Clinical Photos

To get your patient on track for a beautiful smile with OrthoSnap clear aligners, the first step is pre-evaluation. This is an estimate and hypothetical treatment plan. For this step, we need photographs of the patient.

A complete evaluation includes a more accurate cost estimate and an accurate treatment plan. The complete evaluation and the production of aligners require PVS impressions.

This article will focus on the clinical photos required for pre-evaluation, as well as why they are required and helpful information and tips on taking quality photos.

Pre-Evaluation

Patient photos allow us to interpret your instructions and help us understand your prescription. You can submit a case without photos, but we cannot move forward with the evaluation until you upload the required photos.

Good patient photos are needed so we can set the initial articulation properly. This is possibly the most important aspect of the patient’s treatment plan. If the articulation is set incorrectly, it can affect and negatively impact every tooth movement, which can result in a less than desirable outcome.

Also, photos help accurately orient the patient’s occlusal plane. For instance, if we do not receive a picture of the patient smiling, this could result in an excessively tipped or too flat occlusal plane. This can cause the maxillary incisors to appear as though they need extrusion or intrusion.

Photo Requirements

To perform a pre-evaluation, we require photos of eight different angles. To produce the best treatment plan for your patients, our lab requires the following eight photos. They should each be well-lit, clear, and in focus.

The eight angles we need include:

The full face smiling
The full face—not smiling
Occluded buccal view of right lateral
Occluded buccal view of left lateral
Occluded buccal view of anterior
Profile (not smiling)
Occlusal view of lower
Occlusal view of upper

Taking Clinical Photographs

While there are several courses that can help you become more proficient and teach you skills in clinical photography, we can offer several suggestions and tips to improve the quality of your pictures.

Needed materials:

A good digital camera. A dedicated macro lens and ring flash help produce optimal results for intraoral photography.
Intraoral mirrors, with lateral view and full arch in both child and adult sizes, are best.
Cheek retractors.
A solid white background or wall. If needed, you can purchase a foam board or poster to use in place of a wall. This ensures clarity of your patient’s facial features.
A vertically adjustable chair or stool.
A wall-mounted backlight equipped with a “slave flash” is optional but preferred.

Positioning

The patient should be at a 90-degree angle to the camera for extra-oral pictures. With taller patients, you may need to lower the patient or raise the camera. Shorter patients may need to be raised, or the camera may need to be lowered. Having an adjustable stool allows the photographer or assistant to more easily orient the patient.

For intraoral photos, the patient should be relaxed in the dental chair. A dental assistant or the patient can assist with cheek retractors.

Full Face Smiling

Determine camera distance by the optimum focus to provide maximum depth of field. This may differ depending on the lens’ focal length.
Orient the patient’s head vertically in a relaxed, natural position.
With the camera oriented vertically, frame the face from the middle of the neck to the top of their head.
Have the patient look directly into the camera lens.
Have the patient give a natural smile while showing the teeth.

Full Face Not Smiling

This picture is the same as above, but instead of having the patient smile, instruct them to have their teeth, jaw, and lips in a relaxed, natural position while they keep their lips together.

Occluded Buccal View of Right Lateral

You want the right side of the face toward the photographer, so have the patient turn their head to the left.
Using one cheek retractor, pull the right lip away from the gums and teeth. If possible, ensure visibility of the right central to the last erupted molar. Please note, this can be uncomfortable for the patient, so try to get this photo as quickly as possible.
Keep the camera horizontal with the occlusal plane level and in the center of the frame while aiming at a perpendicular angle to the buccal surface of the teeth.

Occluded Buccal View of Left Lateral

Repeat the previous steps for a right lateral but have your patient turn their head to the right instead to allow photography of the left side of the face.

Occluded Buccal View Anterior

Using cheek retractors, pull the lips away from the gums and teeth.
Do not obscure any of the teeth with the retractors.
Keep the camera horizontal, with the center of the frame being the occlusal plane.
Make sure the buccal corridors (between the inside of the cheek and buccal teeth) are visible and well-lit.
Focus on the first premolars and canines and determine (based on the lens) the proper depth of field from the first molars to the central incisors.
Ensure the visibility of the lower and upper gingival sulcus.

Profile (not smiling)

Turn the patient 90 degrees to their left so the right shoulder points directly at the camera. Only the right side of the face should be visible to the camera.
The patient’s head should be relaxed and in a natural position.
If the patient has long hair, pull it back and keep it behind the ear.
Make sure the patient’s eyes are looking straight ahead and remain horizontal.

Occlusal View of Lower

Using a retractor, pull the lip away from the teeth.
Use an arch mirror to capture the full arch—insert the wide end. Bonus tip: gently pushing upward on the mirror helps capture the entire arch, including the last molar.
To help get the camera at 90-degrees to the mirror plane, have the patient tilt their head backward.
Square the framing to a vertical line down the lower arch, midline.
Make sure the entire occlusal surface of the arch is visible.
As much as possible, keep the retractor out of the picture.

Occlusal View of Upper

Using a retractor, pull the lip away from the teeth.
Use an arch mirror to capture the full arch—insert the wide end. Bonus tip: gently pushing downward on the mirror helps capture the entire arch, including the last molar.
To help get the camera at 90-degrees to the mirror plane, have the patient tilt their head forward.
Square the framing to a vertical line of the palate, down the midline.
Make sure the entire occlusal surface of the arch is visible.
As much as possible, keep the retractor out of the picture.

Additional Photography Tips

Remember your best friend—light. Try to take pictures in the best well-lit area of your office. A ring flash mounted on the front of the lens helps provide the necessary light for intraoral photographs.

Utilize the automatic focus on your camera. For most cameras, this involves pressing the shutter button, which is the button that takes photos, halfway before taking the picture. This allows the camera to focus and helps avoid blurry pictures. Just press down on the shutter lightly, before the “click” that actually takes the picture, to achieve maximum focus.

Don’t get too close to what you are photographing. Most cameras cannot focus on things that are too close. This is especially true when using a flash, as the flash can wash out details when you are too close. Instead, take a step back and zoom in on your subject.

Before and After Photos

It’s always a great idea to get both before and after photos of your patients. Since we require the before photos, you should already have a record of them. When your patients complete treatment, be sure to take after photos to show how effective the treatment was.

You’ll be glad you did! Before and after photos are the most influential tool you possess for showing the benefits of OrthoSnap clear aligner treatment. Posting these photos (with your patient’s permission) lets future patients see the amazing results they, too, can achieve.

Related Topics and Information:

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If you have questions or need to speak with someone at Orthosnap, please reach out to us at support@orthosnap.com.