Clinical photography in orthodontics: the standard views, consistency and common errors

Simplified Orthodontics Academy · Published 28 October 2026

Why photographs are part of the record

Sandler and Murray describe photographs as an essential part of the clinical record in orthodontics [1]. McKeown, Murray and Sandler describe photographs taken before, during and after treatment as part of the records, and note that poor-quality photographs can misrepresent the starting situation or the progress of treatment [2]. Sandler and Murray also describe digital photography for orthodontic records [3].

A photograph shows the patient only as the camera saw them. The position of the head, the angle and distance of the camera, and the light all change the picture. This is why the views are standardised: the same view, taken the same way, can be compared from one visit to the next.

The extraoral views

Four views of the face are usual:

• Frontal at rest: the patient faces the camera and looks straight ahead, with the lips relaxed.
• Frontal smiling: the same position, with a posed smile that shows the teeth.
• Profile: the patient turned to the side, still looking straight ahead, so the camera sees the face side-on.
• Three-quarter: the face turned part of the way between frontal and profile, often smiling.

For all four, the head is level and in a natural position, the camera is at the height of the patient’s eyes, the background is plain, and the face is framed the same way each time. Hair is kept away from the face, and glasses are taken off.

In the Studio, Simplified Face uses three of these views: “Frontal at rest, frontal posed smile and profile”. Its landing page says to take the photos “with the camera at eye height”, and that “Photo measurements depend on head position, camera distance and calibration.” A photo is calibrated from the iris, the pupil distance, or a ruler held at the face. Face has no three-quarter view and does not measure intraoral photographs. Simplified Practice keeps photographs in record sets “with frames for extraoral and intraoral photos”.

The intraoral views

Six intraoral views are usual:

• Frontal: the teeth together, seen straight on, with cheek retractors holding the lips away. The midline of the teeth is in the middle of the picture and the biting plane is level.
• Right buccal and left buccal: each side with the teeth together. The retractor on that side is drawn back so the camera can look straight at the side teeth.
• Upper occlusal and lower occlusal: the biting surfaces of each arch, photographed in an occlusal mirror. The mirror image is flipped afterwards so it reads the right way round.
• Overjet: the front teeth seen from the side, showing how far the upper incisors lie in front of the lower incisors.

In the Studio, Simplified Practice keeps intraoral photographs in the frames of each record set. On the Plus and Pro plans, its printing includes “Photo composites”.

Equipment, in general terms

• A camera with a macro lens, which takes sharp close-up pictures of the teeth.
• A flash suited to close work, so the inside of the mouth is evenly lit.
• Cheek retractors, to hold the lips and cheeks away from the teeth.
• Occlusal mirrors, for the views of the biting surfaces.
• A plain background and a fixed place for the patient to stand or sit for the extraoral views.

This article gives no camera settings. Whatever settings a clinic uses, keeping them the same from one visit to the next is what makes the photographs comparable.

Keeping views consistent between visits

Sandler and colleagues compared clinical photographs taken by orthodontists, professional photographers and orthodontic auxiliaries. The orthodontists produced more good-quality intraoral photographs, and the study points to training and a set routine [4].

Consistency comes from doing the same things in the same order:

• the same list of views, taken in the same order;
• the same framing for each view;
• the same head position, and the camera at the same height;
• the same light, background and camera settings;
• the same person, or people trained in the same routine.

Common errors

McKeown, Murray and Sandler describe common errors in clinical photography and how they can be avoided [2]. Some examples of what goes wrong:

• The head tilted or turned, so that the face or the teeth look less symmetrical than they are.
• The camera not square to the view: a buccal view taken from the front, or an occlusal view taken at a slant, changes the apparent shape of the arch.
• The biting plane or the eye line not level in the frame.
• Retractors, fingers, saliva or a misted mirror in the picture.
• A mirror view left unflipped, so that right and left are swapped.
• Too much or too little light, deep shadows, or glare from the flash.
• Strained lips in the rest view, or a forced smile.
• A view missing from the set, or framed differently from the last set.

Storing and labelling photographs

• Name each photograph with the patient, the date and the view.
• Keep the photographs from one visit together as one set, with its stage.
• Keep the original files, and make any edits on copies.
• Back up the files, and keep them where only the people who need them can open them.

Photographs are one part of the record set described in Orthodontic records: what a complete set contains.

In the Studio, Simplified Practice keeps record sets and says: “Add a new set at each stage.” Where Practice keeps the records, in the words of its landing page: “In this browser on this device. If you sign in, a copy is also kept in your private Studio cloud, so your records open on your other devices. When you are signed in, a short list of the next 14 days of appointments is also sent to our server for reminders. If you use patient messages, they are kept on the Studio server.” The privacy policy adds: “Without an account, everything you enter stays on your device and nothing clinical reaches us.”

Consent

Consent and record-keeping rules depend on the country and the clinic, and this article does not cover legal requirements. Using a patient’s photographs outside their record, for teaching, publication or marketing, needs the patient’s written consent.

Limits

• A general description. Clinics use different sets of views, and published guides differ in detail.
• No settings or distances. This article gives no camera settings, distances or magnifications.
• A flat picture. A photograph is a two-dimensional image of a three-dimensional face and mouth. It does not replace the examination or the other records.
• Not treatment advice. This article explains how photographs are taken and kept, not how they are used to decide on treatment.

Educational content for clinicians and students. This page describes how orthodontic photographs are taken and kept. It does not cover treatment or legal requirements, and it does not replace clinical judgement.

References

1. Sandler J, Murray A. Clinical photography in orthodontics. J Clin Orthod. 1997;31(11):729-739.
2. McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod. 2005;32(1):43-54.
3. Sandler J, Murray A. Digital photography in orthodontics. J Orthod. 2001;28(3):197-201. doi: 10.1093/ortho/28.3.197
4. Sandler J, Dwyer J, Kokich V, McKeown F, Murray A, McLaughlin R, O’Brien C, O’Malley P. Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries. Am J Orthod Dentofacial Orthop. 2009;135(5):657-662.

More to read

• Orthodontic records: what a complete set containsNotes, photographs, study models and radiographs, and how sets are kept
• Smile analysis explainedWhat is measured on the frontal smile photograph
• Soft tissue profile lines explainedWhat is measured on the profile photograph
• Simplified FaceFrontal, smile and profile photo analysis
• All articlesOrthodontic analyses, explained