Saturday, December 29, 2012

Distracting Retractors & the Fall of the Roman Empire

Great title, huh? What do they have in common? More than you might imagine...

I’ve traveled around the world for years teaching clinical photography to dentists, assistants, hygienists and laboratory technicians. I’ve seen dentists use everything from $200 "point and shoots” to $8000 professional setups. I’ve seen old single point and shoot systems all the way to four wireless remotes. Regardless of the system, there’s one mistake that I see over and over again, in the office, that is. (The number one mistake I see outside of the office is dentists deciding to take home their camera, but I’ll cover that another time.)

By far, the biggest mistake I see is dentists being too far away from the patient for virtually every shot. Now, that sounds really easy to fix, right? Wrong. There’s a number of reasons for this problem and it’s not as obvious as you think.

As first gloss you might think it’s as easy as simply getting closer, but that’s not so easy. First, unless you’re a seasoned clinical photographer, it goes against one’s instincts to get in real close. For instance, here’s a typical image of what we want to see in a normal, closed retracted image.

Now, let’s take a look at a typical image that I see when I work with dentists on their photography skills.
Notice the retractors in the picture and the space around the arch in the picture. Like I said earlier, a lot of dentists are just not comfortable getting closer to patients, but if you look at the image, you’ll notice that the retractors are simply not being stretched enough. It all starts with the retractors. If the dentist wasn’t worried about perhaps hurting the patient, the retractors would be stretched further, more of the arch would be visible and they would be able to come in closer to the patient to capture a better image.

So what’s the big deal, you ask? Well, let me ask this: When you show an articulator to a patient, so you have mounting stone all over it, or do you clean it up first?

So, now to the Roman Empire and its failure. Ultimately, it was due to a belief that they were invincible; they could conquer anything and take over the world. Strange things start to happen when you think you’re good enough. Somehow details get missed.  Why show an image with things like distracting retractors it really will send a message to the patient and when you’re trying to do Digital Co-Diagnosis it can make a big difference. They WILL judge you based upon their impression of your attention to detail.

Pay attention to the details, especially when they are as easy as simply pulling a retractor just a bit more. In the long run, it will make all the difference.

If you don’t know how to get exceptional images, quickly and easily, consider purchasing my “Exceptional Clinical Photography Made Easy” DVD by clicking HERE.

Best Wishes,

Thursday, December 27, 2012

An easy (and inexpensive) way to get black backgrounds for esthetic dental images

We’ve all been at the dental meetings where the expert esthetic speaker starts showing images with black backgrounds behind the anterior teeth as the crowd “oohs” and “ahhs”. These images look so nice, and I have to admit that they are impressive looking, though they really don;t show you anything that you couldn’t see without the black background.

That said, we all want our images to look as impressive as possible, as long as they meet some basic diagnostic criteria. So, I’ll let you in on a little secret...black backgrounds are REALLY easy to use and shoot, but you do have to master the basics of retractor use first.

Let’s look at a regular anterior image. Nothing fancy. Just a simple anterior retracted image.

clinical photography
Let’s look at a few things about the image, just so we can all be "on the same page” in regard to what we’re looking at. Here’s what matters to me in this image and the critical aspects of how to get them:
- I can see the entire arch going distally (retractor use)
- All teeth (even the posteriors) are in focus (understanding f-stops)
- The cant of the maxillary teeth matches the natural patient presentation (experience)
- The teeth are dry and completely visible (suction use-NOT AIR!!!)
- The lips and cheeks are almost entirely out of the picture (retractor use)

If you can’t master these things, getting nice black background images is going to be tough. Now, for the shameless plug...

If you want to learn how to become a master of retractor (and mirror use), consider buying my “Exceptional Clinical Photography Made Easy” DVD, available at my website by clicking Here. It’s helped hundreds of dentists and gotten rave reviews.

So, once you’ve gotten the basics down, it’s time to look at the esthetic image. Let’s take a peek at one with a black background.

dental photography

Like the other image, let’s dissect it and see what we need to master to get it right every time.

- All teeth are in focus going all the way back (f-stop use)
-  The black background fills in everything without gaps (experience and shape of background)
-  The lighting is perfect (understanding histograms)
-  There are no lips or cheeks in the way (retractor use)
-  The tissue is completely dry (suction AND air)
-  View of soft tissue nearly to vestibule (retractor use)

Here are a few tips:
1. Don’t go buying some fancy black background. For years I’ve used those annoying black dividers that can be found in 3 ring binders. You know the ones...they always get in the way and have zero purpose. They’re made out of black plastic and have three holes punched in them. I take them out, cut them in half and shape two ends like a tongue. They’re about 4 inches long each and I simply place them behind the front teeth before I shoot the image and AFTER I’ve dried the teeth and soft tissue.

2. Use my cut down retractors. When shooting an upper image, there is absolutely no reason to retract the lower lip. I want to get those lips all the way up and out of the way. To see the cut retractors (and the rest of my custom mirrors and retractors) click Here.You MUST pull them laterally and superiorly. Don’t worry, the cut retractors will make it way easier for you without hurting the patient.

3. Practice! Practice! Practice! It takes time to master anything, but you won’t get any better unless you do it all of the time. Just remember that uppers are easy, but lowers do take a long time to master. The tongue makes everything tougher.

Once you start, you can begin using the black background as an addition (NOT A REPLACEMENT) to all of your other great images. Here are a couple of examples.

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clinical photography tips

If you’re reading this, I’d love some feedback if you feel that my making a video showing the techniques here would be of use. If I get enough people thinking that it is, I’ll do it. Just let me know my making a comment asking for it.

Hoping that you all have an amazing 2013, and remember, you can always get me with questions about anything, including topics you’d like covered at Glenn@Kriegercontinuum.com.

Sunday, November 25, 2012

Which Dental Camera Should I Buy?

OK, so the title of this blog caught your attention and now you’re here to learn more about dental cameras. Well, I won’t let you down, but rather than simply give you the actual camera you should buy, I want to cover one of the most often overlooked aspects of dental camera purchases, flashes. They play a bigger role than you might think. I’ll cover camera updates another time.

One of the most common questions that I get is “Which flash should I use on my camera?” Well, the better question should be “Which camera should I use with my flash?” You see, the cameras are going to be pretty close in terms of what they can do for you, but the right flash can make all the difference.

First of all, you must have a macro flash. That means a flash specifically designed to work within a very close distance from the lens. Imagine using the “on board” flash for a close-up picture of a central incisor. You’ll be 6 inches from the tooth and the pop up flash will be about 6 inches from the patient’s eye. Not only will your patient be seeing red dots for days, but it will be impossible for you to light the mouth from that position. That’s a big part of why many point and shoot cameras are not appropriate for dental use. So, macro flashes are generally placed next to the lens so that they can light the oral cavity with ease.

Let’s start with flash brands. There are a lot of reasons to consider using a flash made by the same company as your camera, not the least of which is if anything goes wrong, you can take it to your Canon or Nikon repair center and they won’t blame the other company’s flash or camera. However, some flashes, like the Nikon R1, are specifically designed to work with special functions of their own camera system.

For instance, the R1 is a great flash. It’s a little wider than it’s predecessor, the SB-29S, but being farther to the side allows better shadows (think of shadows at 6 PM versus noon) which allows better surface texture and visualization of embrasure spaces. The R1, when used with the correct camera, is wireless, but only with Nikon Cameras that allow wireless function. So, if you bought a D3100 thinking you’d save some money, but never gave consideration as to whether you could ever use a wireless flash (which you can’t with the D3100), you’re out of luck. You could use the R1C1, which has a built-in commander unit, but you’ve just raised the cost of your flash by an additional $300 which incidentally is how much you saved by buying the D3100 rather than a better camera which is compatible with the R1.
The Nikon R1 Flash System for clinical photography is wireless and gives great adjustability.
There is a learning curve, but it’s well worth it.

The Nikon R1C1 can be used on all cameras that do not have wireless capability.
It’s expensive, so you may want to give thought to whether it’s worth it.
As far as macro flashes from Nikon go, the R1 is about all you get. You can add more speed light units to it, but it’s all the same.

If you like Canon, there are no wireless flash systems that compare to the R1. If you’re thinking of the Metz, don’t. Really...just don’t. I’ve used it extensively and for the price (or any other price) it’s not even close in quality or adjustability. Just don’t, OK?

However, the Canon MT24EX and MR14EX are great flashes, but very different. The 24 is amazingly strong. Like, REALLY strong. Which is great if you want to turn the f-stop way up, but having sat on the working end of it, I can tell you that it’s really hot too. For $750, I’d go with the Nikon R1 on my Canon and be wireless. The 14 is also a great flash and much easier (and more comfortable) to use, but the flashes are directly next to the lens and like I said earlier, you will see a bit more “washing out” of detail, plus, if you’re ever inclined to use a bounce flash like the ones made from Lumiquest (I’ll post on this another time) you’re out of luck. They can attach to the 24, though.
The Canon MT24EX is a GREAT flash but simply may be more than most dentists want or need.
The MR14EX is a great option for Canon users but it does have some limitations.

Like I said, if a great, easy to use wireless flash, which can take bouncers matters to you, then don’t buy a Canon camera, and make sure that the Nikon you buy has wireless commander capability. If, however, you’re happy with the idea of the MT24EX or the MR14EX, then go for a Canon.

Oh, if you want to bring the Sigma EM 140 flash into the discussion, it’s essentially the same thing as 14EX (just much bigger), and I see no good reason to go away from a Canon product for essentially the same product, though many will be lured there for a $150 savings. I’m not making light of the savings (no pun intended) but I have used both and think the Canon is a better product.

The Sigma is a cheaper and bigger alternative to the MR14EX.
I’ll tackle lenses next.

Best Wishes,

Sunday, October 28, 2012

Background Color For Portraits

One of the most common questions I get is: What do I use for backgrounds when I’m taking full face portraits?

Well, the first thing to think about is the texture of the background. Texture? Yes, it is super important. If you have a wall painted with semi-gloss or gloss, your images will look terrible regardless of the color. If you have distracting texture like wallpaper, regardless of color, it won’t look good. Consider eggshell as a paint finish. It works great.

Just as an aside, for almost all orthodontic offices, a synched backlight is used. It eliminates shadows, and though very clinical and not very pretty, it is the standard in ortho.

For everyone else, we’ve got to think of a color. Too light washes out the patient and too dark may blend in with the skin color of some patients, as well as dark hair. Traditionally, dentists have liked neutral colors like taupe, and that’s what I’ve used for years, but I am no longer a fan.  They tend to wash out the patient’s color.
Taupe Dental Photography Background
It’s very unflattering and washes out the patient’s complexion
Avoid whenever possible

Other doctors like blue, but I find it too distracting and the coolness tends to take away from the patient. Plus, in my humble opinion, it’s very dated. Think circa 1997.

I switched to a dark burnt orange about 4 years ago and it made a huge difference in my images. No matter the patient’s skin color, it contrasts very nicely and the warmth is nice for the overall image.

Burnt orange flatters all skin and hair colors
Give it a try. You’ll love the way your images look

One last point.  Simply paint a wall the right color. Don’t try to use poster board and hang it behind the patient. I’m a fan of less work and invariably the stored poster board gets screwed up somehow. However, you can have a background on a roller like they do in professional photography studios and it can work very nicely.

Great backgrounds make for great portraits and that can help you market your practice with some of your beautiful final results.

Best Wishes,

Saturday, September 8, 2012

Welcome Back All!!!

Hi everyone.

I hope that you had a great summer.

Well, it’s been a long couple of months and I apologize for my absence. You see, I started as a full time student at an orthodontic residency, and after 20 years as a restorative dentist, there were obviously a lot of changes in my life.

I apologize for not having the time for posts over the last couple of months, and I hope I am forgiven.

Now that Autumn is upon us, you should start seeing some more fun posts.

Please contact me at glenn@kriegercontinuum.com if there are any subjects you’d like to see me cover.

Best Wishes,

Saturday, June 23, 2012

How Are YOU Evaluating Your Dental Photography??

Hi All.

I just finished my move to South Florida and life has been crazy, but it has allowed me the time to sit and think for a while about the whole "digital photography" thing. You see, there are a ton of reasons to take great images and having taught for so many years has allowed me to interact with many of you and learn a bit more about why you go through the effort and energy of getting exceptional images.

Whether it's an anterior esthetic image or a picture of a lateral arch for purely functional reasons, taking a great image is the goal whenever we pick up the camera, however, there is great debate over almost every aspect of digital dental photography.

There is even great debate over what makes a "great" image. Is it the composition, the subject matter, the pose, the esthetics of it, the clinical value or perhaps even the marketability of the particular image? My answer: I don't think that any one person can define what makes a great image. It's like art. It's subjective. However, for specific shots, there are objective criteria by which we can judge them. For instance, if we were to look at a mandibular arch image, we would want agree that there are certain things that make it "exceptional". They could include:

Arch centered
Entire arch visible
Looking straight down on the arch
Tongue not covering occlusal surface
Dry arch
Lower lip out of the way
Only the mirror image visible (not other teeth)

Of course, there are many other criteria we could add, but these are several that would be relatively non negotiable among most dentists. The question is, when we take a mandibular image, do we keep all of these ties in mind when we shoot the image? Are we actually sitting down and evaluating our images using these criteria? Do we "score" ourselves so that we can get better images next time? If our assistants are shooting images, do we ever sit down and grade their work? Try something on Monday. Take a single image and list all of the criteria by which the image should be graded. Grade each of your criteria based on a point value (ex: 1-10) but list what you consider to be a "passing" and "exceptional" score before you grade.

Of course, there's a bit of subjectivity here, but in the end, if you mark a 6 instead of a 7 or 8 on a criteria or two, it isn't going to destroy the value of everything.

Here's a random example from my library of images. Assuming we give a 1-10 (10 being best) for the aforementioned criteria, let's grade it.

Dental Photography Tips

Arch centered                                                  10 I don't think I could have improved it
Entire arch visible                                             8 I would like to see the retromolar pads
Looking straight down on the arch                   9 Ever so slightly tilted backwards and not straight on
Tongue not covering occlusal surface              10 Not even close to being in the way
Dry arch                                                            9 Pretty dry, but I could have done better
Lower lip out of the way                                   5 Not done very well
Only the mirror image visible (not other teeth) 10

Total Score:                                                 61/70=87% B+
Not bad, but I can definitely improve

I know it takes time, but it's one of the few ways to get better. Try it randomly from time to time and see how you do. You may find that certain issues (like having the arch centered) are things that you do really well and other things (like lip out of the way) may be more challenging.

Only by objectively evaluating your images can you figure out where you need work and do that. Your images are sure to get way better.

Best Wishes,

Friday, May 25, 2012

How to Get AWESOME Lab Images

It's been said that "Good is the enemy of great." When you have something that's good enough, where's the motivation to get something great?

Well, I'm just a GP (about to start an ortho residency for 30 months), so who am I to talk about lab shots? Well, as someone who teaches clinical photography around the world, it's my job to look into every aspect of the subject. I've been using a great product for about 7 years and I'm happy to share it.

dental photography lab photo
We can now make lab images look way better than this traditional image

When you want to show images of casts or lab work, how do you shoot them? There are lots of ways to capture an image, and there's a progression that most people go through.

Maybe you simply put the object on the counter with a nice formica background. Not very pretty or fancy, but the job gets done. Perhaps you go so far as to put a nice bib underneath it instead. Not my favorite, but at least the funky formica design doesn't distract those viewing the image.  If you start to get "fancy" perhaps you decided to put down a piece of black velvet and you may have even gone one step farther and shot an image of the lab work on a mirror like one of those big shot lecturers.

Well, if you're looking to get great lab images and I mean GREAT, you have to consider using the Digital Lighthouse found at Photekusa.com. Yes, it means having one more step, but when you see the difference it makes, you'll understand why you used it. They come in a variety of sizes, and even the largest is only $149.

dental photography tip photo
The digital lighthouse helps give stunning lab images, especially if the object being photographed is metallic or translucent.

The concept is simple. Like a standard soft box used in portrait photography (see image below) using the digital lighthouse removes all glare from flashes.
dental photography tools photo
The digital lighthouse works a lot like this standard soft box by removing glare and shadows and giving a much softer look to the object being photographed.

The only pre-requisite is that your flash must be positioned outside of the white nylon box so that it can be softened. This is where I really love the Nikon R1 (or R1C1) because the two small sb-200 units can be taken off the camera and held outside of the box. If you shoot a Canon 14EX (or Sigma equivalent) you're only going to get light from one direction rather than two and you may consider another flash system for lab work. Photek sells two nice lamps that could take the place of the flashes altogether and you could have the whole setup ready to go at all times.

If you want to skip using flashes altogether, consider buying Photek's lamps.

In another blog post I'll show you exactly how to shoot an image using the flash option. The whole purpose of this post is to show you another way of looking at things. For instance, take a look at the following image taken with a regular flash setup without the digital lighthouse. It was taken a number of years ago and to make it fancier at the time, I used a piece of black velvet background.

dental camera photo tip
Notice the shadows all around the outside of the cast and more importantly, look at the glare coming off the metal pieces of the implant parts. Yes, the image is "acceptable" but we can do much, much better.

Look at the image of the wax up below. Yes, it is well lit and composed properly and it even has a nice velvet background, but it just doesn't "pop".

dental camera tool

Now, look at the following image of a soft tissue cast. With the addition of a nice Photoshop colored background (I always try to disclose non-global changes) you have what I think is an image that is way better.

dental photography camera

Or, take a look at this whitening whitening tray. It's really, really tough to shoot anything translucent because of glare and difficulty getting good depth. The lighthouse tackles that with ease.

cliniIcal dental photography
Using the lighthouse and photoshop for some dust removal on the black background and a very tough to shoot translucent object turns out pretty nice.

Take a look at this hybrid prosthesis...
dental camera

OK, this last image wasn't taken in a lighthouse. It was actually taken on a mirror using the R2 bracket and pocket bouncers, but that's for another blog... ;)

Remember, if you want to get amazing intraoral images, consider ordering my "Exceptional Dental Images Made Easy DVD" or my custom designed mirrors and retractors by clicking HERE.

Also, if you have any questions or want to see me tackle a particular topic, just click HERE and send me an e-mail through my website.

Best Wishes,

Thursday, May 17, 2012

The Upcoming New Mac, Windows 8 and Dentistry: Your Images Had Better Be Great!

Apple is coming out with some pretty big changes to their computers  and new Mountain Lion OS and Windows is coming out with its' radical new OS Windows 8. So, the big question has been, should we wait or buy now? And, if the rumors about the new Mac screen are true, you better start thinking a lot more about shooting images that look awesome WITHOUT being cropped.

dental photography cameradental photography

The rumors are swirling and as we get closer there are more and more comments coming out. Just look at the recent online article which covers some of why you may want to wait. Click HERE to view it.

dental photography camera
Just one view of what Windows 8 desktop will look like

In the end, there is a really interesting article about the new Mac screen which poses some interesting possibilities for dentists. You have to see it. Click HERE.

Currently, a screen with a resolution of 1900x1200 is pretty good (2.28 Megapixels) but the possibilities of the new 17" macbook with a 3840x2400 (9.2 Megapixels) screen is simply mind boggling!!!! If this is true, we're about to see a paradigm shift in both the way we shoot and view images very, very soon.

If you're shooting an older camera, it is possible that you may not even have enough pixels to fill the screen. Of even more concern, if you rely on cropping your images to make them look nice, you also may not have enough pixels to fill the screen regardless of the camera you use.

Plus, your images had better be looking good. If you want better resolution (which you should), every little thing will be seen by you AND your patient. So, if your images aren't clear or poorly composed, they will look worse.

That is why, more than ever, it's important that you shoot amazing images with zero need for cropping. As technology increases, it will become more and more important.

To learn more about the acclaimed DVD that is helping dentists shoot the best images of their career, click HERE and change your practice forever.

Stay Tuned!!!

Wednesday, May 2, 2012

A New Flash Gives Great Dental Portraits Super Fast & Easier Than Ever

In the early 1970's, when I "borrowed" my dad's Minolta FT QL (released in 1966) and decided at age 6 that I loved photography, I had no idea that my hobby would evolve into this. Sure, like every photo geek I had my own B & W darkroom where I would enlarge images, always finding a huge clump of dust somewhere on the enlargement. It was my version of "Where's Waldo" but I kept on going with it and never imagined that one day people would hire me to come and teach them how to get great dental images. I blame it on my dad (both a photo hobbyist and dentist) but even with all of the photo toys that he had, I don't think that we could have imagined the actual functionality of many of the innovations available to the average person today.

I remember the days of setting up a couple of light boxes or umbrellas along with the use of a light meter and an array of equipment to capture really nice portraits. Worse yet, you needed a decent ceiling height to get good images and a lot of room to set the equipment up for different "moods". We still can do that today, but for the average dentist who simply doesn't have the budget or room to create a true studio, I introduce the Stellar Diva 18 inch CFL ring light.

dental camera
The 18" CFL bulb is bright but very cool and comfortable to be near.

What is it, you ask? It's a simplified way to take portraits. The concept is this: Set the light (less than $200) on a tripod or stable base, attach your camera on a flexible stalk (included) and you have perfect lighting. No softlights, no heat, no extra room (or budget) needed. Seriously. Just set it up, seat your subject in front and shoot.

Well, I took it over to a friend's office today to show it to him and we started shooting images. I chose to do things a little differently than they suggest and shot using an old Nikkor 70-300 lens from above , rather than attach the camera to the stalk. You don't need to do this, but I've always enjoyed thinking "outside the box", plus, I love the blurred background I can get using both a low f-stop and the zoom. I guess it's just my style.

Below are a few images and as anyone there can attest, once I set it up, it took literally less than 5 minutes to shoot all of the images you see below.  Are they as good as a $2000 setup with 3 lights? You be the judge, but remember, how good is good enough? With this system, I don't need extra room, it can be set up in the operatory in literally 1 minute and I'd feel fine putting these images up on my wall any day.

Remember, other than slight histogram adjustment and maybe a tiny bit of sharpening, there were no other changes to these images. There was no makeup or hairstyling and I just wanted to see what things would look like in an "average" setting. Scroll to the end of the 5th image and you'll see one more capability of this equipment...

Dental camera
dental photography tips
dental photography
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dental camera
Do you know how hard it is to make your 12 year old daughter smile for dental portraits?!?!?

So, using the light on an angle to the smile, I wanted to see what things could look like without diffusers or bounce. Just the ring light and an oblique angle. I had never tried this before, but the possibilities are endless.

dental camera
This is just the ring light and my camera and nothing else. 

dental photography
Just having fun with an "artsy" anterior shot, but it can do so, so much more.

Only one piece of equipment, for less than $200 to get great portraits and up close shots? I'll be using this a whole lot more...

Saturday, April 28, 2012

The New Lytro Camera...Right for Clinical Photography?

When I got back from my Vegas lecture yesterday afternoon, a package was waiting for me.  About a year ago I put myself on the waiting list for the most anticipated camera to come along in a while. The new Lytro light field camera promised to be a new paradigm in photography. From the way it works to the concepts behind it, there was nothing like it.
The new Lytro may look small but it's a revolutionary approach to photography.

So, what makes it so great? Well, I can't really get into with this small of a space, but click HERE to learn more about the science behind it directly from the company.  In short, the goal of the camera is to allow the user to take a picture of virtually anything and be able to focus on any part of the picture, at any time, AFTER it has been taken. Basically, no matter what's in the picture, you don't focus, you don't use f-stops, you don't worry about flash settings. You merely pick it up, point it and shoot. Click HERE to see some sample images. Just click your mouse on any part and see it come into focus. There has never been anything like it. They are calling it "Living Photos".

I figured I'd take a look and see how it works and more importantly, see if it was good for dental use. After all, it's small, light, simple and I figured that if I could find a new way for dental photos to be taken, why not check it out?

Well, in my first trial, I wasn't impressed. The technology is awesome, but I just don't think it's there ...yet.  The image quality looked grainy and the lighting just wasn't good enough with the ambient room lighting. Remember, it doesn't use a flash.

This is just a first update. I promise to play with it this weekend and update you a but more some time soon...

Tuesday, April 24, 2012

My Clinical Photography DVD Was Reviewed in Dental Economics This Month

The only thing greater than making what you think is a great product is somebody using it and feeling the same way.

In this month's Dental Economics, Dr. Joe Blaes reviewed my "Exceptional Clinical Photography Made Easy" DVD. The DVD shows all of the techniques that I usually teach in my hands-on classes, using an "over the shoulder" approach. I cover patient positioning as well as mirror and retractor placement for ideal images, every time.

The DVD has been purchased by dentists in 14 countries and I'm humbled by all of your comments after you've used it, so thanks.

Below is the review. If any of you have ever watched it, I'd love your feedback. DVD #2 (a prequel ala George Lucas) will cover how to choose a camera, set it up and get perfect lighting for every image by understanding f-stops, flash settings and depth of field.

Sunday, April 22, 2012

Why Great Depth of Field is Important in Dental Photography

Yeah, yeah, I know. Most dentists just want to pick up a camera, point it and get great images. So, if that's the case, then why all the fuss over depth of field?

Years ago, when we shot dental images on slide film, we were told to "focus on the laterals" so that we could get the centrals and cuspids in focus. With the advancement of technology, more specifically flash technology, we suddenly had a way to get a ton of lighting on an area, forcing us to turn the f-stop way up to give us great images.

But what's an f-stop and why does it matter?

f-stops, or apertures, are the adjustable components of the camera that allow light into the camera. The higher the number, the less light it lets into the camera. However, the higher the number, the greater the depth of field. A higher depth of field means that more is in focus from front to back. So, an f-stop of 32 will have much more in focus than an f-stop of 5.

For clinical photography, a higher depth of field means that for certain images we can worry less about having to focus perfectly and we will still get more in focus. For instance, for an anterior retracted image such as the one below, an f-stop of 25 will allow us to get every tooth, from central to 2nd molar in focus. Better yet, when shooting a high f-stop, it means that if you're off a bit in terms of your focus, you can get away with it because you have 2-3 inches of "depth" to play with.

With a higher f-stop, all teeth are easily in focus.
When one doesn't manage the f-stop properly, depth of field can be diminished.  Let's say you shot an image with an f-stop of 9, you will see a considerably diminished depth of field.

Notice how the posterior teeth are out of focus with this low f-stop image

So, the key is to be able to control your f-stop and always shoot with as high of an f-stop as possible for any given situation.  Sometimes, like for full face images, distance from subject requires all the flash power you can muster, as opposed to images such as a single central when there isn't a f-stop high enough to manage the amount of light thrown out by a full power flash, necessitating a lower flash power.

The need to alter flash power and f-stop settings are just two more reasons why I have felt that "point and shoot" cameras (which do not generally have either of the aforementioned features) are simply not appropriate for dental use.

There is one exception to the rule of great depth of field and it's portrait photography. When we take an image of a full face for non-clinical use, we do not want the background in focus, so it's important to manage lighting in such a way that the f-stop used is lower than for intraoral shots.

In portrait images, photographers use low f-stops to emphasize the face and make the background out of focus.

In the future, I'll cover more aspects of this topic including how to set your camera up to do this quickly and easily.

As always, if you have any questions, feel free to email me at Glenn@KriegerContinuum.com .

Best Wishes,

Sunday, April 15, 2012

iDVD as the Best Dental Marketing Tool Ever!!!

Like many dentists, I was a "PC Guy" for years. After all, my office software ran on a PC and it's just the way I was brought up. Then, one day at the mall about 5 years ago, I was walking past the Apple store and decided to stop in. I looked around and decided that I would try an experiment. I bought a cheap, bottom of the line Mac Mini and installed a virtual environment using VMWare ( I can explain this more to you if you're interested) and Windows XP. On that computer I installed the PC dental software so I could see how it could perform.

Well, it worked pretty well, with most of the shortcomings being due to the low computing power of the mini, not the overall nature of the Mac. However, having the mini allowed me to spend a lot of time playing with Mac apps. My favorite quickly became iDVD.

iDVD is ("was"-more on this below) an amazing piece of software that was originally designed to allow you to burn your movies to DVD, however, it was really very useful for marketing your practice. Imagine being able to make a professional movie that could play in your office, showing all of your cases with navigation using nothing more than a remote control.

iDVD allows one to create "chapters" of slideshows that one can see on the home screen. Like any DVD, what you burn allows a repeatable home screen like you might see on any commercial movie DVD. While this screen plays over and over, there are a variety of slideshows of your work that you can setup for one to choose. Best of all, when the shows start, music can play with them and the program will take the song you choose and make the number slides fit it perfectly. It's amazing!

Best of all, once it's burned to disk, all you need to show it is a TV with a  DVD built in. Right now, you could buy a 32" flatscreen TV with a built in DVD player for as little as $279. You can make a DVD in as little as 10 minutes and have a great way of showing off your work to everyone who comes into your office.

Below is an example of what you could make. Your patients could use the DVD remote control to pick which slideshow they want to see.

Here is an example of what the finished "Home Page" will look like while it plays on your computer in the reception area or consultation room.

All your viewer would need to do is pick which of the slideshows they would like to see.  What this blog cannot show you is how nice the screen looks on a TV. The box with the smile circles around and you can pick several picture to cycle. It also has music.

Now, imagine that for your finished cases you made a DVD to send to a patient's workplace along with a mug with your practice name and some mints/candies in it. The DVD could look something like this:

This is what a DVD to be sent to a patient can look like.

If you put nice pictures on the show, there's a pretty good chance that they'll throw it in their DVD player on their computer (can be Mac or PC or regular DVD player) and maybe show a coworker who could become a new patient...

Now, there are only three things that you need to keep in mind:

1. You must have good looking pictures to make this work well. If your images don't look great, it will be like showing a patient a filthy articulator covered in stone. At the least, you may want to consider buying our "Exceptional Clinical Photography DVD" found HERE.
2. For a few reasons, Apple stopped making iDVD this past year. Go and get a copy of iLife 11 and you'll be in great shape. That's where iDVD is found.
3. You must have a Mac to do this. Now, I love PCs as well, but there simply is NOT a program for PC that does what iDVD does as quickly and easily.

I hope this helps, and as always, you can email me with any questions or issues.

Take Care,

Tuesday, April 10, 2012

The One Sentence That Makes All The Difference in Digital Case Presentation in Dentistry

A number of years ago, I had an amazing associate who worked with me. Talented, smart, funny and personable. A great diagnostician, this dentist was an overall excellent communicator. However, though every step in the digital case presentation workflow was followed, the new patients who saw this associate simply didn't schedule a lot of treatment. Worse yet, many of the patients came in for a new patient exam, never to return.

It was perplexing and a real "eye opener" for me. So, I investigated the system and tried to figure out exactly where the problem was. The images were gorgeous and the process worked of me, so why should there be a problem?

After interviewing some of the patients who never returned, I found out something very interesting.  They felt that the dentist was moral and just and that if a treatment plan was presented, it must be one that they felt very strongly about, so they would politely look for a second opinion, not wanting to offend the dentist or make them change their moral nature by "dumbing down" their proposed treatment plan.

Well, we learned from this and it was from that point on that I started every single case presentation with the same line that I teach attendees to my courses.  Before presenting any images or suggestions, I merely say "Now, remember, no matter what we discuss, I work for you, which means that if you don't like any of my suggestions, we're still friends and we can find another solution that does work for you."

The moment I started saying this to patients, you could see their tension disappear. Best of all, it was a natural extension of the entire Digital co-Diagnosis process, of which I am a strong advocate.

Start having this honest and fair discussion with your patients before presenting care and you should see amazing results.

Click here to see why everyone is raving about our "Exceptional Clinical Photography Made Easy" DVD and our revolutionary line of mirrors and retractors to capture the best images of your career.

Best Wishes,

Please e-mail me at Glenn@KriegerContinuum.com

Thursday, March 22, 2012

How To Properly Store Dental Images On Your Computer

Before I get into this topic, I wanted to remind everyone that you can get regular updates on this blog by clicking the "follow" button in the upper left. Best of all, you can do so anonymously, meaning that you'll get regular updates, but no spam or e-mails from us. It's just a great way to keep getting updates related to clinical photography and digital case presentation.

Now, onto the topic at hand...

At every one of my courses, the first question I am invariably asked is "Which camera should I get?" followed quickly by "How should I store my images?".  The first question I answered in my previous post found either below this post or in the archives from last month (on right side of screen). The second one I'll answer below.

Sorry ahead of time to all of my orthodontists who subscribe to this blog. You folks (and myself hopefully in 30 months) are tethered specifically to your image management programs due to specific needs related to how you practice. The information below, however, would be great for you to use for personal image management at home.

When thinking of storing images, what are some of the features of the software I want to use? Let's run through a few. Ideally, the software would be:

              Easy to Navigate
              Regularly Updated
              Supported by Customer Service
              Part of a Stable Company
              Compatible from User to User
One last feature, not to be overlooked, is the ability to pull your images out at will and move them somewhere else. Why?

Imagine that you've bees storing your images using dental software "X" for the last 8 years. It's worked OK for you, but you're kind of getting upset with the way company "X" isn't doing regular updates to their software, and common nuisances are not being corrected. You decide you want to switch to dental software company "Z", only to find out that you cannot batch all of your images over to the new software. What that means is that your thousands of images are now stuck in "X" and would have to be brought over to software "Z" image by image, patient by patient. At last check, there is no guarantee from any dental software company anywhere that they can bring over every image from your old software and place the images in the correct file in the new software. So, if you make the switch to brand "Z", you either need to keep a copy running in the background all of the time on a separate computer, or you have to hire someone to go through every record, one by one, to bring over every image. I call that being held hostage, and there are better options out there.

So, if you're looking for a way to save images for free, with free updates in an easy to use, supported environment that has been proven for decades, is part of a company that will not be going out of business and can be used by virtually anyone on the planet, consider....Microsoft Windows Explorer. It comes FREE on every PC computer and is just sitting there ready to use!!!

Ask any programmer who works for Microsoft about Explorer's ability to save images and files and folders and they will gently correct you and tell you that it isn't about files and folders but rather "database management".  That's exactly what we want!!! A way to manage our database of images.

Using Explorer, we can create folders that make sense, duplicate them for special purposes such as showing our implant or veneer cases. We can search them quickly and we can alphabetize. Best of all, we can have this database stored on a computer other than our server so that it doesn't slow down the server if several users are searching it at once. Simply have your IT person (or yourself) create an icon for that folder on the desktop of any computer in the office and you guessed it...one click and it will open up anywhere in the office.

By right clicking the "Start" button, and left clicking "windows explorer", you'll unlock open one of the best tools we have for database management in dentistry. Best of all, it's FREE!!!

You'll get free updates and it has millions of users, so there are articles of every type on the web that can answer almost any question you can have. It's REALLY easy to use and once you switch to it, you'll wonder why you ever stored your images on your dental software. Plus, you'll have that liberating feeling of knowing that you can change to any dental software company you want, and your images will never have to be touched. That, to me, is priceless, which is why I make teaching it a vital part of all of my 2 Day Master's Class.

Wanna learn, hands-on, how to set up and manage a database of images for dental use? It's a key component of our 2 day Master's Class, along with hands-on clinical photography, image editing and digital case presentation.  Click Here to learn more and let us help you master the technical things to help your practice grow, so you can focus on doing dentistry. You can use code "Blog10" to get 10% off of any of our products or classes.

I'm here whenever you need me, so please e-mail me at Glenn@KriegerContinuum.com, though I look at (and answer) every comment left on this site.

Sunday, March 18, 2012

How to Buy a Camera, Flash & Lens for Clinical Dental Photography

Hi! If you're here, it means that you're trying to learn more about clinical photography and the equipment that goes with it. Kudos for taking the first step. Taking GREAT images (not just mediocre ones) is the first step towards changing your practice quality forever.

Clinical Photography
There's no reason to shoot a mediocre image (left) when you can quickly and easily learn how to get an awesome lateral image (right). Check out our DVD and get images like the right one for increased case acceptance and better documentation.

Also, please look to the right and notice our "Exceptional Clinical Photography Made Easy" DVD for purchase. We're proud that it has been acclaimed as being the best DVD for composition ever made and it's "sister" DVD "Getting Started With Clinical Photography" will be available soon. Don't fret, though, because the first DVD covers all of the tricks and tips to get exceptional composition every time. Click on the picture and use the code "Blog10" to get 10% off the DVD and any of our custom mirrors and retractors.

So, what camera equipment should I buy?

No matter where I go, or whatever group I speak to, this is by far the most common question I get. After all, what is a dental photography "expert" for if not to be a resource for the most up to date dental gear. So, I figured that this would be a great time to post my thoughts on current equipment.

Please keep in mind (or see my last post) about the fact that almost any equipment can be used to get great dental images. It just comes down to the question of how much work do you want to put into getting your images and how many steps do you want to take to get the kind of quality that facilitates increased case acceptance. After all, we MUST have increased case acceptance if we're going to do this, but more on this in future posts...

Also, keep in mind that if you're going to shoot an SLR (which are by far the easier cameras to use for dental photography once you know how) you MUST learn how to manipulate f-stops and flash settings (keep an eye out for our upcoming DVD "Getting Started With Clinical Photography" due out around 8/1/12), but as any of my students can tell you, those are two REALLY easy things to do once you're properly shown how. Though virtually no point and shoot will allow you to manually adjust f-stops or flash settings, the major differences in SLRs brands is the steps you need to take to change those things.

Now, for whatever reason, Canon definitely owns market share in dentistry. No matter what group I am speaking to, roughly 80% of dentists with SLRs seem to using Canons. That's OK. The only hurdle is that Nikon has always been ahead of Canon when it comes to the steps necessary to do what we need to do in dentistry. For instance, to change flash settings on the Nikon flash, one need only turn a dial one click and you're done. On Canon, you need to push the mode button, then select, then + or - an appropriate amount of times, then do it in reverse when you want to return to the original settings. For years, on Canon models, in order to see the histogram (the Almighty's gift to digital dental photographers) one needed to hit the play button, then info and wait for the tiny histogram, while at the same time Nikon models showed the histogram as an overlay that was full size. It was "little" things like this that always irked me with Canon. Are they great cameras? Definitely. Would I buy one for dentistry right now? No. Only because of what I just talked about. There's one more major reason...

Dental photographyNikon has the R1 flash (see right). Yes, it kind of looks like a Klingon bird of prey, but trust me on this. Learn how to effectively use this flash and your images will be exceptional. You see, the flashes are wide which gives you great shadows. Why do we like shadows? They give us ideal surface texture, embrasures and nuances of what we're shooting. Wanna destroy all of that? Use a ring flash. However, if you've learned how to use retractors and mirrors properly, this flash is a breeze to use. Like I said, switching from say a 1/4 flash setting to a full flash (for intraoral versus full face images) is a less than 1 second process. Plus, the flash is wireless, which gets rid of all of thos annoying cords. The angle of the flash is adjustable as well. I could go on and on about why a wireless flash could be useful from full face portraits to shooting lab work in a digital lightbox.

dental photography tips
Canon MT 24EX
Dental photography tips
Canon MR 14EX TTL (Double point, not ring)

Canon has two particular types of flashes that work great (see right) but they really aren't that close to the R1. They make a dual twin flash that looks like the R1 but has tons of buttons and wires and once set up, is far more complicated to use than the R1. They also have the traditional double point flash that works nicely, but again, a lot of buttons, and the flash is very close to the lens which means less shadows, which means less emphasis and highlights.  People think it's a ring flash, but it actually is a double point flash, however for some of our portraits, in order to get rid of annoying shadows, we need to turn off one flash. It's really easy with the R1, but with either of these flashes (or a Sigma equivalent) you'll be hitting so many buttons that you'll like a middle school girl texting her BFF. Of course, you could adapt the R1 to your Canon, but you would need the R1C1 which includes the commander module to make them fire, which increases the size and the price by $250. For that price, I'd stay with the conventional Canon choices.


In this category, again, for dental use, Nikon comes out on top in terms of choices and versatility. As a side note, I never recommend using any "glass" (aka lens) other than what the manufacturer made. I have nothing against 3rd party lenses, but as dentists, we want as little muss and fuss when something goes wrong, and if my camera isn't working properly, I want to hand everything over to them and say "It's all your equipment. Fix it.".  We don't need the camera manufacturer blaming the lens and vice versa.

The old standby for Nikon was the Nikkor 105mm "micro" (only Nikkor uses the term "micro" instead of macro) and the new lens is beautiful, but it costs nearly $950 and is pretty heavy and wide. I'd suggest the 85mm lens which is way smaller, lighter and about $450 less!!! (See below)
dental photography
Nikkor 105mm vs 85mm "micro" lenses

The biggest complaint that most non-dental photographers have is that the lens is too light and feels flimsy, but I can tell you that lecturing all over the US every year and having to lug my "loaner" equipment for my courses, I have never encountered a problem with this lens and I can see no difference between it and the 105mm in terms of quality (see below).
dental photography
Nikkor 105 vs 85 on same patient (unretouched)

Unfortunately, Canon offers the standard 100mm lens which is of slightly lesser quality than the Nikon 105mm but you'll never know the difference. Canon does make a second 100mm lens for a price of about $1100 but we just don't need it for dentistry. The next smaller/lighter lens is the 60mm, but it does change where you have to stand when you shoot images for patients and may bring you a little closer to the patient than you want to be. Remember, you cannot use a lens from one manufacturer with another.


Ok, here is the part you've been waiting for, right? By now, you know what you're locked into a flash and lens depending on the brand, so you have to choose. The price and features of both the Nikon and Canon are almost identical, regardless of which model you want. The only exception is the D90 by Nikon (if you can still find one). If one can still get the D90, which is no longer made, but is a great camera, you can get the lens, flash and body for less than $1900 and there is no comparable Canon setup at that price. If you can't get the D90, the next camera to get in the Nikon family is the D7000. There is no reason to go more expensive unless you like to waste money. It gives you nothing! Do not be tempted to go down to the D5100 either. It does not have commander mode for the R1, so to use the flash you must buy the R1C1 (like a Canon) and you just raised the price by $250.

Canon has some great cameras, but the best one right now is the 60D. It is more than enough camera to do anything you need. I would not suggest jumping up to the 70D when it comes out while the 60D is availale. Remember, we don't need many of the features that these cameras perform. All we need is a light, small camera body that can shoot aperture priority and take the lenses and flashes that we want. The Rebel T2i is a great camera and less expensive, lighter and smaller than a 60D. My only complaint is that the Rebel series (and the Nikon 5100) is and has always been a "consumer" camera. It's less expensive than "prosumer" cameras like the D90, D7000 and 60D which are made more rugged and are meant to last longer and take a bit more of a beating. The way I look at it, this is a commercial application, not a personal application, so why go with a consumer camera. If your budget absolutely doe NOT include a prosumer body, and you want Canon, then go with the Rebel series and maybe upgrade the body at some later date. The lens and flash will fit onto your future camera.

If you do not already own a dental camera but are considering buying one, I would encourage you to attend one of my courses where you'll get to try my loaner equipment before you buy, and at the same time, get personal instruction from me. If you can't make it to my course, at least consider my DVD for exceptional composition available HERE. Also remember that my specialized line of mirrors and retractors is available only through my website, and were developed by me after watching thousands of students use conventional mirror designs. I have been told that they make a huge difference and I would invite you to give them a shot. I offer "starter" sets of mirrors and retractors with and without the DVD, and they can be seen by clicking Here.

Well, I hope this helped. PLEASE, PLEASE, PLEASE REMEMBER: It's not about the camera.  Please see my previous post to understand why. In the end, you MUST get properly trained. Great images, used properly in the "digital co-diagnosed" process will help your communication go through the ceiling and help your case acceptance skyrocket, but it DOES NOT happen by accident.

Please e-mail me Here with any comments or feedback.

Best Wishes,