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.

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...

Nikon 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.

Canon MT 24EX

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.

Lenses

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)

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).

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.

Cameras

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,
Glenn

It's not about the dental camera...

In his famous book "It's Not About The Bike", Lance Armstrong discussed many of the things that helped him become a champion. Unfortunately, many dentists place an undue amount of emphasis on the camera and dental equipment, when they should be worried about the quality of the image. In my humble opinion, they're way off base. Of course, having a proper camera, flash and lens makes a difference, but what is far more important is the composition of the image.

Composition is the makeup of the content of the image. In other words, how accurate of a representation of the real thing are our images. Almost every dentist needs to work on composition, but with great composition, almost any camera will work just fine.

Sure, a Nikon or a Canon may have certain inherent advantages for certain images, but in the end, taking the time getting trained on composition will pay rewards that will last a lifetime. A dark image can be lightened and a light image can be darkened, but a poorly composed image cannot be fixed. You can crop out unwanted information, but in order to get an accurate clinical representation, one should learn to master the art of retraction and mirror use.

To make a point, here is an image taken by me using a standard iPhone. No fancy lenses or lighting equipment.

Of course, it's out of focus, but that's because the iPhone does not have a macro lens-a lens to take an up close picture. However, take a look at the angle of the maxillary arch to the camera and the way the whole arch is seen evenly. This is a function of the mirrors and retractors and good patient positioning, not the camera you bought.

Below is an example of a poorly composed image. The lighting is great and the camera doesn't matter, however, look at the quality of the image. It doesn't properly represent the Angle's classification and we can see the "real" arch. There's simply a lot of extra information and the information that's supposed to be there isn't properly represented.

It's hard to see between the molars and if you notice, the emphasis of the image is on the cuspid, not the bicuspids or molars.

This image is really meant to show the posterior teeth, but the central theme here is not the posterior teeth.

If we could get rid of the "real" arch and just show the mirrored arch, set at 90 degrees to the mirror, we'd be way better off

Below is a much better lateral arch image that has just the information that we want to capture and again, the camera we used is unimportant. It's all about mirrors and retractors and this quality is possible for almost every single patient.

This is the kind of image that allows a patient to see and take ownership of their dental issues and it's the kind of image that allows case acceptance to go through the ceiling.

It just takes some time and instruction to get it right, and like Lance riding a bike, once you learn, you never forget.

Forget about the camera, get trained to capture amazing images and never stop trying to get the best images that you can.

Sorry for the break....

Hi Everyone.

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!!!

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

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

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

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