Documentation

Beyond esthetic dentistry, creating thorough records is imperative to operating a compliant and responsible practice. All new patients should have photographs taken of their starting condition as they enter the practice for clinical reference as well as medical-legal protection for the dentist. Initial photographs serve as a time stamp of the patient’s existing state when they first become a patient. It is important that these photographs are of high quality and include multiple views of the patient’s face, smile, and dentition. Furthermore, within dental esthetics, a workflow should be developed in order to provide consistent, high-level documentation throughout all stages of treatment, including follow-up.

Patient Education and Case Acceptance

Photography is an integral part of communicating with patients. It allows the dentist to show the patient the starting point, existing conditions, findings, simulated treatment options, and examples of finished procedures for understanding and motivation. When discussing esthetic treatment, it provides a conduit to clearly understand patient goals, and aspects of their smiles they do not like and would like to enhance. One approach developed by dentist Bob Barkley in the 1960s and still taught in highly regarded CE courses is the process of codiscovery.

This process involves dentist, patient, and photography, and results in the patients gaining a thorough understanding of the conditions of their dentition and oral health. Bob Barkley spoke to this issue brilliantly when he said, “No greater risk of failure can be run than that of attempting to use traditional patient management procedures in a health oriented restorative practice. Examining and treating a patient’s mouth without prior attitudinal development is an error of omission for which the dentist pays handsomely with time, energy, stress, and money.” Photography is key for this process and results in the success of the attitudinal development of patients, where patients can see their dentition, begin to fully understand and take ownership of their conditions and problems, and strongly value high-level treatment.

In dental esthetics, through the process of diagnosis, treatment planning, and digital smile design, photography is used to develop a clear path for a patient’s treatment. A smile design and proposed outcome can be presented to a patient. A digital simulation of the outcome has a profound impact emotionally on patients because they are able to experience how esthetic dental treatment can influence their overall appearance. Fig. 1 shows the steps of a completed case motivated by photography and a digital smile design process. The more clinicians are able to communicate in this visual fashion, the more patients tend to understand their options and how esthetic dental treatment can help accomplish goals of improving their appearance.

( A ) Initial Patient Presentation. ( B ) DSD Outline Form. ( C ) DSD Virtual Smile Simulation. ( D ) Prototype Try In based on Wax Up. ( E ) Final Restorations.

( Courtesy of Yair Y. Whiteman, DMD, Los Angeles, CA.)

Collaborating and Communication with Colleagues

Esthetic dental treatment is often interdisciplinary, involving close collaboration with other specialists. Esthetic dental treatment always requires detailed laboratory communication. Photography, presentation development, and digital smile design allows for optimal communication for interdisciplinary treatment planning to occur. If a dentist does not practice in close proximity to the dental lab that will be fabricating the restorations where a custom shade appointment can be accomplished, then photography will be required for shade matching purposes ( Fig. 2 ). Photography is also used for evaluating restorations at the try-in appointment and then communicating to the laboratory if modifications are needed. Esthetic dental treatment cannot be done accurately or predictably without photography.

Shade matching for esthetic treatment.

Branding and Marketing

Photography is needed when branding an esthetic dental practice as well as marketing the practice to both grow and maintain its relevance. Photography is used both internally and externally for these purposes. Before-and-after photos of patients can be shown to patients during a consultation. Specifically, completed treatments from cases similar to a patient’s condition can be used as a relatable example of someone else that underwent treatment and experienced an excellent outcome. Examples of completed cases should be included in your overall online presence to help patients find you for the type of treatment you are offering and they are seeking. Photography can help differentiate a dental practice from others depending on the quality that is performed and the style that is displayed.

Dental Education

Photography allows content development for lectures, study clubs, forums, and other aspects of education and collaboration among colleagues. When attending high-level dental meetings, incredible dental photography can be witnessed in presentations. Even if not currently teaching, documenting cases in a complete manner helps to build a library of content that may be used in the future should a teaching or lecturer position ever be pursued.

Evaluating Outcomes

Photography allows dentists to see the outcomes of their work as well as to evaluate successes and shortcomings.

Routinely taking photographs at each step of treatment (diagnosis and treatment planning, prototype try-in, preparations, provisionals, final restoration try-in, cementation, and postoperative) collectively provides information that would otherwise not be available for fully understating outcomes, creating a path to mastering clinical skills.

Digital Single-Lens Reflex Camera Body

The camera body is the main part of the camera minus the lens and lighting setup. Camera bodies come in 2 types: full frame and cropped sensor (Advanced Photo System type C [APS-C]). Full-frame cameras are what professional photographers use. Cropped-sensor cameras have a smaller sensor and are less expensive but are still of excellent quality. A full-frame camera will work for dental photography; however, a cropped-sensor camera is all that is needed for high-level dental photography. By choosing a cropped-sensor camera, a dentist can save thousands of dollars without sacrificing the quality that is needed. Because of their smaller sensors compared with full-frame cameras, APS-C cameras capture only part of the image produced by the lens. This feature is known as a crop factor.

To work around this small variation in sensor size (crop factor), the photographer simply needs to move slightly away from the subject to capture the same image at the same distance as a full-frame camera. This technique results in a magnification phenomenon that influences the focal length once the lens is connected to the body, which means that, depending on the space present in a dental practice, the proper lens type paired with a cropped-sensor camera allows the dentist to take photographs comfortably in a small operatory room setting, versus a larger studio space, which is not always available in a dental practice.

Macro Lens

The type of lens needed for dental photography is referred to as a macro lens. A lens is selected by brand, quality, focal length, and cost ( Table 1 ). The lens is perhaps the most important aspect of the photography setup, where its physical quality is a greater determining factor of overall photo quality outcome than other parts of the dental photography setup. The number on the side of the lens signifies the focal length of the lens. The focal length determines how close the dentist needs to be to the patient in order to capture the desired photo. The appropriate focal length for dental photography is a range (85–105 mm), depending on the type of camera as well as how much space is present in the dental operatory or studio setting.

Table 1

Macro lens recommendations

Lens	Pro	Con
Nikon AF-S Micro Nikkor 85 mm f/3.5	• Lighter in weight • Smaller in size • Less expensive • Decreased working distance required compared with Nikon 105 mm	• Slight lower quality compared with Nikon 105 mm
Nikon AF-S Micro Nikkor 105 mm f/2.8	• High quality • Excellent optics • Smooth, fast focus	• Heavier in weight • Expensive • Larger in size • Increased working distance required compared with Nikon 85 mm
Tamron SP 90 mm f/2.8	• Excellent optics • Middle price range • Can work closer to patient than Nikon 105 mm	• Cannot get as close to patient as Nikon 85 mm
Tokina atx-i 100 mm f/2.8	• Least expensive • Excellent optics • Light in weight	• Slow focus speed may be off-putting and slows efficiency

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