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Inside Dental Technology
May 2018
Volume 9, Issue 5
Peer-Reviewed

Depth of Field

Utilizing photography to capture the clinical, laboratory, and marketing aspects of dentistry

M. Reed Cone, DMD, MS, CDT, FACP

Dental photography is a wonderful tool that creates the perfect admixture of artistic expression and scientific discovery. The images obtained enhance communication with our dental team members, facilitate effective collaboration among clinical colleagues, accelerate the development and mastery of technical skills, and provide a powerful branding medium with which dental professionals distinguish themselves to both patients and potential clients. With so many different iterations available to enter into the creative process, it becomes useful to have a conceptual framework regarding the style and equipment necessary to begin developing a robust photographic portfolio.

There are generally four image categories that are used in the field of dental photography today: macro intraoral, macro extraoral, portrait, and benchtop. Each type of photograph has an identifiable use and a calculated purpose when used to achieve specific imaginative goals. To this end, various lenses (Figure 1) and camera equipment are available to assist in the process. However, the interpretive style and emotive essence in each image type remains largely subjective and is based on the creative heart, mind, and vision of the photographer.

Macro Intraoral Photography

When considering dental photography, macro intraoral images are the most common type that are used for shade analysis (Figure 2) and shown in peer-reviewed journals, such as before-and-after-treatment photos (Figure 3). As the name suggests, these photographs are captured with a dedicated macro lens. By definition, macro photography is limited to lenses capable of producing images on the camera sensor that are at a magnification ratio that is at least equivalent in size to the subject being photographed. This is represented by a 1:1 designation on the barrel of the lens (Figure 4). The ability of the lens to faithfully reproduce objects on the sensor at true life size, or a 1:1 magnification ratio, is important because it allows the lens to focus at very close distances to the subject (eg, the patient's teeth) and helps to eliminate distortion of the final image.

The minimal focus distance of a standard lens, or "kit lens," does not allow for such up close photography or detail resolution without the aid of additional equipment, such as extension tubes (Figure 5). For the various reasons described here, a macro lens should be in the camera bag of every dentist and laboratory technician. It should be noted, that as an additional benefit, a 100-mm macro lens also doubles as an excellent piece of equipment for portrait photography. And for the financially conscious consumer, it is not necessary to purchase the red-line professional series or luxury "L" lenses (Figure 6) in order to acquire amazingly sharp and beautiful photographs.

Macro Extraoral Photography

If intraoral photography is the pumping heart of communication between the dental laboratory and the dentist, then extraoral photography is the life blood of communication between the dentist and the patient. These images extend beyond the borders of the mucosa and show the lips and skin tone of the patient. In doing so, they place the final restorative results in context and offer less graphic and consumer friendly content (Figure 7 and Figure 8). The texture and matte-finish character of the human epidermis responds differently to light than the glossy and moisture laden oral environment. Simple paper diffusers, placed over the flash heads attached to the camera, produce a more flattering, less institutional-looking photograph (Figure 9 and Figure 10). When documenting a case, note that the use of plastic and metal intraoral retractors can create red stretch marks and circumferential creases around the patient's mouth, so be sure to acquire all of the necessary extraoral images first.

Portrait Photography

Although not technically challenging to produce, portraits are perhaps the most difficult images to obtain throughout each phase of treatment. After all, dentists do have a notorious public relations problem. They hurt people, and they're expensive—what is there to grin about? Without the ability to establish trust and rapport with another individual, there is no level of sophistication or technical mastery with a camera that will provoke laughter or a true Duchenne smile from a patient (Figure 11). The power of portrait photography lies in the ability of these images to add a uniquely human element to an otherwise sterile and overtly clinical documentation process. A final cropped and edited headshot of a patient creates a fortuitous branding opportunity since these images will likely be the highest quality and most flattering photographs they possess (Figure 12, composite portraits). Not surprisingly, the patients often use these photos as profile pictures and post to social media. This is phenomenal, organic word-of-mouth marketing that was borne from your routine photography protocol.

Benchtop Photography

The world of dentistry practically begs to be photographed. Aside from all of the essential patient-centered images, there is an infinite amount of material within the dental laboratory and throughout the operatories that provide captivating subject matter to satiate the artistic appetite of the camera (Figure 13 and Figure 14). Repeating shapes and the use of reflective surfaces, such as a mirror, offer exceptionally compelling imagery and force the viewer to observe the mundane details of the clinic in an entirely unique perspective (Figure 15 and Figure 16).

For the truly intrepid photographer, there is no glass that is more unforgiving or intimidating than Canon's MP-E 65-mm 1-5x macro lens (Figure 17). With the ability to reproduce images at five times life size, the addition of this lens into the mix allows for unparalleled intimacy with the subject (Figure 18 through Figure 20). The MP-E 65-mm lens has no ability to autofocus and trying to zero in on your subject has the parallax feel of a high-power rifle scope—the slightest movement or breath will completely alter the composition within the frame and throw the subject out focus. Due to the extreme minimum focusing distance, this lens possesses a very shallow depth of field which results in a heavily blurred background. A tripod is highly recommended accessory to this particular lens. In the same way that extraoral photography adds perspective to patient care, a wide-angle lens is well-suited at the bench to help establish a situational framework for the manufacture and fabrication of the prosthesis (Figure 21 and Figure 22).

Conclusion

There are myriad photographic techniques and technologies currently available to the dentist and laboratory technician. The manner in which these implements are utilized by the dental professional is largely dependent on the personal style and desired outcome of the individual. As a standalone resource, each type of photograph described is an essential component in the documentation protocol. When these singular images are combined, they merge into a meaningful and emotional storyline (such as Figure 23 through Figure 30), which ultimately improves communication and collaboration and aids in continued self-improvement. Most importantly, though, when the pictures reveal the nuance and details that the camera lens exposes about this remarkable profession, it's easier to understand there is so much more to the practice of dentistry than what normally meets the eye.

 

About the Author

M. Reed Cone, DMD, MS, CDT
Nuance Dental Specialists
Portland, Maine

Fig 1. Every camera lens, or “glass,” produces a different look and feel to the final image.

Figure 1

Fig 2. This intraoral shade photograph is used for communication with the laboratory technician.

Figure 2

Fig 3. Intraoral photographs document the patient before and after treatment.

Figure 3

Fig 4. This dedicated lens for true macro photography uses a 1:1 magnification ratio.

Figure 4

Fig 5. A 18- to 55-mm “kit lens” is fitted with a 25-mm extension tube to reduce minimal focusing distance.

Figure 5

Fig 6. Lenses with a red line, or “L,” are a higher quality glass but not necessary for intraoral photography.

Figure 6

Fig 7. Extraoral photographic images provide a contextual framework for each case.

Figure 7

Fig 8. The dry skin and moist lips reflect and react to light differently than the wet oral mucosa.

Figure 8

Fig 9. The use of diffusers over the flash heads creates a pleasing and silky look to extraoral photographs.

Figure 9

Fig 10. The light of the flash on most cameras produces a harsh and unflattering photograph.

Figure 10

Fig 11. When patients are genuinely happy, they laugh with their eyes.

Figure 11

Fig 12. Many hours must be spent with each patient to build a relationship and rapport.

Figure 12

Fig 13. Benchtop photography presents a wealth of subject matter to document.

Figure 13

Fig 14. Macro photography in the laboratory reveals a level of detail rarely seen.

Figure 14

Fig 15. The use of an inexpensive hand-held mirror provides a stunning reflection for ceramic crowns.

Figure 15

Fig 16. The repeating perforations of a nickel-plated impression tray create unique dental art.

Figure 16

Fig 17. The MP-E 65-mm macro lens has the ability to capture images at five times life size.

Figure 17

Fig 18. At several times life size, a commonplace block of dental wax has an otherworldly appearance.

Figure 18

Fig 19. Under high-power magnification, rich textures reveal themselves.

Figure 19

Fig 20. Remarkably bold and dramatic images can be expected with super-macro photography.

Figure 20

Fig 21. A wide-angle lens invites the audience into the world of the technician.

Figure 21

Fig 22. Context is key when telling a story or marketing a product. Go wide for these types of images.

Figure 22

Fig 23. A patient portrait sends the message that there is a human being involved in the case.

Figure 23

Fig 24. The combination of extraoral and intraoral images helps to establish the pre-operative situation.

Figure 24

Fig 25. A simple alginate impression demonstrates that every difficult case has humble beginnings.

Figure 25

Fig 26. Shade photos of hard and soft tissue emphasize the complexity of the treatment process.

Figure 26

Fig 27. Images of the definitive process before and after ceramic layering showcase the technician’s skills.

Figure 27

Fig 28. The juxtaposition of the vibrant porcelain and the matte-finish gypsum provides striking contrast.

Figure 28

Fig 29. Retracted intraoral macro photography documents various treatment phases.

Figure 29

Fig 30. The final result gives context to the restorations and ties the entire treatment process together.

Figure 30

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