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Photography is becoming an increasingly important tool in the dental profession. But documentation
of orthodontic or orthognathic treatment with pretreatment and posttreatment photographs can be
misleading if features on one or both photographs are distorted. The dental photographer must be
constantly aware of the importance of standardizing photographic variables when documentation of
change is important. Although total reproducibility may not be practical, the photographer can
establish a reasonably standardized approach to photographing patients. In this article the authors
present the major considerations for frontal and profile facial photographs. Lens selection, camera
position, subject distance, and position are all variables to be understood and controlled if accurate
reproduction is desired. Numerous frontal and lateral photographs were made with head position,
camera position, jaw position, and lens focal length changed to allow assessment of their
contribution to the final picture. Using easily recognized facial landmarks, dental photographers can
standardize frontal and lateral portraits for more consistent comparison. (AMJ ORTHODDENTOFAC
ORTHOP 1990;98:197-205.)
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B
Fig. 1A. Ideal head position and perspective for a frontal view.
Lens = 105 mm focal length.
Fig. 1B. Sketch of ideal head position for frontal view. A, outer
canthus to superior attachment of the ear (C-SA line); B, interpupillary line; C, encompassing area (crown to collarbone). The
line from the outer canthus of the eye to the hairline is superimposed over the C-SA line and is not specifically labeled in
this diagram.
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Fig. 2A. Ideal head position and perspective for a lateral view.
Lens = 105 mm focal length.
Fig. 2B. Sketch of ideal head position for lateral view, showing
outer canthus to superior attachment of ear (A) and encompassing area of crown to collarbone (C).
IB
Fig. 3. Distorted view caused by backward tilt of head. The chin appears prominent, particularly in the
lateral view.
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1
Fig. 4. Distorted view caused by forward tilt of head. The chin appears to be receded.
sides,
In profile views, several lateral rotation (side-toside) head positions have been recommended. Some
dental photographers recommend that the patient's face
be rotated 3 to 5 toward the camera lens, revealing
Perspective (viewpoint) is determined by the distance between the subject and the film plane. If the
reproduction ratio is held constant and lenses of different focal lengths are used, the distance from camera
to subject will be determined by the focal length of the
lens. A wide-angle lens requires close subject-to-film
plane distances to fill the field and results in viewpoint
distortion known as barrel distortion, with enlargement
of the chin and nose, elongation in the anteroposterior
dimension, and excessive curvature laterally (Fig.
6, A). A slight telephoto lens (ideally I00 mm or
105 nun for 35 mm cameras) provides the best perspective (Fig. 1A). An extremely powerful telephoto
lens creates compression-type distortion, with nearer
subjects appearing smaller, shortening in the anteroposterior dimension, and excessive flattening of features (Fig. 6, B). The best way to standardize facial
portraits is to keep the focal length of the lens the same
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E
Fig. 7. Distorted view caused by incorrect camera position. A, Camera too high; B, camera too low.
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202
Fig. 8. Three mandibular positions shown in lateral views. Differences between each of the positions
are easily discerned. A, Centric relation; B, centric occlusion; C, extreme protrusive position.
(100 m m or 105 mm) and have consistent subject-tocamera distances. Ideally, the camera can be mounted
on a tripod and the same distance used each time the
patient is photographed.
Ideal camera position is one in which a line from
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Fig. 9, A, B. Two mandibular positions shown in frontal view. Differences between the two extremes
are difficult to discern. A, Centric relation; B, extreme protrusive position.
iA
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Fig. 10. Variations in head position mask true changes in jaw position. A, Extreme protrusive position
with a forward head tiff; B, centric relation position with backward head tilt.
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204
I B
L
Fig. 11. Variations in head position accentuate true changes in mandibular position. A, Extreme
protrusive position with backward head tilt; B, centric relation position with forward head tilt.
The orthodontist, the oral surgeon, and the prosthodontist frequently must show accurate pretreatment
and posttreatment portrait photographs. To illustrate the
importance of standardizing photographs and to simulate changes in jaw position, vinyl polysiloxane occlusal
records were made and used to record jaw positions.
Five different occlusal positions from centric relation
to past end-to-end (extreme protrusive position) were
recorded and photographed in frontal and lateral views.
These positions encompassed a range of 7.5 mm. The
photographs show that, in terms of recording differences, the lateral view is far more sensitive than the
frontal view. It is possible to observe differences of as
little as 1.8 nun in the lateral view (Fig. 8), while
differences of as much as 7.5 mm were difficult to
observe in the frontal views (Fig. 9).
When the clinical photographer does not standardize
distance, head position, and camera position, confusing
or misleading photographs are likely to result. An extreme protrusive position with a forward head tilt (Fig.
10, A) is somewhat difficult to distinguish from a retruded jaw position with a backward head tilt (Fig.
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REFERENCES
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2. Gordon P and WanderP. Techniquesfor dental photography. Br
Dent J 1987;162:307-16.
3. Bengel W. Standardizationin dental photography. Int Dent J
1985;35:210-7.
4. Williams R. Positioning and lighting for patient photography.
J Biol Photogr 1985;53:131-43.
5. Larrabee W, Maupin G, Sutton D.: Profile analysis in facial
plastic surgery. Arch Otolaryngol Head Neck Surg 1985;
111:682-7.
6. Farkas L, Bryson W, Klotz J. Is photogrammetry of the face
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7. Davidson T. Photography in facial plastic and reconstructive
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8. Moorrees CF, Kean MR. Natural head position:a basic consideration in the interpretationof cephalometricradi~raphs. Am J
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