For information regarding Clinical photos, refer to the following:

• Overview
• Why does ClearCorrect require photos?
• Photo requirements
• Taking clinical photographs
• Tips on taking photos
• Common photo mistakes
• Before and after photos
• ClearCorrect® Sync Photo Uploader App

Overview

ClearCorrect requires you provide clinical photos for each case you submit. Photos help us understand your prescription and interpret your instructions. If you don’t have the photos on hand when you submit your case, you may be able to upload them later on the case page, but don’t wait too long—the case won’t move forward until we have all required records.

In this article we will cover clinical photographs, why we require them as well as tips and information to help with taking quality clinical photos of your patients.

Why does ClearCorrect require photos?

Proper patient photos of the patient's true occlusion are required so that initial articulation can be set properly. No matter the number of teeth that are moving, initial articulation is perhaps the most important aspect of a treatment plan. If this is set incorrectly, every movement made, no matter how minor, could result in a negative or worsened outcome for the patient. Outside of that, we also need to ensure that the materials we have belong to the patient so that no time is wasted on creating a setup that does not belong to the patient, or wasted time for the doctor reviewing an incorrect setup.

Another reason ClearCorrect requires photos is to accurately orient the patient's occlusal plane. The occlusal plane is a line that is drawn along the occlusal surfaces of the lower molars and premolars. 

Without a photo of the patient smiling, the models may be oriented with the occlusal plane too flat or excessively tipped, causing the maxillary incisors to look like they need to be intruded or extruded. Note in the images below the difference when the occlusal plane is calibrated. The angle of the occlusal plane varies from patient to patient. After receiving impressions data, the technicians must attempt to accurately orient the patient's occlusal plane before staging treatment from your prescription.

Photo requirements

We need photos of eight specific angles:

Your photos will need to be uploaded as digital files when you submit your case in the Doctor's Portal. The most important thing is to include clear, well-lit photos, in focus from all eight angles.

Eight Angles

Below are the eight different photo angles required for your submission. These photos will help us produce the best aligners possible:

• Full face (not smiling)
• Full face (smiling)
• Profile (not smiling)
• Occluded buccal view of anterior
• Occluded buccal view of right lateral
• Occluded buccal view of left lateral
• Occlusal view of upper
• Occlusal view of lower

Watch this video on how to take photos and x-rays.

Taking clinical photographs

There are plenty of courses you can take to gain skill and become more proficient in clinical photography if interested. Here we are offering some quick tips and suggestions for taking good quality clinical photographs.

Materials

To take good quality photos you'll need the following materials:

• Digital camera (traditionally a digital SLR camera with ring flash and a dedicated macro lens will produce the best results for intraoral photography)
• Cheek Retractors
• Intraoral mirrors (full arch and lateral view in both adult and child sizes)
• A solid white wall or background (poster or foam board can be purchased and used instead of a wall). This helps make sure that the patient's facial features are clear in the photo.

     Optional, but preferred:

• A wall-mounted back light equipped with a "slave" flash is preferred, instead of a wall or other background 
• A vertically adjustable stool or chair 

Positioning

For all extra-oral photos the patient should be at a comfortable, direct, 90-degree angle to the camera. For taller patients that may mean that the camera needs to be raised or the patient lowered and vice versa for shorter patients. An adjustable stool or chair enables the assistant or photographer to properly orient the patient's mouth to the camera. 

Full face (not smiling)

• Frame the patient's face from the top of the head to the middle of their neck, with the camera oriented vertically
• Camera distance from the patient is determined by optimum focus at the lens' focal length providing the maximum depth of field (each lens may be different)
• Patient's head should be oriented vertically in a natural and relaxed position
• Patient should look straight ahead directly into the camera lens
• Patient should have their lips, jaw, and teeth in their natural and relaxed position with lips together

Full face (smiling)

Same as above, plus:

• Patient's smile should be natural
• Teeth should be visible

Profile (not smiling)

• Patient's body is turned 90-degrees to their left so that their right shoulder is pointed directly at the camera and only the right side of their face is visible to the camera
• Patient's head should be in a natural and relaxed position
• Patient's eyes should be horizontal and looking straight ahead
• Patient's hair should be pulled back, behind their ear, if long

For all intra-oral photographs the patient can/should be in the dental chair. The patient and/or a dental assistant can help with the cheek retractors.

Occluded buccal view anterior

• Use cheek retractors to pull lips away from the teeth and gums
• Lips and cheek retractors should not obscure any of the teeth
• Camera should be horizontal, with the occlusal plane level in the center of the frame
• The buccal corridors (the area between the buccal teeth and the inside of the cheek) should be well-lit and visible
• Proper depth of field (determined by the lens) will provide focus from the central incisors to the first molars; operator should focus on the canines/first premolars
• The upper and lower gingival sulcus should be visible

Occluded buccal view of right lateral

• Have patient turn their head to their left so the right side of their face is towards the photographer
• Use one cheek retractor to pull the right lip away from the teeth and gums, so that the right central to the last erupted molar is visible (if possible). Note: Try to do this step just before taking the picture so the patient is only uncomfortable for a few seconds and so that you can get as far back as possible.
• Camera should be horizontal, and be pointed in a perpendicular angle to the buccal surface of the teeth with the occlusal plane level in the center of the frame
• If the lips cannot be retracted far enough, with the help of another person or the patient, position a buccal mirror to capture the mesial of the second molars (if erupted), then repeat the previous step
• Crop the frame so there is a minimum of distracting retractors and lips (see photos)

Occluded buccal view of left lateral

• Have patient turn their head to their right so their left side of their face is towards the photographer
• Repeat the steps in the previous section

Occlusal view of upper

• Use a retractor to pull the upper lip away from the teeth
• Insert the wide end of the arch mirror to capture the arch. Note: Pulling down slightly on the mirror can help to get the whole arch up to the last molar.
• Patient may tilt their head forward so photographer can get the camera 90-degrees to the mirror plane
• The framing should be square to a vertical line down the midline of the palate
• Show the full occlusal surface of the arch
• Try to get as little of the retractor in the picture as possible

Occlusal view of lower

• Use a retractor to pull the lower lip away from the teeth
• Insert the wide end of the arch mirror to capture the full arch. Note: Pushing upward slightly on the mirror can help to get the whole arch up to the last molar
• Patient may tilt their head backward so photographer can get the camera 90-degrees to the mirror plane
• The framing should be square to a vertical line down the midline of the lower arch
• Show the full occlusal surface of the arch
• Try to get as little of the retractor in the picture as possible

Tips on taking photos

With most cameras, pressing the shutter button (the button that takes the photo) half way (before you feel that main resistance before the "click") before actually snapping the photo will help to focus the photo. Snapping the photo without first giving the lens a chance to focus usually results in blurry photos.

Light is your best friend. It's what makes photography possible. So it's always best if you can take your photos in the most well-lit area of your office. A ring flash matched to your digital camera and mounted on the front of the lens is the best way to adequately provide enough light for intraoral photos. 

Avoid getting too close to what you're photographing. Many cameras have a hard time focusing on things that are extremely close; in addition, if you have to use flash, the flash will wash out a lot of the detail in the shot if you're too close. Instead, take a tiny step back and simply zoom in on the subject.

Common photo mistakes

Here are a few examples of common mistakes made when taking photos.

	This front view doesn't demonstrate the bite relationship, because the mouth is open and the teeth aren't touching. We need to be able to see how the teeth are fitting together.
	This lower occlusal view shows too much of the facial surfaces of the teeth, and not enough of the occlusal surfaces. It's also blurry and over-exposed. One option is to use a smaller F-stop if the camera has this capability. Zooming out is also a possibility, but with that there will be a general loss of resolution and it is hard to hold the camera steady while zoomed in, so with this option there may be some blurring due to slight movement.
	This front view is washed out and unusable, because the camera was too close to the mouth when the flash went off. Step back and zoom in to correct this problem.
	The angle of this profile photo is too far behind the patient and too high, making the shape of the jaw difficult to see. The camera lens should be level and parallel to the side of the patient's face. (This patient's eyes have been obscured to protect his privacy.)
	The angle of this right lateral view is too far forward. We need to be able to see the full buccal surfaces of both six-year molars to accurately determine the molar relationship.
	This occlusal view is off-center, and doesn't show enough of the molars. Most patients won't be able to open their mouths widely enough to take good photos unassisted. We recommend using an intraoral mirror and retractors.