Читать книгу Protocols for Mobile Dental Photography with Auxiliary Lighting - Louis Hardan - Страница 9
ОглавлениеThe primary reason to document in dentistry is to record with precision the actual oral situation or procedure performed, and as part of this process dental photography can be employed for diagnostic, clinical, and medicolegal purposes.
Patients’ dental records comprise documents concerning the history of their dental conditions, clinical examinations, diagnoses, and treatments. The primary reason to document in dentistry is to record with precision the actual oral situation or procedure performed, and as part of this process dental photography can be employed for diagnostic, clinical, and medicolegal purposes.
High-quality photographs are required to obtain more information from the images, allowing their use in multiple fields of dentistry. Photography can be used for treatment planning, documentation and self-evaluation, communication with the patient and laboratory technician, tracking the evolution of treatment, as well as for publishing, lecturing, and marketing; it can also be used for artistic, insurance, or legal purposes.
Treatment Planning
From the patient’s first visit to the dental clinic, dental photography can prove its worth as a diagnostic and evaluative tool. A complete set of oral photographs is essential to create a thorough treatment plan. It can be a very useful implement for the analysis of facial profiles, for the evaluation of prosthetic rehabilitation, for the detection of caries or enamel defects, and for the assessment of gingival health and periodontal pocket or ridge morphology prior to implant placement. Moreover, photographs can be sent to external specialists for a second opinion without need for patient consultation, facilitating better diagnosis and optimized treatment planning. For esthetic cases, photographs can be used to build a smile design so the patient can see the final outcome via a virtual mockup on screen that can be printed and transferred to the mouth with bis-acryl material (Figs 1 and 2). Many smile design softwares are evolving to be used on smartphones as an app or on a website where you can upload photographs directly from the image gallery.
FIGS 1 & 2 The patient can see his final smile design before beginning treatment. The photographs serve to build this smile, and if the patient approves the design, the dentist can begin the treatment in a guided way.
Documentation and Self-Evaluation
For many years documentation in dental records relied on handwritten notes, radiographs, study models, and clinical photographs. Today most of this documentation is digitized for accessibility purposes. Photographs constitute a very effective archiving tool, providing improved documentation of clinical conditions over time and facilitating observation and monitoring.
Photographs also allow a more precise assessment of the completed work and the procedures followed, enabling effective self-evaluation. Details imperceptible to the human eye without magnification all of a sudden become clear. Moreover, the practitioner can easily examine and compare different procedures for different patients to determine which led to a better outcome, potentially improving future treatment planning.
With the evolution of smartphone cameras, accessibility is further enhanced because every dentist has a phone in his or her pocket that is designed to be user friendly. Photographs taken on a smartphone can be organized into folders by case and later evaluated on a larger screen to evaluate the quality of the work in hopes of improving it in future cases (Figs 3 and 4).
FIGS 3 & 4 Before and 4 weeks after restoration of the first molar (and 1 year after restoration of the second molar). Examination of these photographs allows better assessment of the work performed than direct examination in the mouth and exposes any problems that can be corrected in the future.
Communication with the Patient and the Dental Technician
Effective communication between the practitioner and the patient is crucial for the success of any dental treatment, and a photograph is the simplest way to communicate dental information to patients. Images leave an impression on the patient and give him or her the sufficient confidence to move forward with treatment. Sometimes it is only by seeing photographs of their teeth that patients really understand their current dental situation and the treatment planning that the dentist proposes. This is especially true for patients who have sought dental advice elsewhere with negative experiences.
Patients often appreciate viewing photographs of their dental procedures to see exactly how their treatment was carried out. Patients can hence visualize things that they were only capable of imagining before, such as the presence and size of carious lesions (Figs 5 and 6) or the shape of pulp chambers during root canal treatment. Furthermore, by showing photographs of the clinical sequence of similar cases to the patient during the treatment plan presentation, he or she is better able to understand the procedure and predict the result. This is often helpful in justifying the cost of treatment, especially in advanced cases.
FIGS 5 & 6 Patients should know that sometimes a small black line on a tooth can hide a big carious lesion and that they should consult a dentist when they see such a lesion on their teeth. This information can be very empowering for patients who want to be in control of their dental health.
Good communication should also exist between the dentist and the dental technician, especially in the domain of esthetic dentistry. Even the most detailed description written by the dentist cannot compare to the information communicated with a well-shot photograph. Photographs can help the technician visualize how and where his or her work will integrate in its environment. A large amount of information is transferred via photograph, such as the color, shape, alignment, personalization, translucency, opalescence, and halo effect of adjacent teeth.
In addition to other advanced techniques of communicating color information to the laboratory, the following three photographs are very useful:
1.A photograph of a shade guide positioned edge to edge with the natural tooth to show the difference between them (Fig 7).
2.A polarized version of the previous photograph to show the extension of the translucency and its location in the incisal edge, the presence of some details like white spots, and also the difference in color with the artificial shade guide (Fig 8).
3.A photograph showing the secondary and tertiary anatomy because esthetics are not only hue, chroma, and value but also anatomy (Fig 9).
FIGS 7–9 The three photographs that should be sent to the dental technician: (1) anterior shot with edge-to-edge shade guide under diffused light; (2) polarized version of edge-to-edge shade guide; (3) shot taken with the light coming from the opposite side of the camera to show anatomical details of the teeth.
Evolution of the Treatment
Photographs are taken prior to any treatment to be used as a baseline indicating the primary situation and to be studied for treatment planning. However, follow-up photographs are just as essential to evaluate the progress of the treatment plan. Photographs can be taken on a regular basis throughout different phases of treatment. Thus, the evolution of the clinical situation and the treatment plan can be monitored according to a certain time interval. This is especially important in specialties like orthodontics, prosthodontics, restorative dentistry, and periodontics. Furthermore, photography allows clinicians to objectively assess any changes in color, shape, or integration of any materials used intraorally (Fig 10), which can aid future treatment planning.
FIG 10 Photographic documentation allows the dentist to see the evolution of the treatment and the behavior of dental materials over time. In this case, the fissure sealant on the first molar was performed 20 years prior to those of the other teeth.
Lecturing and Publishing
Dental publishers and meeting organizers are very strict about their image criteria, so it is very important to take high-quality photographs if you are interested in preparing any lectures, posters, articles, or books.
A successful dental lecture is based not only on the contents and the communication skills of the lecturer but also on the quality of the photographs and videos presented. Sought-after lecturers are known for their outstanding photographs (Figs 11 and 12). This is because dentists are visual learners and photographs allow the dental audience to have a clear and comprehensive idea of the topic presented. For example, in diagnosis, photographs make the identification of pathologic situations or lesions and the execution of their treatment easier, because a visual reference was already provided. Photographs or videos also portray the different stages of a procedure step by step, giving audience members a visual guideline that may help them in the future. Furthermore, dentists are able to see a clinical situation on a much bigger scale where details can be highlighted and studied.
FIGS 11 & 12 When lecturing on big screens, high-quality photographs are a must.
Concerning scientific studies and publications, photographic documentation is a huge asset. It gives the opportunity of remote scoring and enables multiple scorers to evaluate images for scientific purposes. Dental clinicians can compare cases or evaluate a given case over time. In this context, dental photography is an adaptable, reliable, and reproducible recording technique that enables longitudinal studies.
Documentation is mandatory in postgraduate programs at universities, so dental students must start learning how to document with photography in their undergraduate career. They must learn how to frame a shot, how to manage light, and how to “make a picture” (Figs 13 to 18). Once these basics are mastered, it will be easier to upgrade to greater photographic skills during the postgraduate program. These will be necessary for any seminars, case presentations, posters, thesis defense, and article publication.
FIGS 13–18 Undergraduate students are able to take good photographs with their smartphones without the use of professional cameras, which is especially useful when they cannot afford one. They only need to be taught how to play with the light and how to frame the shot.
Marketing
If permitted by governing law, marketing and advertising can have a great impact on the success of a dental practice. For a long period of time, dental marketing was by word of mouth, relying mainly on good interpersonal relationships between patients and dental staff and referrals to friends and family. While this is certainly still relevant, digital marketing is becoming increasingly important with the growing use of the Internet and social media. Photographs can be presented on brochures, displayed in the dental clinic, or transmitted via social media networks (eg, Facebook, Twitter, Instagram) or email. Image content is prioritized on many social media platforms, creating an exceptional marketing opportunity for dental practitioners (Figs 19 and 20).
FIGS 19 & 20 With the increasing popularity of social media, digital marketing is taking on more importance in dentistry. High-quality photographs are required to catch the eye of future patients. Smartphones make it easy to take such photographs and immediately upload them to social media platforms.
Photographs used in marketing can be “before and after” photographs or a sequence of photographs showing the different steps of a treatment. Digital marketing like this results in high visibility and targets a large base of potential patients. High-quality photographs are mandatory; otherwise, the advertisement will be a failure, even if the dental treatment and esthetic result were perfect.
Artistic Photographs
Artistic photographs such as those presented in Figs 21 and 22 can form a special and personalized ambiance in dental clinics when they are used for decorative purposes. Furthermore, artistic photographs are primed for marketing via social media. While images like this require established photographic skills, they garner attention and generally encourage potential patients to seek more information about the clinician.
FIGS 21 & 22 Artistic photographs are sometimes difficult to capture, but they are popular and demanded by many patients. Artistic shots of lips, teeth, prosthodontic elements, and more can be achieved by playing with the light and the position of the camera. These images can be used on social media, in lectures, or as decoration in the dental clinic.
Insurance
Most patients depend on their dental insurance to cover the cost of their treatment. Insurance companies must make sure that the patient really needs the treatment they are claiming, and afterward they need to confirm that the proper treatment was carried out. Photographs and radiographs serve as evidence of the pretreatment and posttreatment conditions, demonstrating the execution of treatment, and therefore excellent documentation is mandatory in these cases. An efficient filing system is necessary to have fast and easy access to this information.
Medicolegal
In the medicolegal arena of the dental field, photography is considered a key element in addition to radiographs and plaster casts. In fact, photography may be the only documentation tool that can appeal to the general population, as opposed to radiographs. In addition, preserving plaster casts of every patient for documentation can prove to be difficult because they take up physical space and complicate the filing system. Photographs, especially digital photographs, can be easily stored and organized in a way that allows the dentist to easily access them.
In the unfortunate case that a dentist is sued by a patient, photographs are the best visual aid to portray the treatment delivered. People in the legal field are not acquainted with evaluating radiographs and they may not understand medical terms, so they need visual aids to which they can relate. Meticulous documentation with high-quality photographs ensures that dentists can defend their work. Because it is often impractical and difficult to photograph every stage of every patient’s dental treatment, the decision as to what should be photographed must be left to the dentist to assess the risk. In general, expensive or advanced treatment plans warrant more detailed documentation, as do treatment plans for patients who are particularly skeptical or who have made previous legal allegations. If comprehensive documentation is not attainable, photographs should at least be taken before and after each dental treatment to show the initial conditions and the changes that occurred.
Medicolegal photographic documentation in the dental field is also relevant for forensic identification of human remains, a macabre but sometimes necessary use.
