cost will vary from around $1000-1800 and just don't compare when shot head to head with SLRs.

The comparison of SLRs and "point and shoots" is a complex topic which could easily take up pages of discussion, however here I will merely tell you that while teaching my hands on courses in dental photography, I have never (yes, never) had a student who was using a "point and shoot" camera want to go back to it after properly learning how to use an SLR for dental photography. It's also good to keep in mind the fact that most point and shoot cameras that have been adapted for dental use are not cheap. For slightly more money, a great SLR combination can be found.

When looking for a camera, always look for an authorized dealer. I recently found a dental wholesaler who was trying to sell a specific camera to dentists. One call to the camera company rep confirmed that this reseller was not an authorized distributor for that camera. What this meant is that any dentist who purchased that camera from that distributor instantly had their warranty voided. That's a pretty daunting concept for an expensive piece of clinical equipment.

The standard lens in the industry is a 105mm macro lens. There are companies out there trying to sell odd magnification lenses (i.e.-60mm). Try to stick with the standard 105mm as it is generally accepted as the easiest lens to use and the most widely used as well. Make sure that it is a "Macro" lens, for up close photography. A non macro lens will not allow you to get close enough to your subject for an adequate image.

The "on-board" or built in flash will not be appropriate for the up close images, so you will need a good ring or point flash. Once again, this topic could take up a lot of space, and might be a topic for future discussion. For now, understand that whatever flash you purchase, it should also be rated for macro photography.

So, if you have a good SLR camera, a 105mm macro lens and an appropriate macro flash, all purchased from an authorized dealer, you will have the proper camera setup to potentially allow you to capture exquisite dental images. Of course, there's a lot more to learn but it's a great starting point.

As always, please feel free to contact me if you have any questions. We're all in this together...

But I already own an intra-oral camera...

2007-07-29T16:30:00.000-07:00

You may be asking yourself "Why should I bother learning how to take high quality dental images when I already own an intra-oral "wand"-like camera?" It's a fair question, however, there are some really differentiating features between the two.

I first started using an intra-oral wand camera in 1993. It was awesome. We were able to show patients things like cracks, chips, soft tissue pathology and failing restorations. I was also taking images with an SLR camera, but slide film just had a ton of drawbacks (i.e.-time, cost, not knowing what you had until the image was developed, etc). So, the wand camera dominated use.

When digital SLRs showed up on the scene, it suddenly allowed us to overcome the drawbacks of slide film, however, I guess I am yet to answer the question "Why SLRs as compared to small intra-oral cameras?"

Most dental practice consultants, and lecturers will tell you that the difference between an "insurance" high volume practice and the "boutique" lower volume practice is the comprehensiveness of the treatment plans that are formulated. The boutique practice tends to take more time with patients during the diagnostic phase, and as a result, the dentist tends to more comprehensively diagnose (don't confuse this with wanting to put veneers on everything). This leads to having to see less patients per day with considerably higher dollars/hour being produced, all while creating greater health for patients as compared to the "one tooth at a time" approach adopted by higher volume practices.

Intra-oral wand-like cameras tend to show cracks, chips, etc. on single teeth and although they are valuable, they tend to perpetuate the "one tooth at a time" approach. It is nearly impossible (trust me, I've done this for a while) to match the comprehensive diagnostic information of a digital SLR using mirrors and retractors when comparing it to the image of a single tooth using a standard intra-oral camera. Plus, utilized properly, you can show patients an instant image using an SLR like a wand camera, if you want to, except the image will look far better.

I still use a wand-like intra oral camera from time to time when a patient doesn't have any other comprehensive needs and I want to demonstrate a small crack or chip. I also use it to show failing restorations with the desire to motivate patients to go through the next step, namely, study casts and high quality SLR images, although the right verbal skills will make this transition a very easy one.

Put the wand camera on the shelf for a day and replace those images will full arch, SLR images, and watch your practice begin to change nearly instantaneously. You'll start seeing less patients per day, your dollars per hour will go up and the relationships you create with patients while changing their lives will make the clinical practice of dentistry so much more fulfilling.

Digital dental image workflow suggestions....

2007-07-25T23:13:00.000-07:00

So, you've bought a camera, gotten some training and have some awesome (hopefully) images to show for your effort. What should you do with them? This is one of the most common questions that my students have asked.

Well, you do have several options...

You could simply upload them to your practice management software and show them there. This isn't one of my preferred options. There are a lot of people out there (mostly sales reps) who will try to convince you that storing your images in proprietary software is a great idea. Although consolidation is a nice concept, there are a couple of reasons why I prefer to to keep my images out of my practice management software.

First of all, I rarely look at my images when I am in the treatment room. I use them primarily when I treatment plan and present treatment options. I don't feel that I need them hooked up to every computer. By using windows explorer (simple, free database management software on every PC) I can easily catalogue all of my images in the treatment room where I want to view and present my images. You can easily create a shortcut to that path on any computer so that the images could be seen on any computer.

Additionally, I just went through a software conversion involving two of the largest practice management software companies in the US. Wanna guess what didn't go over in the conversion? Yep, you got it right; the images. By keeping them outside your management software, you retain considerably more control over them.

Once I have catalogued the images, I use Adobe Photoshop (either "full" or "elements" versions work fine) to flip, rotate, crop, sharpen, morph and re-size my images. It's amazingly powerful and productive software that is a "must have" for the dental office.

Last, but certainly not least, I import all of my images into a presentation software such as Microsoft PowerPoint and add annotation, lines, arrows, music and effects and present it to the patients for the most powerful non confrontational case presentation you will ever see.

If the aforementioned ideas seem daunting, please don't be turned off. Once you learn how to do everything mentioned above, the entire workflow can be finished for an entire case by an assistant in less than 10 minutes.

Once you start playing around with a digital image workflow, you'll be thrilled as you see your case acceptance go "through the roof" and help a whole lot more patients get healthy.

Have Fun!!!

Dental Photography Using a Black Background

2007-07-18T06:36:00.000-07:00

We've all seen those really cool looking and snazzy dental images with great close ups and beautiful black backgrounds. Ever wonder how they do it? It's really easy.

Sure, you can go out and buy a special device to help you get those images, but frankly, to me, it's a waste of money.

Here's you can get the same beautiful quality images without having to spend a lot of money and with great simplicity.

Ever seen those annoying (at least to me) black plastic things in the front and back of bigger 3 ring binders? I think that they are meant to help with keeping the pages in place (I frankly have no idea what they are supposed to do). They are usually shaped a little like a boomerang.

Take one out, cut it in half and shape the end like a tongue. Now, whenever you want to take an anterior close up picture, place the tongue shaped end behind the patient's front teeth. You'll find that the black background works perfectly and they are easily sterilized through cold sterilization.

If your staff should accidentally place it in the autoclave and ruin it, no problem. Just make another. It really is that easy.

Good Luck!

Perfect Lateral and occlusal shots

2007-07-10T01:00:00.001-07:00

Hi all.

In my courses, I teach folks how to get perfect lateral and full arch occlussal shots virtually every time, without too much trouble. Let's define "Perfect", by my standards.

For lateral shots: Capturing the arch at 90 degrees (for a true Angle's Classification) with the occlusal plane parallel and down the middle of the mirror and the contra-lateral central to the distal of the second molar.

For occlusal shots: The entire arch, centered without nose, cheek or tongue in the image (yes, I said tongue), 90 degrees to the arch with the buccal surfaces of the teeth visible on all teeth.

It's really important to make sure that the patient is properly positioned, and that your mirrors and retractors are properly aligned. I use specially adapted mirrors and retractors, but it is sooooo easy to do that.

If anyone is interested, let me know, and I'll give more tips, but I wanted to start by defining what it is that we're looking to acheive in what era usually considered the more challenging images in the standard series.

Welcome...

2007-06-28T22:53:00.001-07:00

Hi All.

I decided to start this post because I know there's a need for some great education out there regarding how to use good clinical photography for better diagnosis and exceptional case acceptance.

I've been a photographer sinec childhood and have devoted the last 10 years of my life to finding easier and better ways to get dentists to capture gorgeous images with minimal fuss.

I'm a "wet fingered", practicing dentist 4 days a week, and aside from teaching a 2 day hands on "Digital Co-Diagnosis" course in Seattle, I travel the country teaching dentists how to get this stuff in an easy way.

There's a lot of misinformation out there and there are also a number of "experts" who make this far more difficult than it needs to be, so I want to share my expertise in any way I can.

Please feel free to post any ideas that baffle you, or ask me to cover a topic that you would like to see covered in detail. It's my pleasure to help.

Thanks for coming, and remember...."In dentistry, a picture is worth far more than a thousand words...."