There are six basic elements for a good start when treating patients with clear aligners.
Below is an overview of the six elements. The list may seem relatively mundane, but based on education, training and follow-up in more than 2,000 dental clinics, we've recorded that this is most often where problems arise.
Of the six elements, clinical photography is almost always the most challenging of all. In this post, we review a number of tips on how you can get better at taking a series of clinical photos yourself, or getting a team to take great photos for you.
Prerequisite for clinical confidence
Below you will find the elements that the clinical team must have in order to start treating clear aligner patients with clinical confidence:
That the clinic has found and assigned an external aligner expert as a collaborator.
To take a series of high quality clinical photographs to a specific standard in approximately 2 minutes
To be able to take full jaw IO scans of the upper and lower jaw, as well as a fusion bite.
To take a panoramic x-ray and an enormal x-ray of the maxillary and mandibular front.
To upload all relevant data to your clear aligner manufacturer.
To link the clinic's external expert to the case as a collaborator and send an email to the collaborator with the case number and a description of the dentist's and patient's wishes for the end result of the treatment.
Most dentists tend to take these elements lightly. After all, it looks relatively easy and straightforward, so it should be easy to implement. Therefore, most dentists focus on becoming more proficient at making orthodontic diagnoses, working with the clear aligner software, figuring out how to prepare orthodontic treatment plans and how to link them to the restorative final treatment, and so on and so forth.
The reality is just that this is where 90% of all interested dentists stop their journey with clear aligners. Because it's time consuming and difficult. There's a reason it takes 3 years to become an orthodontist. It requires massive knowledge and experience. In addition, it is actually challenging to find space for the six basics in a busy everyday life. Especially if you only perform them when a patient expresses an interest in orthodontics.
Can you imagine the patient's experience?
Just consider what a patient interested in orthodontics is going to experience if these elements are not rehearsed into a fixed routine that just runs on autopilot.
How would you feel if you were a patient in a clinic where the dentist and the dental assistant look at each other a little confused before they go to find photo equipment in 3-4 different places in the clinic, not quite seeming to have a handle on the technical elements. Just as they seem unsure when to take photos and IO scan. Add to that the fact that the team seems pressed for time and has difficulty answering the questions you have about the treatment.
The short-term and long-term impact of the clinic
Can you also imagine the negative impact that kind of experience has on the patient's propensity to accept the treatment when you have to present it later?
Can you imagine the impact that kind of experience might have on the story patients tell about the clinic to family and friends? (= Clinic brand)
To ensure you can help more patients, it is therefore important that you and your team practice the very basic disciplines BEFORE you get the first interested patient in the chair.
This means that the clinic must make sure that the team members who have contact with clear align treatments:
Know what data to collect and how.
Know where all the equipment is stored
Know how all devices work
Practices taking clinical photos and IO full jaw scans on a daily basis.
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What data to collect?
Make sure everyone in the team knows the necessary photo protocol. Everyone should know where to find a template with photos, they can compare their photos with the template and make sure they have all the photos before letting the patient leave the clinic (once the protocol is rehearsed and working).
You can find such a template here: https://www.alignerservice.com/photo-protokol
Alternatively, you can apply a photo app to a smartphone and use it to guide you through the series of photos to be taken.
Where is the equipment stored?
It's almost standard that when we visit a clinic that wants hands-on training in clear aligner workflows, the dental team typically spends 5-10 minutes locating the camera/smartphone, light source, mirrors, retractors, bowl of hot water and then cables for charging and image transfer. That's just too long to make it work in a busy clinic.
Make sure all the items you need for clinical photography are in one place in the clinic. Have it lined up in such a way that, by default, the equipment is placed so that it is charged when not in use (or always have extra batteries for flash and camera in a charger). There's simply nothing worse than having to take photos, only to discover that the equipment isn't charged.
Put the equipment in a way that it is well organised and ready to use.
Optimally, close to a computer used for uploading photos.
For example, have 2 trays with mirrors, retractors, bowl for hot water and space for camera/phone and light source/flash. So everything can be taken out of the cabinet and ready for use in the clinic in relatively few seconds. (You and I both know that 5 seconds in a dental clinic is a very long time - so to have an effective workflow that gets used, it needs to be super efficient).
As you can see, there's no difference in how you need to have your photography equipment ready, compared to all the other clinical equipment you have in the office.
How does it work?
When an interested patient sits ready to have photos taken, the photographer needs to know exactly what is going to happen and how. This is not the time to read through manuals and guidelines. This is not the time to call the boss and ask how to use the equipment.
It's no use thinking that just because you've practised using your camera once or twice, everyone in the clinic can figure it out afterwards. You need hands-on training with the equipment. Not just once, but many times.
Everyone should have tried the following several times:
Finding the equipment
Turning it on/off
Locating apps or a photo template
Taking photos according to protocol
Check and assess if the image quality is ok, without the need of any assistance.
Upload photos to computer or practice server
Crop, rotate and flip photos correctly
Transfer the photos to the patient-specific photo archive of the medical record system and store them there.
Know how to do it all according to GDPR/HIPPA guidelines.
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Daily training
Most of us tend to want to get a handle on all the theoretical elements of clear alignment treatments first. In a way, that's fine too. The reality we most often encounter in clinics that have stalled in implementing clear aligner treatments in the clinic is more about failing to get the very basics right from the start. So although it may seem trivial, it is absolutely essential that everyone practices the necessary skills regularly. Preferably several times a week!
High quality clinical photos, taken according to a specific protocol (not difficult), are the most important prerequisite, together with an intraoral scan that follows the scan protocol 100%. It is not easy if you have not tried it before. It is time consuming and can send the wrong signal to a patient interested in having orthodontic work done.
Our recommendation is:
Start by learning all about how to take a series of good photos for orthodontic use
Find a series of photos from an optimal photo protocol (Feel free to use this one), So you and your team can see what your photos should look like.
Make sure the photo protocol is in place when you take your photos. That way you can keep an eye on whether you're on the right track or forgetting something.
Get the right equipment so that you can take a full series of high-quality photos in 2 minutes without assistance. You can order the equipment we recommend here.
Set a goal that your dental assistant, your dental hygienist and you take a full series of photos on one patient per day. Only then will you become good at taking great photos, in a way that looks professional to patients.
Every morning when you come to work, tell the receptionist which patient you want to take photos of. This commits you to taking the photos you have set as a goal.
Make sure you photograph all the nicest patients - whether they need treatment or not. It's not about you needing these photos. It's about being able to take them professionally when you need to. You can't do that if you don't practice a lot!
When you choose to take photos of the clinic's kindest patients, you ensure that you yourself will have a good experience. Which motivates you to take more photos. Important: Take turns giving each other feedback on the quality of the photos you take.
Let the dentist take a series of photos first and then let the dental assistant give feedback on the quality. This method opens the door to giving feedback to the dentist. By making it legitimate to give the boss useful feedback, employees open themselves up to receiving feedback when their photos need to be evaluated. Once each team member has taken photos of about 50 patients, you begin to be ready to take photos of your potential orthodontic patients - even if you don't see orthodontic patients, you should continue practicing taking photos on a daily basis. Otherwise, you will forget your skills! As with any other skills, these need to be maintained. If you don't use your skills on a weekly basis, you will never be really good. (Which is also why the practice needs to have an external expert on board until the practice does about 100 alignment treatments a year itself).
It's not easy to take a series of good clinical photos. If it were super easy, everyone would already be doing it. Because clinical photos are the best tool in the world for communicating with patients and documenting a snapshot of teeth and occlusion.
Want a guide to taking a full series of photos in 2 minutes using a smartphone?
Would you like to read more about how you can use your photos to communicate with your patients. Getting to "yes"?
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Many kind regards
Jesper Hatt DDS
Phone: +41 78 268 00 78