Hello, I'm Dr. Kevin Wallace. I'm here to demonstrate some easy techniques to capture interaural photos for the purposes of record keeping. Proper photographic records are imperative, both for documentation of a patient's baseline occlusion as well as long-term follow-up. With proper training, this is something that can be performed by clinical staff. I will demonstrate techniques for capturing five images, three in centric occlusion in addition to maxillary and mandibular occlusal views. There are four critical components to perfecting interaural photographs, lighting, focus, retraction, and camera angle. During this demonstration, we will be focusing primarily on the last two, retraction and camera angle. I want to mention that while these images have historically been captured using a digital camera, there are many clinicians now who use the camera on their phone for this purpose. Either way, retraction and camera angle are the most important variables that can improve the quality of a photograph. Today I'll be using a digital camera. There are a great variety of retraction devices and mirrors that can be purchased for this purpose. No single device is inherently better than another. Having a few choices available allows the clinician to adapt to the needs of a particular patient or situation. The retractors that I will be using today are unilateral plastic retractors that either the doctor, assistant, and or patient can hold. I find it easiest to have the patient sitting upright. For all three centric occlusion shots, I want to position my camera so that it is level with the occlusal plane. Too positive or negative an angle will not capture the intimate contact between the upper and lower teeth. It is also critical that the horizontal angle be similar to the one used when taking bite wing x-rays. If my camera is positioned too close to the midline plane, I will not be able to see the cusp de fascia relationships. If it is positioned too close to the coronal plane, I will not be able to see first and or second molars, whose relationship is important to capture and record. As you align your camera angle, it is important to remind the patient to keep their teeth tightly together. Okay, Joanna. Next, I'm going to take some photos to record the occlusion of your teeth. I'm going to place these retractors and then I'm going to have you hold them and stabilize them while I take the photos. Close just a bit, great, and hold. And close all the way, right together. And loosen your grip on the left and pull to the right. Right there, hold it. This is too high. This is too low. This is too sagittal. And this is too coronal. And this is where I want to be. Okay, Joanna, if you could pull equally on the retractors, both right and left. Keeping the patient upright, I will proceed to the maxillary occlusal view. Here it is helpful to have the chair lowered as far as it will go so that the camera can be angled down toward the mirror. I like a mirror that is wide enough to cover the entire arch, in addition to retracting the buccal mucosa away from the buccal surfaces of the teeth. If a mirror is too narrow, it will allow the buccal tissues to collapse over the occlusal surfaces. If the mirror is warmed in tap water, it will prevent fogging. The mandibular occlusal view is easiest to capture with the patient fully reclined and the chair raised to a comfortable height. The warmed mirror is now carefully placed flush with the maxillary occlusal surfaces and slowly moved posteriorly to cover the distal teeth. Again, ask the patient to open as widely as possible and focus the camera on the mirror from the sagittal plane. Positive and negative movement along the sagittal plane will allow the photographer to find the position of least distortion. Rehearsing the shot allows the patient to understand what is expected of them regarding position. Oral appliances that maintain the mandible in a protrusive position at night naturally apply forces to the dentition. Research shows that tooth movement and bite changes are a common side effect of long-term use of an oral appliance. A proper photographic record of pre-treatment occlusion will assist the clinician in monitoring for changes in the dentition and improve communication with the patients. Thank you for watching this video, and I hope the information presented today will help improve your photographic documentation.

interaural photos

record keeping

dentistry

photographic records

occlusion