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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 pa- tient’s expectations, and the continued growth of aesthetic dentistry, particularly within the private sector. I believe that good communications be- tween dentist and technician is essential, and can be further enhanced by making use of new tech- nology, in an effort to achieve ideal restorations that will satisfy both the patient’s and the dental professional’s 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 elimi- nate the need for remakes, due perhaps to incor- rect 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 impor- tance. • A careful shade analysis by a clinician or technician, and the consequent production of a prescription or map of the tooth that will of- fer 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 dehydra- tion (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 res- torations – 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 clincian’s 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 re- sultant 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 condi- tions. However, last October, I was introduced to the new Optilume POV (Point of View) lighting system for use with both loupes and dental pho- tography. 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

Technology Improved communications through dental photography Phil Reddington explains how technology has helped him produce successful

Figure 1: Patient’s appearance presented at pre-op stage

Technology Improved communications through dental photography Phil Reddington explains how technology has helped him produce successful

Figure 2: Basic shade determination using conventional shade guide

Technology Improved communications through dental photography Phil Reddington explains how technology has helped him produce successful

Figure 3: Taking the stump shade

Technology Improved communications through dental photography Phil Reddington explains how technology has helped him produce successful

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

Technology Improved communications through dental photography Phil Reddington explains how technology has helped him produce successful

Figure 4: Patient’s resultant post-operative appearance, showing much improved aesthetics

106 Aesthetic dentistry today

March 2008 Volume 2 Number 3

Technology

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

Figure 6: Shows photographic result when using SLR camera and ring flash. Note the ‘bleached or flashed- out’ appearance due to specular reflection

performed, and to determine if it would offer ad- vantages 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 magni- fication of 1 in 2(x2) Custom white Balance set using 18% grey card Ring flash (Macro ring light) on ETTL mode POV Setting – ½ light setting, angle 45 degrees Over the next few weeks, Alex was briefed to look out for patients who exhibited interest- ing dentitions. These patients were duly photo- graphed, and it was then that we noticed interest- ing 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 inter- nal colours and features were not ‘masked-out’. This ability to show the all-important internal colourations is down to the POV’s constant light source. When viewed on a good screen the in- tensity and shade of the internal nuances were much easier to determine, especially in the usu- ally hard to capture incisal third. Whilst neither method can be 100% accurate for shade match- ing, 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 selec- tion of comparative photographs. Clinical pho-

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

Figure 8: This picture illustrates the specular reflection with a ring flash, and lack of detail or definition of internal tooth colours and effects

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

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 clini- cians 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 resto- rations that satisfy patients, clinicians and my-

self.

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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

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

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

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

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 stria- tions in all teeth, due to low level of specular reflection

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

Figure 11: Shade details

Technology Figure 5: Colour indicator. A guide to assist in assessing specific colour details in teeth

Figure 12: Good communication

106 Aesthetic dentistry today

March 2008 Volume 2 Number 3