LVI Photographic Series

Thomas K. Hedge D.D.S., F.A.C.E.
LVI Vision
January 2002

LVI has developed a recommended photographic series to aid our doctors and staff in diagnosis and treatment planning for neuromuscular and esthetic dentistry. Once this series is utilized for diagnosis and treatment planning, it can be used for patient presentation and laboratory communication.

This series was developed specifically with digital photography in mind, but film cameras can be utilized also. There are 20 images in this series. There are many other useful shots that were not included to try to keep the number of images manageable.

There are six categories of shots in this series. The first category is the extraoral head shots. The first and most simple shot is the frontal portrait. The face can be framed in almost any manner, but the occlusal plane of the teeth must be parallel to the long axis camera lens to allow for accurate imaging. This shot is the only one with the longer aspect of the frame vertical. Ask the patient to show teeth when they smile. The next two shots are profile shots with the patient at rest and in occlusion. A shot with the patient biting on cotton rolls can be added to demonstrate opening the vertical.

The next category is the extraoral smile shots. These shots are framed to the corners of the mouth. The first shot is of the lips at rest with the lips slightly parted to show teeth. The next is a full smile. These two shots show what happens to the curtain of muscles that make a smile. The final two shots are of the lateral smile. This allows the patient to see there smile from the point of view others see. How many teeth show? Do we see the first molars?

The third category is the start of the intraoral shots. From this point on, all shots will be retracted. The first two are the full arch from the front in occlusion and slightly open to show the lower anterior teeth. A perio probe can be layed across the centrals vertically to measure the Shimbashi in the closed shot. The next shot is of the four incisors. The next two shots are of the buccal right and left in occlusion. These are shot in a mirror with the opposite side retracted. The mirror retracts the side you are shooting.

The next two views are the Occlusal views. Have the patient hold the retractors, while your assistant holds the mirror and blows a stream of air across the mirror. Additional information can be gained by marking the occlusion with articulating paper prior to taking the shots.

The next category is the four quadrant views. These are the most powerful views, in terms of patient impact. These are shot from the distal of the cuspid to the second molar. These shots eliminate the need for intraoral video camera shots because the have greater resolution and show more teeth.

The last two views aid us in our neuromuscular diagnosis. The first view is the parayngeal view. Have the patient hold the retractors while the assistant retracts the tongue with a mirror. We are evaluating the tonsils and airway in this shot. The last view is the submental face. We have the patient tilt their head back and shoot from their chin capturing the maxillary incisor midline, filtrum, septum, and nasal airway.

A photographic diagnosis is every bit as important as any other piece of diagnostic capability. There is a wealth of information that can be missed and this information can be reviewed after the patient is gone.

We go over this in great detail with a hands on session with various cameras at the Digital Dentistry course.