DentalPhotography

Mike R Sharland

An Update on Digital Photography for the General Dental Practitioner

Abstract: Digital photography technology has moved on dramatically in recent years, with photography in general becoming an even greater part of the social scene. The popularity of camera mobile phones and compact cameras have been major factors in the resurgence in the popularity of general photography. So, how has this revival and technological advancement affected dental photography? Understanding the equipment, and how to use it successfully, is still important, but many of the advancements have made life very much easier for the dental practitioner wanting to embrace this visual medium. Clinical Relevance: This article will keep practitioners updated on the equipment available, and make the choice of equipment easier. Dent Update 2008; 35: 398-404

The articles published in 20041,2,3 covered a variety of techniques: these generally have not changed, so they will not be covered again in this article. However, information regarding camera settings etc. can be found at http//:www.thedigitaldentist-site.org.uk

Getting started
Camera choice

It could be anticipated that a 4 Megapixel camera will be more than adequate for many years to come.1 It is still adequate, but because of the constant hype, 5, 6, 7..12 megapixels are the norm for most cameras. Do we really need all of those pixels? Yes and no! A higher pixel count means a higher resolution image, much higher than you would need for a computer monitor or a 7 x 5 print. But, with the popularity of image manipulation software such as Adobe Photoshop Elements, and the increasing popularity of the RAW, a file

Figure 1. A range of cameras all capable of intra-oral photography: (a) Digital SLR 2; (b) Bridge 3; (c) Compact.

type discussed later in this article, more pixels are a bonus. So as far as megapixels are concerned, more is better, but there are many other considerations, such as cost and storage options for these larger image files.
What camera? (Figure 1)

Mike R Sharland, Head of Multimedia Services, School of Dentistry, University of Birmingham, St Chads Queensway, Birmingham B4 6NN, UK.

Digital SLR (Single Lens Reflex) camera; Digital Compact camera; or Bridge camera? Just the 3 choices then? Not quite, behind these three camera types is a huge choice of specifications. So where do you start? The author has already established that more megapixels cant be a

bad thing, but both DSLR and Compact can have the same megapixel count. In 2004, camera choice was more limited, the cost-effective choice being a compact digital camera. Since then, Digital SLRs have dropped dramatically in price, though the lenses and flash necessary for dental photography have remained fairly static. A big gap in cost between DSLRs and compact cameras still exists. Practices that are looking to the future, and want to promote a more professional image, will invest in a DSLR from the outset. The pros and cons for Compact, Bridge and DSLRs are shown in Table 1. July/August 2008

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Camera type Compact

Viewing Method LCD/Rangefinder

Lens Fixed Zoom

Flash Built in

Advantages Size Low cost Can produce good intra-orals Size Reasonably low cost

Disadvantages Inconsistent Needs practice

Bridge

LCD or Viewfinder (Electronic)

Fixed Zoom

Pop-up

light

Pop-up flash not ideal for dental photography. Needs another source Needs practice Size Cost Needs light source and macro lens

DSLR

Viewfinder (LCD Live View*)

Interchangeable

Pop-up

Point and shoot Consistent quality results

*Latest models only.

Table 1. Compact/Bridge/DSLR: advantages and disadvantages.

Figure 2. 105 mm and 55 mm lens comparisons showing working distances. A 105 mm Macro would achieve 1:1 magnification at 15 cm.

satisfactory, but with limited functionality in terms of autofocus and metering. Flash units previously used on 35 mm cameras will often not operate on the new digital SLRS. So it may be a good time to change to Canon and Nikon, and, although many manufacturers are endeavouring to bridge the gap, namely Sony, Samsung, Pentax etc, there is still the issue of compatible accessories at a reasonable price that needs to be carefully considered. The author understands that there is also an element of personal choice. Most DSLR systems can be used for dental photography, it may just take a little more time, effort and expense to put a system together. The authors own personal recommendations are at the end of this article.
Lens choice

As far as choice of manufacturer is concerned, the big two, Canon and Nikon may still be considered to be the best option in terms of support and accessories, in particular for dentistry. Users may well feel that they need to stick with systems because they have 35 mm lenses that will fit the equivalent manufacturers digital cameras. These lenses are often July/August 2008

Optimized lenses specifically for the digital format are now available and optical quality is constantly improving. The majority of compact cameras still have good macro facility built in but DSLRs ideally need an interchangeable macro lens for intra-oral images. Lenses are measured in focal lengths, a zoom lens has two numbers, one

relating to its widest angle of view (Wide Angle 28 mm) and the other its narrowest angle of view (Telephoto 90 mm), it also has other numbers in between. The telephoto or the bigger of the two numbers being of more interest to us in terms of working distance (gives more space between the user and the patient); compact cameras generally come with zoom lenses. In the case of a DSLR camera, a prime (non zoom, fixed focal length) macro lens is preferable. These broadly speaking come in two types or focal lengths. A 60 mm macro lens will give the user the magnifications required, but the working distance will be shorter than if using a 105 mm macro lens at the same magnification. A reasonable working distance is more comfortable for patient and photographer and can have other photographic advantages (Figure 2). A major factor when taking clinical photographs is the macro capability of the lens. Macro is the ability to produce an image at 1:1 magnification or greater and, though many cameras will be designated as having macro, not all will achieve 1:1 magnification. The best way of checking the macro function on a Compact or Bridge camera is to try it out in store. Macro lenses for DSLRs generally will achieve at least 1:2 magnification. DentalUpdate 399

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Figure 3. Optical Zoom V Digital Zoom (2 images showing the effect of zooming in digitally).

Rangefinder Unsuitable for close up work, available on some compact cameras

LCD Live preview of image on compact cameras and some newer DSLRs

Viewfinder Available on Bridge (EVF*) and DSLRs. Viewing is Through The Lens (TTL)

pixelated (individual pixels can be detected in the image). When using digital zoom the camera is enlarging the centre of the image, just like enlarging a 35 mm picture, and the user will get a grainy result, which is referred to as noise in digital photography (Figure 3). Digital zoom is not available on DSLRs. In the previous section, it was mentioned that lenses from 35 mm equipment can be used on DSLRs with some limited functions. This is true, however, there is a difference in manufacture between a lens designed for 35 mm and one designed for digital. The main factor in this is the way light hits the sensor, and lenses specifically designed for digital should get better image quality than using a conventional 35 mm lens on a DSLR.
Viewfinders

Table 2. Viewfinder types. *Electronic viewfinder.

In the case of Compact or Bridge cameras, the user must be careful that the camera is not using digital zoom to achieve

close-ups. In this respect, digital zoom is the camera zooming in electronically on the image. The resultant image can be

Essentially, there are four methods of viewing your image prior to taking a photograph (Table 2). Rangefinder typesnot really any change here, simply a piece of glass running front to back in the camera, not suitable for close up work as its not seeing what the lens is seeing. LCD Screens are getting bigger, brighter and higher resolution. The latest on the Professional Nikon D3 DSLR is a 3 LCD 922,000 pixels, many Compact cameras

Type

Style

Recommended Lens Focal Length

White Balance Settings

Possible Settings

Power

Ring Flash

Ring Flash

100 mm

Flash

ISO 100 F22, 1/200th ISO 100 F22, 1/200th ISO 100 F22, 1/200th ISO 400 F16, 1/60th ISO 400/800 F16, 1/60th

Rechargeable batteries Rechargeable batteries Rechargeable batteries Rechargeable batteries Separate battery pack

Ring and Point Flash

Ring Flash and Point Flash Twin Flashes

100 mm

Flash

Twin Flash

100 mm

Flash

LED Light

Ring Light

60 mm

Daylight/Cloudy

POV

Twin Lights

60 mm

Daylight

Table 3. Light Sources (DSLR) and settings.

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and can see little use for it in dentistry at the present time. Electronic ViewFinder (EVF) This is a small LCD with a magnifier lens for eye level image viewing. It is mainly used on Bridge and video cameras. It gives a good view of what the lens is seeing, however, focusing is not as easy as a conventional viewfinder (see below). Throughthe-lens (TTL) Digital SLR (Single Lens Reflex) cameras view the image directly through the lens, and thus give the user a view of exactly what is being photographed.
Light sources

Figure 4. Alternative light sources: (a) Dine Ring and Point flash; (b) LED; (c) POV twin light source; (d) Twin flash.

This is one area that has seen big developments since the introduction of affordable digital SLRs. Conventional ringflash is the first choice for most users. It is a good light source for digital SLRs, as it has always been for 35 mm SLRs, but now there are some relatively new kids on the block, in particular LED light sources and colour corrective consistent light sources such as the POV(ref ) . The user needs to decide which source will suit his/her equipment and image requirements, each of these light sources will produce good intra-oral images, albeit with different combinations of lenses and settings and it is important to take these into consideration when deciding on a light source. Table 3 and Figure 4 should help you decide. Another consideration with your light source is specular reflection (light reflected off the tooth surface). Where this appears will vary depending on the light source: for instance a ringflash, because of its position around the lens, will reflect off the centrals, whereas the POV or twin flashes will produce a different result (see Figure 5).
File types4

Figure 5. (a) Ringflash; (b) LED light; (c) POV; (d) G9 on.

will have large LCD screens but its the large pixel count on the Nikon which makes it stand out. Compact cameras have always had LCD screens that allow you to preview, ie compose your shot on screen, as well as reviewing your picture afterwards. Up until

recently, DSLRs did not have the preview facility, but now the newer cameras are being introduced with Live View which gives you the option of composing your image on LCD rather than through the viewfinder. The author considers that it is the use of this new feature that is debatable,

As has been the case for many years, images taken on most digital cameras are saved as JPG (Joint Photographics Experts Group) files. JPGs are a compressed image file, and therefore can suffer from artefacts (the degradation of pixels in the image, resulting in some blockiness of the image). Tiffs (Tagged Image File Format) were also a common file option on digital July/August 2008

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RAW 11.5 MB

TIFF 36 MB

JPG Fine 3.5 MB

JPG Normal 2.5 MB

JPG Basic 0.8 MB

See Table 4 for a comparison of file size in relation to camera megapixels and file types.

Approximate sizes
Table 4. File size/type comparison based on a 12 megapixel DSLR.

Camera settings
Once camera/lens/flash have been purchased, the results achieved, whether it is an inexpensive Compact camera or an expensive top of the range DSLR, are dependent on the choice of settings. This will affect, amongst others, the exposure (light or dark photograph), the depth of focus (how much is in acceptable focus from front to back of the mouth), and colour. Go to http://www. thedigitaldentist-site.org.uk to see the authors recommended settings.

Compose and photograph image (JPG & RAW)

Download to PC or Laptop

Burn CDR/DVD or RAW images only and store in a safe location

Open images on PC/LT in Photoshop Lightroom to add tags and ratings

Digital workflow
In Photoshop make duplicate, copy, and adjust image as required
This is a buzz word at the moment. It defines the way you work with digital photography, from pressing the shutter to manipulating and backing up your images. For instance, the authors digital workflow is as shown in Table 5. The author will go through this process every time a shoot is finished. Individuals may have very different workflows, but one thing that should be common is the inclusion of a robust back-up solution.

Save adjusted image as a PSD (Photoshop Document)

Save adjusted image as TIFF or JPG

Burn onto CDR/DVD with original RAW

Print or submit image for publication, certification etc.

Image transfer
Digital cameras usually have a link lead to plug into your PC/Mac. This can be a USB or Firewire/i-Link (Sony) connection. All modern computers/laptops will have at least one USB connection. Software such as Adobe Photoshop Elements (currently version 6) or the free software Picasa from http:// picasa.google.com/download/thanks. html are ideal for downloading and to catalogue images. If the user does not wish to tie the camera up downloading the images, then invest in a card reader. The removable camera memory card will slot into this reader, which again will be connected via USB.

Backup to external Hard Drive

Table 5. Flow chart of workflow.

cameras, some cameras still include this file type as an option. This uses a form of lossless compression and doesnt suffer from artefacts as such. Now there is another file option on many cameras, DSLR and Compact, and that is RAW. This doesnt stand for anything other than a raw data file of your image it is not a typical image file. RAW files will need special software to view and change settings. July/August 2008

The choice of file will be dependent on your uses. The author believes that anything other than routine shots as a record should be taken in RAW format. It does have a big impact on storage, but the overhead costs of this have come down significantly over the past 5 years. RAW files are often the specified file format for many submissions to Associations,5 one of the main reasons for this is that a RAW file cannot be directly manipulated.

Conclusion
Digital photography is becoming an essential part of everyday dental practice. DentalUpdate 403

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All practitioners should consider the benefits, not just in the short term, but long term too, especially in medico-legal terms, patient education, staff training, etc. By keeping to simple guidelines, dental photography is well within the capabilities of all staff and, in particular, the dental nurse, who is in an ideal position to take photographs throughout procedures with little impact on surgery time and organization. The authors ideal specifications for photography in the dental practice are:
For Compact cameras:*

and flash. *Recommended Canon G9

References
1. Sharland MR. Digital imaging for the general dental practitioner: 1. Getting started. Dent Update 2004; 31: 266272. Sharland MR. Digital imaging for the general dental practitioner: 2. Intra-oral imaging. Dent Update 2004; 31: 328332. Sharland MR. Digital imaging for the general dental practitioner: 3. Extra- oral imaging. Dent Update 2004; 31: 385390. Turner J. Digital imaging: an update. Dent Update 2008; 35: 385395. http://www.bacd.com

For Digital SLRs:*

6 Megapixels+ 100 mm* or 60 mm Macro lens Ringflash*/LED Light/Colour Corrected Portable light source *Recommended Canon 400D or 450D/Sigma 105 mm Macro/Dine Ring and Point flash Nikon D60 or D80/Sigma 105 mm Macro/Dine Ring and Point flash.
Acknowledgements

2.

3.

4 Megapixels+ Good optical zoom Good macro capability Manual control of aperture, shutter speed

4.

The author acknowledges the support of Professor Trevor Burke, School of Dentistry, University of Birmingham.

5.