Hooray! Lightroom 3 is finally released!

Oh, I am so excited, and all you dental photographers should be, too!  Adobe has finally released Photoshop Lightroom v.3, and I'm downloading it right now.  I can't wait to show you how wonderful this program is for us as dentists/photographers, because there are so many features here that you are going to LOVE, even if you're a real newbie to this game.  Now that we've successfully moved to our new Charlotte dental office, and we're getting things settled down a bit more, I finally have a little more time to do all the work for this site that I've been wanting to do. Since I'm adding a new orthodontic assistant full-time in July, it's time to develop some new and improved training materials so I can get my whole staff up-to-speed.....it's nice to have guinea pigs for something like this, you know?  LOL

Stay tuned!

Scratch my mirrors and die....then buy me Starbucks for a week!

How to care for dental mirrors

Ok, so I can't take credit for the title or ANY of the following post, as it was copied verbatim from a post on a professional dental forum.  Fortunately my friend doesn't mind me copying and pasting as long as I paste his name really big right here.  LOL

Michael J. Melkers, DDS, FAGD

Visiting Faculty, The Spear Institute

www.MichaelMelkers.com

With no further ado.......here is how to take care of those really expensive dental mirrors:

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OK-in the never ending battle, we bought some new mirrors this week and have come up with the following office policy:

The first person to scratch the new mirrors:
1-dies
2-buys the office Starbucks for a week...

I take alot of pics in the office and scratches drive me crazy-especially when they are projected or published...so I came up with this idea:

Step 1:  Buy new mirrors AND a box of microfiber photo cloths...I bought the cloths from Uline.com for about 35 bucks...




Unfold said cloths and tuck in mirros...



Fold the top to the bottom then the sides over the sides...


Bag 'em and run 'em through the sterilizer...



Mirrors stay safe, clean, sterilized, always have a cloth..keep em clean, keep the drops off in the autoclave...open the bag and the mirros stay on the cloth at all times.  The cloths can be washed as well.

New Canon 100mm f/2.8L macro lens

Canon recently announced upgrades to a number of their top lenses, and for pro photographers these should generally be welcome.  For dentists, however, there is one change that is not quite so good for one reason: the primary lens recommended for dentists and their teams, the Canon 100mm f/2.8 macro lens, has been updated to be an "L" glass (pros typically call their high-quality lenses "glass," not "lens;"  just a little FYI).  What does this mean?

For practical purposes in dentistry, there is only 1 downside to this update, and that is that the new lens is more expensive than the previous lens by about $400, but without any real benefit.  Sure, the image quality will be even higher, the lens will focus a bit faster, but the previous lens was completely adequate for everything we needed to do.

Click here to see the new lens.

Now, if you are a serious photographer outside the dental office, this lens does offer (to my mind) 1 truly significant improvement over the previous incarnation: it is waterproof or very water-resistant when combined with a Canon 7D, 5D Mark II, or any of the 1D series cameras.  It is not water-resistant with any of the EOS Rebel series.

Due to this update, I am re-considering my usual recommendation to purchase the Canon 100mm f/2.8 macro for dental offices, and for cost reasons, many of you may want to look at the Sigma 105mm f/2.8 macro instead.  If you can get your hands on one of the older versions (still available at some stores) or get a used one, then definitely go for it.

2 Extremely Useful Websites for Learning Digital Photography and Editing Software

Along the lines of my last post on recommended software for dentists to use for managing, cataloging, and editing their pictures, there are a couple websites that I have found extremely useful and well-done, because they both have enormous selections of online video tutorials:

Lynda.com 


KelbyTraining.com

Figured I ought to mention both of those.  :-)  Each does have a very reasonable subscription fee, whether you choose to sign up for a monthly or annual subscription.

Cosmetic Dentistry Slideshow from Lightroom 3 beta

In keeping with the topic of my last post, and which should lead nicely back to the subject of managing patient expectations, I'd just like to show a MP4 slideshow that I created directly in Adobe Photoshop Lightroom 3 (beta), along with the steps necessary, so anyone can see just how easy this will be once the real version is released:

 5 Steps to Create the Slideshow with Lightroom 3 beta:

1. In the Library module, use CTRL + left mouseclick to select all the photos you want to include.
2. Change to the Slideshow module.
3. Pick one of the templates provided by default or create your own using the Layout options on the right side of the screen.
4. Simply go through the Layout options one-by-one (extremely self-explanatory), including selecting a music track from iTunes.
5. In the lower left, choose "Export Movie."  
6. Let 'er rip.  :-)

Seriously......that's it.  OK, it did take a little time just to choose the colors I wanted and to type in the text for the Intro and Concluding slides, but altogether, the slideshow that you see here (linked from my photography website, although it can be done through any number of services, such as YouTube) took me less than 4 minutes to create.  While I had done some previous editing to add borders and my watermark, once LR 3 is released, they will supposedly be including an easy set of features to add borders and watermarks very easily.

Here you go:

Dental Imaging Software and Photo Storage - the Hows & Whys?

OK, I lied......before I talk about patient expectations, since I already started on the subject of software, I shall continue in that vein for a bit, as it seems to be right near the top of the poll in terms of "need-to-know".

Use PMS (Eaglesoft, Dentrix, etc) or Not?

Personally, I do not use, nor do I recommend using, the Imaging modules of the dental PM software that is currently on the market.  Why not?

1. Cost: While some include the Imaging Modules, most charge a premium for the versions with all the bells-and-whistles, and quite simply, NONE of them are remotely as good as the most popular photography software available outside dentistry, and ALL of them are a LOT more expensive.
2. Lack of Keyword Capability: In just about every photography program available today, including Google's free Picasa, you have the ability to use Keywords, or Tags.  These are descriptive terms to used to identify what is in the picture.  For example, in dentistry you might want to have keywords related to what lab you used, which adhesive, which composite or amalgam used, type of isolation, reason for treatment, etc.  This allows you the option of tracking your work over time.
3. Harder to find images you want: in dental PM software, you have to generally keep your images in each person's file; if it's years down the road and you want the pictures you took of, "Hey......what was that guy's name about 5 years ago we did the single anterior crown for?????"  Ummmmmmmm, not too easy to do, is it?  This ties in with the lack of Keywords/Tags, too.
4. Harder to Group images for specific purposes: Let's say you want to put together a nice collection of pictures of veneer cases, or Six-Month Braces, or CEREC crowns, or implant overdenture cases, you have to go through all of the patients, in most cases export the images individually to another folder (and they don't make this really easy IMO), THEN you can start working with them.
5. Limited Editing Capabilities: Especially in comparison to programs like Photoshop, or even Photoshop Elements, most dental PM software has extremely limited editing capabilities.  Of the ones I know, the best is Apteryx.  However, it is again more expensive than just about any photo software currently available, and it has the same limitations regarding Keywords, image searching, and image grouping.

OK, so what software do I use/recommend? 

Personally, I like Adobe Photoshop Lightroom, which is currently in version 2, and version 3 will be released sometime in spring 2010.  Here are some other programs you can choose, though, and then I'll cover more of why these programs are IMO far superior to dental PM software imaging modules.

• Photoshop Elements 8
• Google Picasa
• Aperture 2

5 Reasons Photoshop Lightroom Rocks for Dentists

1. Easy Folder Hierarchy: It's basically just like Windows Explorer, in that you can set up a folder structure in any way that you want.  Here's the way I have it set up: My Pictures > Year > Procedure Type > Patient Name > Date of Service.  It's easy to keep track of all pictures by calendar year, and by having procedure types (such as Basic Restorative, Cosmetic, Periodontal, Implant, etc), you can put like types of procedures together.
2. Easy Keyword Tagging:  This is really one of THE most powerful tools available with LR or the other programs.  By using Keywords, you can easily label pictures with any descriptor you want.  As some examples, here are some I use: Decay, Recurrent Decay, Chipped Porcelain, Acid Erosion, Gingival hypertrophy, Posterior Composite, Anterior Composite, Veneer, Feldspathic, Empress, Surpass, Preop, Portrait, Amalgam, and you can probably think of a gazillion more.  And here's where it gets useful: Tracking your work over time!  Let's suppose that, after 5 years of using a particular lab, always using Captek crowns and cementing with zinc phosphate, you want to pull up ALL of the pictures of ALL patients in the last 5 years who got Captek crowns from that lab and which were cemented with zinc phosphate so you can see how they hold up........type the Keywords into the search field, and BAM!  There you go!  OR........say you know that there was an amazing veneer case you did 8 years ago, but you can't remember the patient's name, no problem!  Just select the year you want, perhaps choose keywords "Veneer, Maxillary, XYXYX Lab" and BAM!  There you go, all the maxillary veneer cases from the year 2002 that you did with XYXYX Lab are right there, and you can easily identify the case you want.  This is just an incredible feature.
3. Creating Customized Galleries and Slideshows:  This is another superb feature for anyone who wants to easily showcase their work.  Lightroom has several features that allow you to create highly customized Web Galleries, Slideshows with music, and more; with plug-ins (most are free, some have a small fee), you can upload galleries to sites such as Flickr, Smugmug, Zenfolio, and others.  Google's Picasa has a built-in tool to let you upload pictures to your online Picasa galleries, from which you can create links, Flash slideshows, and more.  The marketing potential of these customizable photo groupings is tremendous.  The slideshow seen on the right of my Blog is linked from my SmugMug photography site, and all those pictures were uploaded directly in a large batch.  EASY.  And the upcoming release of Lightroom 3 will have even more of these features built in!
4. Easy-to-Use Editing Features: with most of these programs, the controls to do a ot of basic editing are right at your fingertips, such as Cropping, Correcting Red-eye, Correcting overexposed or underexposed pictures, adding borders, etc.  Therefore, the learning curve to use them is much faster and shallower.
5. NON-DESTRUCTIVE editing!  This is a wonderful benefit like you wouldn't believe, especially when you're new.  Essentially, Lightroom does not actually edit the image file; instead it writes the edits "on-top-of" the file in a set of instructions that are rendered onscreen.  NOT UNTIL you export the image in some way (online, printing, slideshow) will those edits be permanently part of the new file.  Even then, though, the ORIGINAL file remains untouched, and you can revert back to it at any point.

Hence my recommendation to use a non-dental software for cataloging and editing your pictures. Please post comments and questions or send me an email for further clarification. 

Smile Imaging - What Software and How to Manage Expectations

Here's a question I received from a colleague by email recently, and it's such a good one, it's the perfect opening for a blog entry.  Thanks to Rich M. for asking (and I do welcome questions and comments, so please......leave a comment or send a question by email.).

Q: "One question on my list is whether you use imaging software in your presentations so patients can view current and proposed/expected outcomes.  I've been warned this could be a tricky area to get into due to a gap in patient expectations and actual outcome.  What do you say and what software for this purpose do you use (if you do use any)?"

A:  What we have here is really 2 questions; the first is about software and a "How-To-Do......?" and the second is about patient expectations if you do a computerized smile mock-up to show them what you think the outcome will be.  Let's start with the software question first, because it's actually the easier question to answer, although the technical aspect of making it happen is a bit trickier.

Software: If you want to make this process really easy on yourself, there are several pretty good services available that will do the smile imaging for you; while I don't personally use them nowadays, I have used them in the past and gotten very good service:

• SmileVision Lab
• SmilePix 

This next service I have not used personally, but they are recommended by the DaVinci Lab, Dr. Woody Oaks, and others, so I figure they can do a good job, too.

• SmileArt

This next service is actually a relatively easy one to implement in your office; naturally, there is a learning curve, but they offer pretty good support to get you up and running.  If I were doing more cosmetic cases these days myself, I'd probably go back to using this one, but I'm having more fun doing a ton of 6MonthSmiles Adult Ortho and Laser Periodontal Therapy cases.

• Digital Dentist Cosmetic Imaging Service (The Lorin Berland Smile Style Guide/Library)

All these services have a very simplified set-up that you can implement very easily; the absolute easiest are the first 3, because all you have to do is take the pictures and email them; you usually get the completed Before/After Cosmetic Imaging back within 24-48 hours.  They offer a "Rush" option as well.

Here's another significant benefit to working with both SmileArt and SmileVision:  they are both part of full-service dental labs with a focus on esthetic dentistry.  Therefore, they can help not only do the Before/After Imaging, they can actually provide the crowns/veneers/bridges/etc. to bring the case to a successful conclusion.

That said, what software do I personally use nowadays?  Well, if anything, I use Adobe Photoshop CS4.  This is a program I use almost daily as a photographer, so it's what I'm most comfortable with, and I know how to do the things that most patients want to see imaged.  However.......for most dentists, unless you're really serious about this, I do NOT recommend you go this route, because it has a VERY steep learning curve.  It also does require the most time.

Since this post has already gotten a bit long, I'll answer Part 2 of Rich's question, about managing patient expectations, in my next posting.

4 Lens "Positions" for Dental Pictures with the Canon 100mm macro

In dentistry, there will typically be 4 "types" of pictures that you will take, regardless of the purposes for which you take them.  They are:

1. The Full Face/Portrait
2. Full Smile/Retracted Smile or Full Arch
   
3. Quadrant
4. Single-tooth (not very often except for endo)

When shooting each of these, I have found that there are certain "positions" of the Canon 100mm f/2.8 Macro lens that approximate these consistently and easily.  Remember: DO NOT HAVE EITHER YOUR LENS OR CAMERA ON AUTO; BOTH SHOULD BE ON MANUAL AND MANUAL FOCUS.  To make it nice and easy, check out these pictures, then download the "Cheat Sheet" for use in your office.

For a FULL FACE/PORTRAIT, position the lens like this:




For a FULL/RETRACTED SMILE and FULL ARCH:



For a QUADRANT or 1:2 Picture:



For a SINGLE-TOOTH:



I'll soon have an equivalent set of pictures for the Canon 60mm f/2.8 macro lens, and eventually for Nikon and Sigma lenses.

RAW or JPEG for dental photography?

Here's another thought that popped to mind this evening as I was playing with my new Canon 7D (oh god, how I love this thing already!), and it relates to 2 questions many colleagues ask:

1) Should I shoot in RAW or JPEG?
Simple answer to a complex question: UNLESS you are taking pictures that you need in RAW because you're aiming for accreditation with the American Academy of Cosmetic Dentistry or a similar organization, I recommend you shoot in JPEG.  Why?  Well, there are no PMS (practice management software) programs of which I know that can handle RAW files; you need much bigger memory cards if taking a lot of pictures; RAW files do take longer to download; you need a lot more HD memory to store a large number of RAW files.  As a comparison:
     My work PC has roughly 44,000 pictures of patients that I've taken with all my digital cameras going back to 2002 (my first was an Olympus C2500L), and the My Pictures folder is approx. 130GB.  My home PC has approximately 20,000 pictures in the My Pictures folder, but because I shoot all my personal stuff in RAW, that folder is about 300GB!  So only 1/2 the pictures, but more than double the memory required.  And with the new 7D having RAW files of about 24MB each, that will increase fast!

While JPEG files do degrade slightly over time when opened and closed many many many times, with the current resolution of images, the likelihood that such degradation will be visible in your entire lifetime is practically zilch.  Ain't gonna happen.  No need to worry about it.

If you ARE aiming for accreditation, why is it therefore important to shoot in RAW?  For a very simple reason: the RAW file is equivalent to a digital negative, and it is ALWAYS that equivalent.  Even if you edit it, the original is always there and can be recovered, so it's impossible to "fake" pictures by editing them.  That way the examiners can be 100% positive that no-one is trying to sneak something by that was really Photoshopped.

2) OK, so I shoot in JPEG for intraoral/extraoral photography, what level of resolution should I choose?
Since JPEGs can be handled pretty easily by virtually any computer these days, and you can get a lot more pictures onto a card and HD, it makes sense IMO to shoot at the largest resolution (the "L" with the smooth curve next to it, not the steps).   Sure, you could shoot much smaller files, but what's the point?  At some time you will probably regret having a lower-quality image that you can't improve/upsize......but it's easy and fast to take a bigger-than needed picture and downsize it.

5 Good Cameras for Dental Photography

Now to the real question: Which camera/flash/lens combination should I buy? 

I'll start off with what I think are simply THE standard lenses and flashes to get, as these won't change much over time, even though the camera bodies will.

For Canon lenses (overall, more dentists use Canon than any other brand in my experience), you want EITHER the:

1. Canon 100mm f/2.8 macro lens  OR
2. Canon 60mm f/2.8 macro lens

There is only 1 Canon ring-flash commonly used (while the twin-light flash is really nice, it's trickier to learn and definitely more expensive), and that is the Canon MR-14EX ring flash. 

For Nikon, the comparable lenses are:

1. Nikon Telephoto AF Micro-Nikkor 105mm, OR
2. Nikon Macro AF Micro-Nikkor 60mm

As far as I know (which is a lot less about Nikon that Canon, admittedly), Nikon does not make their own ring flash comparable to the Canon MR-14EX.  The one I've seen commonly recommended is the Sigma EM-140 DG TTL Macro Ring Flash for Nikon.

So does this mean that these are the ONLY combinations of DSLR lenses and flashes that you can get?  NOPE, not by a long shot!  However, they are the most common selections used by skilled dental photographers, and so....if you happen to need help from a colleague, it's easiest to get help on these.  So rather than give out every single combination of lenses, bodies, and flashes that could be used, to keep it simple, these are the ones I recommend you consider.

Remember that the most important feature in the lens is it MUST BE A MACRO.  Otherwise, you will not be able to get close enough to the teeth to photograph them well.
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Now on to the Camera Bodies: 

For Canon, as of today (12/22/09), I recommend the Canon T1i for 1 very simple reason: not only does it have all the nice features necessary to take high-quality pictures, it ALSO has 1080p HD video recording capabilities.  And with the Internet rapidly becoming a major force in reaching both new and existing patients, video can be a powerful tool for influencing them; follow this link to see some of my patient testimonials on YouTube!  The sheer convenience of having both a video camera and a DSLR in 1 is just too nice.  And, if you happen to be a microscope-using dentist (which I also highly recommend), you can hook up the T1i to your camera adapter and record both video or still images.
Of course, you can also use any of the following Canon camera bodies: 10D, 20D, 30D, 40D, 50D, XT, XTi, XS, XSi, or even go really upscale with the Canon 5D, 5D Mark II, or 7D.  However, I don't recommend those because of the price.


For Nikon, I recommend the (for the same reasons as above) Nikon D5000 or the D90.  If those don't float your boat, you can choose any of the following (just be aware that none of these have the video either): D40, D60, D80, or D200.  Again, if you want upscale, go for the D300s or D700.

OK, if you count up all those possibilities, you'll realize that's actually WAAAAAAY more than 5 possibilities.  I've given you the criteria I use when recommending, though, so you should be able to make your choice.  If not, please ask questions!

I'll cover some of the alternative DSLR camera bodies, lenses, and flashes in a future post.

What kind of digital camera should I buy?

Of all the questions I receive, the single most frequent one has to be, "What camera should I buy if I want to take pictures of patients and teeth for my office?  The second is often, "Do I have to get one of those big cameras with interchangeable lenses, or can I use a Point-n-Shoot?  Might as well get these covered right away.

Let me give you my personal bias first:
    Point-and-Shoot (POS) cameras have come a long way in the last few years, and they can take very high quality, high resolution pictures.  The primary limitations are:

1. Inability to control both exposure and f-stop to get pictures completely in focus and well-lit.
2. The flash angle is such that the front of the mouth is super-bright and the back is very dark.
3. Many do not offer a manual focus option, and the mirror reflection can really screw with the auto-focus.

Digital SLR (DSLR) cameras, on the other hand, offer complete control over every aspect of taking pictures, which means all you need is the right settings, and you'll capture virtually perfect pictures every time with just a little practice.  The 2 biggest advantages to using a DSLR for dental photography are:

1. Can choose from several macro lenses to get extremely close-up pictures; dental photography is mostly a variation on Macro Photography, or the art of shooting small things very close-up. 
   
2. Can use a ring-flash or dual-mount flash for bright, even, shadow-less pictures even in the very back of the mouth.

Therefore, I am a BIG proponent of using DSLR cameras for dental photography.  Yes, they are more expensive, but given the importance of quality images when communicating with patients or documenting work for all kinds of purposes, they pay for themselves extremely quickly.

Next post......WHICH camera/lens/flash combination to buy, and where?

Why Digital Photography for Dentists?

As a kid, my Mom, sister, and I were constantly aggravated by my Dad's fascination with photography, because he would take FOREVER (it seemed to us at at the time) to compose and take a shot while we were on vacation, or he would want to take a gazillion pictures of us so we'd have to sit there with a frozen grin on our faces while he snapped off a number of shots. Never did I imagine that one day I would do the exact same thing to my own wife and 2 daughters, but that's what happened!

Interestingly, though, it was actually my friend and Charlotte dental colleague, Dr. Ross Nash, who actually got me interested in photography on a more serious level, when I was still a recent grad of UNC-CH School of Dentistry. The memory of seeing Ross' ROOM full of slide books (and yes, I mean it was literally a room unto itself, about 750,000 slides in 2000, I think) is still a vivid one! At the time, though, digital cameras were still too expensive, and the software too difficult to use, for many to use. Like many, I started with a Yashica Dental Eye III film camera; anyone else remember that? LOL

But the advent of the Canon Digital Rebel in 2004 signaled a new beginning, as affordable digital SLR cameras came on the market. That was my first foray into digital dental photography, and my interest and passion since then has only grown. Another colleague and terrific photographer, Dr. Tony Soileau, was key to igniting the fire with his portrait photograpy course for dentists at the Nash Institute. It is now an indispensable and critical part of my daily dental practice, as well as a passion for photography outside the office.

It's been a long journey, though, to learn all that I have, requiring many thousands of dollars in CE, thousands of hours shooting and learning software, and then figuring out how to present and use the pictures taken. Today, I receive emails and private messages from colleagues almost on a daily basis, asking the fundamental questions about getting started, especially through Dentaltown.

The good news, though, is that integrating dental photography into your practice is now easier and more affordable than ever, and what's even better than that is that the software is becoming more affordable and easier to use. It can still be a daunting taks, though, to decide what you need, where to get it, how much to spend, what software to use (your PMS or something else, for example), how to start taking pictures and troubleshoot, how to train your staff, etc.

Over time, I'll be discussing the fundamentals of photography, of DSLRs, and really.....all the whats/whens/whys/hows of using digital dental photography. Follow along, feel free to comment and add your own experience, or ask questions.