Digital Dental Photography

Digital Photography and Workflow for Dentists

Dental Photography

Dental Imaging Software and Photo Storage – the Hows & Whys?

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OK, I lied……before I talk about patient expectations, since I already started on the subject of software, I shall continue in that vein for a bit, as it seems to be right near the top of the poll in terms of “need-to-know”.

Use PMS (Eaglesoft, Dentrix, etc) or Not?

Personally, I do not use, nor do I recommend using, the Imaging modules of the dental PM software that is currently on the market.  Why not?

  1. Cost: While some include the Imaging Modules, most charge a premium for the versions with all the bells-and-whistles, and quite simply, NONE of them are remotely as good as the most popular photography software available outside dentistry, and ALL of them are a LOT more expensive.
  2. Lack of Keyword Capability: In just about every photography program available today, including Google’s free Picasa, you have the ability to use Keywords, or Tags.  These are descriptive terms to used to identify what is in the picture.  For example, in dentistry you might want to have keywords related to what lab you used, which adhesive, which composite or amalgam used, type of isolation, reason for treatment, etc.  This allows you the option of tracking your work over time.
  3. Harder to find images you want: in dental PM software, you have to generally keep your images in each person’s file; if it’s years down the road and you want the pictures you took of, “Hey……what was that guy’s name about 5 years ago we did the single anterior crown for?????”  Ummmmmmmm, not too easy to do, is it?  This ties in with the lack of Keywords/Tags, too.
  4. Harder to Group images for specific purposes: Let’s say you want to put together a nice collection of pictures of veneer cases, or Six-Month Braces, or CEREC crowns, or implant overdenture cases, you have to go through all of the patients, in most cases export the images individually to another folder (and they don’t make this really easy IMO), THEN you can start working with them.
  5. Limited Editing Capabilities: Especially in comparison to programs like Photoshop, or even Photoshop Elements, most dental PM software has extremely limited editing capabilities.  Of the ones I know, the best is Apteryx.  However, it is again more expensive than just about any photo software currently available, and it has the same limitations regarding Keywords, image searching, and image grouping.

OK, so what software do I use/recommend? 

Personally, I like Adobe Photoshop Lightroom, which is currently in version 2, and version 3 will be released sometime in spring 2010.  Here are some other programs you can choose, though, and then I’ll cover more of why these programs are IMO far superior to dental PM software imaging modules.

5 Reasons Photoshop Lightroom Rocks for Dentists

  1. Easy Folder Hierarchy: It’s basically just like Windows Explorer, in that you can set up a folder structure in any way that you want.  Here’s the way I have it set up: My Pictures > Year > Procedure Type > Patient Name > Date of Service.  It’s easy to keep track of all pictures by calendar year, and by having procedure types (such as Basic Restorative, Cosmetic, Periodontal, Implant, etc), you can put like types of procedures together.
  2. Easy Keyword Tagging:  This is really one of THE most powerful tools available with LR or the other programs.  By using Keywords, you can easily label pictures with any descriptor you want.  As some examples, here are some I use: Decay, Recurrent Decay, Chipped Porcelain, Acid Erosion, Gingival hypertrophy, Posterior Composite, Anterior Composite, Veneer, Feldspathic, Empress, Surpass, Preop, Portrait, Amalgam, and you can probably think of a gazillion more.  And here’s where it gets useful: Tracking your work over time!  Let’s suppose that, after 5 years of using a particular lab, always using Captek crowns and cementing with zinc phosphate, you want to pull up ALL of the pictures of ALL patients in the last 5 years who got Captek crowns from that lab and which were cemented with zinc phosphate so you can see how they hold up……..type the Keywords into the search field, and BAM!  There you go!  OR……..say you know that there was an amazing veneer case you did 8 years ago, but you can’t remember the patient’s name, no problem!  Just select the year you want, perhaps choose keywords “Veneer, Maxillary, XYXYX Lab” and BAM!  There you go, all the maxillary veneer cases from the year 2002 that you did with XYXYX Lab are right there, and you can easily identify the case you want.  This is just an incredible feature.
  3. Creating Customized Galleries and Slideshows:  This is another superb feature for anyone who wants to easily showcase their work.  Lightroom has several features that allow you to create highly customized Web Galleries, Slideshows with music, and more; with plug-ins (most are free, some have a small fee), you can upload galleries to sites such as Flickr, Smugmug, Zenfolio, and others.  Google’s Picasa has a built-in tool to let you upload pictures to your online Picasa galleries, from which you can create links, Flash slideshows, and more.  The marketing potential of these customizable photo groupings is tremendous.  The slideshow seen on the right of my Blog is linked from my SmugMug photography site, and all those pictures were uploaded directly in a large batch.  EASY.  And the upcoming release of Lightroom 3 will have even more of these features built in!
  4. Easy-to-Use Editing Features: with most of these programs, the controls to do a ot of basic editing are right at your fingertips, such as Cropping, Correcting Red-eye, Correcting overexposed or underexposed pictures, adding borders, etc.  Therefore, the learning curve to use them is much faster and shallower.
  5. NON-DESTRUCTIVE editing!  This is a wonderful benefit like you wouldn’t believe, especially when you’re new.  Essentially, Lightroom does not actually edit the image file; instead it writes the edits “on-top-of” the file in a set of instructions that are rendered onscreen.  NOT UNTIL you export the image in some way (online, printing, slideshow) will those edits be permanently part of the new file.  Even then, though, the ORIGINAL file remains untouched, and you can revert back to it at any point.

Hence my recommendation to use a non-dental software for cataloging and editing your pictures. Please post comments and questions or send me an email for further clarification. 

    Smile Imaging – What Software and How to Manage Expectations

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    Here’s a question I received from a colleague by email recently, and it’s such a good one, it’s the perfect opening for a blog entry.  Thanks to Rich M. for asking (and I do welcome questions and comments, so please……leave a comment or send a question by email.).

    Q: “One question on my list is whether you use imaging software in your presentations so patients can view current and proposed/expected outcomes.  I’ve been warned this could be a tricky area to get into due to a gap in patient expectations and actual outcome.  What do you say and what software for this purpose do you use (if you do use any)?”

    A:  What we have here is really 2 questions; the first is about software and a “How-To-Do……?” and the second is about patient expectations if you do a computerized smile mock-up to show them what you think the outcome will be.  Let’s start with the software question first, because it’s actually the easier question to answer, although the technical aspect of making it happen is a bit trickier.

    Software: If you want to make this process really easy on yourself, there are several pretty good services available that will do the smile imaging for you; while I don’t personally use them nowadays, I have used them in the past and gotten very good service:

    This next service I have not used personally, but they are recommended by the DaVinci Lab, Dr. Woody Oaks, and others, so I figure they can do a good job, too.

    This next service is actually a relatively easy one to implement in your office; naturally, there is a learning curve, but they offer pretty good support to get you up and running.  If I were doing more cosmetic cases these days myself, I’d probably go back to using this one, but I’m having more fun doing a ton of 6MonthSmiles Adult Ortho and Laser Periodontal Therapy cases.

    All these services have a very simplified set-up that you can implement very easily; the absolute easiest are the first 3, because all you have to do is take the pictures and email them; you usually get the completed Before/After Cosmetic Imaging back within 24-48 hours.  They offer a “Rush” option as well.

    Here’s another significant benefit to working with both SmileArt and SmileVision:  they are both part of full-service dental labs with a focus on esthetic dentistry.  Therefore, they can help not only do the Before/After Imaging, they can actually provide the crowns/veneers/bridges/etc. to bring the case to a successful conclusion.

    That said, what software do I personally use nowadays?  Well, if anything, I use Adobe Photoshop CS4.  This is a program I use almost daily as a photographer, so it’s what I’m most comfortable with, and I know how to do the things that most patients want to see imaged.  However…….for most dentists, unless you’re really serious about this, I do NOT recommend you go this route, because it has a VERY steep learning curve.  It also does require the most time.

    Since this post has already gotten a bit long, I’ll answer Part 2 of Rich’s question, about managing patient expectations, in my next posting.

    4 Lens "Positions" for Dental Pictures with the Canon 100mm macro

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    In dentistry, there will typically be 4 “types” of pictures that you will take, regardless of the purposes for which you take them.  They are:

    1. The Full Face/Portrait
    2. Full Smile/Retracted Smile or Full Arch
    3. Quadrant
    4. Single-tooth (not very often except for endo)

    When shooting each of these, I have found that there are certain “positions” of the Canon 100mm f/2.8 Macro lens that approximate these consistently and easily.  Remember: DO NOT HAVE EITHER YOUR LENS OR CAMERA ON AUTO; BOTH SHOULD BE ON MANUAL AND MANUAL FOCUS.  To make it nice and easy, check out these pictures, then download the “Cheat Sheet” for use in your office.

    For a FULL FACE/PORTRAIT, position the lens like this:

    For a FULL/RETRACTED SMILE and FULL ARCH:

    For a QUADRANT or 1:2 Picture:

    For a SINGLE-TOOTH:

    I’ll soon have an equivalent set of pictures for the Canon 60mm f/2.8 macro lens, and eventually for Nikon and Sigma lenses.

    RAW or JPEG for dental photography?

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    Here’s another thought that popped to mind this evening as I was playing with my new Canon 7D (oh god, how I love this thing already!), and it relates to 2 questions many colleagues ask:

    1) Should I shoot in RAW or JPEG?
    Simple answer to a complex question: UNLESS you are taking pictures that you need in RAW because you’re aiming for accreditation with the American Academy of Cosmetic Dentistry or a similar organization, I recommend you shoot in JPEG.  Why?  Well, there are no PMS (practice management software) programs of which I know that can handle RAW files; you need much bigger memory cards if taking a lot of pictures; RAW files do take longer to download; you need a lot more HD memory to store a large number of RAW files.  As a comparison:
         My work PC has roughly 44,000 pictures of patients that I’ve taken with all my digital cameras going back to 2002 (my first was an Olympus C2500L), and the My Pictures folder is approx. 130GB.  My home PC has approximately 20,000 pictures in the My Pictures folder, but because I shoot all my personal stuff in RAW, that folder is about 300GB!  So only 1/2 the pictures, but more than double the memory required.  And with the new 7D having RAW files of about 24MB each, that will increase fast!

    While JPEG files do degrade slightly over time when opened and closed many many many times, with the current resolution of images, the likelihood that such degradation will be visible in your entire lifetime is practically zilch.  Ain’t gonna happen.  No need to worry about it.

    If you ARE aiming for accreditation, why is it therefore important to shoot in RAW?  For a very simple reason: the RAW file is equivalent to a digital negative, and it is ALWAYS that equivalent.  Even if you edit it, the original is always there and can be recovered, so it’s impossible to “fake” pictures by editing them.  That way the examiners can be 100% positive that no-one is trying to sneak something by that was really Photoshopped.

    2) OK, so I shoot in JPEG for intraoral/extraoral photography, what level of resolution should I choose?
    Since JPEGs can be handled pretty easily by virtually any computer these days, and you can get a lot more pictures onto a card and HD, it makes sense IMO to shoot at the largest resolution (the “L” with the smooth curve next to it, not the steps).   Sure, you could shoot much smaller files, but what’s the point?  At some time you will probably regret having a lower-quality image that you can’t improve/upsize……but it’s easy and fast to take a bigger-than needed picture and downsize it.

    How Many Megapixels Do You Need?

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    This is one of those questions that always comes up when new photographers are asking what camera they should get.  When you consider how much the advertising for digital cameras seems to focus on the number of megapixels, it’s not really surprising, but still a bit unfortunate, because it gives the impression that one must have the camera with the most MP to keep up.

    The truth of the matter is, when we’re talking about digital photography for dentistry, in particular, any DSLR since Canon came out with its Digital Rebel (6.3MP) back in ’03 has been totally adequate.

    BTW – I still use the same 100mm macro lens that I bought with that Rebel back in 2004, so it may be reassuring to know that you won’t need to keep upgrading lenses every few years.That’s one of the keys to quality pictures that most people don’t understand: it’s more important to have quality lenses than a camera with high megapixel count for sharp, clear, colorful pictures.

    So the simple answer to the question?  Any digital DSLR that has ever been made has more than enough megapixels, so don’t worry about that at all.  🙂

    5 Good Cameras for Dental Photography

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    Now to the real question: Which camera/flash/lens combination should I buy?

    I’ll start off with what I think are simply THE standard lenses and flashes to get, as these won’t change much over time, even though the camera bodies will.

    For Canon lenses (overall, more dentists use Canon than any other brand in my experience), you want EITHER the:

    1. Canon 100mm f/2.8 macro lens OR
    2. Canon 60mm f/2.8 macro lens

    There is only 1 Canon ring-flash commonly used (while the twin-light flash is really nice, it’s trickier to learn and definitely more expensive), and that is the Canon MR-14EX ring flash.

    For Nikon, the comparable lenses are:

    1. Nikon Telephoto AF Micro-Nikkor 105mm, OR
    2. Nikon Macro AF Micro-Nikkor 60mm

    As far as I know (which is a lot less about Nikon that Canon, admittedly), Nikon does not make their own ring flash comparable to the Canon MR-14EX.  The one I’ve seen commonly recommended is the Sigma EM-140 DG TTL Macro Ring Flash for Nikon.

    So does this mean that these are the ONLY combinations of DSLR lenses and flashes that you can get?  NOPE, not by a long shot!  However, they are the most common selections used by skilled dental photographers, and so….if you happen to need help from a colleague, it’s easiest to get help on these.  So rather than give out every single combination of lenses, bodies, and flashes that could be used, to keep it simple, these are the ones I recommend you consider.

    Remember that the most important feature in the lens is it MUST BE A MACRO.  Otherwise, you will not be able to get close enough to the teeth to photograph them well.
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    Now on to the Camera Bodies:

    For Canon, as of today (12/18/2010), I recommend the Canon T2i for 1 very simple reason: not only does it have all the nice features necessary to take high-quality pictures, it ALSO has 1080p HD video recording capabilities.  And with the Internet rapidly becoming a major force in reaching both new and existing patients, video can be a powerful tool for influencing them; follow this link to see some of my patient testimonials on YouTube! The sheer convenience of having both a video camera and a DSLR in 1 is just too nice.  And, if you happen to be a microscope-using dentist (which I also highly recommend), you can hook up the T2i to your camera adapter and record both video or still images.
    Of course, you can also use any of the following Canon camera bodies: 10D, 20D, 30D, 40D, 50D, 60D XT, XTi, XS, XSi, or even go really upscale with the Canon 5D, 5D Mark II, or 7D.  However, I don’t recommend those because of the price.

    For Nikon, I recommend the (for the same reasons as above) Nikon D5000 or the D90.  If those don’t float your boat, you can choose any of the following (just be aware that none of these have the video either): D40, D60, D80, or D200.  Again, if you want upscale, go for the D300s or D700.

    OK, if you count up all those possibilities, you’ll realize that’s actually WAAAAAAY more than 5 possibilities.  I’ve given you the criteria I use when recommending, though, so you should be able to make your choice.  If not, please ask questions!

    I’ll cover some of the alternative DSLR camera bodies, lenses, and flashes in a future post.