Year : 2018 | Volume
: 10 | Issue : 2 | Page : 59--60
Photography: A diagnostic tool
Matrishva B Vyas
Consultant Orthodontist, Nagpur, Maharashtra, India
Dr. Matrishva B Vyas
F-8-9 Gurudarshan Complex, Chhapru Nagar Square, Central Avenue Road, Nagpur Maharashtra - 440 008
Photography is one of the Diagnostic Tools for communication, Diagnosis and Documentation. Lots of diagnostic information regarding Intra-oral as well as extra-oral features can be captured with this tool. Photographs are excellent tools to educate patients and to show the progress of the treatment. Even though the cephalogram can gives an accurate information regarding hard tissue anomalies, its correlation with soft tissue dynamics is also essential. With the advent of digital photography there is a paradigm shift in the diagnosis of facial anomalies and structures.
|How to cite this article:|
Vyas MB. Photography: A diagnostic tool.J Int Clin Dent Res Organ 2018;10:59-60
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Vyas MB. Photography: A diagnostic tool. J Int Clin Dent Res Organ [serial online] 2018 [cited 2019 Mar 21 ];10:59-60
Available from: http://www.jicdro.org/text.asp?2018/10/2/59/249139
Photograph is one among the basic tool that enables a clinician to synthesize relevant information pertaining to the patient. This information, in turn, shall point toward a proper diagnosis. Hence, in that sense, the photograph is one of the sublime weapons in the armory of accurate diagnosis.
Before the advent of Cephalometry, application of photography to orthodontic diagnosis was a logical outcome of the work of Simon and Lischer. Lischer constantly wrote about the positive correlation between facial features and dental deformities and the interdependence of resultant relations in the determination of diagnosis, prognosis, and therapeutics., He goes on to write in 1924 that the distortion of facial lines constitutes the common complications of oral deformities.
With the introduction of Simon's Gnathostatics, the rationale became more apparent. Facial lines reflected conditions of malocclusion and by orienting the head according to anatomical landmarks and photographing it that way, the type of deformity could be determined and treated. He was the first to coin the term, “Photostatics,” the way to procure standardized photographic representation for each patient at each time.
Serial photograph thus taken would reveal not only the therapeutic progress but will also be a great asset in diagnosing a case.
Even, Eastman Kodak company in its journal underlines the significance of photography in writing that the photograph records the external manifestations of health, disease, and deformity, as related to the teeth, gums and adjacent tissues, and the development of facial characteristics.
However, this early lead was soon nullified with the advent of cephalostat and standardization of radiographic technique. Objective assessment of cephalometric radiograph left only the subjective role for photographs. The race for correcting numbers became the gold standard, and photography took the back seat.
The purpose of photography remained nothing more than obtaining confirmatory evidence of deductions already reached, and sometimes to establish additional proof in borderline cases. This blocked the evolution of standardized technique in picture-taking process, as well as lack of sound photographic evaluation or analyzing methods.
Most facial pictures showed that no attention had been paid to positioning of the head. Whether by coincidence or by design, the “posttreatment” pictures always managed to show up better advantage than the pretreatment. However, for the science of photography, damage was done. Clinicians started losing faith in pictures, just because it was thought that it can be manipulated.
However, once again, the circle took a turn, and there was a paradigm shift from numbers game of cephalometric to the soft-tissue-based diagnosis. With this shift, photography reassumed its importance as one of the essential diagnostic tool. The shift proved to be a necessity rather than anything else, primarily because of medicolegal issues which gave more weightage to patients' aspirations, as well as in some way, the growing concern of radioprotection.
The possibility of performing qualitative analysis through photograph was explored. Several studies were reported in the literature that compared cephalometrics and photometrics. Significant and positive correlations between majority of cephalometric and photometric variables were proved. All these studies, the details of which are not within the purview of this article, concluded that photometric analysis serves as a powerful method to address craniofacial disorders, establish treatment planning, evaluate surgical results and orthodontic outcome, and also study the facial growth.
Photometric is a feasible and a practical alternative when radiography is considered too invasive or logistically impractical. Photometric measurements can be performed repeatedly, and data stored permanently. This makes longitudinal studies also possible.
Use of photograph as a diagnostic aid was also established by many workers when they studied the impact of buccal corridor, lip line, or smile arc on facial attractiveness. With the help of photographs, they reiterated the need to address these vital esthetic signs. However, many such studies remained only an academic exercise than transforming into a real clinical goal.
Assessment of profile using visual treatment objective (VTO) with photograph was universally accepted and formed a standard protocol in myofunctional therapy. Likewise, use of lip lines to study and objectively assess the profile became routine.
Nearly, a decade ago, David Sarver conceptualized soft-tissue-based diagnosis and treatment planning. To encompass both function and esthetics, he developed a model called classification of appearance and esthetic analysis, which comprised three components: macro-, mini-, and micro-aesthetic divisions. Functional goals were evaluated in the context of expanded dentofacial analysis. His model proved a framework for the systemic evaluation of esthetic needs of each patient. The emphasis was on proportionality rather than linear or angular norms.
With the introduction of such concepts, intraoral photographs also reassumed its importance in orthodontic diagnosis. Loads of information were deduced from a properly shot series of intraoral photographs. Serial intraoral photographs serve as a handy source of contextual reference for therapeutic diagnosis.
The paradigm shift toward soft-tissue-based diagnosis also saved many teeth from extractions. Cephalometric findings and study model analysis routinely were biased to show the need for extraction by overstating the discrepancy. However, a careful study through photographs formed nonextraction plan. Many of the problems encountered in the extraction treatment approach were prevented. In certain cases, the need to know cephalometric numbers was altogether omitted. Photographs provided the necessary information.
It is proper to conclude by saying that properly shot clinical photograph is a “diagnostic-image” unraveling many underlying discrepancies and providing sound diagnostic understanding.
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Conflicts of interest
There are no conflicts of interest.
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