“What do I buy to take photographs in my office?” This is a very common question. How you equip yourself and your team will have a profound impact on the work you end up doing, so let’s take a look at all the factors at play.
For purposes of this discussion, “mirrorless and DSLR” refer to larger cameras with interchangeable lenses. Typically that means a body, a 100mm macro lens, and a ring or twin flash. The photography industry collectively combines DSLR and mirrorless into a larger category called “interchangeable lens cameras”, or ILC for short. “Smartphone” refers to a mobile phone such as an iphone, Pixel or Samsung Galaxy paired with a suitable lighting system, such as our patented VPR 500.
Who is your audience?
Patients = Any choice with good lighting
Professionals = ILC with good lighting generally
Are you taking the photographs primarily for your patients, or will you also display the photographs in a professional context? Smartphones take very good photographs, but a large sensor camera will take better ones. The gap is closing, but it is still there.
If you are lecturing, applying for accreditation with a dental society such as the Academy of Cosmetic Dentistry, or contributing to professional publications, ILC’s are currently the accepted standard. Even if you may be happy with the quality of your smartphone photos, the doctors who do accreditations may not share the same opinion. Accreditation eligible cases don’t grow on trees. Use ILC when your membership, diplomate or fellowship status is on the line.
Can you tell which photo was taken with a smartphone, and which was taken with a larger sensor mirrorless camera?
If you are primarily showing the images to patients in person, or especially on social media, the smartphone driven imaging system wins.
Who is shooting the photos?
Team members = smartphone wins handily
Doctor = smartphone still wins
We can put in custom presets into large cameras to help recall the settings faster, similar to how we all push “1” or “2” to recall our dental chairs or driver seats into a comfortable working position. But it’s undeniably easier to shoot most dental photographs with a smartphone. Most dental team members do NOT have a professional photography background. They are most accustomed to using their iPhone or Android to take casual photos. A full sized mirrorless setup is a big ask.
One small niche we invented years ago was the single handed mirrorless setup shown above. It was half the weight of a DSLR setup, focused faster than almost all of them to this day, and provided lighting quality somewhere in between a ring and twin flash. The camera body was the now discontinued Panasonic Lumix GH4 (still available used on ebay). It has a tiny macro lens made by Olympus. I wrote about this a long, long time ago here. You can buy the divuser here.
For busy offices that rely on team members to shoot day to day images, such as orthodontic practices, it’s imperative that you choose something easy to use. Make photography as fun as possible. If you make it a chore, it won’t get done. Any process that waits for the doctor to do it, becomes a bottleneck. In my opinion, any day to day imaging solution should be team member friendly.
Enter the VPR. Short for Vu’s Phone Rig, it is my double patented solution to easy, consistent lighting using a tool any team member is familiar with: a smartphone camera.
What kind of shots are most critical?
The Ortho 8: We take a lot of orthodontic composites. Even though we are a general practice, the basic 8 shots are the foundation of comprehensive diagnosis and treatment planning. This 8 shot series was taken using a Samsung Galaxy S23 Ultra and the VPR 500. Every office should be doing this or a similar series for their new patient intake. And fortunately, almost everything works here. Of note, both camera and smartphone benefit from a different, larger lighting setup for the extraoral headshots. The small lights and flashes that work well for close up are never large enough to take a nice portrait. For professional looking results, your light source must always be larger than the subject that you are trying to photograph! Advantage: tie
Black Contraster Photos: the black contraster is a staple of cosmetic and full arch dentistry. This is a tough one for ANY camera, because the black background fools most auto-exposure systems. Any time a phone or camera CPU sees black, it assumes the exposure is too dark, and increases the exposure, blowing out the image. You can use flash exposure compensation on an SLR to correct for this; simply tell the camera to turn the flash down -1 to -2 stops from where it automatically exposes. Or you can use manual exposure based on flash to subject distance. On a phone, you must “tap and slide” the exposure down. This gets very tedious if multiple shots are needed. Smartphones can also compensate on the exposure side; the technique varies per phone and app used. While both smartphones and cameras can take this shot, the larger ILC cameras will win in terms of dynamic range. This type of photo is all about have a lot of rich tonality in the shadow and highlight areas, which smartphones still struggle with. Advantage: DSLR and mirrorless
The shade taking photo: Communicating shade to the lab requires lighting and the camera to be set at the same color temperature. Ideally, that temperature should be locked, so the shade looks the same from picture to picture. SLR and mirrorless are auto white balance out of the box, but any competant setup of dental camera settings will lock white balance in place. This makes them inherently more consistent for color rendering than smartphones. Samsung phones require you to enter pro-photo mode to lock in a color temperature. iPhones are at a profound disadvantage here, as Apple continues to omit white balance control from the camera app. (in fairness, so do many Android phones) You must select shoot your iphone through a third party app in order to lock in white balance. You can get usable shade photos with a smartphone, but it does require more care and attention to detail than it does on a larger camera. Cross polarization, which is mandatory for many lab technicians, is much easier to come by on a DSLR/mirrorless as well. Advantage: Interchangeable lens cameras
Transillumination photo: this is shot uses a pen light with a fiber optic tip to visualize coronal fractures. It’s virtually impossible to do with a mirrorless or SLR, because it requires a point flash and just the right amount of fill light. It also requires exceptional high dynamic range processing of the image, as the lit part of the tooth is often much brighter than the surrounding area. At the time of this writing, only three specific Samsung phones (and possibly a Huawei or two) can even do this shot. This is an exceptionally difficult shot to take, and is honestly an edge case scenario. Advantage: smartphone
Moving pictures: taking video is far easier on a smartphone. DSLRs, the descendents of SLRs, were conceived in the era of 35 mm film. They are inherently clunky taking video, as your viewfinder has to be blocked to even capture video. Mirrorless cameras are much better, but it’s still difficult to get video because much more light is required. Audio quality on either side is poor; you must adapt external microphones in either case to get professional sounding results. At the top end, an ILC can get true cinema level video, but the technique and workflow required is frankly out of reach of most dental team members. And while you can do a credible editing job editing video on the phone these days, it’s a non-starter for any ILC. So for the quick clips that most offices would capture (testimonials, occlusion tracking, TMJ/pain diagnostics, etc) advantage goes to smartphones.
Social media: smartphones are the literal anchor of social media. The apps live on the phone. There are a few select cameras with very narrowly crafted live streaming or perhaps cloud uploading capability. But none of them hold a candle to even the most basic smartphone. If you want to show your work or share your thoughts on social media immediately, do not pass go. Advantage: smartphones
How much workflow do you want to have?
The workflow from capture to patient record (or elsewhere) varies considerably depending on what tool is used. Professional photographers typically shoot onto their memory cards, load the cards onto a USB reader, and then download them into their digital asset mangement software (DAM). The most popular is probably still Adobe Lightroom. Dental practices typically use imaging software such as Apteryx, Dexis, Sota, Eaglesoft, etc. All of them will import an image file, typically in jpeg format, into the system.
We found that the when using Eaglesoft and other on-premises software, the USB reader allowed for quick drag and drop importing of the images into the patient’s chart. This has the advantage of being tied to the patient’s chart in a HIPAA compliant storage format. Some newer software allow you to upload from the smartphone. We use SOTA cloud, which lets us select images from our phone’s camera roll and insert it into the patient’s cloud folder. Another great solution for fast smartphone uploading is IOC snapshot, which works with almost on-prem software. It emulates (pretends to be) an intraoral camera. Any smartphone photo you take through its app will almost instantly appear on your dental practice software.
Smartphones do enjoy nearly instant backup and synchronization. Having the photos available to show the patient in the operatory computer within seconds greatly facilitates communication. We backup our images using a corporate level Google Workspace account and the Google photos option. Dropbox is a popular alternative. Make sure you are selecting a HIPAA compliant option for a given provider. If it’s free, chances are it isn’t compliant.
Ideally, the images should take as little human input as possible to get into a safe, retrievable storage location.
You don’t have to have just one
We shoot almost exclusively with smartphones now in the office. There are currently 3 smartphones and 5 different VPR to help us get our patient images. I give my team members the option to use a mirrorless camera. My GH4 rig is half the size and weight of even the smallest SLR setups. Yet when given the choice, our assistants always choose the smartphone solution. Many of our VPR customers have reported a similar experience. Their SLR’s are now collecting dust.
At the same time, we have dentists who want or need the utmost image quality. Some of them lecture or publish professionally. There will always be a place for interchangeable lens cameras in dentistry. Large sensors will always collect more light and more depth of color than a small one can. Apple, Google, and others have done what seemed impossible with much less light collecting area at their disposal. It is possible that mobile devices may one day fully close the gap by transcending their physical limitations with computational magic. This article has shown you examples of smartphone photography that are clinically acceptable; but on very close inspection, large cameras will still win on image quality, even if they lose on portability and ease of use.
So which to choose? A lot of stress and anxiety is created when we limit ourselves to just one choice. Perhaps there are budgetary constraints. Maybe it’s too much trouble to train team members on multiple modalities. But consider that most dental offices have a panoramic for one type of image, a size 2 x-ray sensor for bitewings, and perhaps a size 1 or 0 x-ray for children. Each of these imaging devices has a specific set of pros and cons that complement each other. And like radiography, your photography should be team driven, not doctor dependent. You may start with one type of photography system, and then supplement with another down the road. Don’t worry about edge case scenarios. If you decide to upgrade as your needs grow, keep the former model as a spare. We don’t expect a forcep, single bur or handpiece to do all the dentistry in our offices. Start with a solution that meets most of your day to day needs, allowing for the possibility that you’ll add something else to your imaging armamentarium in the future.
Side note: DSLR vs Mirrorless
This used to be a very vigorous debate. But the marketplace has spoken, as have the camera makers. Olympus and Panasonic struck first with the mirrorless Micro 4/3 system. Sony came in and dominated with aggressive innovation. Canon and Nikon came bedgrudingly and late, but all of them except Pentax have ceased DSLR development. There will be no more new DSLR bodies or lenses. Mirrorless is the future whether you like it or not. I personally jumped onto the mirrorless train very early with Olympus and then Panasonic. They were a little smaller, and a little lighter than their DSLR equivalents, but the unending thirst for more features or speed have made the size and weight creep back up to DSLR standards. Still, there are fewer moving parts to break. Electronic viewfinders give us a live preview of the exposure and color balance of our photos. New focus systems are both faster and more precise for the single shots that dentists need to take. Most of the early shortcomings of mirrorless cameras have been solved. The new generation of mirrorless lenses are all optically superior to their much older DSLR predecessors. Besides nostalgia or perhaps photographing birds and footballs in flight, there’s almost no advantages left to the DSLR vs the newest mirrorless systems.
If you need a good deal on a used camera, there is nothing wrong with a great DSLR like the Nikon D850 or the Canon 5D Mark 2-4. Heck, even a Rebel T6 can cut it. Just don’t expect any love or updates in those product lines.
(which camera to buy is the subject of a long and completely separate post)