Picture Yourself Communicating Better - Part 2

Many doctors hesitate when they think about clinical photography as it draws up a mental image of a very costly system involving high-end cameras, ring flashes, understanding film speeds and exposures, and technical expertise in taking pictures. This may be so with many of the intraoral photos we see in published technique articles, but for communicating tooth position involving removable prosthetics, this couldn’t be further from the truth. Ideally, photographs communicating removable prosthetics need to portray speaking distance, shoulder-up full-face views as the evaluative benefit is in the overall facial picture as it pertains to facial support, the intraoral balance of white and pink, and their framing by the lips and mouth. This in effect puts the technician chairside and changes their exposure to the patient from solely an articulated model, to seeing the entire facial canvas and the effects tooth and bone position and replacement have on the overall patient appearance.

This kind of photographic access to the patient can easily be accomplished using inexpensive ($150 or less) point-and-shoot digital cameras  and standard overhead lighting. Cameras even at this price range are rated from 10-14 megapixels, ideal for enlarging mouth close-ups with no pixilation. The key is to make it as simple as possible for your clients to implement. To lessen objections from those resistant to owning one, I have my own stock of point-and-shoot cameras. Ten cameras are less expensive than one fully adjustable articulator, yet can provide far reaching benefits that were once only available to those with clinical exposure to the patient. Once the benefit of using the camera is illustrated, the practice usually purchases their own. Images are sent via memory card or using any of the cloud storage utilities, such as DropBox, available on the Internet.

Make Suggestions

Just as important as the camera are your suggestions of pictures to be taken, and how to use them when we look at them. Because our interest is in using photos to drive facial esthetics, the most beneficial poses are of smiling and repose (rest) taken in frontal and profile views. Smiling reveals white to pink exposure and framing by the lips and mouth, while rest reveals positional support of the teeth on the lips and face.

Here are my suggested stages for frontal and profile pictures to be taken in repose (rest) and smiling:

Photo Stages

• Pre-condition stage photos:* Facial photos that may have been taken near maximum dental health. Establishes a goal.

• Existing stage: Full or partially dentate, present prosthetics in place. Establishes a baseline.

• Development stages: Baseplates and rims with markings and set-ups. Establishes comparisons.

• Finalization: Confirms state of approval to finish. Establishes a tractable confirmation.

• Delivery stage: The most motivational and educational elements that a doctor can provide himself and a technician who strives to deliver his clients the best. Establishes a team success.

^{*Provided by patient}

In each stage typically only 4 pictures per appointment are needed, two frontal (smile and rest) and two profile (smile and at rest). Photos should be preferably taken with the patient sitting upright or standing to avoid influences of gravity on facial muscles from being in an incline position.

Precondition Stage

Precondition stage photos are usually school photos, wedding or event photos. Any pictures where a smile is prominently displayed during the patient’s maximum dental health works best. Generally you will scan a paper photo as these photos tend to be cherished by the patient.

Existing Stage

Existing stage photos (Figs. A1, A2 & A3) establish a baseline for corrections. Photograph of frontal smile view illustrates several areas for improvement. Noted deficiencies include a reverse smile, short bicuspids exacerbating pink exposure, too much gingival display in the anterior. Profile photos illustrate anterior over jet in terms of under support or over extension. Definition of the philtrum and upper lip from the frontal view indicate or confirm esthetic support.

Developmental Stage

Developmental stage photos (Figs. B1, B2 & B3) identify rim dimensions and markings as they relate to framing of lips and mouth. Because rim dimensions direct tooth placement both apically and facially, these photos allow for discernment of how exacting the rim addresses tooth lengths, lip support, and negative space and provides information visually allowing for tighter approximations of esthetic tooth placement. Midline and cuspid line markings for facial landmarks aid in esthetic tooth selection if so directed.

Finalization Stage

Finalization stage photos (Figs. C1, C2 & C3) confirm arrangement and tooth placement as it relates to the rim and its surrounding oral framework. In this example, esthetic corrections indicate raising the patient’s left side to follow the lower lip line to define an esthetic curve. A slight narrowing of the arch form was indicated to develop slightly more negative space in the corners of the mouth. Correction of axial tooth angle on tooth No. 8 also is indicated. This patient wore lipstick and makeup believing she was receiving the finished product at this appointment. Interesting to note how lipstick visually affects framing of the tooth arrangement in comparison to her photo 2 weeks post-delivery.

Delivery Stage

Delivery stage photos (Figs. D1, D2 & D3) are usually taken on the day of delivery but I believe are best taken days or weeks post-delivery. Anxiety of receiving a new prosthetic has faded and patients are more relaxed and natural because they have had time to adjust to their new appliance and any fine-tuning issues that may have been needed.

Using digital cameras to track cases in the lab (see Part 1 of this article) and provide the technician with valuable chairside perspective means techno-clinical dentistry communication can start to realize the full potential of interdisciplinary communication in removable and fixed full-mouth reconstruction (Fig.  E).

For more specifics about digital communication and other topics please see my videos: youtube.com/user/TomZale56.

About the author

Tom Zaleske is Benchtop Editor for Dental Lab Products. The owner of Matrix Dental Laboratory in Crown Point, Ind., he has more than 25 years of experience in removable prosthodontics and regularly lectures on providing high quality service to dentists and most importantly to their patients. He can be reached at matrixdental@comcast.net.