Using Imaging Technology to Communicate with your Lab By: David Allen, Director
US & Canada, Kodak Dental Business

In this article, Merrill A. Grant, DMD, and Adrian Jurim, CDT, MDT, discuss ways in which imaging technology facilitates effective communication between dentists and dental labs. They discuss how the proper use of imaging can mean all the difference when it comes to quality restorations. For example, selecting the right equipment and mastering imaging techniques helps ensure that accurate information about patient tooth color, shape and other characteristics will be shared. Imaging technology can also help dental professionals understand and manage their patients’ expectations.

As imaging technology matures, dentists can expect more turnkey ways to produce and share imaging documents with dental labs and other professionals. But as Dr. Grant and Mr. Jurim show, the need to maintain a dialogue between dentists and labs is also important. As they discuss their experience with imaging technology, it’s clear that the more dental professionals share, the better everyone becomes at delivering quality patient care.

Dr. Merrill Grant: Adrian, as a restorative dentist, I rely on 35mm photography to communicate case information to dental laboratories. Like many dentists, I assumed that slide film was the ideal medium. It’s what most of us have been taught: slide film provides the most accurate photographic record. Then recently, I did some research on labs’ preferences and learned that many would rather have prints than slides, because prints don’t require special viewing equipment. Is that true for your lab?


Dr. Adrian Jurim, CDT, MDT: Yes, there is a lot of truth to that statement. It’s helpful to consider this question within the context of a dentist’s complete range of options. Prints from intraoral video cameras or instant cameras are typically low-resolution images. Thirty-five millimeter photography, on the other hand, permits a more sophisticated use of lighting and other techniques that tend to result in higher quality images. In addition, there are 35mm film products, like Kodak Dental Photographic Film, that are professional-grade products. Professional films give more consistent color and more reliable results.

Because of these factors, dentists who use 35mm photography, and achieve a level of skill with it, tend to produce better images, regardless of whether they shoot on print or slide film. Therefore, it becomes a matter of which format is easiest for porcelain artists to use, and you’re right: unless the lab has installed lightboxes at each ceramist’s workstation, prints are easier for us.

Grant: I’ve also found that prints are great because you can write on them. You can draw the midline, point out specific formations or even write notes right on the print.

Jurim: Yes, that is very helpful and we appreciate it when dentists include that information.

Grant: What about digital photography?

Jurim: More and more dentists are switching to digital. Just about every day, we receive a call from a dental office who wishes to send digital image files. The great advantage of digital course is that you can look at the pictures right away.

Grant: I like digital photos because you know if you’ve captured the information you need while the patient is still in the chair.

Jurim: Yes, digital images are very convenient. Sometimes a dentist can email images to the lab while their patient waits to discuss a case.

Grant: What are your thoughts on using shade tabs in the photographs to document tooth color?

Jurim: I think shade tabs are very important. When it comes to color, the lab needs a true point of reference. Since we usually don’t see the patient, our only point of reference is the shade tab.

Grant: Would you prefer for a dentist to send the actual shade tab?

Jurim: It would be great to receive the actual tab, but few dentists send them to us.

Grant: Yes, I know, most dentists photograph the shade tab and think they’ve provided enough information.

Jurim: Exactly...but what dentists need to understand is the shade tab material is different from tooth material, so it’s reflective qualities are different.

Grant: I’ve also noticed that shade guides appear different under different light sources. Even when lights are supposedly color-corrected, I’ve noticed variations among light sources. I’ve also seen variation in the guides themselves. If you compare a set of shade guides from a few years ago to a new one, the colors won’t be identical due to fading. I’m sure most dentists wouldn’t notice this, but to porcelain artists it must be glaringly obvious.

Jurim: Yes, you’re absolutely correct, it really is a problem we’ve been dealing with for years.

Grant: So other than sending the actual tab with the prescription, what else can a dentist do to communicate proper shade for the lab?

Jurim: The most important thing is to make sure the tab is placed properly in the photograph. It needs to be on the same plane as the teeth. Otherwise, it will be too close to the flash, or too far away. Either way, the color will be distorted.

Grant: How important are pre-operative photos to your lab?

Jurim: Very important! To the trained eye, there is so much information available in pre-op photographs: color distribution within the tooth, base color, maverick color, incisal color, whether or not there’s a halo effect—we are able to learn so much.

Grant: What views do you particularly like for pre-ops?

Jurim: A full face is critical, so we can see facial landmarks, and elements like the length of the teeth. For color, it’s more important to have good close-ups.

Grant: For the close-ups, do you like 1:2 magnification?

Jurim: Yes, and 1:1. Each gives us a different set of information.

Grant: Do you like to have a “smile at rest” view?

Jurim: Actually, that view is very important for us because it shows the natural shadow of the lip and how it affects tooth color. A retracted smile just doesn’t provide that information.

Grant: How about shots with a black background to show the incisal edge?

Jurim: That is useful only to show distribution of the incisal translucency. It can’t be used to document color, because the background distorts tooth color. We have experimented by photographing teeth against both black and blue backgrounds, and they distort tooth color substantially.

Grant: Is there anything special you like to see on retracted smile views?

Jurim: In general, labs like to see shots taken at a number of different angles. The flash tends to wash some detail out, particularly surface texture. By shooting at a number of angles, dentists capture more texture information.

Grant: Dentists could also experiment with different types of flashes. Point flashes, which offer directional lighting, can be used to emphasize shadow detail.

Jurim: Yes, varying light to show detail is very important.

Grant: Do you find that you pick up surface texture better from photographs or study models?

Jurim: Study models, absolutely. To do it with photography alone, the dentist would need to be a highly sophisticated photographer, able to manipulate the camera aperture and lighting to emphasize surface texture. Unless a dentist is willing to take their photographic skills to that level, it’s much easier to rely on using a study model.

Grant: Do you also need photography of the provisionals?

Jurim: Yes, that is also important. It shows us what the dentist intends to achieve with the restoration.

Grant: Would you say there is a relationship between photography and the quality of cosmetic dentistry?

Jurim: Definitely. In my opinion, a dentist cannot do decent cosmetic dentistry without decent photography. And a dentist can’t do excellent cosmetic dentistry without excellent photography.

Grant: In my own personal experience, I’ve noticed that dentists who do their own photography tend to become better dentists.

Jurim: No question about it. They are constantly improving their skills. They become more sophisticated as dentists, and also more demanding of their labs.

Grant: What are the biggest problems you experience, in terms of how dentists communicate with you?

Jurim: Too little information. Too often, dentists tell us the shade tab number and nothing else.

Grant: You can’t re-create teeth unless you know what they need to look like.

Jurim: Exactly. We do our best work when we have the most information, including written notes, photographic documentation and study models. The more we know about the patient’s natural teeth and the dentist’s vision for the restoration, the better we’re able to do our jobs. DT

	Merrill A. Grant, DMD, is a graduate of the University of Pittsburgh School of Dental Medicine and maintains a private practice in Satellite Beach, FL, emphasizing cosmetic services and complex dental reconstruction. He is a graduate of the Baylor School of Dentistry Contemporary Esthetics and Treatment Planning Program. He is a fellow of the Academy of General Dentistry, a member of the American Academy of Cosmetic Dentistry, and a charter member of the Florida Academy of Cosmetic Dentistry. Dr. Grant can be reached at by phone at (321) 777-1337 or through email at callisto@msn.com.
	Adrian Jurim, CDT, MDT, owner, Jurim Dental Studio, Inc., is a graduate of the Kerpel School of Dental Technology and holds a Master’s Degree in Dental Technology from New York University. He is a member of the American Academy of Cosmetic Dentistry and an honorary member of the American Society for Dental Aesthetics. Jurim founded the Institute for Advanced Studies in Cosmetic Dentistry and lectures worldwide on cosmetic restorations. In 1981, he invented, developed and patented the concept of etched porcelain laminate veneers. Mr. Jurim can be reached by phone at (516) 466-1722 or through email at Adrian@jurimdental.com.