Today, I received a submission for the Clinician’s Corner section of the Journal that documented the treatment of a patient who required some relatively difficult tooth movements. The results of the treatment were presented in photographic format, and the outcome was excellent. Perfect, in fact. So perfect, that I became suspicious of the authenticity of the digital photograph. To determine whether the photograph had been altered digitally, I gradually enlarged the image in the area of concern. As I magnified it, I could see where the photograph had been altered to make the posterior occlusal interdigitation look perfect. What did I look for? Pixelation.
As most of you are aware, computer software can be used to clean up digital orthodontic photographs by lightening or darkening the image, changing the contrast, saturating or desaturating the color intensity, or slightly altering the color of skin, teeth, and gingiva. Actually, I do not have a problem with these alterations if they allow the observer to view the image in a more realistic way.
Computer software can also be used to make other changes. Dust spots on the photograph from debris on the lip retractors, mirror, or camera lens can be removed quite easily by grabbing a few pixels from an adjacent area of the photograph and superimposing them over the dust spot. This cleanup method is common, and again I have no problem when authors perform this minor adjustment.
However, in the photographs I was observing, the adjacent gingival tissue had been moved to create a papilla where one was not actually present. In another area of the same image, part of the tooth enamel was extended vertically to improve the appearance of the occlusal interdigitation of the posterior teeth. This type of alteration is not acceptable because it misrepresents the true clinical situation. I would classify this misrepresentation as fraud. In the dictionary, fraud is defined as intentional deception made for personal gain. The personal gain in this case was to make the result look better and enhance the likelihood that this submission would be accepted for publication in the Journal .
This is not the first time that I have received photographically fraudulent submissions. Once, a case report was submitted in which a very nice posttreatment result had been achieved in a difficult adult malocclusion. However, on the posttreatment panoramic radiograph, the mandibular third molars were horizontally impacted and causing periodontal problems for the patient. So, I suggested that the author should have these teeth removed, take a new panoramic radiograph without the third molars, and submit the new radiograph to be included with the published case report. I received the new panoramic photograph. The third molars had been carefully removed—from the photograph by using Adobe Photoshop. I verified this by having the oral radiology department at the University of Washington perform a test by using digital subtraction radiography, and it showed clearly that the image of the panoramic radiograph had been digitally altered. I rejected the article.
On another occasion, an author submitted a nicely treated case report. The posttreatment result was excellent, and the lateral intraoral photographs showed a beautifully interdigitated occlusion. However, when I looked at the panoramic radiograph, I could see interproximal spaces between the maxillary incisors and between the mandibular molars. When I looked again at the intraoral photographs and gradually enlarged the images, I could see the irregular pixelation that occurred as the author had tried to close the open interproximal contacts by covering them with enamel from the adjacent teeth. I rejected the article.
Let me be perfectly clear. This is fraud. It is an ethical violation that will simply not be tolerated by the American Journal of Orthodontics and Dentofacial Orthopedics . I will reject any article in which this type of alteration is attempted; furthermore, the author risks even greater scrutiny in the future if this ethical violation has been discovered. Remember, if a posttreatment result looks too good to be true, then perhaps the photographic image has been altered digitally.
