by Jeffrey B. Dalin, DDS, FACD, FAGD, FICD
Dr. Dalin: Digital photography is becoming popular among dentists. Photographic images can be used to help with diagnosis, treatment planning, and case presentation. They also are useful in lab communications. I include a digital image with my anterior cases. Digital cameras are simple to use, quick to learn, and give superb results. This month, I am speaking with Dr. Greg Lutke about how to incorporate this technology into dental practices. Dr. Lutke is founder and CEO of Dallas Dental Solutions, a digital hands-on facility that teaches advanced hands-on courses on digital communication technology for dentistry. Greg, why should dentists incorporate digital photography into their clinical routines?
Dr. Lutke: “Visual communication” has been described as perfect communication. Simply put, this is the power of modern digital photography. Visual communication includes talking with patients during consultations and with your ceramist during the restoration fabrication. The opportunity for patients to directly view their existing condition — through their eyes — is the powerful first step in creating a trusting dentist-patient relationship.
Dr. Dalin: Dentists have a choice between digital single lens reflex (SLR) cameras and simpler point-and-shoot models. What are the advantages and disadvantages of each?
Dr. Lutke: A digital SLR camera is the easiest camera to use and the only choice to provide complete color accuracy of the digital image. While point-and-shoot models are advertised as “easier and less expensive,” actually just the opposite is true. The overall image quality of the best point-and-shoot camera is poor and not sufficient for the needs of dental professionals. It is also difficult to use in a clinical environment.
Once a dental professional learns about the digital SLR camera and the associated digital workflow, he or she is set to go. Modern digital photography with a digital SLR results in stunning image quality and a technique simple enough to become a standard part of all new cases.
Dr. Dalin: Our readers might represent diverse levels of understanding of digital photography. Can you summarize the important features to look for when selecting a camera in terms of optical vs. digital zoom, and number of megapixels?
Dr. Lutke: Current digital SLR cameras from Nikon and Canon have resolutions (or pixel dimensions) beyond a dental professional’s needs. So resolutions should never be a consideration in selecting a camera. Once cameras reached six megapixels, then dental professionals had sufficient resolution for needs with patients and laboratories.
The lenses used in dentistry are called “macro,” or close-up photography lenses. These lenses don’t have a zoom (optical) feature like those that might be used for vacation photography. These dental lenses are usually 100 to 105 mm and are standard for dental photography. The key is the dental flash. For years, Canon has had a good flash that adjusts its light output automatically during patient photography. This ability is called TTL, or through the lens, metering. Nikon has a tremendous wireless TTL flash for dentistry that doubles as a wireless portrait photography studio. I use the Nikon flash and believe it is the state-of-the-art dental flash.
I do recommend either Nikon or Canon to dental professionals since I think these companies have a total solution for dental photography.
Dr. Dalin: Digital cameras take pictures in different formats: JPEG, TIFF, and RAW. Can you talk about the positives and negatives of these formats?
Dr. Lutke: Each format is the best for specific uses. Let’s look at each:
JPEG: JPEG is a universal picture file format. It is clearly the most used picture format in digital photography due to its small size. This is also its chief advantage. The small file size of a JPEG makes it ideal for Internet transfer and storage of numerous images on practice hard drives. On the downside, JPEG images undergo degradation during file creation. This loss of quality is mainly in color information but also in sharpness. In other words, the original picture undergoes quality reduction on the path to small file size. The loss in compression applied to JPEG conversion happens each time a JPEG file is edited and saved. Thus, multiple edits to an original JPEG results in many generations of quality loss. This is the format’s big disadvantage. Overall, a JPEG is still sufficient for most user needs. Final grade: Best for the Internet and PowerPoint uses.
TIFF: TIFF is also a universal picture file format. But TIFF is much the opposite of a JPEG. TIFF files are large — about four times larger than a JPEG of the same pixel dimension or resolution. TIFF file creation is “lossless” and the highest possible image quality for saving picture files. Few digital cameras use TIFF as a capture file type, so it is typically used as a file type for edited images in Adobe Photoshop. The TIFF file format also allows for multiple layers. This is most useful in patient or laboratory communication. Layers can be text, lines, or other objects used to communicate horizontal planes on patient faces during esthetic case development. Overall, the TIFF format is about the highest image quality and layers. Final grade: Best for printing, lab communication, and overall image quality.
RAW: A RAW file is not yet a universal picture file format. A RAW file is simply information captured by the camera sensor and saved for image creation by a computer. The computer then converts a RAW file to one of the universal picture files, like JPEG or TIFF, for dental uses. In other words, RAW is a capture file format only. These raw files are read-only.
During RAW format capture mode of a dental patient, camera settings are ignored (except for ISO). Decisions on exposure, white balance, sharpness, and resolution are decided by the photographer later during work on the computer. This is both the chief benefit (quality) and the chief disadvantage (time) for the RAW format. Of course, the advantages far outweigh the disadvantages if the photographer is most interested in quality and archival quality patient photography. RAW format capture has been described as the only digital photography that is superior to 35-mm photography. The chief advantage for the dental photographer is “real” images that have virtually perfect color. The original RAW file (a read-only file) must be converted to either a JPEG or TIFF file for dental uses. Final grade: Has, by far, the best capture format, the most options after image capture, and can be used when digital photography simply becomes just photography. RAW capture is the only format I use with patients.
Dr. Dalin: How can we best learn to utilize Adobe Photoshop and cosmetic imaging?
Dr. Lutke: Adobe Photoshop has been described as a difficult and complex software. Fortunately, the parts needed for dental professionals are easy and straightforward to learn. First, Photoshop can correct the two problems digital pictures exhibit — narrow tonal range and slight blurriness. Dental professionals can learn how to correct a histogram and add sharpness. This is all the help they need from Photoshop to improve image quality.
You listed cosmetic imaging as a Photoshop skill. It is for a dentist who is classically trained in smile design. Once a dental professional knows the proposed final smile — following the rules of occlusion, periodontal tissue height, buccal corridor position — then it is Photoshop from there. Creating a Photoshop layer to mimic a veneer or ceramic crown is the most useful tool, but whitening and tissue contouring are necessary for most cases, too. Managing Photoshop layers to create a proposed smile for a patient who is interested in esthetics or a restorative treatment plan is a powerful communication, maybe the most important communication in case acceptance.
Dental professionals can master the skills necessary to cosmetically image a “before smile” photograph. We teach these skills in hands-on courses at Dallas Dental Solutions. But dental professionals who understand layers could learn this technique on their own. Either way, cosmetic imaging is certainly worth the effort and will pay huge dividends in communicating the results of clinical skills.
Dr. Dalin: Would you discuss the use of PowerPoint and patient presentations?
Dr. Lutke: PowerPoint is the final step. PowerPoint is communication or storyteller software. PowerPoint combines the digital photographs, digital X-rays, digital video, and cosmetic imaging for a truly cohesive consultation. When a dentist gathers data on a patient and then carefully formulates a treatment plan, it is PowerPoint that visually communicates the treatment plan to the patient. I think this is the most important step in the digital process. The PowerPoint presentation is 100 percent about the patient’s existing dental condition and 100 percent about the patient’s proposed solution. All this is communicated visually.
Dr. Dalin: Dentists do not need to be afraid of these technologies. Won’t education and training help prevent this?
Dr. Lutke: Exactly. We just need to start. The good news is that the digital technology we need to learn is easier than the dentistry we do daily. The difference is digital technology is just a new subject for most of us. A good plan would be to get a digital SLR camera with a macro lens for dentistry and a true TTL flash for exposure control during patient photography. Then practice on staff, family members, or anyone who is willing to help you learn. Practice is the best teacher.
The second step is to learn the computer part of photography. This would include installing Adobe Photoshop and Microsoft PowerPoint softwares. The computer part can be fun and may be the least stressful part of this experience because you don’t work on it with a patient present. You can learn the software efficiently and become proficient, but at your own pace. Again, repetition is the key to adding technology to your practice.
Dr. Dalin: Is there anything else you want to discuss about digital photography?
Dr. Lutke: I would encourage everyone to experience the wonderful world of digital technology. I promise a fantastic journey, many interesting moments, and some frustration along the way. In time, you will learn the details and become a master of digital dentistry. In the end, you will wonder how you ever practiced without digital technology. Not only will you enjoy this great experience, but your patients will benefit from understanding their dental solutions in a new way. Everyone wins with digital!
Gregory M. Lutke, DDS, maintains a private practice in Plano, Texas, that specializes in esthetic zone dentistry. He is founder and CEO of Dallas Dental Solutions, a digital hands-on facility where Dr. Lutke teaches advanced hands-on courses on digital communication technology. Reach him at [email protected].
Jeffrey B. Dalin, DDS, FACD, FAGD, FICD, practices general dentistry in St. Louis. He is the editor of St. Louis Dentistry magazine, and spokesman and critical-issue-response-team chairman for the Greater St. Louis Dental Society. He is a co-founder of the Give Kids A Smile program. Contact him at [email protected].