Guidelines_for_clinical_photography_2015 Rev.pdf
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CLINICAL PHOTOGRAPHY GUIDELINES Academy of Laser Dentistry’s Annual Conference •
Observe good clinical practice: o Ensure protective eyewear is worn o Adhere to all relevant safety measures o Wear examination gloves o Apply rubber dam as appropriate o Employ other techniques as necessary.
•
Take intraoral photographs in the landscape mode of camera orientation. For extraoral photographs, use portrait mode.
•
For intraoral photography, use a camera with a macro lens or facility with the ability to produce 1:1 images. In general, use the smallest aperture to maximize depth of field.
•
Calibrate the camera system to determine and become familiar with the optimal settings for intraoral and extraoral photographs.
•
Clean the target site of debris, excess saliva, blood, air bubbles, impression material, excess cement, glove powder before taking photograph. Target area should be moist but not desiccated. Change surgical drapes as needed to avoid bloodstained images.
•
Isolate the target site (include only what is necessary in photograph) o Use clear plastic retractors as appropriate to afford an unrestricted view of the target area. Use bilateral retractors for anterior areas, unilateral retractors for posterior and lateral views. Position the retractors symmetrically to avoid the appearance of a canted image. Pull the retractors out and away before taking the picture. o As needed, use a black spatula to prevent coverage of the front teeth by the lips. Position any contrasting device so that it does not create a shadow. o For occlusal, lingual, palatal, and lateral views of target areas, use front-coated chromium, rhodium, or titanium mirrors to provide maximum reflectance and avoid reflection distortions and double images. Use special care in cleaning and storing these mirrors in order to maintain their delicate surface coasting in a scratch-free condition. Control fogging by dipping mirror into hot water then drying it with a soft tissue. Alternatively, use a light stream of air from the air syringe to keep the mirror from fogging. o Keep the patient’s nose out of a palatal view of maxillary incisors. o Avoid beard hairs. o Retract the tongue with a mirror or have the patient move the tongue to the posterior so as not to obscure the teeth. o It is helpful, but not mandatory, to include the laser handpiece in the intraoral view. The laser need not be operating when this “During Procedure” picture is taken. o Keep fingertips, mirror edges, and retractors out of the picture as much as possible. If patient assists in holding retractors, have patient wear examination gloves. o It is suggested to obtain slightly larger image frames to allow cropping as necessary.
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 1 of 4
•
Ensure optimum visualization, lighting and exposure o As much as possible, keep viewpoint, positioning, lighting, color, magnification, perspective, contrast, and background the same. Standardize photographic conditions so that direct comparisons are possible, even if successive photographs are taken by different photographers over long time intervals. o Select a flash system designed specifically for macro photography. Use a ring flash for posterior teeth or areas of difficult access. Use bilateral flashes mounted on a bracket for anterior areas to help capture fine detail, texture, translucency, and subtle color transitions within individual teeth. Do not use an LED flash which provides relatively low intensity illumination and compromises image quality and depth of field. o Photograph the teeth in correct axial alignment (for example, the occlusal plane should be parallel to the horizontal in the photograph, not canted). o Align the optical axis perpendicular to the row of teeth to be photographed to maximize consistency and depth of field. o Long-handled, front-silvered, glass mirrors are preferred. o When using mirrors, try to photograph the mirror image only. Frame the image so that lips and mirror edges are minimized. Do not show unreflected teeth. Having both the direct and mirror image appear in the same photograph is confusing. o Use of manual focus is recommended, as auto-focus is unreliable in the oral cavity. In general, for anterior shots, focus on the central and lateral incisors to ensure that the maximum number of teeth are in focus. o Avoid shadows. As a general rule, when using a single (not a ring) flash in conjunction with a mouth mirror, keep the flash on the mirror side. o Strive for optimum exposure. Keep in mind that mirrors absorb light, and exposures will have to be adjusted accordingly. Light absorption characteristics vary from one mirror to another. Generally, use an aperture compensation of +1 f-stop to help ensure proper illumination of mirror shots. o If using a digital camera, check the overall brightness of the image with the histogram function. The peak should appear in the middle of the histogram for extraoral views, and slightly to the right side for intraoral views, consistent with a somewhat brighter image. o Unless the clinical condition warrants otherwise, keep tonal values uniform throughout, especially in pre- and postoperative images. If using a digital camera, recalibrate the white balance if the control screen shows inaccurate color shades. o Include reference measuring device (as for biopsies). o Use clean, neutral backgrounds for tabletop photography (instruments, impressions, materials, and so on). o To photograph a radiograph, mount the camera on a tripod and align it with the center image on the light box. For digital cameras, set the camera to ‘black and white’ mode to reduce file size. Turn off the room lights and block any light from doors and windows. Use black cards to block excess light from the light box. Use the camera’s self-timer setting to avoid camera shake from the long exposure. o To photograph a monitor, mount the camera on a tripod and align it with the center image on the monitor. For cathode-ray tube monitors, set the camera to ‘night’ mode to produce a long exposure and avoid horizontal bands across the monitor. Turn off the room lights and block any light from doors and windows which cause reflections in the monitor. Use the camera’s self-timer setting to avoid camera shake from the long exposure. o Eliminate poor quality images (over- or underexposed photos, out of focus images, poor orientation, etc.).
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 2 of 4
•
Take full photographic series: o X-ray o Before procedure o During procedure o Immediately postoperative o Short postoperative time interval (3-14 days) o Moderate postoperative time interval (1 month) o Longer postoperative time intervals (minimum of 3 and 6 months).
•
If appropriate, perform bilateral study (laser vs. conventional).
Intraoral Photography References 1.
Ahmad I. Digital dental photography. Part 1: An overview. Br Dent J 2009;206(8):403-407.
2.
Ahmad I. Digital dental photography. Part 2: Purposes and uses. Br Dent J 2009;206(9):459-464.
3.
Ahmad I. Digital dental photography. Part 3: Principles of digital photography. Br Dent J 2009;206(10):517-523.
4.
Ahmad I. Digital dental photography. Part 4: Choosing a camera. Br Dent J 2009;206(11):575-581.
5.
Ahmad I. Digital dental photography. Part 5: Lighting. Br Dent J 2009;207(1):13-18.
6.
Ahmad I. Digital dental photography. Part 6: Camera settings. Br Dent J 2009;207(2):63-69.
7.
Ahmad I. Digital dental photography. Part 7: Extra-oral set-ups. Br Dent J 2009;207(3):103-110.
8.
Ahmad I. Digital dental photography. Part 8: Intra-oral set-ups. Br Dent J 2009;207(4):151-157.
9.
Ahmad I. Digital dental photography. Part 9: Post-image capture processing. Br Dent J 2009;207(5):203-209.
10.
Ahmad I. Digital dental photography. Part 10: Printing, publishing and presentations. Br Dent J 2009;207(6):261-265.
11.
Antonelli JR. Dental photographic standardization for case documentation. Compendium 1991;12(7):504, 506-511.
12.
Bengel W. Standardization in dental photography. Int Dent J 1985;35(3):210-217.
13.
Blazejewski SW 3rd. Photographic documentation for veterinary dentistry and oral surgery. J Vet Dent 2012;29(4):270-274.
14.
Ettorre G, Weber M, Schaaf H, Lowry JC, Mommaerts MY, Howaldt H-P. Standards for digital photography in cranio-maxillo-facial surgery – Part I: Basic views and guidelines. J Craniomaxillofac Surg 2006;34(2):65-73.
15.
Fan PP. A practical guide for achieving excellence in dental photography. Part I: The essential elements. Oral Health 1998;88(11):43-44, 47-48, 51-52, 55-56.
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 3 of 4
16.
Fan PP. A practical guide for achieving excellence in dental photography. Part II: Full face and direct extra oral views. Oral Health 1999;89(1):16-18, 21-22, 25-26.
17.
Fan PP. A practical guide for achieving excellence in dental photography. Part III: The direct intra oral views. Oral Health 1999;89(2):47-48, 51, 53-54.
18.
Fan PP. A practical guide for achieving excellence in dental photography. Part IV: The indirect or mirror intra oral views. Oral Health 1999;89(10):37-38, 41-44, 47-48.
19.
Fan PP. A practical guide for achieving excellence in dental photography. Part V: The indirect or mirror intra oral views. Oral Health 2000;90(1):21-24, 27-30, 33.
20.
Goodlin R. Photographic-assisted diagnosis and treatment planning. Dent Clin North Am 2011;55(2):211-227, vii.
21.
Jakowenko J. Clinical photography. J Telemed Telecare 2009;15(1):7-22.
22.
Llop DR. Technical analysis of clinical digital photographs. J Calif Dent Assoc 2009;37(3):199-206.
23.
McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32(1):43-54.
24.
Nash R. Dental photography: An integral part of modern dentistry. Compend Contin Educ Dent 1996;17(8):724, 726-727.
25.
Nayler JR. Clinical photography: A guide for the clinician. J Postgrad Med 2003;49(3):256-262.
26.
Persichetti P, Simone P, Langella M, Marangi GF, Carusi C. Digital photography in plastic surgery: How to achieve reasonable standardization outside a photographic studio. Aesthetic Plast Surg 2007;31(2):194-200.
27.
Schaaf H, Streckbein P, Ettorre G, Lowry JC, Mommaerts MY, Howaldt H-P. Standards for digital photography in cranio-maxillo-facial surgery – Part II: Additional picture sets and avoiding common mistakes. J Craniomaxillofac Surg 2006;34(7):444-455.
28.
Shagam J, Kleiman A. Technological updates in dental photography. Dent Clin North Am 2011;55(3):627-633, x-xi.
29.
Sharland M. Improving your image ... then and now. Digital photography in dentistry. Dent
Update 2013;40(4):333-334, 336. 30.
Shorey R, Moore K. Clinical digital photography: Implementation of clinical photography for everyday practice. J Calif Dent Assoc 2009;37(3):179-183.
31.
Snow SR. Assessing and achieving accuracy in digital dental photography. J Calif Dent Assoc 2009;37(3):185-191.
32.
Steel C, Behle C, Bellerino M, Hastings J, Saby B, editors. A guide to accreditation photography. Madison, Wisconsin: American Academy of Cosmetic Dentistry, [2002].
33.
Wander P. Dental photography in record keeping and litigation. Br Dent J 2014;216(4):207-208.
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 4 of 4
Observe good clinical practice: o Ensure protective eyewear is worn o Adhere to all relevant safety measures o Wear examination gloves o Apply rubber dam as appropriate o Employ other techniques as necessary.
•
Take intraoral photographs in the landscape mode of camera orientation. For extraoral photographs, use portrait mode.
•
For intraoral photography, use a camera with a macro lens or facility with the ability to produce 1:1 images. In general, use the smallest aperture to maximize depth of field.
•
Calibrate the camera system to determine and become familiar with the optimal settings for intraoral and extraoral photographs.
•
Clean the target site of debris, excess saliva, blood, air bubbles, impression material, excess cement, glove powder before taking photograph. Target area should be moist but not desiccated. Change surgical drapes as needed to avoid bloodstained images.
•
Isolate the target site (include only what is necessary in photograph) o Use clear plastic retractors as appropriate to afford an unrestricted view of the target area. Use bilateral retractors for anterior areas, unilateral retractors for posterior and lateral views. Position the retractors symmetrically to avoid the appearance of a canted image. Pull the retractors out and away before taking the picture. o As needed, use a black spatula to prevent coverage of the front teeth by the lips. Position any contrasting device so that it does not create a shadow. o For occlusal, lingual, palatal, and lateral views of target areas, use front-coated chromium, rhodium, or titanium mirrors to provide maximum reflectance and avoid reflection distortions and double images. Use special care in cleaning and storing these mirrors in order to maintain their delicate surface coasting in a scratch-free condition. Control fogging by dipping mirror into hot water then drying it with a soft tissue. Alternatively, use a light stream of air from the air syringe to keep the mirror from fogging. o Keep the patient’s nose out of a palatal view of maxillary incisors. o Avoid beard hairs. o Retract the tongue with a mirror or have the patient move the tongue to the posterior so as not to obscure the teeth. o It is helpful, but not mandatory, to include the laser handpiece in the intraoral view. The laser need not be operating when this “During Procedure” picture is taken. o Keep fingertips, mirror edges, and retractors out of the picture as much as possible. If patient assists in holding retractors, have patient wear examination gloves. o It is suggested to obtain slightly larger image frames to allow cropping as necessary.
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 1 of 4
•
Ensure optimum visualization, lighting and exposure o As much as possible, keep viewpoint, positioning, lighting, color, magnification, perspective, contrast, and background the same. Standardize photographic conditions so that direct comparisons are possible, even if successive photographs are taken by different photographers over long time intervals. o Select a flash system designed specifically for macro photography. Use a ring flash for posterior teeth or areas of difficult access. Use bilateral flashes mounted on a bracket for anterior areas to help capture fine detail, texture, translucency, and subtle color transitions within individual teeth. Do not use an LED flash which provides relatively low intensity illumination and compromises image quality and depth of field. o Photograph the teeth in correct axial alignment (for example, the occlusal plane should be parallel to the horizontal in the photograph, not canted). o Align the optical axis perpendicular to the row of teeth to be photographed to maximize consistency and depth of field. o Long-handled, front-silvered, glass mirrors are preferred. o When using mirrors, try to photograph the mirror image only. Frame the image so that lips and mirror edges are minimized. Do not show unreflected teeth. Having both the direct and mirror image appear in the same photograph is confusing. o Use of manual focus is recommended, as auto-focus is unreliable in the oral cavity. In general, for anterior shots, focus on the central and lateral incisors to ensure that the maximum number of teeth are in focus. o Avoid shadows. As a general rule, when using a single (not a ring) flash in conjunction with a mouth mirror, keep the flash on the mirror side. o Strive for optimum exposure. Keep in mind that mirrors absorb light, and exposures will have to be adjusted accordingly. Light absorption characteristics vary from one mirror to another. Generally, use an aperture compensation of +1 f-stop to help ensure proper illumination of mirror shots. o If using a digital camera, check the overall brightness of the image with the histogram function. The peak should appear in the middle of the histogram for extraoral views, and slightly to the right side for intraoral views, consistent with a somewhat brighter image. o Unless the clinical condition warrants otherwise, keep tonal values uniform throughout, especially in pre- and postoperative images. If using a digital camera, recalibrate the white balance if the control screen shows inaccurate color shades. o Include reference measuring device (as for biopsies). o Use clean, neutral backgrounds for tabletop photography (instruments, impressions, materials, and so on). o To photograph a radiograph, mount the camera on a tripod and align it with the center image on the light box. For digital cameras, set the camera to ‘black and white’ mode to reduce file size. Turn off the room lights and block any light from doors and windows. Use black cards to block excess light from the light box. Use the camera’s self-timer setting to avoid camera shake from the long exposure. o To photograph a monitor, mount the camera on a tripod and align it with the center image on the monitor. For cathode-ray tube monitors, set the camera to ‘night’ mode to produce a long exposure and avoid horizontal bands across the monitor. Turn off the room lights and block any light from doors and windows which cause reflections in the monitor. Use the camera’s self-timer setting to avoid camera shake from the long exposure. o Eliminate poor quality images (over- or underexposed photos, out of focus images, poor orientation, etc.).
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 2 of 4
•
Take full photographic series: o X-ray o Before procedure o During procedure o Immediately postoperative o Short postoperative time interval (3-14 days) o Moderate postoperative time interval (1 month) o Longer postoperative time intervals (minimum of 3 and 6 months).
•
If appropriate, perform bilateral study (laser vs. conventional).
Intraoral Photography References 1.
Ahmad I. Digital dental photography. Part 1: An overview. Br Dent J 2009;206(8):403-407.
2.
Ahmad I. Digital dental photography. Part 2: Purposes and uses. Br Dent J 2009;206(9):459-464.
3.
Ahmad I. Digital dental photography. Part 3: Principles of digital photography. Br Dent J 2009;206(10):517-523.
4.
Ahmad I. Digital dental photography. Part 4: Choosing a camera. Br Dent J 2009;206(11):575-581.
5.
Ahmad I. Digital dental photography. Part 5: Lighting. Br Dent J 2009;207(1):13-18.
6.
Ahmad I. Digital dental photography. Part 6: Camera settings. Br Dent J 2009;207(2):63-69.
7.
Ahmad I. Digital dental photography. Part 7: Extra-oral set-ups. Br Dent J 2009;207(3):103-110.
8.
Ahmad I. Digital dental photography. Part 8: Intra-oral set-ups. Br Dent J 2009;207(4):151-157.
9.
Ahmad I. Digital dental photography. Part 9: Post-image capture processing. Br Dent J 2009;207(5):203-209.
10.
Ahmad I. Digital dental photography. Part 10: Printing, publishing and presentations. Br Dent J 2009;207(6):261-265.
11.
Antonelli JR. Dental photographic standardization for case documentation. Compendium 1991;12(7):504, 506-511.
12.
Bengel W. Standardization in dental photography. Int Dent J 1985;35(3):210-217.
13.
Blazejewski SW 3rd. Photographic documentation for veterinary dentistry and oral surgery. J Vet Dent 2012;29(4):270-274.
14.
Ettorre G, Weber M, Schaaf H, Lowry JC, Mommaerts MY, Howaldt H-P. Standards for digital photography in cranio-maxillo-facial surgery – Part I: Basic views and guidelines. J Craniomaxillofac Surg 2006;34(2):65-73.
15.
Fan PP. A practical guide for achieving excellence in dental photography. Part I: The essential elements. Oral Health 1998;88(11):43-44, 47-48, 51-52, 55-56.
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 3 of 4
16.
Fan PP. A practical guide for achieving excellence in dental photography. Part II: Full face and direct extra oral views. Oral Health 1999;89(1):16-18, 21-22, 25-26.
17.
Fan PP. A practical guide for achieving excellence in dental photography. Part III: The direct intra oral views. Oral Health 1999;89(2):47-48, 51, 53-54.
18.
Fan PP. A practical guide for achieving excellence in dental photography. Part IV: The indirect or mirror intra oral views. Oral Health 1999;89(10):37-38, 41-44, 47-48.
19.
Fan PP. A practical guide for achieving excellence in dental photography. Part V: The indirect or mirror intra oral views. Oral Health 2000;90(1):21-24, 27-30, 33.
20.
Goodlin R. Photographic-assisted diagnosis and treatment planning. Dent Clin North Am 2011;55(2):211-227, vii.
21.
Jakowenko J. Clinical photography. J Telemed Telecare 2009;15(1):7-22.
22.
Llop DR. Technical analysis of clinical digital photographs. J Calif Dent Assoc 2009;37(3):199-206.
23.
McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod 2005;32(1):43-54.
24.
Nash R. Dental photography: An integral part of modern dentistry. Compend Contin Educ Dent 1996;17(8):724, 726-727.
25.
Nayler JR. Clinical photography: A guide for the clinician. J Postgrad Med 2003;49(3):256-262.
26.
Persichetti P, Simone P, Langella M, Marangi GF, Carusi C. Digital photography in plastic surgery: How to achieve reasonable standardization outside a photographic studio. Aesthetic Plast Surg 2007;31(2):194-200.
27.
Schaaf H, Streckbein P, Ettorre G, Lowry JC, Mommaerts MY, Howaldt H-P. Standards for digital photography in cranio-maxillo-facial surgery – Part II: Additional picture sets and avoiding common mistakes. J Craniomaxillofac Surg 2006;34(7):444-455.
28.
Shagam J, Kleiman A. Technological updates in dental photography. Dent Clin North Am 2011;55(3):627-633, x-xi.
29.
Sharland M. Improving your image ... then and now. Digital photography in dentistry. Dent
Update 2013;40(4):333-334, 336. 30.
Shorey R, Moore K. Clinical digital photography: Implementation of clinical photography for everyday practice. J Calif Dent Assoc 2009;37(3):179-183.
31.
Snow SR. Assessing and achieving accuracy in digital dental photography. J Calif Dent Assoc 2009;37(3):185-191.
32.
Steel C, Behle C, Bellerino M, Hastings J, Saby B, editors. A guide to accreditation photography. Madison, Wisconsin: American Academy of Cosmetic Dentistry, [2002].
33.
Wander P. Dental photography in record keeping and litigation. Br Dent J 2014;216(4):207-208.
© 2014 The Academy of Laser Dentistry Guidelines for Clinical Photography 2015 v3
Page 4 of 4
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