Martin B. Goldstein, DMD, discusses clinical situations to show clinicians how to maximize the use of their DSLR cameras.
Q: Does our dental office really need a digital single-lens reflex (DSLR) camera?
A: Many dentists are able to use simple point-and-shoot cameras, and even smartphone cameras, most notably when capturing images of the anterior dentition. To effectively and consistently take images of the posterior dentition is another story. Using point-and-shoot cameras for full-arch occlusal and single-molar shots requires considerable skill and, frankly, a fair amount of luck. More often than not, shadows are cast that interfere with diagnostically valuable images. The exception would include point-and-shoot cameras that have been modified with add-on lens and flash enhancements. Ultimately, a DSLR camera provides a more accurate preview of your shot, more accurate color renditions, and crisper images with the ability to tweak and save your own camera settings to optimize it for dentistry.
Q: It seems as if a DSLR is just another overly complex gadget that no one in the office will understand how to set up and use. Is this correct?
A: That used to be the case. In the days of manual focus and manual flash, DSLR usage had a steep learning curve. Today, DSLR cameras feature auto-focus, auto-exposure, and the ability to save your most frequently used settings (typically intraoral and facial). In effect, DSLR cameras have become more like point-and-shoot cameras. Your primary responsibility is to learn how to compose and take the shot. The most painless way to introduce a DSLR camera into the dental office is to buy one from a dealer that specializes in dental photography (such as Dine Corp or PhotoMed). Companies like these sell camera systems that are already set up for dental photography. This relieves the clinician of the “trial and error” experienced when purchasing from online purveyors that possess no knowledge of dental photography.
Q: Okay, we’ve got the thing out of the box and it’s ready to go. Who should be taking the pictures?
A: I strongly recommend that both your chairside assistants and your hygienists become the primary photographers in your office. Just as your auxiliary team is called upon to take radiographs, they can also be easily trained to be your dental photographers. To start, have your hygienist take 5 simple shots before or after the radiographic series is taken when seeing new patients. These shots are the anterior retracted shots (open and closed), the maxillary and mandibular occlusal shots, and a full-face portrait. While this set can be supplemented with others taken at a later time, these basic shots provide a solid foundation for treatment planning when the patient is not in your chair.
Q: What is the best way to recoup the investment in a dental photography system?
A: Without a doubt, the concept of “co-diagnosis” provides a bridge to patient trust and compliance. The old expression “seeing is believing” fits like a glove when making treatment recommendations. My typical protocol, with new patients who have first seen the hygienist, is to co-view their dental photographs tooth by tooth. This is done in full-screen mode on a monitor during a preliminary treatment planning session. This larger-than-life-size viewing experience typically has a profound effect on the patient’s willingness to listen to any treatment-related comments and recommendations. Those same basic shots are referred to when completing treatment in order to afford the patient the opportunity to visually observe any and all progress made from the preoperative condition. Patients are encouraged by this sharing of their personal photographic information and will be much more likely to start and finish treatment. Presenting dental needs in this manner opens the door for restoring quadrants that are in need as opposed to single-tooth restorations, certainly a more efficient and profitable way to practice.
Q: Can use of cosmetic simulations when presenting anterior dentistry be a way to increase the return on investment of a new digital camera system?
A: Yes, digital renderings such as those offered by Smile-Vision and Glidewell Laboratories—to mention a couple—are enormously helpful. These simulated renderings get patients excited about smile rehabs and, furthermore, in cases where lab-fabricated restorations are involved, they provide a blueprint for the laboratory team to follow to ensure work that is consistent with patient expectations. The majority of my smile design cases have been launched by (1) taking a full-face portrait, (2) uploading it to Smile-Vision, and then (3) making my treatment recommendations. The patient then returns to view his or her new virtual smile simulation and to discuss what treatment methods would be appropriate to meet the patient’s aesthetic goals and desires. This approach is easier to understand than looking at dental models and diagnostic wax-ups. The only other proven method to do this is to do a chairside mock-up, but this can be considerably time consuming.
Q: What about the posterior dentition? Where does my DSLR camera fit in there?
A: Though a bit more demanding, your DSLR camera can, in fact, emulate an intraoral video camera. Your shots will often require a mirror, but the results are indeed sharper than the images obtained by video still shots due to the higher image resolution. Most commonly, the DSLR-acquired image is useful to demonstrate to your patient an uncovered intracoronal fracture or simply a cusp fracture. Having your DSLR camera handy at the chair is mandatory for this “show and tell” process to take place. Saving such images for easy retrieval affords you a convincing backup, should your patient or an insurance carrier question an outcome, or even the need for treatment. My insurance billing office team is delighted when they have instant access to the backup they need to appeal a denied claim.
Q: Agreed. Many dental offices should be using our cameras more often! What else do we need to know?
A: There are 2 other critical areas. The most obvious is doctor-technician communication. From this day forward, do not send your lab team an impression of an anterior tooth without an accompanying photo that includes a shade tab and an accurate rendering of the adjacent teeth in the image. This will dramatically reduce the number of “re-dos” on your anterior restorations, increasing your bottom line. The other key area may not be so obvious. Recording the appearance of soft-tissue lesions, most often found by your hygienist, provides a basis for comparison when your patient is asked to return for a 2-week follow-up. Before-and-after shots can assist in decisions related to referral for a biopsy. Biopsies done in our office are sent to the pathology lab with a pre-op photo of the lesion. Lesion images can also be sent electronically to oral surgeons for on-the-fly assessments regarding the urgency of a follow-up appointment. These tips to put your digital camera system to work will enhance your daily activities and elevate the level of your practice.
Dr. Goldstein practices general dentistry in Wolcott, Conn. He is a Fellow in the International Academy of Dento-Facial Esthetics and the Academy of General Dentistry. He can be reached at martyg924@cox.net.
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