Should I buy a digital or intraoral camera ... or both?

The headline of this article might seem like a simple question, but it’s not.

The headline of this article might seem like a simple question, but it’s not. This question reminds me of the old saying “That’s treating the symptom, not the disease.” The answer can be found by exercising a bit of self-analysis. Ask yourself some basic questions.

What purpose will the camera serve? What clinical or business processes will you enhance through the use of digital images? How do you plan to implement new procedures for obtaining, managing, and using the new images in your practice? What team members will be involved and how? What is the discretionary budget for this objective? What are your competitors doing in the way of imaging? Do you have a dependable and affordable way to address the installation and support of the digital hardware?

Ahhhh, now a dozen or more new questions have been spawned! It’s no wonder so many practices have only one old intraoral camera and one older SLR camera ... or possibly no cameras. It is a sad fact that some practices use their extraoral cameras more often to take pictures of sporting events, holidays, and vacations than they do of patients. Our technology consultants often hear the comment, “Yes, we have an intraoral camera somewhere in our storage closet.”

With a little bit of planning and a moderate commitment to following through, either an extraoral or an intraoral camera can add exciting new facets to your practice. So, which one should you buy? Let’s examine our “self-analysis” questions to find out.

What purpose will the camera serve?

Patient recognition pictures stored in patients’ charts enhance trust by allowing your team to meet and greet with confidence and use the patients’ names with assurance. An inexpensive Twain-compliant camera works best. Almost all Canon cameras are Twain-compliant. Most practice-management software programs support Twain acquisition of images. This can be done with an intraoral camera, but taking these kinds of photos with an intraoral camera is a waste of clinical time. Use an extraoral camera in the reception area for this.

“Smile design” is greatly aided with extraoral photography. Using an extraoral camera provides a foundation for creating digital renditions (cosmetic-imaging software) of what the intended results of treatment are anticipated to look like. Religiously taking before and after pictures increases patient satisfaction and can enhance your team’s understanding of past interactions between the patient and your practice. Additional portraits or full-face shots with partial and full smile shots can be very effective. Always take these additional extraoral shots for your whitening and cosmetic patients.

“Before and after photos can be of two different types, but are best handled with a high-quality extraoral camera specifically recommended by the manufacturer for close-up photography. One type of before and after pictures (clinical treatment) is obtained in the clinical environment, with and without retractors. The other type of before and after photos (cosmetic/esthetic) are “full face” and can be taken by nonclinical team members.

Images can be an important part of clinical diagnosis and provide cohesive team communication about areas of concern inside the patients’ mouths. There is no substitute for an intraoral camera for this purpose. Intraoral shots with proper magnification are a must.

Imaging can be a tremendous aid when explaining the necessary treatment to patients. For this purpose, the intraoral shots are much better than any extraoral shots you could use.

What clinical or business processes will you enhance through the use of digital images?

To increase the sense of community between your team and your patients, use extraoral patient portraits in the chart. To streamline the flow of patients from team member to team member with less need of an escort, extraoral shots are great. To increase cosmetic-case acceptance, extraorals with cosmetic imaging workups are best. To increase case acceptance for restorative, hygiene, and most esthetic dentistry, you need intraoral images.

If your practice intends to create (or already has) a dedicated treatment coordinator position, this area of your practice demands both intraoral and extraoral cameras.

From the business office perspective, do you have a need to “close” the sale of cosmetic cases? Extraoral cameras should help increase case acceptance. If restorative, crowns, fillings, and regularly-scheduled hygiene appointments are the areas you need to improve, an intraoral camera is your only true choice.

How do you plan to implement new procedures for obtaining, managing, and using the new images in your practice?

Do you plan to obtain all your images “in the chair”? In this case, you could elect to accept a vendor’s claim that an intraoral camera is all you need. Many intraoral camera vendors offer an interchangeable lens or a “full face/portrait” setting on their cameras. So, if this is the case, then you might be able to go with an intraoral camera only.

Depending on which camera you select (or perhaps both), you’ll need to sit down with your team and work out the step-by-step process of how the images will be collected, when and where they will be collected, what new responsibilities will be assigned and what old ones can be eliminated, how photos will be expected to be used for each business or clinical process, what the standard “no exceptions” processes are, and what the optional or discretionary processes are.

When you have a handle on those processes, tasks, and responsibilities, you may discover that the strengths or weaknesses of your dental team will affect your decision.

What team members will be involved and how?

Who will be responsible for reviewing the pictures for accuracy and usability? Who will be responsible for making sure the pictures are annotated and stored properly? After the pictures are taken, who will be responsible for making them available to the doctor or clinical staff and communicating areas of interest?

If you are short on staff and require that any unassisted person be able to produce all the types of images you need, you’ll have to settle for what you can probably get in the clinical area using an intraoral camera (with the full-face lens). Holding a set of retractors, taking the quadrant shots and anteriors, mandibular arch, etc., is not easily accomplished by one person with an extraoral camera. If you are willing to involve the business staff, hygiene, and clinical assistants, the clinical assistants or business staff should be able to get the best extraoral shots with a true extraoral camera, while the clinical assistants and surgical team members handle the intraoral shots.

Do you plan to have the business staff transfer the pictures (taken by the clinical staff) into the computer and properly annotate or store them in the appropriate patient chart or corresponding storage location? If this is your plan, a few extraoral cameras and five or 10 storage cards and a card reader would work best.

What is the discretionary budget for this objective?

This is the area that will most likely determine “which camera should I buy or should I buy both?” If you have a small budget and are not performing a lot of cosmetic dentistry, you probably would benefit more by starting out with the intraoral camera to increase case acceptance of restorative work. Once your profits are up, you can add more intraoral cameras and/or invest in a cosmetic- imaging software package and some really nice extraoral cameras.

If your budget is constrained and your main objective is to increase the cosmetic aspect of your practice, start with the extraoral camera. You can use these images for before and after photos to show treatment progression, potential outcomes, and options. You can also use these photos to create a “smile book” for your reception area and to assist team members in patient identification and communications.

If you don’t have a budget constraint, buy both and use the intraoral camera for dedicated intraoral shots and the extraoral camera for the standard series of extraoral and facial shots.

What are your competitors doing in the way of imaging?

If an examination of what other dental practices in your area are doing reveals a lack of competitive impetus, start small. Take your time understanding how you and your staff will handle and use the technology you choose. Get competitive bids from at least three vendors.

Try to get the vendors to come into your practice and demonstrate their software and cameras to the whole team. Then make your final decision on which system or systems you want to tackle, and in what order.

If your competition is ahead of you in this area, you may have no choice but to go with both systems to achieve parity. Pay for training when it is available and have extra meetings to practice with the technology on each other before going “live” with patients.

Get all the kinks out of the process and then force yourselves to commit to one imaging process at a time throughout the practice. Get it down so that you are functioning confidently and then move to the next system.

Do you have a dependable, affordable way to address the installation and support of the digital hardware?

If you have a great support team available locally and your systems are in top shape, you can afford to dive right into both types of imaging systems. That is, of course, provided you have the budget. Does your imaging budget include the cost of computer support or training on the software and imaging systems?

If the computer system you have is older or the support you have is marginal, you should certainly only try to implement one system first. Start with one camera and add additional ones after you’re sure they won’t create problems in your production.

If you think your situation warrants the purchase of both types of cameras, make sure that your computer system and network can handle the extra load that imaging will place on them. It is extremely important that you involve your computer support person when implementing both types of systems. Arrange time with support team members to make sure they will be able to assist you with the installation and testing of the systems.

David Redwine has more than 25 years of technology industry experience and currently serves as information technology manager and technology consultant at Jameson Management, Inc. Contact him by phone at (877) 369-5558, by e-mail at david@jamesonmanagement.com, or visit the company’s Web site at www.jameson management.com.

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