PHOTOGRAPHIC-ASSISTED DIAGNOSIS AND TREATMENT PLANNING

Presented by: Guided by:

DR. IMLIYALA LONGCHAR Dr. Dax Abraham
(MDS 1ST YEAR)

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Endodontics
 LITERATURE ANALYSIS FORM (LAF): for a Literature Review* or Meta-
Analysis
(* = either Systematic or Traditional)
Short Version of the LAF: for use in Case Presentation Seminars

STUDENT NAME: Imliyala Longchar

DATE OF PRESENTATION: 2/6/16

ARTICLE TITLE: “Photographic-Assisted Diagnosis and Treatment

Planning” .

AUTHOR(S): Ron Goodlin, DDS.

JOURNAL REFERENCE: Dent Clin N Am 55 (2011) 211-227.

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THE RESEARCH QUESTION

1. Write the Research Question that this reviewed collection of original studies
were addressing.

(include a clear statements of the; 1) Indep Var, 2) Dep Var, and 3) Relevant
Population/Study Characteristics)

[TIP: use the 2 “H0 Format” slides from the SAPL Skills Clue Sheet as a model to
create your answer to this question]

 This article describes the recommended digital dental

Photographic equipment and how to produce the standard series of

diagnostic dental photographs.
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TYPES OF STUDIES that were Included in this Review or Meta-
Analysis

2. Classify the studies as either: (circle only one option below if all the
studies were of ‘one type’,
…but, if more than ‘one type’ of study was summarized in the report, write
the # of articles of each specific type of study on the short line before each
study type below)

[TIP: use the “4 Questions to ID type of Epidemiologic Study’ slide from the
SAPL Skills Clue Sheet]
- Lab Study - Analytical Epi. - Experimental Epi.
- Cross-sectional - Randomized clinical trial - other type of clinical trial
- Case History - Case Control - Retrospective Cohort
- Descriptive Epi. - Prospective Cohort

 This study is a Descriptive study.

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3. Amongst the articles included in this Review or Meta
Analysis, how many of the specific articles included
had the following levels of “inherent potential to
make a statement of causation”:
(on the short line before each below answer, write the
# of articles with that level of ‘inherent potential for a
statement of causation’) [TIP: use “Cylinders of
Causation” slide on SAPL Clue Sheet]

• Very strong
• Strong #
• Moderate
• Non-existent

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RESULTS:

5. Were the findings, as reported, of practical/clinical importance? √ Yes

__ No

DISCUSSION & CONCLUSION

6. Does the discussion proceed logically based on ‘set of studies’ presented? √ YES
No

7. Does the author state that ‘cause and effect’ is proven by this set of studies? √ Yes
__ No

8. In your opinion is this claim justified by: _√_ the data analysis….and/or the research
methods

9. Do the author(s) avoid generalizing beyond the limitations of the project? _√_ Yes
__ No

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UTILITY of this article and its findings for your
dental practice

10. What is the effect of the ‘eligibility criteria’ used to select

the set of original studies in this report? (select one choice)
• So restrictive that I cannot see any ‘generalizability’
back to patients in my practice at all.

 Somewhat restrictive so I would have to be

‘intelligently selective’ as to whom I generalize
these findings. (write out details on ‘to whom you could
generalize these findings in #12 below).

• Given the ‘eligibility criteria’ as stated, I could apply

these findings to all patients in my practice.
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11. State specifically how (and for whom) you would incorporate these
findings into your practice.
• In this article, it was observed that digital photography is
the standard of care and practice in esthetic dentistry and
should be used to help assist the practitioner in diagnosis
and treatment planning of esthetic cases.

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 Diagnosis and treatment planning of aesthetic cases requires the use of photographs
that are specifically designed to give the practitioner the information required to make
that diagnosis and develop the treatment plan.

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Three important questions must be answered:
(1) what photographs are required,
(2) how do we take them, and
(3) how do we interpret them to do the
diagnosis and treatment planning required?

The standardization of clinical photographs was

first described by this author in 1979.

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 The advent of digital photography
allows the practitioner to show the
photographs immediately,

to co- diagnose, and to work with the

patient .

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 The American Academy of
cosmetic dentistry describes
their required standard
series of accreditation
photographs to include a
facial View, three smile
views, three retracted views,
three close up views, and
two occlusal views. Fig. 1

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Department of Conservative dentistry and
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Department of Conservative dentistry and
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Through the work of spear, and this author, Additional views have been shown.

These include the tooth shown at rest view, The incisal edge "VVVV" position, and
the horizontal "VVVV" position to determine IEP and neutral zone horizontal
position. Figure 2.

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Equipment requirements and photographic principles:

BASIC PRINCIPLES:

The sensitivity of the card to light is determined by the ISO, the

higher the ISO the grainier or more pixelated the image, so in
dental photography we want to use the lowest ISO possible,
usually 100 to 200 to have a clear, crisp, sharp photograph.

The amount of light that enters the camera is controlled by the

aperture, the shutter speed, and the intensity of the light.

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 APERTURE AND DEPTH OF FIELD:

The opening in the lens is called The aperture. It can be changed from
large to small. The opening is measured as an F: stop. The larger opening
has a smaller number, i.e., F: 2.8 , Where as a small opening has a large
number, i.e., F: 32.The size of the opening determines the depth of field.
We need to have as small an aperture in the lens as is possible. Figure 3.

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 Shutter speed and sharpness:
The next way to control the light is by the time we allow the light to enter
a camera, the time the aperture stays open. This is controlled by the
shutter. The longer the shutter stays open, the more light that enters, but
the blurrier the photograph becomes because of camera shake and
movement.

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Lighting with Flash (Strobe):

The final method is to control the intensity of the light and that is
controlled by the flash unit.

In dental photography if the flash is on top it will cast a shadow into the
mouth so the flash must be mounted on the end of the lens.

The flash unit can be a ring light or a point source. The flash should be
set on its maximum intensity to allow us to use the smallest aperture .

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The lens:

The most important piece of equipment is the lens. Macro photography is the ability to take close up
photographs. A true macro lens will give the practitioners the ability to "dial in" the magnification ratio required
to take each type of photograph and get down to a 1:1 magnification ratio, which means the image in the camera
is the same size as it is in real life.Figure 5.

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Magnifications ratio:

It is pre-determined by turning the lens barrel. In dental

photography we use only three magnifications ratios.
The head shots are taken at 1:10 magnification;
The smile views, occlusal views, and retracted views are taken
using a 1: 2 ratio ;
And the close up shots are taken at a 1:1 magnification ratio.

Focusing:

Maintaining the magnification ratio is of paramount

importance, so instead of using the autofocus feature we focus
by rocking back and forth until the image becomes clear.

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Camera body

Any digital camera body that fits the lens will do. and
we do not need the mega - mega pixels. A simple
digital back that will allow you to shoot in manual mode
with around 10 megapixels is more than sufficient.

SLR versus point and shoot

The costs of the systems are way down and the ease of
use of the SLR system So far outweighs the point and
shoot system's needed post picture manipulation and
distortion that there is no question that the SLR option
is the way to go.

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Standard series of cosmetic photographs and how to take them

In the Goodlin method there are four steps for every photograph:
"Set-Spot-Rock and Roll.“

1) Set the magnification ratio and the exposure F: stop number

appropriate for that view.

2) Position the focusing point on to the spot that is desired, e.g.,

tip of the nose, papilla.

3) Rock forward and backward to "Focus. “

4) Roll the camera like a steering wheel to make sure the image is
straight.
Push the button.
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Department of Conservative dentistry and
Endodontics
The cosmetic standard series (17 views) is as follows:

Full face 1:10

Right profile view 1:10
Tooth show at rest 1:2 lick lips, swallow, slightly part your lips…. Tooth show
at rest is critical to determine IEP.
Full exaggerated smile 1:2 EEEEEE
Horizontal view VVVVVV 1:2
Tipped forward VVVVVV 1:2
Right Lateral smile view 1:2
Left lateral smile view 1:2
Retracted view anterior teeth closed 1:2
Retracted view anterior teeth slightly open 1:2
Right lateral retracted view 1:2 teeth closed 1:2
Left lateral retracted view 1:2 teeth closed 1:2
Close up anterior centrals view 1:1 with block- out paddle.
Close up right lateral retracted view 1:1 with Block-out paddle paddle
Close up left lateral retracted view 1:1 with block-out paddle
Maxillary occlusal views 1:2 (photograph the reflection in an occlusal mirror)
Mandibular occlusal views 1:2 (photograph the reflection in an occlusal
mirror)
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DIAGNOSIS AND TREATMENT
PLANNING

In aesthetic dentistry, a combination of Cephalometrics and

anthropometric principles can be used to measure the
dentofacial characteristics.

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 Facial proportion

A well proportioned face is divided into thirds, from

forehead through the hairline, the
eyebrows/Glabella, the base of the nose/sub-
nasion, and the edge of the chin/ Menton.Figure 9.
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 Golden proportion

Based on the principles of the ratio of 1.618:1, the dento

facial characteristics can be determined.Figure 10

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Treatment planning and imaging
Once the preliminary treatment plan is created using
photographic imaging, fig. 11.

This can then be duplicated on a diagnostic wax-up

model to be used to transfer the information to the
mouth allowing the patient and practitioner to see the
results.

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Department of Conservative dentistry and
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 Treatment planning is very similar to the procedures
we follow in setting up the full denture case.
Step 1 -Is to determine the correct occlusion rim height

Step 2-Is to create the midline position.

Step 3-is to create maxillary incisors inclination to stay within the neutral zone.

Step 4-is to create the correct height-to-width ratio of the central incisors by crown lengthening to create
the correct IEP and height-to-width ratio.

Step 5-is to make sure the maxillary 6 anterior teeth are fabricated to principles of golden proportion and
that the gingival height of contour follows aesthetic guidelines.

Step 6-is to set up the remaining maxillary posterior teeth to the correct occlusal plane.

Step 7-is to set up the mandibular incisor teeth at the correct incisal edge position and inclination to create
the desired anterior guidance within in the envelope of function.

Step 8-is to set up the mandibular posterior teeth to the maxillary occlusal plane and established anterior
guidance.
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IMAGING USING PHOTOSHOP

Global edits:
we need to correct deficiencies in the tonal range and sharpness
for every digital photo we take. And this is simple using photo
shop or many other photo imaging software packages that are
available.

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References

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THANKYOU

Department of Conservative dentistry and

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