My Favorite Photograph: It Tells the Whole Story (Almost)

As a clinician, I look for a consistent and predictable means to help me properly diagnose and plan treatment for patients. As a technician, I look for a consistent and predictable process that allows me to achieve the desired outcome when fabricating restorations.

Both of these objectives can be accomplished through the use of photographs. They are an essential means of communication within the dental team and for conveying information to patients.

My favorite photograph clearly shows the comparison of the interpupillary line and the occlusal planes of both the maxillary and mandibular arches relative to horizon. This is essential to treatment planning, whether it is for orthodontic, periodontal, or restorative therapies.

The maxillary or incisal/occlusal plane cannot be more than one degree off from level, otherwise it will be unacceptable to professionals and patients.  

In order to have optimal esthetic and functional success, a critical goal of treatment is to level the incisal and occlusal planes of both arches. During treatment planning, using photographs is extremely helpful. They are a visual representation of your clinical examination/evaluation.

​Setting up your patient photograph for optimal results:

It is crucial that the doctor is able to clearly communicate the patient's incisal and occlusal planes relative to horizon to the laboratory technician, and photography is a key element to accomplishing this goal. The following steps will help you achieve the optimal photographic result:

• Make sure the photographer is approximately 6 feet from the patient.
• The photograph should be in portrait format with the patient looking into the horizon.
• The image must represent the patient in a natural posture. The interpupillary line is frequently level with the horizon, but that may not always be the case. Therefore, it is critical to determine if the interpupillary line is canted relative to horizon. This must be captured in the photograph.
• The patient should stand with their shoulder blades against a wall, but with their head away from the wall. If the head is against the wall, the head will be tipped backward, and the posture will not be correct. 
• The patient should be holding lip retraction to expose their teeth.
• The anterior teeth should be separated 1.0 to 2.0 mm at the incisal edges.
• The center of the camera lens should be at the level of the incisal embrasures of the maxillary centrals.
• Frame the photograph to include the forehead and the chin. The center of the photo should be the embrasure between the central incisors. 
• The viewfinder should be parallel to the horizon.
• Take the photograph perpendicular to the facial plane at the level of the maxillary arch.
• If the image when viewed on the computer does not represent what was observed clinically, it is because the camera was not level. A correction can be made by rotating the photographic image. The center of the lens is positioned at the incisal embrasure of the maxillary central incisors, which should be at the center of the image.

The remainder of the story is captured by taking portrait photographs with lips in repose and a full smile. They need to be composed by positioning the camera position as was described above.  

(Click this link for more dentistry articles by Dr. Bob Winter)

Bob Winter, D.D.S., Spear Faculty and Contributing Author