Taking clinical photographs

Guide for Clinical Photographs

This guide covers the essentials for taking quality clinical photographs for orthodontic treatment with clear aligners to submit on the Proligner Dr Portal. Each patient is different so photographic views, especially when only impressions are provided, better enable the Proligner Treatment Planning Team to complete your prescription.

Photographs are Essential

Clinical photographs are used to: 

1. Set initial articulation

A key part of developing a treatment plan is to properly set the initial articulation. Photographs provide a view of patient’s true occlusion.

1. Orient the occlusal plane

Photographs enable accurate orientation of the occlusal plane, so it is not set too flat or overly tipped. Without it a photographic reference maxillary incisors may appear as though they require intrusion or extrusion.

Key Equipment:

1. Camera

The best photos are taken by a an expensive DSLR, fancy ring light and a macro lens. However, quality photos can be taken with a simple iPhone. 

2.  Retractors & Mirrors

Retractors and mirrors are essential. Don't use your fingers. Have a range of retractors and mirrors on hand to get the best fit. Having an appropriate retractor then have another team member get in close. This is where a small, light and easily handled iPhone is an advantage over a bulky DSLR.

Eight photos are required for each case:

1. Front-facing (no smile)

2. Front-facing (with smiling)

3. Profile (no smile)

4. Front bite: Occluded buccal view anterior

5. Upper teeth: Occlusal view of upper arch

6. Lower teeth: Occlusal view of lower arch

7. Left bite: Occluded buccal view of left lateral 

8. Right bite: Occluded buccal view of right lateral

How to take each clinical photograph

The first thee photos should be taken with the patient standing.

1.  Front-facing (no smile)

Patient should look straight at the camera without a smile. No need to be serious, just natural. Position the camera centre and parallel to the face.

2.  Front-facing (smiling)

As above, but have patients think of their new smile. Their teeth need to be visible

3. Profile (no smile)

Position the patient 90o to the camera, with only the right-side of the face visible to the camera. Position the head in a natural and relaxed position, with the eyes looking straight ahead. Long hair should be back behind the ear. Again, make sure the camera is centre and parallel.

The remaining five photos are intra-oral and are best taken with the patient in the dental chair. It is easiest if a dental assistant helps with cheek retractors.

4. Front bite: Occluded buccal view anterior

Pull the lips and cheeks away from the teeth with cheek retractors. Position the centre of the frame inline with the occlusal plane. The insides of the cheeks should be well lit. To make sure the incisors to the first molars are in focus by focusing on the canine or first premolars. Have the upper and lower gingival sulcus visible.

5. Upper teeth: Occlusal view of upper arch

Using a retractor and a mirror, capture the full arch. Frame the photo down the midline of the palate.

6. Lower teeth: Occlusal view of lower arch

Using a retractor and a mirror, capture the full arch. Frame the photo down the midline of the lower arch, showing the full occlusal surface.

7. Left bite: Occluded buccal view of left lateral 

With the patient’s left side of their head facing the camera, use a retractor to pull away the left lip so the last molar is visible. The camera should be positioned inline with the occlusal plane level in centre of frame. For those whose lip does not retract far enough, use a buccal mirror to capture the mesial of the second molars.

8. Right bite: Occluded buccal view of right lateral

Same as above on the opposite side.

Common Mistakes

x  Teeth not together on the front view. Failing to have the teeth touching means the bite relationship can’t be demonstrated.

x  The occlusal views show too much facial rather than occlusal surfaces.

x  Blurry or over-exposed. When the camera is too close it can be hard to hold the camera still and the flash can wash out the image. Move the camera back and try a lower F-stop setting. 

x  Not positioning the camera parallel to the face, and the off centre of the occlusal plane

x  Not capturing the molars as the camera is positioned too far forward or there is not enough light.

Before and After (and During)

Capture photos at the start, end, and throughout treatment. It is also advisable to continue to capture photos when the retainer is in place. 

While tracking treatment effectiveness is a valuable reference for professional development, it is also rewarding for both the patient and dentist to see the outcome of all the hard work.

These images also document a practice’s track record of success and, with permission, may be used in social media and practice’s website, demonstrating success to potential new patients.