Have you ever been frustrated with a diagnostic wax-up or final restoration returned by your laboratory? There could be several underlying reasons the result was not the one you expected. 

There are several questions you can ask yourself when troubleshooting what might have gone wrong. Did you comprehensively complete the prescription form? Did you provide photographs in addition to the written information?

There are three times during comprehensive care or esthetic treatment when clear and concise communication is essential. One of the best ways to improve communication is with accurate photographs. I suggest you provide photographs at the following three phases of treatment.

Diagnostic Phase

The essential photographs to be sent to the laboratory during the diagnostic phase of treatment, are preoperative images. They include:

1. Portrait with lips in repose - lips separated by 4.0 mm

portrait in repose dentistry

2. Portrait with maximum smile

portrait with maximum smile dentistry

3. Portrait with lips retracted and anterior teeth separated by 2.0 to 4.0 mm

lips retracted anterior teeth dental photo

4. Portrait of the patient with the facebow

facebow dental photo
mounted dental laboratory casts

5. Intraoral close-up image (1:2) with shade tabs of current shade and expected shade if different from the current condition. The shade tabs are positioned at the incisal edge of the teeth to the incisal edge of the tab, or if the technician prefers, the gingival third of the tab next to the incisal edge of the teeth. I suggest using Vita Classical and Master shade guides.

dental shade tabs
horizontal reference lines dental photos
desired tooth length esthetics
tooth shape dental esthetics photos
intra oral photography
intraoral photography
intraoral photography tips
take better dental photos

Treatment Phase

The essential photographs to be sent to the laboratory at the time of final restoration fabrication, are images of the provisional restorations. They include:

1. Portrait with lips in repose - lips separated by 4.0 mm

dental portrait lips in repose

2. Portrait with maximum smile

dental photo maximum smile provisional restorations

3. Portrait with lips retracted and anterior teeth separated by 2.0 to 4.0 mm

lips retracted dental portrait

4. Portrait of the patient with the facebow

provisional restoration facebow dental photo

5. Intraoral close-up image (1:2) with anterior teeth separated by 2.0 to 4.0 mm

intral oral photo provisional restorations dental portrait

6. Tooth preparation with shade guide/prep guide next to the teeth

shade tab photographs esthetic dentistry

7. Intraoral (1:2) preoperative shade of teeth and shade tab, and expected shade

pre-operative tooth shade tabs dental photography

8. If the treatment requires the technician to fabricate a restoration to replace soft tissue, a photograph of the pink ceramic shade guides next to the gingival tissue is required. The shade guide should be from the manufacturer of the pink ceramic the technician will be using.

gingival shade tabs dental esthetics

If Esthetic Adjustment Is Required

The recommended photographs will be taken of the restoration tried on the prepared tooth using try-in paste. The try-in paste bridges the space between the restoration and the prepared tooth. This is the only way to evaluate the final shade with translucent restorations.

adjusting teeth dental photography

In the case of an anterior single restoration, the photos needed are:

1. Full face portrait with patient in maximum smile

2. Full face portrait with lips retracted and anterior teeth separated by 2.0 and 4.0 mm

3. Intraoral close-up image (1:2) with anterior teeth separated by 2.0 to 4.0 mm

4. Intraoral close-up image (1:1) of restoration

5. Intraoral close-up image (1:1) of contralateral tooth

6. Intraoral close-up (1:2) of restoration with shade tabs in view (original and possibly new shade tab)

7. Intraoral close-up (1:2) of contralateral tooth with shade tabs in view (original and possibly new shade tab)

8. Intraoral close-up (1:2) of tooth preparation with shade tabs in view

In cases where multiple teeth are involved (anterior only or anterior and posterior), and occlusal planes need to be evaluated, the photographs needed are:

1. Portrait with lips in repose - lips separated by 4.0 mm

2. Portrait with maximum smile

3. Portrait with lips retracted and anterior teeth separated by 2.0 to 4.0 mm

4. Intraoral close-up (1:2) with the original expected shade tab and the new requested shade tab, if a shade adjustment is required

5. Intraoral close-up (1:2) of the tooth preparations with shade tabs and/or preparation guide tabs. This new photograph of the teeth is suggested because the original photograph of tooth preparations may have been inaccurate due to color changes caused by dehydration.

Including photographs with your laboratory prescription should lead to a decrease in remakes, and improve the overall esthetics of your cases.

(Click the link for more articles by Dr. Bob Winter.)  

Bob Winter, D.D.S., Spear Faculty and Contributing Author