Protocols for Mobile Dental Photography with Auxiliary Lighting [1 ed.] 0867159464, 9780867159462

Table of contents :
Protocols for Mobile Dental Photography with Auxiliary Lighting
Front matter
Contents
About the author
Foreword
Chapter 1: Introduction
Chapter 2: Why Document?
Treatment Planning
Documentation and Self-Evaluation
Communication with the Patient and the Dental Technician
Evolution of the Treatment
Lecturing and Publishing
Marketing
Artistic Photographs
Insurance
Medicolegal
Chapter 3: Advantages of Mobile Dental Photography
Disadvantages of DSLR Cameras
Chapter 4: Specifications of a Smartphone Camera
Megapixel Count
Sensor Size
Shutter Speed and Aperture Size
Lenses
Other Technologies
File Type
Chapter 5: Accessories Needed for MDP
Retractors
Mirrors
Contrastors
Diffusers and Polarizers
Chapter 6: Types of Light
Diffused and Bounced Light
Polarized and Cross-Polarized Light
Why Polarized Photographs in Dentistry?
Chapter 7: Smile Lite MDP
The Device
LED Lights
Polarized and Diffused Light
Posterior Photographs
Full Light
Chapter 8: Important Rules for MDP
Smartphone Preparation
Properly (and Comfortably) Holding the Smartphone
White Balance Setting
Use of Retractors and Contrastors
Distance Between Camera and Teeth
Distance Between Camera and Patient
Golden Rule: Zoom, Focus, Shoot
What to Avoid
Chapter 9: How to Take Intraoral Photographs with MDP
Anterior MDP
Posterior MDP
Lateral MDP
12 O’clock Photograph
Occlusal MDP
Polarized MDP
Chapter 10: How to Take Extraoral Photographs with MDP
Portrait
Half-Illuminated Portrait
Artistic Photographs of Lips
Mobile Eye Photography
Birefringence MDP
Chapter 11: Mobile Dental Video
Communication
Documentation
Accessories
Camera
Chapter 12: Applications of MDP
Anterior MDP
Posterior MDP
MDP for Case Documentation
Other Daily Uses for MDP
Portrait MDP
Polarizers and MDP
Epilogue
Index
Back Cover

Citation preview

Introduction Why Document?

Protocols for

Advantages of Mobile Dental Photography

Protocols for MDP with Auxiliary Lighting

CONTENTS

Hardan

01 02 03 04 05 06 07 08 09 10 11 12

Specifications of a Smartphone Camera Accessories Needed for MDP Types of Light Smile Lite MDP Important Rules for MDP How to Take Intraoral Photographs with MDP How to Take Extraoral Photographs with MDP Mobile Dental Video Applications of MDP

MOBILE DENTAL PHOTOGRAPHY with Auxiliary Lighting Louis Hardan, dds, phd

ISBN 978-0-86715-946-2

90000>

9 780867 159462

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Protocols for Mobile Dental Photography with Auxiliary Lighting

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Library of Congress Cataloging-in-Publication Data Names: Hardan, Louis, author. Title: Protocols for mobile dental photography with auxiliary lighting / Louis Hardan. Description: Chicago : Quintessence Publishing, 2020. | Includes bibliographical references and index. | Summary: “Demonstrates how to document dental treatment and take artistic photography with a smartphone camera in conjunction with auxiliary lighting”-- Provided by publisher. Identifiers: LCCN 2020020011 | ISBN 9780867159462 (hardcover) Subjects: MESH: Photography, Dental--methods | Dental Records | Mobile Applications | Smartphone | Lighting Classification: LCC TR708 | NLM TR 708 | DDC 617.60022/2--dc23 LC record available at https://lccn.loc.gov/2020020011

© 2020 Quintessence Publishing Co, Inc Quintessence Publishing Co, Inc 411 N Raddant Road Batavia, IL 60510 www.quintpub.com 54321 All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher. Editor: Leah Huffman Design: Sue Zubek Production: Sarah Minor Printed in China

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Protocols for

MOBILE DENTAL PHOTOGRAPHY with Auxiliary Lighting Louis Hardan, dds, phd

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CONTENTS About the Author vi Foreword vii

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Introduction 1

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Why Document? 3

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Advantages of Mobile Dental Photography 15

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Specifications of a Smartphone Camera 23

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Accessories Needed for MDP 29

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Types of Light 35

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Smile Lite MDP 43

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Important Rules for MDP 53

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How to Take Intraoral Photographs with MDP 67

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How to Take Extraoral Photographs with MDP 83

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Mobile Dental Video 101

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Applications of MDP 107

Epilogue 117 Index 118

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ABOUT THE AUTHOR Louis Hardan, dds, phd, is a professor and the director of the master program in the Restorative and Esthetic Department at Saint Joseph University in Beirut, Lebanon. He received his dental degree in 1989 and continued his postdoctoral education at Saint Joseph University, where he obtained a certificate for basic science in 1993, completed his specialization in restorative and esthetic dentistry in 1995, and completed his PhD in oral biology and materials in 2009. Dr Hardan maintains a private practice in his hometown of Byblos, Lebanon, and he is the scientific director and an honorary and active international member of StyleItaliano. He is also the country chairperson for Lebanon of the European Society of Cosmetic Dentistry. Dr Hardan is the inventor of Smile Lite MDP (Smile Line), a device used to take high-quality dental photographs with a mobile phone, for which he won the Best of Class Technology Award in 2017, as well as Posterior Misura (LM instrument), an instrument for shaping direct posterior composites. He has many publications to his name in international journals and has given several international lectures and courses on esthetics, restorative dentistry, and mobile dental photography.

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FOREWORD “You should never judge a photographer by the type of film used, but only how he uses it.” –Ernst Haas Since Professor Louis S. Hardan joined the StyleItaliano team, every day he has shown the curiosity and interest in simplified dentistry that is in our StyleItaliano DNA. One day he came to us and said, “Taking a good dental photo must be as easy and pleasant as taking a selfie.” We were shocked by this, considering all the effort that goes into taking high-quality photographs in the clinic, all the devices and details required, all the money invested in making the communication better and better in our courses and lectures. But then he came with a smart prototype and showed us a series of photographs. They were breathtaking—in clarity, resolution, sharpness, and the way the light was managed. And the device in question was his mobile. With some smart lighting of course. We finally understood. He was thinking exactly of all the dentists and students who don’t take photographs because it is too complicated and expensive. He was thinking of an easy way to communicate with the dental technician. He was thinking of the assistants, always struggling with the professional camera. He was thinking of the easiest and best way to speak with the patient and create a positive relationship. All of this is the real philosophy and target of StyleItaliano. We are proud of this work, proud to encourage every dentist to always document every case. This is the way to grow your skills and to share emotions with everyone around. Although some may express cynicism at the use of smartphones in clinical photography, we would like to remind you of the initial quote by Ernst Haas: “You should never judge a photographer by the type of film used, but only how he uses it.” Smartphone cameras are evolving rapidly, and the photographs in this book are the best proof that it is not the type of camera that dictates the quality of a photograph—it’s how you use it. Enjoy the book with passion and bright eyes!

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Introduction T

Billions of photographs are taken worldwide each day, and most of them are captured with a smartphone.

he past is gone, we live in the present, and no one can predict the future. This is a reality that we cannot deny. Because our memories can be unclear and lack detail, to keep them alive we often try to capture moments with photographs and videos. Inventor Nicéphore Niépce is credited as the first to take a partially successful photograph in the early 19th century. This technology was slow to evolve, eventually picking up pace in the late 20th century with the introduction of pocket cameras, followed by the integration of cameras in mobile phones in recent years. In 2011, only about 10% of the world’s population used a smartphone. In 2018, that figure jumped to 36%, with an estimated 3.8 billion users in 2021. Because smartphones are relatively similar in design, utility, and performance, smartphone companies are shifting their attention to the quality of their products’ cameras to give them the competitive advantage in the marketplace. After all, billions of photographs are taken worldwide each day, and most of them are captured with a smartphone. Improved optical zooming (10× or more), 360-degree video, and 3D imaging with depth sensing are the serious projects of the future for smartphone cameras, and there are plenty of other innovations on the horizon. This technology war between the dueling smartphone companies has spurred rapid evolution in the capabilities of smartphone cameras, leading even some professional photographers to start using their smartphones to take high-quality photographs with great definition. We know that many dentists already use their smartphone cameras to document their cases and communicate with their laboratory because they do not have professional cameras, but a poorly taken photograph can compromise the quality of the dentistry delivered to the patient. Therefore, it is important to understand how to properly use a smartphone camera in the context of clinical photography. That is why we started the Mobile Dental Photography (MDP) project in 2012; we wanted to find a way to make documentation and communication easy and affordable to all dentists and laboratory technicians, including students. Even in hospitals, the trend of using smartphones and wireless technologies is increasing with the aim of providing high-quality, cost-effective, and altogether better health care. 1

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Why Document? P The primary reason to document in dentistry is to record with precision the actual oral situation or procedure performed, and as part of this process dental photography can be employed for diagnostic, clinical, and medicolegal purposes.

atients’ dental records comprise documents concerning the history of their dental conditions, clinical examinations, diagnoses, and treatments. The primary reason to document in dentistry is to record with precision the actual oral situation or procedure performed, and as part of this process dental photography can be employed for diagnostic, clinical, and medicolegal purposes. High-quality photographs are required to obtain more information from the images, allowing their use in multiple fields of dentistry. Photography can be used for treatment planning, documentation and self-evaluation, communication with the patient and laboratory technician, tracking the evolution of treatment, as well as for publishing, lecturing, and marketing; it can also be used for artistic, insurance, or legal purposes.

Treatment Planning From the patient’s first visit to the dental clinic, dental photography can prove its worth as a diagnostic and evaluative tool. A complete set of oral photographs is essential to create a thorough treatment plan. It can be a very useful implement for the analysis of facial profiles, for the evaluation of prosthetic rehabilitation, for the detection of caries or enamel defects, and for the assessment of gingival health and periodontal pocket or ridge morphology prior to implant placement. Moreover, photographs can be sent to external specialists for a second opinion without need for patient consultation, facilitating better diagnosis and optimized treatment planning. For esthetic cases, photographs can be used to build a smile design so the patient can see the final outcome via a virtual mockup on screen that can be printed and transferred to the mouth with bis-acryl material (Figs 1 and 2). Many smile design softwares are evolving to be used on smartphones as an app or on a website where you can upload photographs directly from the image gallery.

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FIGS 1 & 2 The patient can see his final smile design before beginning treatment. The photographs serve to build this smile, and if the patient approves the design, the dentist can begin the treatment in a guided way. FIGS 3 & 4 Before and 4 weeks after restoration of the first molar (and 1 year after restoration of the second molar). Examination of these photographs allows better assessment of the work performed than direct examination in the mouth and exposes any problems that can be corrected in the future. FIGS 5 & 6 Patients should know that sometimes a small black line on a tooth can hide a big carious lesion and that they should consult a dentist when they see such a lesion on their teeth. This information can be very empowering for patients who want to be in control of their dental health.

Documentation and Self-Evaluation For many years documentation in dental records relied on handwritten notes, radiographs, study models, and clinical photographs. Today most of this documentation is digitized for accessibility purposes. Photographs constitute a very effective archiving tool, providing improved documentation of clinical conditions over time and facilitating observation and monitoring. Photographs also allow a more precise assessment of the completed work and the procedures followed, enabling effective self-evaluation. Details imperceptible to the human eye without magnification all of a sudden become clear. Moreover, the practitioner can easily examine and compare different procedures for different patients to determine which led to a better outcome, potentially improving future treatment planning. With the evolution of smartphone cameras, accessibility is further enhanced because every dentist has a phone in his or her pocket that is designed to be user friendly. Photographs taken on a smartphone can be organized into folders by case and later evaluated on a larger screen to evaluate the quality of the work in hopes of improving it in future cases (Figs 3 and 4).

Communication with the Patient and the Dental Technician Effective communication between the practitioner and the patient is crucial for the success of any dental treatment, and a photograph is the simplest way to communicate dental information to patients. Images leave an impression on the patient and give him or her the sufficient confidence to move forward with treatment. Sometimes it is only by seeing photographs of their teeth that patients really understand their current dental situation and the treatment planning that the dentist proposes. This is especially true for patients who have sought dental advice elsewhere with negative experiences. Patients often appreciate viewing photographs of their dental procedures to see exactly how their treatment was carried out. Patients can hence visualize things that they were only capable of imagining before, such as the presence and size of carious lesions (Figs 5 and 6) or the shape of pulp chambers during root canal treatment. Furthermore, by showing photographs of the clinical sequence of similar cases to the patient during the treatment plan presentation, he or she is better

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able to understand the procedure and predict the result. This is often helpful in justifying the cost of treatment, especially in advanced cases. Good communication should also exist between the dentist and the dental technician, especially in the domain of esthetic dentistry. Even the most detailed description written by the dentist cannot compare to the information communicated with a well-shot photograph. Photographs can help the technician visualize how and where his or her work will integrate in its environment. A large amount of information is transferred via photograph, such as the color, shape, alignment, personalization, translucency, opalescence, and halo effect of adjacent teeth. In addition to other advanced techniques of communicating color information to the laboratory, the following three photographs are very useful:

FIGS 7–9 The three photographs that should be sent to the dental technician: (1) anterior shot with edge-to-edge shade guide under diffused light; (2) polarized version of edge-to-edge shade guide; (3) shot taken with the light coming from the opposite side of the camera to show anatomical details of the teeth. FIG 10 Photographic documentation allows the dentist to see the evolution of the treatment and the behavior of dental materials over time. In this case, the fissure sealant on the first molar was performed 20 years prior to those of the other teeth.

1. A photograph of a shade guide positioned edge to edge with the natural tooth to show the difference between them (Fig 7). 2. A polarized version of the previous photograph to show the extension of the translucency and its location in the incisal edge, the presence of some details like white spots, and also the difference in color with the artificial shade guide (Fig 8). 3. A photograph showing the secondary and tertiary anatomy because esthetics are not only hue, chroma, and value but also anatomy (Fig 9).

Evolution of the Treatment Photographs are taken prior to any treatment to be used as a baseline indicating the primary situation and to be studied for treatment planning. However, follow-up photographs are just as essential to evaluate the progress of the treatment plan. Photographs can be taken on a regular basis throughout different phases of treatment. Thus, the evolution of the clinical situation and the treatment plan can be monitored according to a certain time interval. This is especially important in specialties like orthodontics, prosthodontics, restorative dentistry, and periodontics. Furthermore, photography allows clinicians to objectively assess any changes in color, shape, or integration of any materials used intraorally (Fig 10), which can aid future treatment planning.

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Lecturing and Publishing Dental publishers and meeting organizers are very strict about their image criteria, so it is very important to take high-quality photographs if you are interested in preparing any lectures, posters, articles, or books. A successful dental lecture is based not only on the contents and the communication skills of the lecturer but also on the quality of the photographs and videos presented. Sought-after lecturers are known for their outstanding photographs (Figs 11 and 12). This is because dentists are visual learners and photographs allow the dental audience to have a clear and comprehensive idea of the topic presented. For example, in diagnosis, photographs make the identification of pathologic situations or lesions and the execution of their treatment easier, because a visual reference was already provided. Photographs or videos also portray the different stages of a procedure step by step, giving audience members a visual guideline that may help them in the future. Furthermore, dentists are able to see a clinical situation on a much bigger scale where details can be highlighted and studied. Concerning scientific studies and publications, photographic documentation is a huge asset. It gives the opportunity of remote scoring and enables multiple scorers to evaluate images for scientific purposes. Dental clinicians can compare cases or evaluate a given case over time. In this context, dental photography is an adaptable, reliable, and reproducible recording technique that enables longitudinal studies. Documentation is mandatory in postgraduate programs at universities, so dental students must start learning how to document with photography in their undergraduate career. They must learn how to frame a shot, how to manage light, and how to “make a picture” (Figs 13 to 18). Once these basics are mastered, it will be easier to upgrade

FIGS 11 & 12 When lecturing on big screens, high-quality photographs are a must. FIGS 13–18 Undergraduate students are able to take good photographs with their smartphones without the use of professional cameras, which is especially useful when they cannot afford one. They only need to be taught how to play with the light and how to frame the shot.

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to greater photographic skills during the postgraduate program. These will be necessary for any seminars, case presentations, posters, thesis defense, and article publication.

Marketing If permitted by governing law, marketing and advertising can have a great impact on the success of a dental practice. For a long period of time, dental marketing was by word of mouth, relying mainly on good interpersonal relationships between patients and dental staff and referrals to friends and family. While this is certainly still relevant, digital marketing is becoming increasingly important with the growing use of the Internet and social media. Photographs can be presented on brochures, displayed in the dental clinic, or transmitted via social media networks (eg, Facebook, Twitter, Instagram) or email. Image content is prioritized on many social media platforms, creating an exceptional marketing opportunity for dental practitioners (Figs 19 and 20).

FIGS 19 & 20 With the increasing popularity of social media, digital marketing is taking on more importance in dentistry. High-quality photographs are required to catch the eye of future patients. Smartphones make it easy to take such photographs and immediately upload them to social media platforms.

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FIGS 21 & 22 Artistic photographs are sometimes difficult to capture, but they are popular and demanded by many patients. Artistic shots of lips, teeth, prosthodontic elements, and more can be achieved by playing with the light and the position of the camera. These images can be used on social media, in lectures, or as decoration in the dental clinic.

Photographs used in marketing can be “before and after” photographs or a sequence of photographs showing the different steps of a treatment. Digital marketing like this results in high visibility and targets a large base of potential patients. High-quality photographs are mandatory; otherwise, the advertisement will be a failure, even if the dental treatment and esthetic result were perfect.

Artistic Photographs Artistic photographs such as those presented in Figs 21 and 22 can form a special and personalized ambiance in dental clinics when they are used for decorative purposes. Furthermore, artistic photographs are primed for marketing via social media. While images like this require established photographic skills, they garner attention and generally encourage potential patients to seek more information about the clinician. 11

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Insurance Most patients depend on their dental insurance to cover the cost of their treatment. Insurance companies must make sure that the patient really needs the treatment they are claiming, and afterward they need to confirm that the proper treatment was carried out. Photographs and radiographs serve as evidence of the pretreatment and posttreatment conditions, demonstrating the execution of treatment, and therefore excellent documentation is mandatory in these cases. An efficient filing system is necessary to have fast and easy access to this information.

Medicolegal In the medicolegal arena of the dental field, photography is considered a key element in addition to radiographs and plaster casts. In fact, photography may be the only documentation tool that can appeal to the general population, as opposed to radiographs. In addition, preserving plaster casts of every patient for documentation can prove to be difficult because they take up physical space and complicate the filing system. Photographs, especially digital photographs, can be easily stored and organized in a way that allows the dentist to easily access them. In the unfortunate case that a dentist is sued by a patient, photographs are the best visual aid to portray the treatment delivered. People in the legal field are not acquainted with evaluating radiographs and they may not understand medical terms, so they need visual aids to which they can relate. Meticulous documentation with high-quality photographs ensures that dentists can defend their work. Because it is often impractical and difficult to photograph every stage of every patient’s dental treatment, the decision as to what should be photographed must be left to the dentist to assess the risk. In general, expensive or advanced treatment plans warrant more detailed documentation, as do treatment plans for patients who are particularly skeptical or who have made previous legal allegations. If comprehensive documentation is not attainable, photographs should at least be taken before and after each dental treatment to show the initial conditions and the changes that occurred. Medicolegal photographic documentation in the dental field is also relevant for forensic identification of human remains, a macabre but sometimes necessary use.

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Advantages of Mobile Dental Photography The cameras in our smartphones are integrating photography into our lives on a much more intimate level than ever before.

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hotography has slowly become an indispensable tool in our daily life, and that is primarily because of smartphones and the accessibility that smartphone cameras provide. No longer do we only take photographs to capture landscapes (Fig 1) or portraits; instead we take photographs of products that strike our fancy, food that captivates us (Fig 2), posters that interest us, or pretty much anything we don’t want to forget. While photography’s chief goal is still to chronicle our life’s events and to capture moments that we want to remember and relive (Fig 3), its use now goes way beyond that, even into the classroom where students take photographs of things they deem relevant to their studies. The cameras in our smartphones are integrating photography into our lives on a much more intimate level than ever before.

FIGS 1–3 Smartphone cameras are used on a daily basis to capture life’s moments. Their use is simple, their results are wonderful, and they allow fast sharing via social media. 1

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FIGS 4 & 5 One of these photographs was taken with a DSLR camera with twin flashes, and the other was taken with a smartphone combined with a twin daylight LED. A little difference is seen in brightness and contrast, but this can also occur when taking multiple photographs with the same camera. It is remarkable how similar the photographs are in terms of their quality, especially considering the vast price gap of the two devices.

Disadvantages of DSLR Cameras Digital single-lens reflex cameras (see Fig 6), known as DSLR, are considered the gold standard apparatus for photographic documentation. In the dental field, however, this type of camera system is often impractical due to the complexity of the apparatus and training required. Furthermore, with the tremendous and noticeable evolution of smartphone cameras in the last few years, the simple addition of a daylight device (eg, Smile Lite MDP [Smile Line]; see Fig 7) to a smartphone camera can result in photographs almost equal to those taken by DSLR (Figs 4 and 5). For the purposes of this book, mobile dental photography (MDP) refers to a smartphone camera being used with an auxiliary light source. DSLR cameras have three main disadvantages in comparison with MDP: (1) the cost-effectiveness, (2) the weight of the camera, and (3) the learning curve for each device.

Cost-effectiveness Taking a good photograph with a DSLR camera requires a multitude of accessories, including the lens, multiple light gadgets (ring flash, twin flash, etc), and the polarizing filter (Fig 6). With all of this equipment comes a hefty price tag, usually upward of several thousand dollars. The MDP device (Fig 7) is a much more economical choice because the camera and lens are already present in our smartphone, meaning we are only really covering the cost of the different lights, polarizing filter, and diffusers.

Weight The second main disadvantage of DSLR cameras is their weight. With the body of the camera itself, the lens, and the flashes, the DSLR system is heavy and often bulky to use in the dental practice. The MDP device, on the other hand, has all the necessary accessories built into its small body, making it lightweight and easy to maneuver in clinical practice.

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FIGS 6 & 7 Professional and high-quality photographs with a DSLR camera require the body of the camera, a lens, a ring flash, twin flashes, polarizers, diffusers, and bouncers. When using the MDP device, on the other hand, the camera and the lenses are already in the phone; the device itself acts as a mini studio with all the accessories required to take anterior, posterior, and polarized photographs. FIG 8 The learning curve for MDP is very short. This photograph was taken by a banker who knows nothing about dentistry or dental photography. By telling him how to hold the MDP device and how to zoom, focus, and take the photograph, he was able to have this result on the first attempt. 6

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FIGS 9 & 10 An example of apps that can be used on smartphones to organize the photographs into folders, subfolders, and favorites.

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Learning curve Finally, the learning curve for using a DSLR system is much longer than with MDP and smartphone camera use. The settings in the smartphone camera are user-friendly, simple, and effective (Fig 8), whereas DSLR cameras have more complex functions and tools, making the learning procedure much more complicated. Perhaps the greatest advantage of MDP is the simplicity of its daily use. Various apps can be downloaded onto the phone, allowing a vast range of services from organizing photographs in patient files and folders to communicating directly via social media with patients and laboratory technicians (Figs 9 and 10).

Light Another essential advantage of MDP is the continuous light of the device. With DSLR camera systems, the flash light is momentary, so the final photograph is not what the photographer was seeing without the light (Fig 11). When using the MDP device, however, the photographer can see exactly what will be captured by the camera because the light is continuous (Fig 12).

Disinfection Additionally, DSLR devices cannot be disinfected, whereas the uncomplicated structure of MDP allows your personal device to be properly covered by plastic wraps, with only a small opening at the camera level (Figs 13 to 15).

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FIG 11 With DSLR cameras, the user needs to change the settings many times before landing on a good photograph, because the final result can be seen only after the flash is turned on. Sometimes the user is not even able to attain the desired results.

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FIG 12 With MDP, the user can see the final result before taking the photograph because the light is continuous. The process is fast, and we can even take nice photographs of fidgety children.

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FIGS 13–15 To prevent crossinfection between patients, smartphones can be covered by plastic wraps with a small opening for the camera lens. Even if the phone won’t be used to take photographs, patients will appreciate this meticulous procedure. Another way to disinfect the phone is to use special disinfectant spray or wipes dedicated to this purpose.

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Specifications of a Smartphone Camera Numerous factors play a major role in defining picture quality, like sensor size, pixel size, aperture, software, and more.

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retty much anyone can take a decent photograph with little to no effort using a smartphone. Photography has become an easy and instant process where photos can be directly seen and assessed. With the development and evolution of smartphones and their cameras, picture quality is constantly improving, even to the point where professional photographers are turning to their smartphone cameras for their daily use (Figs 1 to 3).

FIGS 1–3 With the evolution of smartphone cameras, professional photographers have more trust in their capabilities, often turning to their phones for their daily photography and for uploading photos quickly onto social media.

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Megapixel Count When we think of picture quality we think of megapixel (MP) count. The term megapixel refers to the number of millions (mega) of pixels in an image. Each pixel on a camera sensor captures the reflected light of an object and converts it into image data, so a 16-MP camera has a sensor containing 16 million pixels. To capture a high-quality photograph with MDP, the smartphone sensor must have a minimum of 12 MP, because digital zooming is required to crop the view before taking the photograph. However, smartphone cameras with less than 12 MP can still give acceptable photographs when the right lighting is used. It is important to note that image quality doesn’t depend entirely on megapixel count. Numerous factors play a major role in defining picture quality, like sensor size, pixel size, aperture, software, and more.

FIG 4 The quality of the sensor is important for obtaining a high-quality photograph. The light reflected by the subject being photographed hits the photodetectors in the sensor, corresponding to each pixel in the image capture. An interpolation software algorithm produces the final image after transformation of the converted information into a digital signal.

Sensor Size A larger sensor can contain more pixels, allowing a more detailed depiction of variance in one image. Moreover, when pixels are larger, more light can reach the sensor. As a consequence, the larger the sensor and the larger the pixel size, the more competent a camera can be (Fig 4).

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FIGS 5 & 6 Very simple smartphone cameras have no lens at all but a pinhole to focus the light. More advanced cameras have one convex lens, and the higher-quality cameras include both convex and concave lenses to reduce chromatic aberrations in the final outcome. These lenses carry the light to the sensor.

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Shutter Speed and Aperture Size Furthermore, some smartphone software programs or camera apps allow the control of other camera functionalities such as shutter speed and aperture size. These parameters determine the quantity of light that reaches the sensor. The shutter is like a curtain that rolls over the sensor and allows light to reach the sensor for a fraction of time depending on its speed. When the shutter speed is slow, the fraction is large (1/60) and more light can reach the sensor so the photographs appear brighter and more blur exists; when the shutter speed is fast, the fraction is small (1/320) and less light reaches the sensor, resulting in a darker image with less blur. In some smartphones, the shutter speed can be modified manually, knowing that there is no actual mechanical shutter in the camera; it is entirely electronic. The aperture is a set of blades in the lens that create an octagonal shape. This shape can be widened open so the whole lens is exposed, or it can be closed to a small hole at the center of the lens. Aperture size is represented by f-stops. The smaller the f-stop is, the greater the aperture size. When a wide aperture size is used (low f-stop), the photographs appear brighter, but the depth of field is shallow. In new smartphones, the aperture is not fixed and can be dual (eg, f/1.5 and f/2.4).

Lenses Because manufacturers have to keep our smartphones slim and light, smartphone cameras are small and yet must fit multiple lens elements in addition to the sensor (Figs 5 and 6). To facilitate better-quality

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Specifications of a Smartphone Camera

photography, the dual rear camera setup was introduced. A dual camera helps capture sharper and more detailed images because there are two sensors. It also allows an ultrawide-angle mode, or a shallow depth of field, or even an increased optical zoom. Today smartphone companies are introducing phones with triple camera setup with wide-angle lens allowing 120-degree field of view. With these multilens cameras, optical zooming can go from 2× to 5× or even 10×, with greater magnification possible in future generations. This optical zooming will enhance the quality of the final photograph because the existing digital zooming uses fewer pixels in the sensor and thus results in lower-quality images.

Other Technologies Some smartphones support multishot/frame noise reduction technologies. In this special processing mode, the camera shoots 12 images in three groups of 4, and then these are combined into a single shot to give the best clarity with the minimum amount of noise in any setting. This is another factor explaining the improvement of smartphone photography even in inexperienced hands.

File Type In general, the final photograph is saved in .JPEG format, but in some new smartphones it is possible to save photographs as .RAW files.

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Accessories Needed for MDP T The best photographs in MDP are obtained with the help of accessories such as retractors, mirrors, contrastors, polarizing filters, and diffusers.

he best photographs in MDP are obtained with the help of accessories such as retractors, mirrors, contrastors, polarizing filters, and diffusers. The lips, cheeks, and tongue should not appear in photographs meant to show teeth. To facilitate this sorting, good retractors are needed. To accurately reflect teeth, especially in the posterior region or when taking an occlusal, lingual, or palatal view, good mirrors are needed. To have soft light and show smooth details, diffusers are needed. And in shade matching and in communicating with the laboratory technician, a polarized filter is needed to create a polarized photograph with no reflection of the light.

Retractors Retractors are used to pull away the lips, the cheeks, and the tongue so that the photographer can have better access to the teeth and oral cavity. Retractors come in different shapes and sizes, and they can be either plastic or stainless steel. There are two main categories of retractors: self-retracting retractors and one-sided retractors. Self-retracting retractors have a semicircular shape with two extremities that are placed simultaneously in the mouth (Fig 1). These retractors are able to retract both sides at the same time, and they are mostly used for frontal photographs. One-sided retractors are straight retractors that are used for lateral photographs (Fig 2). These retractors require a personal manipulation that can be from the patient or the assistant. One-sided retractors are preferred to the self-retracting ones because their action can be controlled and adjusted as necessary. For posterior photographs, retraction is more complicated: The tongue and the cheek should be retracted to be able to have a full view of the posterior teeth. Normally this is accomplished with mirrors or

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Accessories Needed for MDP

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flat retractors, but the easiest way is to use Photo-CAD (Smile Line; Fig 3). This kit comes with three bendable retractors, two for the anterior retraction and one for the posterior.

FIG 1 This self-retracting, doublesided retractor does not need to be held by the patient or an assistant, and by pulling on one side, the lateral view of the teeth can be exposed. FIG 2 One-sided retractors are the most common because they allow control of the retraction force to give the best exposure of the chosen area. They can be held by an assistant or the patient. FIG 3 Well-retracted anterior and posterior photographs can be taken with Photo-CAD retractors.

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FIG 4 Different shapes of mirrors used in dental photography. To ensure a sharp photograph, they should be highly reflective and front-surface mirrors.

Mirrors Mirrors designed for dental photography come in different shapes and sizes (Fig 4). The dentist chooses the most appropriate size based on the patient’s mouth. The most commonly used mirrors are the occlusal mirror and the lateral mirror. They are used to obtain photographs in indirect view, making it possible to take easier and wider shots. The quality and the reflectivity of the mirrors should be very high (chromium < rhodium < titanium < dielectric). Front-surface reflective mirrors should be used in dental photography to avoid a double picture, as seen with back-surface reflective mirrors.

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Accessories Needed for MDP

Contrastors Contrastors noticeably improve picture quality by eliminating the soft tissue surroundings and giving a black background. Most contrastors are made of black ionized aluminum or copper panel covered by silicone and are gray or black in color. Their shapes vary according to their use (Fig 5): anterior, occlusal, lateral, and posterior.

Diffusers and Polarizers The diffuser filter, used in front of the flash, scatters and spreads the light in a way to transmit a softer light (Fig 6). The resulting light is no longer directed from a concentrated source to the destined structure directly, and hence no hard shadows or reflection appear. The diffuser effect is not only useful for dental structures, but it is also very beneficial in portrait photography as well. A polarizing filter can be placed in front of the camera lens and the light source to eliminate the glare from the dental tissue surface (Fig 7). The resulting photograph can then be used to determine the color and brightness of the teeth with the utmost precision.

FIG 5 Various contrastors used in dental photography. Anterior and occlusal contrastors are used to create a black background and to clearly show the incisal halo and translucency of anterior teeth. FIG 6 Diffusers are placed on the light source to soften and diffuse it, resulting in fewer bright spots and shadows in the photograph. FIG 7 A polarizer is placed in front of the light and camera lens to prevent glare.

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Types of Light

Light is the defining factor for image creation, so it comes with no surprise that light plays a major role in determining the picture quality when using any kind of camera. FIGS 1–3 The diaphragm of the camera works like the iris of the eye: In low light the iris will open to let more light enter the retina, and in strong light the iris will retract to permit less light penetration. With some smartphone models (eg, Samsung Dual Aperture f/1.5–f2.4), the aperture of the camera can expand and retract automatically to let in more light when it is dark and less light when it is too bright.

V

isible light is the portion of the electromagnetic spectrum that can be detected by the human eye. The wavelengths of the visible light spectrum range from 380 to 700 nanometers. The human eye can depict this light and transform it into electrochemical impulses. When comparing a human eye to a camera, we notice that the lenses in both focus images onto a light-sensitive surface: the retina for the eye and the sensor for the camera (Figs 1 to 3). We notice that light is the defining factor for image creation, so it comes with no surprise that light plays a major role in determining the picture quality when using any kind of camera.

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Types of Light

Source

Imaginary wall

Source

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The best representation of any image, especially concerning color representation, is obtained under daylight. In dental clinics, however, we cannot always ensure such light conditions, which is why dental photography relies mostly on the light provided by the flash. With MDP in particular, the light should be around 5,500 K, similar to daylight. Multiple light accessories can modify the direction of the emitted light, which creates vast potential in photography; we can talk about diffused light, bounced light, and polarized or cross-polarized light.

Imaginary wall 5

Diffused and Bounced Light In fact, we must differentiate between bounced and diffused light. Bounced light is obtained from reflective surroundings, like ceilings and walls; it is the light that an object receives from reflections rather than the source (Figs 4 and 5). Diffused light is obtained when the light passes through a diffuser. Diffusers allow spreading of the light so that it is evenly distributed. When a diffuser is used, light is no longer concentrated from one source but rather scattered, thereby removing deep shadows. Thus, diffusers eliminate harsh light and give way to softer and smoother light (Fig 6), eliminating reflection on the surface and enabling portrait and artistic photographs in addition to intraoral shots.

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FIGS 4 & 5 The umbrella is used in photography to redirect light from the source and bounce it onto the subject. FIG 6 An example showing how light can be softened and diffused to create fewer bright spots and shadows.

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Polarizer 1

Unpolarized light

Polarizing filter

Light source

Polarized light

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Isotropic object Polarizer 2

Multidirectional waves of light Polarizer 2 is 90° to polarizer 1; no light is seen

8 Polarizer 1

Polarizer 2

Light source Unpolarized light 9

FIG 7 The multidirectional beams coming from a light source will be stopped by the polarizing filter, allowing only one light beam to pass. FIG 8 Cross polarization is achieved when two polarizers are placed with a 90-degree difference in orientation between them. FIG 9 TCP: A thin layer of an object is placed between two polarizing filters to reveal its optical properties by transmission of the light through this object.

Light and different colors reach the eye and the camera Light vibrating in the direction of the polarizer

Light vibrating in many planes and with many wavelengths

Polarized and Cross-Polarized Light A polarizer is another light accessory that can be of great use in photography. It acts like a directional grid, allowing only one light beam, the one in the same plane of polarization, to pass through the grid (Fig 7). When using two different polarizers with perpendicular orientations, the result is cross polarization. One polarizer is placed on the camera while the second is placed in front of the light source, with a 90-degree difference in orientation between them (Fig 8). Two major categories of cross polarization exist: transmissive cross polarization (TCP) and reflective cross polarization (RCP).

Transmissive cross polarization TCP allows birefringence images to be taken that can help us study the optical properties of different materials. This is particularly interesting when it comes to enamel optical characteristics, but the specimen must be sliced into thin layers in order for the photograph to be properly taken by transmission of the light through the object. The polarizer in front of the camera can be rotated and the colors may change because of the alteration in the direction of the light’s oscillation (Fig 9).

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Types of Light

Polarizing sheet

45° Object

Background

Rotating polarizing filter attached to lens

Polarizing sheet

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Reflective cross polarization RCP reduces unwanted specular reflections that obscure the fine details of dental structures (Fig 10). It allows an objective analysis of dental images because it provides a high-contrast, hypersaturated photograph. Surface reflections are removed so that the objective elements of colors are perceived—hue, chroma, and value—and the incisal translucency is seen clearly.

Why Polarized Photographs in Dentistry? The use of polarizers in dental photography comes with many advantages: (1) It can completely eliminate glare and enhance contrast and saturation. (2) It is a nondestructive, noncontact technique. And (3) it is simple to use, with an easy and fast learning curve. Polarized images can have multiple applications: • Pathology and diagnosis: By eliminating surface reflection, it is easier to perform a differential diagnosis (Figs 11 and 12). • White lesion detection: Early demineralization can be detected, especially after orthodontic treatment (Figs 13 to 16).

FIG 10 RCP: A polarization filter is placed on the light source and another one on the lens of the camera with a 90-degree orientation between them. The light hits the object and then it is reflected to the camera. FIGS 11 & 12 A photograph using a flash will reveal a lot of reflection that can mask the real pathology. A polarized photograph with MDP eliminates all the glare and shows the real aspect of the surface. FIGS 13 & 14 A polarized photograph will show the size and localization of white spots better than a photograph taken with reflected light. FIGS 15 & 16 With reflected light, white spots cannot always be seen in photographs following orthodontic treatment. In polarized photographs taken with MDP, however, this demineralization after orthodontic treatment is clear.

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FLASH

POLARIZED

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• Shade and color: In restorative direct restorations, shade can be estimated following objective criteria, and color value can be detected following black and white exposure (Figs 17 to 19). Shade can also be matched using the button technique, which involves placing buttons of various resin composite shades on a tooth and then taking a polarized photograph. When studying the photograph, the shade of the button that does not appear on the incisal edge is the enamel shade, and the shade of the button that does not appear in the cervical region is the dentin shade (Figs 20 and 21). • Posterior regions: Polarized photographs can also be taken in posterior regions to eliminate light reflection (Fig 22). This will highlight the dental anatomy and the state of dental restorations.

FIGS 17–19 For composite direct restorations, the button technique can be used for effective shade matching. In this technique, small amounts of composite resin shades are placed on the cervical part of the tooth to determine the dentin shade and on the incisal part to determine the enamel shade. After decreasing the brightness of the photograph and increasing the contrast, the shade that matches the cervical color of the tooth is selected as the proper dentin shade. To select the proper enamel shade, the photograph is converted into black and white to see which button best matches the enamel of the tooth.

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FIGS 20 & 21 Compare Fig 20 taken with all the samples of composite with Fig 21, where only the matching shades are kept on the tooth to confirm the shade selection. FIG 22 A polarized photograph in the posterior region will better portray the state of any dental restorations and dental anatomy because the light reflection is eliminated.

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Smile Lite MDP W In truth, we make a good image; we don’t take it. With good lighting, a smartphone camera is perfectly able and sufficient to take a goodquality photograph.

hen it comes to photography, instruments do not dictate the quality of the result, even though some accessories are of great importance. The quality depends on how the photo is taken rather than what camera or what tools are used. In truth, we make a good image; we don’t take it. With good lighting, a smartphone camera is perfectly able and sufficient to take a good-quality photograph. The concept of MDP first started with Smile Lite for shade matching, which emitted a light similar to daylight (Figs 1 and 2). The shade matching process relied on calibrating the smartphone’s camera according to a given shade of gray under the same light. For each type of smartphone, the gray color is perceived differently, so the role of Smile Lite was to adjust this perception to get reliable, simple, and efficient shade matching. As a first attempt at dental photography using a continuous daylightemitting device, the Smile Lite device acted as a ring flash. When a twin flash effect was needed, two Smile Lite devices were used. An assistant’s help was needed to facilitate this, because one device was needed on each side to provide sufficient light (Fig 3). The disadvantage of this setup was that the two light sources could not possibly be held stable, so the same conditions could not be replicated between images. To ensure steadiness, stability, and reproducibility, a new prototype was created with two light sources equally distant from the camera (Fig 4), and this eventually became Smile Lite MDP.

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Smile Lite MDP

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7 FIGS 1 & 2 Smile Lite device originally designed for shade matching. FIG 3 To simulate the effect of twin flash, two Smile Lite devices were used, one on either side of the patient. FIG 4 The first fiberglass prototype to take photographs with the lights always at the same position from the smartphone camera. The results started to be reproducible. FIGS 5–7 Different views of the Smile Lite MDP.

The Device Smile Lite MDP is a “mini studio” for intraoral dental photography with a smartphone (Figs 5 to 7). Multiple LED lights are built into the middle and lateral sides of the device, so it can be used as a ring flash, a twin flash, or both together. Diffusers can be mounted to the lateral lights to give a softer light, and a polarizer can be fixed to the central light and in front of the camera lens to take a polarized photograph. Practically any smartphone can fit in the device because the phone holder can be adjusted from 55 to 85 mm while ensuring that the camera stays in the middle of the device (Figs 8 to 10). In addition, special holders allow one-handed photography with Bluetooth technology (Fig 11).

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Smile Lite MDP

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FIGS 8–10 The smartphone adapter is adjustable, so any smartphone with a width between 55 and 85 mm will fit in the device. By unscrewing the hexagonal screw, the adapter can be slid on its rail to adjust to the correct height for a given smartphone. The camera should be centered in the window of the Smile Lite MDP.

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FIG 11 MDP Monopod, a special holder used to take photographs with one hand via Bluetooth.

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FIGS 12 & 13 To achieve the ring flash effect, the central light must be turned on, with maximum capacity of light, and the lateral lights must be turned off. Because the light is very close and surrounds the area being photographed, it illuminates the teeth evenly and is reflected in the middle of the teeth, resulting in few shadows visible in the photographs. This central light is also used to take posterior photographs. FIGS 14 & 15 The twin flash effect is used frequently in dentistry because it provides a selective and balanced lighting that enhances the contrast between light and shadow, highlighting the contour and form as well as the surface and texture. To achieve the twin flash effect, the lateral lights must be turned on and the central light must be turned off. Note all the details made visible in the center of the teeth with this type of lighting.

LED Lights Central light Eight LEDs in the central light give the ring flash effect (Fig 12), so when using this setting the reflection will be visible in the middle of the tooth (Fig 13). Posterior photographs can also be taken with this setting.

Lateral lights Six LEDs are built into each lateral light to give the twin flash effect, emitting light from both sides of the teeth (Figs 14 and 15).

Lateral lights with diffusers The lateral lights can be covered with two plastic diffusers to emit softer light from the sides of the device (Figs 16 and 17).

Central light with polarizer A polarizer filter can be mounted onto the central light and the camera lens to polarize the light and remove the reflection on the teeth (Figs 18 and 19).

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Smile Lite MDP

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Polarized and Diffused Light One of the most interesting assets of this device is that, unlike the professional camera, it allows the use of multiple features at the same time, like polarized and diffused light. The polarizer is mounted on the central light and the camera lens with maximum light power, and the diffusers are mounted on the lateral lights with minimum light power (Figs 20 and 21).

Posterior Photographs To take posterior photographs, the central light should be illuminated at full power. These photographs can be taken directly or indirectly using a mirror.

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FIGS 16 & 17 Two plastic diffusers are used to provide diffused light, resulting in a less blown-out image. The diffusers are attached to the device with a strong magnet. To achieve this effect, the lateral lights must be turned on to the maximum capacity, and the central light must be turned off. FIGS 18 & 19 To create a polarized photograph, the black polarizer filter is used on the central light and the camera lens, attached with a strong magnet. The lateral lights must be switched off, and any strong light contamination should be eliminated from the surroundings. The central light must be turned on with maximum power. A polarized photograph will show all the details of the dentin, the beauty of the incisal halo, and all the intensities and translucencies in the teeth. FIGS 20 & 21 Another special effect that you can achieve with Smile Lite MDP is the polarized photograph with a dimmed, diffused light. All the lights must be turned on, and the polarizer and the diffusers must be used. The central light should be turned to the maximum capacity, and the lateral lights should be kept at the lowest intensity. With this special setting, the internal dentin and the surface characteristics of the enamel and gingiva will be visible. FIGS 22 & 23 Photographs in the posterior region are very tricky. Strong light with the central light on and good retraction are a must. Direct MDP photographs show many details from an oblique angle. FIG 24 Indirect posterior photographs are taken with full power of the central light and with the use of a retractor and a good-quality mirror. The occlusal surface of the teeth is seen from a top view as if the camera is parallel to the occlusal plane of the posterior teeth.

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Direct posterior photographs For direct posterior photographs, the retraction should be accomplished with a retractor (Fig 22) or with rubber dam (Fig 23).

Indirect posterior photographs Indirect posterior photographs are taken using the central light at full power along with a retractor and a mirror (Fig 24).

Full Light All three groups of LEDs can be used for occlusal, lateral, and full-face photographs (Figs 25 to 29).

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Smile Lite MDP

FIG 25 Occlusal views are widely used for documentation in orthodontics and prosthodontics. These photographs require good retraction, a good-quality occlusal mirror, and all lights on at full power. FIGS 26 & 27 Lateral views require good retraction with a V-shaped or classical retractor as well as all lights on at full power. These photographs can be taken directly or indirectly using a mirror. FIGS 28 & 29 Full-face photographs require all of the lights to be at maximum power.

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Important Rules for MDP A clean lens, adequate retractors and contrastors, accurate white balance, a calculated distance to the object, and "zoom, focus, shoot" are the golden rules to have the best MDP.

FIGS 1 & 2 Fingerprints on the camera lens will result in a blurry image.

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his chapter describes all the steps, tips, and tricks for successful MDP.

Smartphone Preparation First of all, the smartphone itself must be protected, disinfected, and cleaned. A simple phone case can be used to protect the phone, while disinfection can be achieved by using specially designed disinfecting wipes or spray that does not harm the phone or by covering the phone with plastic wraps. The lens should then be cleaned because it is usually smudged with fingerprints (Fig 1). When a lens is not clean, the sharpness of the photograph is affected (Fig 2). Because of this, some of the newer smartphones indicate when the lens needs to be cleaned by displaying a message on the screen. The lens should be cleaned with a microfiber tissue (Figs 3 and 4).

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Important Rules for MDP

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Properly (and Comfortably) Holding the Smartphone Hold the smartphone with four fingers and use the thumb to take the photograph. Usually the index and pinky fingers are on opposite edges of the phone, while the middle and ring fingers support the back of the phone.

FIGS 3 & 4 To ensure sharp images, the lens must always be cleaned with a microfiber tissue before taking any photographs.

White Balance Setting White balance (WB) is important in the depiction and representation of colors, especially in rendering specific colors correctly. If the flash of the camera or any kind of light is used and the WB is not set properly, most of the time the colors in the final photograph tend to have a yellow or blue aspect. To obtain a genuine photograph that imitates the exact colors existing in reality, the WB should be adjusted according to the light used. If real daylight or a light giving almost the same temperature (eg, Smile Lite MDP 5,500 K) is used, the WB must be set to daylight. In some smartphones, depending on the processing system inside the sensor, the final photograph is automatically close to the natural colors of the teeth, whereas in others the WB must be set manually.

How to adjust the WB manually when using daylight or Smile Lite MDP Android smartphones If the smartphone being used has the Android operating system (eg, Samsung, LG, Huawei), in the PRO mode of the camera, find the WB

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FIGS 5–8 By changing the WB setting in Android smartphones according to the temperature of the light used, the final colors are more natural. This setting is changed in the PRO mode by clicking on the WB icon and changing the setting from Auto to Daylight, represented by the picture of the sun. By clicking on the K icon, the WB can be set manually and gradually.

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settings, select “White Balance,” and choose “Daylight.” By selecting this feature, the camera sensor is able to correctly analyze colors (Figs 5 to 8).

iOS smartphones With some generations of iPhones, the photograph results in almost natural colors, while in others the WB must be set manually. Because iPhones do not have a built-in app to modify the temperature, one must be downloaded to allow control of the WB (Figs 9 and 10). Many are available, such as Yamera (AppMadang), ProCamera (Cocologics), and Silkypix (Ichikawa Soft Laboratory). While taking photographs using these apps, the colors seen in real life should be compared to the colors seen on the phone’s screen, and the WB should be set accordingly (Figs 11 and 12). Photographs can be taken once the WB is rectified to the point where the image on the screen matches the colors of real life.

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FIGS 9 & 10 With an iPhone, an app (eg, ProCamera) must be downloaded to change the WB of the camera. The WB setting should be changed gradually as the colors on the screen are compared to the colors in real life.

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FIGS 11 & 12 Changing the WB setting to be compatible with the temperature of the light used will result in a photograph with more natural color respresentation.

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FIGS 13 & 14 Anterior retractors will hide and retract the lips so that only the teeth and gingiva appear in anterior photographs. FIGS 15 & 16 Lateral retractors will retract and hide the cheeks when taking lateral photographs.

Use of Retractors and Contrastors Retractors and contrastors should be used to retract the lips, the tongue, and the cheeks and to create a black background behind the teeth. This will emphasize what we want to see (Figs 13 to 20).

FIGS 17 & 18 Occlusal contrastors are mostly used for anterior photographs, primarily to hide the tongue and create a black background.

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FIGS 19 & 20 Photo-CAD (Smile Line) retractors and contrastors are used for posterior dental photographs to retract the tongue and cheeks so that the focus is on the tooth in the center. FIG 21 For intraoral photographs, the distance between the lens of the camera and the teeth must be between 15 and 20 cm. If the distance is shorter, a barrel distortion will occur that is related to wide-angle lenses.

21

Distance Between Camera and Teeth For intraoral photographs, the distance between the smartphone camera and the teeth should be between 15 and 20 cm (Fig 21). At this distance, the camera is close enough so that the little details can be detected but far enough so that no barrel distortion occurs (Figs 22 and 23). A barrel distortion occurs when the camera is too close to the photographed subject/object.

FIGS 22 & 23 In the top photograph, the camera is 10 cm from the patient, whereas in the bottom photograph, the camera is 20 cm from the patient. There are noticeable differences between the two photographs. First, the central incisors are different in size. Second, the depth of field is poor in the upper photograph; starting from the canines and moving distally, the photograph is out of focus. Third, the molars are visible in the bottom photograph but not in the top one.

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Important Rules for MDP

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Distance Between Camera and Patient For full-face photographs, the distance between the smartphone camera and the face of the patient should be 150 cm. A barrel distortion occurs when the camera is closer than this distance (Figs 24 to 28). This effect is also seen with DSLR cameras when we change the lens from 35 mm to 105 mm. With the short focal length, the DSLR should be close to the patient, so the barrel distortion is obvious, whereas the phone can stay far from the subject to avoid deformation.

FIGS 24–28 Various distances between the camera and the face of the patient (from left to right): 20 cm, 40 cm, 70 cm, 110 cm, and 150 cm. When the camera is close to the patient, the barrel distortion is very clear. When the distance increases, there is less deformation and we start to see progressively the ears of the patient. At 150 cm, the face is normal and it is similar to the 1:1 ratio that we see when the 100/105 mm lens is used with the DSLR camera.

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FIGS 29 & 30 To ensure the best natural colors with MDP, the view must be zoomed to let the software focus on the teeth and the gingiva and not on the surroundings. Zooming is accomplished by enlarging the image in the screen with two fingers.

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Golden Rule: Zoom, Focus, Shoot When we take a photograph with a smartphone, to simplify the process the phone’s software calculates the mean of colors and lights it detects and exposure it receives, adapting the final photograph accordingly. This is why it is so easy to take great-quality photographs outside in natural light with our phones. When we zoom in, the phone analyzes a smaller portion of the image. The mean is then calculated according to the visible part of the image only, and the final photograph is adapted to this part without the surroundings disturbing the final result (Figs 29 and 30). Without zooming, the surroundings (lips, retractors, clothes, hair) can affect the phone’s calculations and result in unnatural colors of the teeth and gingiva. Cropping of a photograph taken without zoom will only result in a representation of teeth and gingiva with fake colors and lighting (Figs 31 to 33). 61

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FIGS 31–33 Note the difference in brightness and color between the two intraoral images seen here. The first was taken without zoom and then cropped, whereas the second was zoomed first to eliminate the surroundings before being taken. After zooming, the software is able to focus on the teeth and gingiva, performing any necessary adjustments to optimize the outcome.

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FIGS 34 & 35 Once the zooming is done, the sharpness of the image is focused by tapping in the middle of the view on the screen. If the frame is good and the colors are natural, the photograph can be taken by tapping or clicking on the specific icon/button.

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By zooming so that only the teeth and gingiva appear in the frame, the colors and the exposure of the camera sensor will be specifically adapted for them. The result is a better customized image. To focus the image on your smartphone, tap on the structure you want to capture in the photograph and shoot (Figs 34 and 35). Smartphones with multiple lenses have optical zooming as well as digital zooming. Before performing the digital zooming, we have to activate the optical zooming by selecting the icon of 2×, 5×, or 10× on the camera screen or in the settings. The optical zooming will not lower the quality of the final photograph like the digital zooming does.

What to Avoid Using the smartphone’s flash The smartphone’s flash is not designed to take intraoral and close-up photographs; it is too powerful and does not have the temperature of daylight. In addition, the smartphone software is not fast enough to calculate the right exposure and WB, especially when the phone is so close to the subject (15 to 20 cm). When this flash is used, the colors in the photograph will tend toward blue or yellow (Fig 36). This is why the light should be continuous for MDP, so the phone has enough time to analyze the light and the photographer has enough time to adjust the WB accordingly to obtain natural colors of the teeth and gingiva.

Using fingers to retract Unnecessary objects surrounding the teeth and gingiva should not be visible in the final photograph. This includes fingers used to retract (Fig 37). Instead, appropriate accessories should be used to retract and hide objects that should not be visible (Fig 38), and even these retractors should not be seen in the final photograph. 63

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38

Bending hands while taking photographs The smartphone should be as parallel as possible to the teeth to have a natural-looking photograph with the best dimensions of the teeth. To facilitate this, a grid can be added in the settings of the smartphone camera to divide the screen with horizontal and vertical lines. These lines reveal the orientation of the phone in comparison to the teeth (Figs 39 to 41). When taking the photograph, it is important that the camera is held directly in front of the teeth and not above or below them, because this will distort the image and make the teeth look either taller or shorter than they are in reality (Figs 42 and 43).

FIG 36 When the smartphone’s flash is used, the final photograph does not have natural colors because the light is too fast and bright for the algorithm of the smartphone to calculate the correct exposure and colors. FIGS 37 & 38 Many photographs posted on social media show serious mistakes, like showing fingers with and without gloves or showing the surroundings to the dental region, like the nose, the clothes of the patient, the floor of the clinic, and the retractors with the hands holding them. FIGS 39–41 To avoid canted photographs, a grid can be added to the screen of the smartphone to help in calibrating the occlusal plane.

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FIGS 42 & 43 When the camera is not parallel to the teeth, they appear shorter when the camera shoots from the direction of the incisal edge and longer when the camera shoots from the cervical direction.

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How to Take Intraoral Photographs with MDP T

his chapter details how to successfully use MDP for all kinds of intraoral shots.

Anterior MDP To succeed with MDP, the position of the dentist, the camera, the light, and the accessories used must be coordinated and optimized.

Positioning The operator should stand behind the patient, at a 12 o’clock position (Fig 1), and the patient should rotate his or her head backward slightly so that the face is parallel to the camera (Fig 2). If the operator stands at the side of the patient, at an 8 o’clock position, the photographs tend to be deviated toward one side (Fig 3).

Camera The camera should be parallel to the anterior surface of the teeth and not deviated upward or downward. This is important in order to ensure that the lengths and widths of the teeth are not distorted. The grid on the smartphone screen is helpful in maintaining proper orientation; the axes of the teeth and the lines of the grid should be parallel (Fig 4).

Accessories Two retractors, one at each side, are necessary. The patient should hold the retractors and pull the lips and cheeks to the outside, anteriorly and horizontally. This will help straighten the upper lip to keep it out of the photograph (Fig 5). Anterior contrastors can be used, and an occlusal mirror must be used for palatal and lingual views. For these occlusal views, the operator should stand next to the patient, at an 8 o’clock position.

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1 FIGS 1 & 2 To ensure a balanced photograph between the right and left sides, the operator should stand behind the patient.

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FIG 3 When the operator is next to the patient, there is a tendency to show one side more than the other. FIG 4 The grid on the screen is very helpful. The horizontal plane should be parallel to the incisal edge. The positioning of the operator behind the patient will afford better visibility to take a balanced photograph. FIG 5 The use of retractors is mandatory to have photographs without the lips and cheeks visible. The use of contrastors will hide the tongue and give a nice black background to the photographs.

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Tips and tricks Anterior incisal anatomy To show the complexity of the incisal third, including the mamelons, translucency, and the incisal halo, a polarizer should be used to eliminate any light reflection. To see this complexity without polarizing the light, a black occlusal contrastor can be used with two lateral lights with diffusers, and the brightness must be reduced in the camera settings (in some smartphones, it can be reduced directly on the screen while taking the photograph; Fig 6). While this will reveal the incisal halo and all the anatomical modifications of the incisal third of the tooth, it is important to note that if the light source is dimmed and not the brightness in the phone while taking the photograph, the ISO will be very high and the noise (small black points) will increase in the final photograph.

FIG 6 The incisal complexity can be seen with MDP by using a black contrastor and two lateral diffused lights. The brightness of the light must be decreased in the settings of the camera to show the beauty of the incisal edge.

Secondary and tertiary anatomy To show secondary and tertiary anatomy, the light source must be held away from the camera on the other side of the teeth, so that the shadow of the secondary and tertiary anatomy is depicted by the camera (Figs 7 to 13). The camera can be parallel to the teeth or oblique. The light can be diffused or natural.

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Light

Light

Mesial 8

Distal Subject

Mesial 10

Distal Subject

FIGS 7 & 8 To show the structure of the enamel, the light must be coming from an angle opposite to that of the camera. In this photograph, the diffused light is coming from one side and the camera is parallel to the teeth on the other side. Compare this to Fig 6, where the secondary anatomy is not visible. FIGS 9–11 In this photograph, the hard light is coming from opposite the camera, and the camera is oblique to the buccal surface of the central incisors.

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FIGS 12 & 13 The light can be directed from the incisal edge and the camera from the cervical part of the teeth. Light

Incisal

Cervical Subject

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FIGS 14–16 Direct posterior photographs are taken with the operator next to the patient. The occlusal surface is shown in diagonal view. These views reveal the 3D anatomy of posterior teeth and can be used to document different steps of the working protocol.

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Posterior MDP Positioning The operator should stand next to the patient at a 9 o’clock position when photographing the patient’s left posterior teeth and at an 8 o’clock position when photographing the patient’s right posterior teeth. These positions are used for photographing both maxillary and mandibular posterior teeth. The photographs can be taken in direct view without a mirror, especially for the mandibular teeth when a diagonal view is needed (Figs 14 to 16).

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FIGS 17–19 In direct view, PhotoCAD retractors can be used to keep the tongue and cheek out of the final photograph; only the teeth can be seen after zooming and cropping. In this direct angulated view, the excess of composite can be seen and eliminated to avoid a high occlusion.

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Camera The camera should be held as close to the patient as possible to ensure enough light and to avoid the need for significant zooming. The grid on the screen of the smartphone is helpful for these posterior photographs to align the occlusal surfaces in the middle of the screen. Remember: Zoom first, then focus, then shoot.

Accessories Posterior photographs are more complicated than anterior ones because the clinician must retract the patient’s tongue and cheek to have a full view of the posterior teeth. This can be done with mirrors or flat retractors, but the simplest way is to use Photo-CAD retractors (Smile Line; Figs 17 to 19). From one side, the internal part of the cheek will be retracted and from the other side the tongue will be moved away so it does not interfere with the posterior teeth. The posterior retractor can be used with or without a mirror (Figs 20 to 22).

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FIGS 20–22 The mirror can be used for occlusal photographs using a retractor for the upper lip and a Photo-CAD retractor for the tongue and cheek. These photographs can capture small sectors of the arch or the entire posterior region in one shot.

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Lateral MDP Positioning The operator should stand next to the patient at a 9 o’clock position when photographing the right lateral view of the teeth and at an 8 o’clock position when photographing the left lateral view of the teeth (Figs 23 and 24).

Camera The camera should be 15 to 20 cm away from the patient to have enough light and to avoid any distortion of the teeth. It should be as parallel as possible to the buccal surfaces of the posterior teeth (Fig 25). Again, the grid on the screen should help to avoid any tilting of the occlusal posterior buccal curve. Remember: Zoom first, then focus, then shoot.

Accessories A good lateral view includes the most posterior teeth. To accomplish this, a V-shaped retractor is needed (Fig 26). A black contrastor can be used to show only one arch at a time (Fig 27).

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FIGS 23 & 24 For lateral photographs, the operator should stand next to the patient. FIG 25 The camera is parallel to the occlusal plane of the posterior teeth, as verified by the grid on the screen. The smartphone should be held 15 to 20 cm away from the teeth. FIG 26 V-shaped retractors are used to provide maximum retraction of the lip and to show the most posterior teeth. FIG 27 A lateral view can also show only one posterior sector using a V-shaped retractor and a black contrastor.

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12 O’clock Photograph This photograph is very important in many smile design protocols because it shows the buccopalatal position of the anterior teeth. For these photographs, the operator stands behind the patient at a 12 o’clock position, and the patient is asked to smile. The tip of the nose mingles with the philtrum (Fig 28).

Occlusal MDP Positioning For maxillary occlusal shots, the operator should stand next to the patient at a 9 o’clock position. For mandibular occlusal shots, it should be an 8 o’clock position (Figs 29 and 30).

Camera The camera should be far from the patient, at a distance where the operator can see the entire occlusal arch on the screen of the phone. The grid on the phone can help to ensure balanced photographs; the lines of the grid should be parallel to the lines joining the canines, the premolars, and the molars. Once the entire occlusal arch is reflected on the mirror and appears symmetric, the operator should focus the camera and take the photograph.

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FIG 28 For the 12 o’clock photograph, the operator stands behind the patient, who is asked to smile. The camera is moved until the tip of the nose blends with the philtrum. The incisal edges of the central incisors must be parallel to the grid on the screen. Zoom, focus, shoot. FIGS 29 & 30 Occlusal photographs are taken for different dental purposes. For these views, the operator stands next to the patient and takes the photograph with an occlusal mirror.

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Accessories For occlusal photographs with MDP, two main accessories are needed: an occlusal mirror and an anterior contrastor also used as a retractor for the lip and to hide the nose in the maxillary anterior region. The operator should place the camera parallel to the mirror, which is almost at 45 degrees from the surface of the occlusal arch (Figs 31 and 32).

Polarized MDP Positioning Because polarized photographs are taken for anterior sectors (Figs 33 and 34), the operator positioning is the same as for anterior MDP— behind the patient at a 12 o’clock position (see Fig 1).

Accessories A special filter is required to polarize the light source and cross polarize the light reflected from the teeth (Fig 35). Retractors are also needed to retract the lips, and a contrastor is needed to create a black background in the final photograph. The retractor should be black and opaque to avoid any additional polarization of light caused by other types of retractors.

FIGS 31 & 32 The occlusal mirror should be held at 45 degrees from the occlusal arch. The patient is asked to open as wide as possible, and a black X contrastor or black anterior contrastor is used to retract the lip and hide the nose. FIGS 33 & 34 Polarized photographs are generally used for anterior teeth, so the operator should stand behind the patient at a 12 o’clock position as seen in Fig 1. FIG 35 The filter used with Smile Lite MDP. This filter covers the lights of the Smile Lite device, and the camera of the smartphone is covered with another polarizer placed at a 90-degree angle to cross polarize the light reflected from the teeth.

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How to Take Extraoral Photographs with MDP T

his chapter details how to successfully use MDP for all kinds of extraoral shots.

Portrait We as dentists do not treat the smile in a vacuum; we must consider the entire face when planning a case.

The portrait is a crucial photograph in dental documentation. We as dentists do not treat the smile in a vacuum; we must consider the entire face when planning a case. As such, the portrait is very important in the preoperative and postoperative steps of smile design. Any portrait can be taken with a smartphone camera with any kind of light.

Operator positioning The operator should stand 1.5 m away from the patient to avoid any distortion of the face. This should also help to evaluate whether the patient is in a straight and symmetric position (Fig 1). FIG 1 After ensuring that the patient is in a symmetric and comfortable position, the operator should stand about 1.5 m away from the patient to avoid any distortion of the face that can occur when closer (see chapter 8, Figs 24 to 28).

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3

Camera The camera should be parallel to the face of the patient; the grid on the screen can help with orientation by adjusting the eyes to be parallel to the horizontal lines (Figs 2 and 3). Zoom, focus, and then shoot. All kinds of portraits can be taken with MDP: full-face, three-quarter position, and profile. All of these are taken with the settings in Auto mode. In some smartphones where the colors are not natural, the white balance (WB) should be changed to daylight or custom WB (see “White Balance Setting” in chapter 8).

Accessories The accessories for a good portrait photograph are mainly two: the light source and the background. The background is generally white or black, depending on the effect desired in the final photograph and the protocol being used (eg, in orthodontics, a white background is often required for portraits).

FIGS 2 & 3 The smartphone should be parallel to the face of the patient, and the interpupillary line should be parallel to the horizontal lines of the grid. The photograph can be cropped afterward to show just what we need for our documentation. FIGS 4 & 5 A black matte background can be used to increase the contrast in portrait photographs. When the softboxes are lateral to the patient, shadows are visible on the face. FIGS 6 & 7 Three continuous-light softboxes can also be used to take portrait photographs. One light is on either side of the patient and the third is placed above and slightly in front of the patient to add more light on the hair and face. This will reduce the shadows on the face.

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The light can range from natural daylight to softboxes with continuous light emitting almost the same temperature as daylight (5,500 K). Either two softboxes can be used, one on either side of the patient (Figs 4 and 5), or an additional softbox can be added over the head of the patient to give more artistic lighting on the face and hair (Figs 6 and 7). The position of lights will change the outcome regarding the shadows on the patient’s face. If full light is required, the lights must be in front of the patient. If more artistic shadows are needed, the lights should be placed more lateral to the head of the patient.

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Half-Illuminated Portrait Artistic photographs are nice for posting on social media. One of the most popular and desired artistic photographs is the black and white half-illuminated portrait (HIP). It is easily taken with a smartphone, and with some editing the final photograph can be amazing (Fig 8).

Operator and camera positioning The operator and camera positioning are the same as for normal portrait photography.

Accessories There are two accessories required for an HIP: the light source and the background. The background is generally black so half of the face can merge with the background while the other half is highlighted and illuminated. The light source is ONE daylight softbox placed next to the patient on one side to illuminate the corresponding half of the face. On the other side of the patient, all the reflecting surfaces should be removed to maximally reduce the reflection of light on the other half of the face.

Patient positioning and expression The patient should be as close to the softbox as possible without touching it, allowing just enough room to facilitate cropping of the head during the editing (Fig 9). The head should be manually positioned vertically, as the patient will likely tilt the head toward the light (Figs 10 and 11). Depending on the desired outcome, the patient can give a serious look or a shy smile.

8 FIG 8 Example of the HIP. FIG 9 In the HIP, the head of the patient should not touch the softbox light. FIGS 10 & 11 The dentist should guide the patient’s head into a vertical position. Note that the light is illuminating half of the face without reflection onto the other half.

Editing Once the photograph is taken, it must be edited. Any photo-editing program can be used because the steps are easy and can be found in any simple editing software.

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1. Cropping Any unwanted areas in the photograph, especially the softbox light itself, are removed by cropping. The face is centered in the middle of the photograph (Fig 12). 15

2. Black and white The photograph is converted to black and white (Fig 13), or all the saturation in the image is eliminated. 3. Brightness The brightness of the photograph is reduced until only half the face is illuminated (Fig 14). 4. Contrast The contrast of the photograph can be increased if the operator sees that this will add a darkening effect (Fig 15). This step is not mandatory.

FIGS 12–15 Editing of the photograph starts by cropping to eliminate the unwanted areas, followed by converting the image to black and white, reducing the brightness, and increasing the contrast if necessary. FIGS 16–18 Final results of the HIP. This artistic photograph is very popular and easy to realize.

5. Save When the proper effect is achieved, the photograph is saved and is ready for use (Figs 16 to 18).

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Artistic Photographs of Lips Eye-catching photographs of lips are all the rage on social media and even in some lectures (Fig 19). These photographs are possible with MDP using some tricks and proper accessories.

Operator positioning The camera should be 20 to 25 cm away from the lips of the patient (Fig 20).

Accessories Like the HIP, these photographs require a light source and background. The background is a daylight softbox to create a white background in the photograph (Figs 21 and 22). The direct light on the lips comes from either another daylight softbox placed as close as possible to the patient or a Smile Lite MDP device placed on the smartphone.

Patient positioning

FIG 19 Example of the type of artistic photograph of the lips so popular on social media. FIG 20 For artistic photographs of lips, the operator should hold the camera 20 to 25 cm away from the patient to be able to see the lips in a sharp view after zooming and focusing. FIGS 21 & 22 The softbox itself is used as a background in this kind of photograph to create a white illuminated background. FIG 23 Because it is difficult to take photographs with an illuminated background, an additional light can be added onto the smartphone and/ or the high dynamic range (HDR) can be activated in the camera settings.

The patient should be as close as possible to the softbox to create a white background. The patient can hold a tube of lipstick or a piece of fruit or any other imagined object.

Tips and tricks It is very difficult to take photographs with an illuminated background. In everyday photography outdoors, if there is light in the background, the faces of any people in the photograph will appear dark. In that case, we turn on the flash to illuminate the faces before we take the photograph. For artistic shots of the lips, there are two solutions to this problem (Fig 23): 1. Activate the HDR (high dynamic range) in the smartphone camera settings to capture better details from bright and dark areas in the photograph. 2. Add more light from the opposite side of the background directly onto the lips. This can be either another softbox placed very close to the patient or the Smile Lite MDP device with diffusers over the lateral lights.

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Editing Depending on the desired outcome, editing software can be used to increase the brightness and/or adjust the contrast and saturation (Figs 24 and 25). Any photo-editing app can be used. Figures 26 to 29 show some of the artistic photographs of lips taken at MDP workshops.

FIGS 24 & 25 Editing of this initial photograph involved a slight increase in brightness, contrast, and saturation. The final result is more beautiful. FIGS 26–29 Artistic lip photographs taken in MDP workshops. The result is very nice when all the rules are respected: white background, distance between the camera and the patient, and light management.

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Mobile Eye Photography

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Smartphones can be useful instruments in ophthalmology for examination and assessment of visual acuity, color vision, astigmatism, pupil size, Asmler grid test, and more. This part of the chapter describes how to take mobile eye photography (MEP) of the anterior part of the eye just for artistic purposes. These photographs showcase the beauty of the internal anatomy of the iris muscles.

Technique for clear eyes

31 FIGS 30 & 31 MEP of clear eyes and dark eyes showing the anatomical details of the iris muscles.

Clear eyes (blue, green, gray) are more visible under direct light than dark eyes, which should be photographed under indirect light (Figs 30 and 31). Photographs taken under direct light on clear eyes will show many anatomical details of iris sphincter muscles. The light is the most important point for MEP. We need a light strong enough to illuminate the internal part of the iris and show sharp details. Any LED light can be used. The light can be hard or soft (diffused light on the lateral LEDs), it can be polarized light to be able to see the details without reflection of the light, or it can be combined (soft and polarized light). The smartphone should be parallel to the face of the patient, and the camera lens should be 15 to 20 cm away from the eye of the patient. First the user zooms to see the eye on the screen and then focuses on the closed eye (Figs 32 and 33). The patient is asked to open the eye and look directly into the camera (Fig 34), and the photograph is taken very quickly before the camera changes the focus (Figs 35 and 36).

Technique for dark eyes The anatomy of iris muscles in dark eyes (brown, black, hazel) are not as visible under direct light. Therefore, the light cannot be direct (see Fig 31); it should come from the external angle of the eye to illuminate the anatomical details of the iris muscles by highlighting the shadows (Fig 37). The light can be hard or polarized to be able to see the details without any reflection. The smartphone should be on the opposite side of the light, on the other angle of the eye to catch the anatomy of the iris muscles more than the colors (Fig 38). The camera lens should be 15 to 20 cm away from the eye of the patient. First the user zooms to see the eye on the screen and focuses on the lid. The patient is asked to open the eye and look straight ahead (not into the camera), and the photo is taken (Fig 39). This technique can also be used for clear eyes to show the 3D anatomy of iris muscles.

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33

34 FIGS 32 & 33 Technique for MEP with clear eyes. The smartphone should be held 15 to 20 cm away from the eyes of the patient. The first step is zooming to see the eye on the screen, and then the image is focused by tapping on the screen in the middle of the eye.

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FIG 34 The patient should then open the eye and look straight into the camera. The dentist should be very quick to take the photograph so that the proper focus is maintained. FIGS 35 & 36 In Fig 35, one central LED was used, and the reflection of the LEDs can be seen in the middle of the eye. In Fig 36, the central light was polarized; there is no clear reflection of the LEDs and the colors are different. FIGS 37 & 38 Technique for MEP with dark eyes. The light should come from the opposite side of the camera to see the 3D effect of the muscles of the iris. The patient should look straight ahead and not into the camera.

38

FIG 39 When the light is coming from an angle and opposite to the camera, the 3D effect of the iris muscle can be depicted.

39

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40

FIG 40 This photograph shows the birefringence of a tooth with a frontal cut, revealing amazing colors shining through the enamel.

Birefringence MDP Birefringence is an optical property that is observed when an object or material has a refractive index that varies with the direction and quality of light. In the late 1980s, Claude Sieber stunned the dental specialty with incredible colored photographs of extracted sliced teeth. He had captured the birefringence of the tooth materials. Over 30 years later, dental professionals continue to be amazed by this kind of photograph, especially if they do not know how to do it themselves. While the technique was kept a secret for a long time, photographs like that shown in Fig 40 can be easily taken by anyone with a smartphone and the proper materials and accessories, including an extremely thin slice of tooth (< 100 µm thick), a continuous daylight LED source like the Smile Lite MDP, two polarizing filters, and a diffuser. The different colors seen in the final photograph are the result of changes in the wavelength of light as it passes through the different organic and mineral structures of the tooth.

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41

42

44

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45

Tooth preparation Freshly extracted teeth are cut with a laboratory saw or a diamond disk, then thinned and polished with polishing disks to be thinner than 100 µm (Fig 41). The tooth can also be cut through the frontal plane, from the occlusal to the apical, and the dentin and part of the enamel are removed with a bur to keep only the external enamel shell (see Fig 40). Once the slices are ready, they can be immersed in virgin olive oil for 1 week to increase their refractive index.

Accessories A continuous daylight LED device with a white diffuser is needed so the small LEDs do not appear concentrated in one part of the photograph (Fig 42). A polarizing filter is placed over the diffuser, and the sliced tooth is sandwiched between that filter and another polarizing filter. The top filter will be manually rotated (Fig 43). The naked eye can see the amazing color changes when this filter starts to rotate. When the axes of the polarized filters are at 90 degrees, the background is transformed to black because the light is totally cross polarized (Fig 44). When the axes of the polarized filters are parallel, the background is white (Fig 45).

FIG 41 The slice of the tooth should be as thin as possible, less than 100 µm, to let the light pass through. FIGS 42 & 43 A continuous light is mandatory in birefringence MDP to see the details prior to taking the final photograph. This light should be covered by a diffuser to soften the light. Two polarizing filters should then be placed on top of the diffuser, with the extracted tooth slice in between them. FIGS 44 & 45 The top polarizer filter is rotated by hand. When the polarizing axes are perpendicular, the light is stopped and the background is black. When the axes are parallel, the background is white.

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FIGS 46 & 47 The top polarizing filter is turned with one hand, and the smartphone is held with the other hand. Photographs are taken as the polarizer is rotated.

47

Camera The polarizer on the top is rotated with one hand, while the smartphone is held with the other hand (Fig 46). For those who cannot keep the phone stable, it should be placed on a tripod. The camera of the phone should be approximately 20 cm from the tooth slice. One should zoom, focus, reduce the brightness, and then start taking photographs while rotating the polarizing filter on the top (Fig 47).

Editing These images should be edited to increase the value of colors that exist in the photograph. The same is done with birefringence photographs taken with DSLR to enhance the colors emitted by the teeth. This editing can be done with simple photo-editing software in the smartphone or with a PowerPoint program, which is the easiest way to do it. The background is removed to have one unified color, and then the sharpness, brightness, saturation, and contrast are all increased (Figs 48 and 49).

Final result The final colors that we can get while turning the upper polarizer will vary, and different artistic photographs will result (Figs 50 to 54). Final editing of the photographs will enhance the anatomical details and the variety of colors of the organic and mineral structures of the teeth (Figs 55 and 56).

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How to Take Extraoral Photographs with MDP

48

49

50

51

52

FIGS 48 & 49 Birefringence photographs taken with MDP edited in PowerPoint by eliminating the background and increasing the sharpness, saturation, contrast, and brightness. The colors are more intense and richer.

53

54

FIGS 50–54 The same slice of a tooth can emit many different colors as the upper polarizing filter is rotated and the polarization angle changes. The result can also be enhanced by increasing the contrast and saturation of the photograph.

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FIGS 55 & 56 Birefringence photographs and all artistic MDP can be used as wall decoration in clinics.

55

56

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11

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Mobile Dental Video D

ental videos are important tools for dentists because they show many details that cannot be captured with still photography. They can play an active part in improving the communication between the dentist, patient, laboratory technician, and the dental community at large.

Videos can play an active part in improving the communication between the dentist, patient, laboratory technician, and the dental community at large.

Communication Dental videos can be made to educate, clarify, and explain various treatments and procedures to current and potential patients. When this type of video is presented on social media, it becomes a powerful instrument in online marketing with a great influence on the customer base. The visual representation facilitates comprehension of the clinical steps, giving patients an idea of what to expect during and after the procedure and why this procedure was suggested in the first place. When patients better understand recommended procedures, they are more likely to accept them and get motivated for their dental restorations, dental implants, orthodontics, or oral hygiene. Videos are also an important addition to communication with the dental technician, especially when it comes to smile designs, because the technician is able to see the patient, assess the smile, and choose the best dimensions of teeth to suit the patient prior to fabricating any restorations.

Documentation Videos can also be used for documentation, especially now that the image quality in a video can attain the level of a traditional photograph. They can be streamed in lectures, bringing cases to life: Instead of using

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Mobile Dental Video

1

2

numerous static photographs to represent the sequence of a procedure, a video shows the actual progress of the treatment. With smartphones, we can have high-quality 4K and 8K videos. Dental videos are especially important while building a smile design, because the video can show the dynamic movement of the patient’s lips when talking, smiling, and expressing emotions. This facilitates understanding of what suits the patient’s face best, before and during the mock-up try-in. For this kind of video, the extraoral MDP technique is used.

FIGS 1 & 2 The Smile Lite MDP Flex Arm is a tool to hold a smartphone for videos and/or normal photographs. It can be clamped to a fixed support, and its flexibility is very low.

Accessories The smartphone must be held in a fixed position, so a stable holder should be used; otherwise, the phone will be vibrating and the quality of the video will be very bad. The Smile Lite MDP Flex Arm (Smile Line) can be clamped on a table or any other fixed surface to hold the phone in a stable way (Figs 1 and 2). A traditional tripod can also be used, but the phone cannot be as close to the patient as with the Flex Arm.

Camera The camera can have two positions: (1) between the patient and the clinician, who can work while looking at the smartphone screen (Figs 3 and 4); or (2) angulated far from the clinician, who can work with loupes, but the video will not be from the clinician’s angle of view.

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3

FIGS 3 & 4 Video of a resin infiltration procedure. The smartphone is between the operator and the patient. From this 12 o’clock position, the dentist can work without loupes while looking at the screen of the smartphone because the scene is magnified.

4

To allow sufficient space for the dentist to work, the smartphone should be distant from the patient, at least 18 cm away, which is the normal distance for taking an anterior photograph. Optical zooming should be applied first, followed by digital zooming, so the quality of the video will not be affected (Figs 5 to 9). In some smartphones, 2× optical zoom is available, while in others 5× or 10× optical zoom is possible. Videos of instruments or other dental materials can also be taken with a smartphone. In this case, the continuous light softboxes for extraoral photography can be used (Figs 10 and 11). The smartphone can be fixed with a tripod; again, the optical zooming should be applied first, then the digital, to show a specific part or the whole instrument (Fig 12). To show the instrument turning, it can be mounted on a motor (Figs 13 to 15).

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8

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FIGS 5–9 Screenshots from the video showing the quality of the final outcome. These videos can be used even for lecturing on big screens without losing quality. FIG 10 The three softboxes used for extraoral photography—one on each side and one above—can be used to take extraoral videos of instruments. The phone is fixed with a tripod, and a black or white background can be used. FIG 11 The instrument seen in this photograph, the LM-Arte Posterior Misura (LM-Dental), is used to gauge the height of the composite wall while restoring a Class II caries lesion on the same level of the adjacent tooth.

12

FIG 12 Before starting the video recording, optical zooming and then digital zooming should be performed, and the camera should be focused on the instrument by tapping on the screen before the instrument starts to rotate on the motor. FIGS 13–15 Screenshots from a video showing the turning of the LM-Arte Posterior Misura instrument.

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Applications of MDP

The only limit to the applications of MDP in the clinic is your imagination.

T

his chapter highlights the many types of photographs you can take with MDP.

Anterior MDP Anterior photographs are taken with either normal or polarized light depending on the desired outcome (Figs 1 to 11).

FIGS 1–6 Anterior photographs taken with diffused light (left) and polarized light (right). All details of the teeth and gingiva can be seen. 1

2

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6

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Applications of MDP

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10

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11

Posterior MDP Posterior photographs are taken with a hard, strong light (Figs 12 to 19).

MDP for Case Documentation With adequate light and technique, all kinds of documentation photographs are feasible (Figs 20 to 28).

Other Daily Uses for MDP MDP can be used to see the smallest defects in analog impressions or in final restorative treatment (Fig 29). It can also be used to document laboratory work (Figs 30 to 33). Figures 34 to 45 highlight other daily uses for MDP.

FIG 7 The textures of the teeth and gingiva are well highlighted by placing the light only from the opposite side of the smartphone. FIG 8 Documentation of a gauge bur being used for veneer preparation through the mock-up. FIG 9 Etching enamel while restoring a Class IV cavity preparation, taken with lateral diffused light. FIGS 10 & 11 Shade matching can be performed with diffused or polarized light to communicate shade to the laboratory technician or to select the shade of the composite to be used in the future restoration.

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FIG 12 Good retraction and a strong light are needed to capture a direct view of a posterior quadrant. FIGS 13 & 14 Direct posterior view (left) and the same quadrant reflected using a mirror (right). FIGS 15–19 Direct MDP used with strong light to document the restorative procedure on the right second molar. A mirror was used for the before and after views. 12

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Applications of MDP

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23 FIGS 20–28 All photographic documentation needed for an orthodontic diagnosis can be done with MDP. Anterior, lateral, and occlusal views as well as frontal, oblique, and profile portraits can be easily taken with MDP.

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Applications of MDP

29

30

31

32 FIG 29 MDP used to highlight defects in an analog impression. FIGS 30 & 31 Laboratory work can be documented with MDP using both diffused and lateral light.

33

FIGS 32 & 33 Once the 3D model of the future smile design is printed, an impression is taken with heavy and light silicone. This impression will be filled with bis-acryl material to see the final mock-up in the patient’s mouth.

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34

36

35

37

38

FIGS 34 & 35 Patients may not remember the initial situation of their teeth, so providing them with the before and after photographs may be appreciated. FIGS 36 & 37  MDP can be used to digitize analog radiographs. FIG 38 When the dentist cannot diagnose a lesion, MDP is the fastest way to communicate with another specialist.

39

FIG 39 Photographs taken with smartphones can be used as backgrounds for PowerPoint slides. This image was taken using diffused light under a glass with water droplets.

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Applications of MDP

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46 FIGS 40 & 41 The smartphone can be used to project the work during a workshop, where the operator works while watching the screen after zooming. The workshop attendees can follow the demonstration and have the same view as the clinician. The phone can be connected to the projector either wirelessly or with a cable. FIGS 42 & 43 A softbox with continuous daylight can be used with a black background for live-streaming with an Internet connection. The author live-streamed from Lebanon to lecture at the 37th International Italian Academy of Prosthetic Dentistry Congress in Italy in November 2018. FIGS 44 & 45 A video filmed with the smartphone of the patient can be used to explain a specific procedure to them, such as how to brush the teeth or how to place an elastic in orthodontics. With videos like this, the patient can review the procedure any time he or she wants. FIGS 46 & 47 Portraits taken with different temperatures of daylight provide a variety of artistic outcomes. FIGS 48 & 49 Photographs taken with MDP plus polarizers.

47

Portrait MDP Portraits for documentation or for artistic purposes can be accomplished with different types of light, including direct, diffused, or bounced sunlight as well as softboxes with diffused continuous daylight (Figs 46 and 47).

Polarizers and MDP The polarizer filter can be used for artistic photographs such as birefringence photography and polarized eye photography (Figs 48 and 49).

48 49

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Epilogue T Add your personal touch, be creative, and be yourself.

FIGS 1 & 2 One photograph was taken with a DSLR camera and the other with MDP. The lighting and the dimensions of the sensors are not the same, but the difference between the images is not dramatic. Knowing that the evolution of smartphone cameras is faster than that of DSLR cameras, it is up to you to judge the future of dental photography.

aking a photograph is an art: You must choose what to show in an image, when to take the photograph, how to get the right lighting for the desired reflection, and where to position the camera to ensure the right angle of view. To obtain a great outcome, you cannot rely entirely on the gadgets you are using. It doesn’t matter what camera, lenses, or light sources you have available. The most important thing is to master the tools, feel the scene, and determine the desired outcome. Even after following the basic guidelines of photography, the photograph will always be influenced by the photographer’s subjectivity. Add your personal touch, be creative, and be yourself. Keep trying to achieve better results and never stop until you reach your goal. Enjoy every moment, savor every second, and try to get the most out of life. As a final word, always remember that some are born talented, but excellence is achieved through knowledge and practice: This is how we become masters (Figs 1 and 2).

1

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Index Page numbers followed by “f” denote figures.

A

C

Accessories for birefringence photographs, 96, 96f contrastors. See Contrastors. diffusers. See Diffusers. light, 36, 36f. See also Light. mirrors, 29, 31, 31f, 74, 75f polarizers. See Polarizers. retractors. See Retractors. Advertising, 10f, 10–11 Analog impressions, 108, 112f Android smartphone, white balance adjustments on, 54–55, 55f Anterior incisors, 70, 70f Anterior photographs applications of, 107, 107f–108f description of, 29, 30f intraoral, 67–72, 68f–72f Anterior retractors, 57, 57f Aperture, 25, 25f Apps description of, 18, 19f for white balance setting on iPhones, 55, 56f Artistic photographs description of, 11, 11f half-illuminated photograph, 86–89, 86f–89f of lips, 90, 91f–92f

Camera. See DSLR cameras; Smartphone camera. Carious lesions, 4f, 5 Clear eyes, 93, 93f–94f Color value, 40, 40f Communication dental videos for, 101 dentist–dental technician, 6 patient–dental technician, 5–6 photographs for, 5–6 Continuous-light softboxes, 84–85, 85f, 90, 91f, 103, 105f, 114f Contrast, 88, 88f Contrastors anterior MDP uses of, 67, 69f uses of, 32, 33f, 57, 57f–58f Cropping, 61, 62f, 88, 88f Cross-infection, 21 Cross-polarized light, 37, 37f–38f

Digital marketing, 11 Digital zooming, 63, 103, 105f Direct posterior photographs, 49, 49f Disinfection, 19, 21f Documentation in dental records, 2–5, 4f dental videos for, 101–102 medicolegal, 12 photographs used for, 4f, 5, 108, 110f–111f in postgraduate programs, 8, 10 DSLR cameras barrel distortion with, 60 cost-effectiveness of, 17, 18f disadvantages of, 17–20 disinfection limitations of, 19 flash light of, 19, 20f mobile dental photography versus, 15–21, 15f–21f weight of, 17 Dual camera, 26

D

E

Dark eyes, 93, 93f–94f Dental records, 2–5, 4f Dental technician dentist and, 6 patient and, 5–6 Dental video accessories, 102 applications of, 114f–115f camera, 102–103, 103f–105f communication uses of, 101 documentation uses of, 101–102 Diaphragm, 35f Differential diagnosis, 38, 39f Diffused light description of, 36, 36f for enamel images, 71f shade matching uses of, 108 Smile Lite MDP device, 48, 48f Diffusers description of, 32, 33f, 45 lateral lights with, 47 polarized filter over, 96

Editing, 86, 88f, 92, 92f, 97 Electromagnetic spectrum, 35 Enamel etching of, 108f photographs of, 71f Extraoral photographs continuous-light softboxes for, 84–85, 85f, 90, 91f, 103, 105f lips, 90, 91f–92f portrait. See Portraits. Eyes, 93

B Barrel distortion, 58, 58f, 60, 60f “Before and after” photographs, 11, 113f Birefringence photographs accessories for, 96, 96f camera positioning for, 97, 97f definition of, 95 polarizer filter for, 115f results of, 97, 98f tooth preparation for, 96, 96f Bis-acryl material, 3, 4f Bounced light, 36, 36f Brochures, 10 Button technique, 40, 40f

F Filter, 80 Finger retraction, 63, 64f Fingerprints on lenses, 53, 53f Flash, 63, 64f Flash light, 19, 20f Front-surface reflective mirrors, 31 f-stops, 25 Full-face photographs, 49, 51f

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H Half-illuminated portraits, 86–89, 86f–89f High dynamic range, 90

I Incisal halo, 70 Indirect posterior photographs, 49, 49f Insurance, 12 Intraoral photographs anterior, 67–72, 68f–72f lateral, 49, 50f, 76, 76f–77f polarized, 80, 81f posterior, 73–74, 73f–74f. See also Posterior photographs. 12 O’clock, 78–80, 78f–80f iPhone apps, 55, 56f white balance adjustments on, 55, 56f Iris muscles, 93, 94f

J .JPEG, 26

L Laboratory work, 108, 112f Landscapes, 15, 15f Lateral lights, 47, 48f Lateral mirror, 31 Lateral photographs, 49, 50f, 76, 76f–77f Lateral retractors, 57, 57f Learning curve, 18, 19f Lectures, 8, 8f LED lights, 45, 93, 95–96 Lenses cleaning of, 53, 53f–54f description of, 25–26 fingerprints on, 53, 53f multiple, 63 Light accessories for, 36, 36f for anterior incisal anatomy, 70, 70f bounced, 36, 36f continuous-light softboxes, 84–85, 85f, 90, 91f, 103, 105f, 114f cross-polarized, 37, 37f–38f diffused. See Diffused light. for enamel images, 71f flash, 19, 20f polarized. See Polarized light. for portraits, 85, 85f, 115f

types of, 35f–41f, 35–38 visible, 35 Lips, 90, 91f–92f

M Mamelons, 70 Marketing, 10f, 10–11 MDP. See Mobile dental photography. MDP Monopod, 46f Medicolegal field, 12 Megapixel count, 24 MEP. See Mobile eye photography. Microfiber, 54, 54f Mirrors, 29, 31, 31f, 74, 75f Mobile dental photography. See also Smartphone(s). advantages of, 15–21, 15f–21f anterior, 67–72, 68f–72f applications of, 107–115, 107f–115f definition of, 17 disinfection advantages of, 19, 21f DSLR cameras versus, 15–21, 15f–21f intraoral. See Intraoral photographs. learning curve for, 18, 19f light from, 19, 20f origins of, 1 rules for, 53–64 Mobile dental video. See Dental video. Mobile eye photography, 93, 93f–94f Multishot/frame noise reduction, 26

O Occlusal mirror, 31 Occlusal photographs, 49, 50f, 75f, 79f, 80 Occlusal retractors, 57, 57f One-sided retracting retractors, 29, 30f Optical zooming, 26, 63, 103, 105f

P Patient dental technician and, 5–6 smartphone camera and, distance between, 60, 60f Photo-CAD retractors, 30, 30f, 58f, 74, 74f Photo-editing, 86, 88f, 92, 92f, 97 Photographs anterior. See Anterior photographs. artistic. See Artistic photographs. “before and after,” 11, 113f bending hands while taking, 64, 65f

birefringence. See Birefringence photographs. of color guide, 6, 7f cropping of, 61, 62f, 88, 88f documentation uses of, 4f, 5, 108, 110f–111f folder-based organization of, 5 history of, 1 insurance uses of, 12 intraoral. See Intraoral photographs. lateral. See Lateral photographs. lecture uses of, 8, 8f medicolegal uses of, 12 occlusal. See Occlusal photographs. patient–dental technician communication uses of, 5–6 polarized, 80, 81f posterior. See Posterior photographs. second opinions using, 3 self-evaluation uses of, 4f, 5 smile design uses of, 3 treatment planning uses of, 3, 4f Pixels, 24 Polarized filters, 96, 96f, 115f Polarized images applications of, 38–40, 39f–40f in posterior region, 40, 41f Polarized light description of, 37, 37f shade matching uses of, 108 Smile Lite MDP device, 48, 48f Polarized photographs, 80, 81f Polarizers for anterior incisal anatomy, 70 central light with, 47, 48f description of, 32, 33f, 37f, 37–38 Portraits accessories for, 84 background for, 84, 84f–85f camera positioning for, 84, 84f contrast in, 84, 85f half-illuminated, 86–89, 86f–89f light for, 85, 85f, 115f operator positioning for, 83, 83f Posterior photographs applications of, 108, 109f camera positioning for, 74, 74f description of, 29, 30f, 40 direct, 49, 49f, 73f indirect, 49, 49f operator positioning for, 73, 73f Smile Lite MDP, 48–49, 49f Publishing, 8f, 8–10

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Index

R Radiographs analog, digitizing of, 113f medicolegal uses of, 12 .RAW, 26 Reflective cross polarization, 38, 38f Retina, 35, 35f Retraction fingers used for, 63, 64f retractors used for. See Retractors. Retractors anterior MDP uses of, 67, 69f Photo-CAD, 30, 30f, 58f, 74, 74f uses for, 29, 30f, 57, 57f–58f V-shaped, 76, 77f Ring flash, 43, 45f, 47, 47f

S Samsung Dual Aperture (f/1.5-f2.4), 35 Self-evaluation, 4f, 5 Self-retracting retractors, 29, 30f Sensor, 24, 24f Shade, 40, 40f Shade guide, 6, 7f Shade matching, 43, 108, 108f Shadows, 85, 85f Shutter speed, 25, 25f Smartphone(s) Android, 54–55, 55f apps on, 18, 19f cost-effectiveness of, 17, 18f dental uses of, 1 flash on, 63, 64f folder-based organization of, 5 holding of, 54 iPhone, 55, 56f preparation of, 53 prevalence of, 1

Smile Lite MDP on, 46f technological innovations of, 1 weight of, 17 Smartphone camera for anterior photographs, 67, 69f aperture of, 25, 25f for dental video, 102–103, 103f–105f diaphragm of, 35f high dynamic range in, 90 for lateral photographs, 76 lenses of, 25–26 light of, 19, 20f megapixel count of, 24 patient and, distance between, 60, 60f for portraits, 84, 84f for posterior photographs, 74, 74f sensor of, 24, 24f shade matching uses of, 43 shutter speed of, 25, 25f specifications of, 23f–26f, 23–26 teeth and, distance between, 58, 58f–59f for 12 O’clock photograph, 78, 78f–79f Smile design, 3, 102, 108, 112f Smile Lite MDP central light, 47, 48f description of, 17, 18f, 43 device, 45, 45f–46f diffused light, 48, 48f filter with, 80 Flex Arm, 102, 102f full light, 49, 50f full-face photographs with, 49, 51f lateral lights, 47, 48f lateral photographs with, 49, 50f LED lights, 45 occlusal photographs with, 49, 50f polarized light, 48, 48f posterior photographs, 48–49, 49f ring flash, 43, 45f, 47, 47f

shade matching uses of, 43 smartphone adaptor for, 45 twin flash effect of, 47, 47f white balance adjustments, 54–55, 55f–56f

T TCP. See Transmissive cross polarization. Teeth anterior. See Anterior photographs. posterior. See Posterior photographs. smartphone camera and, distance between, 58, 58f–59f Transmissive cross polarization, 37, 37f Treatment evolution of, 6, 7f photographs used in, 5 Treatment planning, 3, 4f, 6 12 O’clock photograph, 78–80, 78f–80f

V Visible light, 35 V-shaped retractors, 76, 77f

W White balance, 54–55, 55f–56f, 84 White lesions, 38, 39f Wide-angle lens, 26

Z Zoom/zooming description of, 26, 61–63, 62f digital, 63, 103, 105f optical, 26, 63, 103, 105f

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Introduction Why Document?

Protocols for

Advantages of Mobile Dental Photography

Protocols for MDP with Auxiliary Lighting

CONTENTS

Hardan

01 02 03 04 05 06 07 08 09 10 11 12

Specifications of a Smartphone Camera Accessories Needed for MDP Types of Light Smile Lite MDP Important Rules for MDP How to Take Intraoral Photographs with MDP How to Take Extraoral Photographs with MDP Mobile Dental Video Applications of MDP

MOBILE DENTAL PHOTOGRAPHY with Auxiliary Lighting Louis Hardan, dds, phd

ISBN 978-0-86715-946-2

90000>

9 780867 159462

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