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Technology

Improved communications through


dental photography
Phil Reddington explains how technology has helped him
produce successful dental restorations
Modern dentistry now places extra demands on
the dental team. This is due to an increase in patients expectations, and the continued growth of
aesthetic dentistry, particularly within the private
sector. I believe that good communications between dentist and technician is essential, and can
be further enhanced by making use of new technology, in an effort to achieve ideal restorations
that will satisfy both the patients and the dental
professionals exacting standards.
As it is not always possible for all dentists to
have a one-to-one communication with their
technician, this places even more importance on
establishing excellent links of communication
between both parties.
We know that we will never completely eliminate the need for remakes, due perhaps to incorrect shade interpretation, but there are several
options open to us that can help reduce these to
a minimum.
When restoring teeth in the aesthetic zone, I
consider the following to be of optimum importance.
A careful shade analysis by a clinician or
technician, and the consequent production of
a prescription or map of the tooth that will offer guidance for the technician. Most porcelain
manufacturers now produce colour indicators, in
addition to conventional shade guides that can
help break down elements that are present within
the tooth that is to be matched .
Pre-Op photographs that avoid tooth dehydration (this can temporarily lighten teeth), using a
ring flash, or the Optilume POV, or sometimes
both! Some pictures can also be shown with
shade tabs and some without.
A stump shade photograph for all ceramic restorations This is just as important as the overall
shade, as it will determine the level of opacity

that may be required, which in turn can influence


the appropriate system or material to opt for.
Comments from the patient. This can be just
as relevant the clincians observations as patients
will inevitably have a pre-conceived idea of what
they want, and it is important to obtain their
opinion.
To return to the subject of photography, I have
owned and used various cameras for many years,
and currently use a Canon 400D SLR camera,
with ring flash and macro lens, and have often
used this as an aid in shade matching.
All too often, I have looked closely at the resultant photographs that were taken at the shade
mapping stage, and found myself struggling to
find some of the finer details that I had drawn!
This obviously meant that for some reason the
camera was not giving me all the information I
required, and I could only assume that this was
probably due to less than ideal lighting conditions.
However, last October, I was introduced to
the new Optilume POV (Point of View) lighting
system for use with both loupes and dental photography. Optident manufacture the POV, and as
my laboratory is situated close to the Optident
offices, it enabled me to try it out in conjunction
with my SLR camera. The POV utilises H.I.D
Technology (High Intensity Discharge), which
produces exceptional brightness, but without
specular relection. The portable light source can
be magnetically attached to the camera lens, and
the bi-lateral lighting angles can be varied to suit
different photographic requirements. The main
advantage over the ring flash is that it provides a
constant and consistent light quality, whereas the
ring flash lighting is momentary.
With the help of Dr Alex Renshaw, and a few
willing technicians, I decided to see how the POV

Phil Reddington heads up a team of seven dental technicians at Beever


Dental Technology, a cosmetic and implant laboratory based in Leeds.
He has over 17 years experience in Dental Ceramics, and is also a full
member of the British Academy of Cosmetic Dentistry. In recent years,
he has guided the laboratory towards several prestigious awards. These
include a Laboratory Commendation at The Probe dental Awards, a
Finalist in the Private Dentistry Awards for Lab of the Year, and together
with Dr Craig Parker, he was a finalist in Smile Makeover of the Year
2007. www.beeverdental.com tel: 0113 261 3421
106 Aesthetic dentistry today

Figure 1: Patients appearance presented at pre-op stage

Figure 2: Basic shade determination using conventional


shade guide

Figure 3: Taking the stump shade

Figure 4: Patients resultant post-operative appearance,


showing much improved aesthetics

March 2008 Volume 2 Number 3

Technology

Figure 5: Colour indicator. A guide to assist in assessing


specific colour details in teeth

performed, and to determine if it would offer advantages over the conventional ring flash.
After some initial adjustments we found that
the following camera settings suited our needs
and these are as follows:
Aperture setting F22
Shutter speed 1/100th of a second
ISO Setting 800
Lens Sigma 50mm 1-2.8 macro lens at a magnification of 1 in 2(x2)
Custom white Balance set using 18% grey card
Ring flash (Macro ring light) on ETTL mode
POV Setting light setting, angle 45 degrees
Over the next few weeks, Alex was briefed
to look out for patients who exhibited interesting dentitions. These patients were duly photographed, and it was then that we noticed interesting differences between those pictures that had
been taken with the conventional ring flash and
those that had used the POV lighting system.
Whilst both sets of photos were acceptable,
there were distinct differences. The ring flash
photos showed good surface detail and texture,
but some internal fractures, striations and stains
were not discernable and tended to exhibit a
bleached out or flashed out appearance .
The POV picked up surface texture, but what
really made it unique was the way that the internal colours and features were not masked-out.
This ability to show the all-important internal
colourations is down to the POVs constant light
source. When viewed on a good screen the intensity and shade of the internal nuances were
much easier to determine, especially in the usually hard to capture incisal third. Whilst neither
method can be 100% accurate for shade matching, the combination of these two photographic
techniques, together with a shade description is
certainly worth utilising. To illustrate the points
made in the above article, there follows a selection of comparative photographs. Clinical pho-

Figure 6: Shows photographic result when using SLR


camera and ring flash. Note the bleached or flashedout appearance due to specular reflection

Figure 7: Same patient but photographed using the


Optilume H.I.D. POV Camera attachment, on a half-light
intensity setting. Note detail of the various colour areas
in the teeth, and clear definition of striations and other
internal tooth effects, due to lack of specular reflection

Figure 8: This picture illustrates the specular reflection


with a ring flash, and lack of detail or definition of
internal tooth colours and effects

Figure 9: The same patient, but with the Optilume POV


lighting (half intensity setting). Note pronounced detail
in the incisal areas, staining and clearly defined striations in all teeth, due to low level of specular reflection

Figure 11: Shade details

Figure 10: Optilume POV camera attachment

tographs in Figures 1-4 were taken by Dr Craig


Parker.

Acknowledgements
I would like to acknowledge the following clinicians who have helped me develop my skills as
a ceramist, and that have supported me in my
efforts to achieve better overall communications.
Dr Craig Parker, Dr Steve Gibson, Dr Simon
Agabeg, and finally Dr Alex Renshaw . Without
their valued feedback, it would not have been
possible for me to produce quality dental restorations that satisfy patients, clinicians and myA
self.

The Optilume POV is a product of Optident Ltd, IDC, Valley Drive, ILKLEY, LS29 8AL. Tel:
01943 605050. email: sales@optident.co.uk Website: www.optident.co.uk

106 Aesthetic dentistry today

Figure 12: Good communication

March 2008 Volume 2 Number 3

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