Sandler J, Murray A. Clinical photography in orthodontics. J Clin Orthod. 1997; 31:729-739
Morse GA, Haque MS, Sharland MR, Burke FJ. The use of clinical photography by UK general dental practitioners. Br Dent J. 2010; 208
Nayler JR. Clinical photography: a guide for the clinician. J Postgrad Med. 2003; 49:256-262
McKeown HF, Murray AM, Sandler PJ. How to avoid common errors in clinical photography. J Orthod. 2005; 32:43-54

Tricks of the Trade: Benefits of Backlighting

From Volume 15, Issue 3, July 2022 | Pages 154-155


Kelly Smorthit

MChD/BChD, MFDS RCS (Ed), MRes, MOrth RCS (Ed)

Speciality Registrar in Orthodontics, LDI/Chesterfield Royal Hospital

Articles by Kelly Smorthit

Email Kelly Smorthit

Jonathan Sandler

BDS (Hons), MSc, PhD, MOrth RCS, FDS RCPS, BDS(Hons), MSc, PhD, FDSRCPS, MOrth RCS, Consultant Orthodontist, , DOrth RCS

Consultant Orthodontist, Chesterfield Royal Hospital, Chesterfield, UK

Articles by Jonathan Sandler

Email Jonathan Sandler


Some simple methods of controlling lighting will improve the quality and consistency of clinical records and communication process with patients. It will also provide optimal quality photographs for presentations and professional examinations. In this Trick of the Trade, the simple technique of using backlighting to produce high-quality extra-oral images is discussed.

Clinical photography in orthodontics is fundamental for optimal record keeping, treatment planning, communication and consent.1 Taking clinical photographs also plays an important role in teaching, reflective practice and in supporting clinicians from a medico-legal standpoint.2

High-quality clinical photography relies on optimal patient positioning, the appropriate use of light and the correct application of camera settings.3 Some simple methods of controlling lighting will make a substantial improvement to extra-oral photographs, which will ultimately improve the quality of the clinical records.4 It will also provide high-quality photographs for cases used for any professional examinations and for presentations. Use of a slave flash for backlighting can markedly improve the quality of clinical photographs.

Recommended set up

A digital camera (eg Canon EOS 80D) with a macro ring flash (eg Canon MR14EX II) and one slave flash (eg Canon Speedlite, 430 EX III RT) is required (Figure 1).

Figure 1. Camera and slave flash set up.

The slave flash is positioned behind the patient, to illuminate them from behind, and also to ‘white out’ the background. Care should be taken to position the slave flash not too anteriorly, to avoid washing out the profile or the underside of the chin. The slave flash and camera are set up to the same channel, to communicate wirelessly, enabling simultaneous discharge (Figure 2).

Figure 2. Both set to channel 3.

The use of the slave flash will remove the shadow that is sometimes thrown ahead of the patient's profile, by the ring flash, and will also accentuate the patient's profile.

Figure 3 shows a profile view where a white Perspex screen has been used as the background, but a white roller blind works equally well. In Figure 3a, the photograph was taken with the slave flash whiting out the background, while Figure 3b was taken with no slave flash. Figure 4 demonstrates a profile view with a blue background with (Figure 4a)and without (Figure 4b) a slave flash. Note the shadow cast in front of the subject in Figure 4b. Similarly, in Figure 5, the three-quarter view with slave flash (Figure 5a) and with no slave flash (Figure 5b) can be seen. Again, note the shadow in front of subject in Figure 5b.

Figure 3. Profile view where a Perspex screen is used as the background. (a) Slave flash whiting out the background. (b) No slave flash.
Figure 4. Profile view with a blue background. (a) With a slave flash. (b) No slave flash: note the shadow in front of subject.
Figure 5. Three-quarter view with a blue backgound. (a) With slave flash. (b) No slave flash flash: again, note the shadow.

Top tips for optimizing extra-oral shots

  • Position patient at same height as photographer;
  • Patient's hair behind their ears;
  • Remove glasses;
  • Frankfort plane horizontal;
  • Non-reflective background and eliminate shadows using backlighting (via slave flash);
  • Patient in centric occlusion (rather than adapting a habitual postural position to camouflage a Class II skeletal relationship or over-closing in a severe Class III case).
  • Conclusions

  • Choose a background of your choice;
  • The use of a dedicated slave flash is a simple measure that can significantly improve the shot by ‘whiting’ out the background.