April 3, 2019
by Adamo E.Notarantonio, DDS, FAACD
We’ve all heard the cliché, “a picture is worth a thousand words”, but the reality is, they may be worth even more than that. Images help us learn, communicate, explain tough concepts, and certainly inspire us.
We are very visual creatures. A large part of the human brain dedicates itself to visual processing. In the book Silent Messages written by Albert Meharabian, he states that seven per cent of communication is verbal, while 93 per cent is non-verbal. Images are able to grab our attention easily, and we are immediately drawn to them. Images help us become involved, and help contribute to the storytelling process that can make our jobs more engaging. In dentistry today, the power of the image is inevitable, and for that matter, a necessity.
In dentistry, pictures play an important role in many areas. This article will focus on their importance in the following areas:
• Patient Communication
• Lab Communication
• Self- Assessment
• Artistic Implementation
Effective doctor-patient communication is a central function in building a solid doctor-patient relationship. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication, as well as their patient’s ability to understand them. Basic communication skills alone are insufficient to create and sustain a successful doctor-patient relationship. A photograph is an extremely powerful tool to enhance that communication.
Quality photography can enhance patient communication in many ways. We have all informed patients of treatment needed (Fig. 1), only to be shot down with the response, “It doesn’t hurt”. These patients who are not in pain rarely ever even know that they have an issue. However, when presented with an image they can see and understand, they are far more likely to acknowledge and accept the treatment proposed.
Pictures can also aide the clinician in explaining a misconception of treatment completed on a patient. The image in Figure 2 came from a new patient that the author re-cemented a veneer that had fallen out on tooth #9. The patient was shown the veneer with a mirror and left content following treatment. Shortly after, the patient called the office irritated accusing the doctor of re-cementing it incorrectly and “crooked”. The patient returned immediately and was shown two powerful images, an occlusal view of the anteriors and a radiograph (Fig. 3). It was explained to the patient that the “rotation” that she saw was indeed a rotated #10 and the radiograph confirmed proper seating of the previously re-cemented veneer.
There are many ways we can communicate smile design options with our patients as well. From photos to digital smile design, these can be very effective in showing our patients what “could be”. One very effective tool, in the author’s opinion, is found in the Adobe Photoshop program. This tool is called Liquify. The Liquify filter lets you push, pull, rotate, reflect, pucker, and bloat any area of an image. The distortions you create can be subtle or drastic, which makes the Liquify command a powerful tool for retouching images as well as creating artistic effects. The example in Figure 4 shows a patient the possible achievable outcome on peg laterals in the lateral incisor position with minimally invasive veneer preparations. Note the “original” look, versus some of the “manufactured” smile design options available today.
Communication with specialists can be equally effective with good photography, simple graphics and concise explanations. Communicating with an orthodontist, or any specialist for that matter, without photography can be challenging. Two different sets of eyes may view the same situation very differently. However, when this is clearly laid out in a photograph with lines, arrows and a concise explanation, acceptance and collaboration can be much more effective (Fig. 5).
To take these to a whole new level, take note of Figures 6 and 7. The initial image is a retracted edentulous arch. As you can see in Figure 7, complete planning, from the surgical to the restorative phase, was completed by Dr. Jesus Ostos of Madrid, Spain. This type of planning keeps everyone involved in this multi-disciplinary case on the same page from start to finish.
When attempting to achieve the highest level of Cosmetic Dentistry, lab communication is critical. When completing an entire upper arch of porcelain restorations, choosing a single shade, i.e., B1, along with other minor instructions, can result in a successful outcome. However, when matching one or two anterior teeth, a lab prescription that simply says, “fabricate veneer shade B1” will undoubtedly leave the clinician and the patient very frustrated. When matching one or two anteriors, great detail is required for esthetic success, especially if the laboratory is not a local one. Note the detail in the dentition in Figures 8A and 8B. These polarized photos show translucency, halo effects and details that a technician could never pick up on in a prescription alone. Furthermore, there are techniques that allow for an objective numerical value to be applied to a subjective exercise such as shade selection. The use of an emulation gray card (Fig. 9), designed by Sasha Hein, allows the clinician and lab technician to apply number values (L.A.B. Values) (Fig. 10) to the adjacent tooth and ceramics, allowing for a much better chance of success of achieving single tooth esthetic success. This is clearly seen in the case example in Figure 11, a single veneer completed on tooth number nine by ceramist Julian Cardona, TPD, Ecuador.
Self-assessment is the process of looking at one’s self in order to assess aspects that are important to one’s identity. It is one of the motives that drive self-evaluation, along with self-verification and self-enhancement. Without self-assessment and critique, one cannot grow and improve. Our job as clinicians is to provide the best care we can to our patients. Surely the level of dentistry we provided straight out of school is inferior to what we are capable of 20 years later, or is it? In the book, Talent is Overrated, there are clear examples of professionals who are no better at the job they perform after 20 years than they were when they first started. Why is that? The answer is simple. There was no desire to improve and with that no form of “deliberate practice” completed. It is our duty to continue to provide the highest level of care to our patients. With that in mind, we must continue to educate ourselves, improve on our skills, and evaluate ourselves through current and past work via photography, so we can recognize where those improvements need to be. There is no doubt in my mind that anterior resins I completed ten years ago were not of the same caliber they are today (Fig. 12). I hope that I look back on the resins I complete today and say the same thing about them ten years from now.
We live in a very fast paced world. Most people scan through a large quantity of material each day, most of them being images. It is critical that we realize the importance of images in our marketing campaigns, in our educational opportunities, and in our social media platforms. Platforms such as Facebook, Instagram and YouTube allow us to showcase our work, learn from some of the best clinicians in the world, and market to a network of patients that were previously unreachable. In order to be successful, the images we share need to be of the highest quality. With the pace that people browse through all the platforms they are involved in, only images of the highest qualities will be recognized.
Finally, the digital camera and photography has helped me discover the artist in me, which I never knew existed. From taking simple intra oral photos, to working with makeup artists and models, I have been able to create a brand that I not only enjoy, but am able to market and attract new patients with. We have all spent many years and hours understanding and learning about the science we perform on a daily basis. Most of us will agree that dentistry can be tedious after a while, but combining it with a creative flare has sparked a new excitement for myself, my staff and my patients. With the many platforms of social media, it is very easy to show the artist in you. One of my favorite quotes from Pablo Picasso states, “Learn the Rules like a Pro, so you can break them as an Artist” (Figs. 13-19).
It is clear to see the power of the digital camera as it relates to dentistry. From patient communication, to lab communication, all the way to social media and marketing, I can honestly say that the one tool I cannot live without in practice is my camera. I also feel that dentists practicing without one are at a severe disadvantage, as are their patients. It improves everything we do day to day and more importantly, allows us to have the ultimate self-assessment so that we can improve over time. In the words of Ayelet Noff, founder and Co-CEO of Blonde 2.0, “If one does not constantly improve, one stays behind. People must always stay on top of their game, whether through forward thinking or innovative actions. We live in a remarkable age in which technology is evolving rapidly and assisting us in continually improving ourselves and our work methods. Immerse yourself in change. Don’t be afraid of it. Carpe Diem”.
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About The Author
Adamo E. Notarantonio, DDS, FICOI, AAACD is a 2002 graduate of SUNY at Stony Brook School of Dental Medicine. Dr. Adamo was Accredited by the AACD in 2011. He currently serves as the Accreditation Chairman, is on the American Board of Cosmetic Dentistry, the American Board of Cosmetic and Esthetic Dentistry and volunteers for the AACD’s Give Back A Smile program. Dr. Adamo is a Kois Center graduate, has multiple publications and lectures nationally and internationally. Dr. Adamo is a member of the ADA, AGD, the American Equilibration Society, and the International Congress of Oral Implantologists. He is currently an Adjunct Clinical Instructor at NYU College of Dentistry in the Honors Aesthetics Program.