Tech Tip: Common photo mistakes

We know that taking quality intraoral photos can sometimes be difficult, so we recently published an article with information and tips for taking clinical photos. This is a follow up to that article with some examples of common photo mistakes to be aware of when taking clinical photos and submitting your cases. 

Common photo mistakes


photos mistake 1 This front view doesn't demonstrate the bite relationship, because the mouth is open andthe teeth aren't touching. We need to be able to see how the teeth are fitting together.
photos mistake 2 This lower occlusal view shows too much of the facial surfaces of the teeth, and not enough of the occlusal surfaces. It's also blurry and over-exposed.  One option is to use a smaller F-stop if the camera has this capability. Zooming out is also a possibility, but with that there will be a general loss of resolution and it is hard to hold the camera steady while zoomed in, so with this option there may be some blurring due to slight movement.
photos mistake 3 This front view is washed out and unusable, because the camera was too close to the mouth when the flash went off. Step back and zoom in to correct this problem.
photos mistake 4 The angle of this profile photo is too far behind the patient and too high, making the shape of the jaw difficult to see. The camera lens should be level and parallel to the side of the patient's face. (This patient's eyes have been obscured to protect his privacy.)
photos mistake 5 The angle of this right lateral view is too far forward. We need to be able to see the full buccal surfaces of both six-year molars to accurately determine the molar relationship.
photos mistake 6 This occlusal view is off-center, and doesn't show enough of the molars. Most patients won't be able to open their mouths widely enough to take good photos unassisted. We recommend using an intraoral mirror and retractors.

Tech Tip: Taking clinical photos

ClearCorrect requires you provide clinical photos for each case you submit. Photos help us understand your prescription and interpret your instructions.

Proper patient photos of the patient's true occlusion are required so that initial articulation can be set properly. No matter the number of teeth that are moving, initial articulation is maybe the most important aspect of a treatment plan. If this is set incorrectly, every movement made, no matter how minor, could result in a negative or worsened outcome for the patient. Outside of that, we also need to ensure that the materials we have belong to the patient so that no time is wasted on creating a setup that does not belong to the patient, or wasted time for the doctor reviewing an incorrect setup.

Your photos will need to be uploaded as digital files when you submit your case in ClearComm. The most important thing is to include clear, well-lit photos, in focus from all eight angles.

Eight Angles

Below are the eight different photo angles required for your submission. These photos will help us produce the best aligners possible:

  • Full face (not smiling)
  • Full face (smiling)
  • profile (not smiling)
  • Front view
  • Right lateral view
  • Left lateral view
  • Upper occlusal view
  • Lower occlusal view
photos image

Watch this video on how to take photos and x-rays.

Taking clinical photographs

There are plenty of courses you can take to gain skill and become more proficient in clinical photography if interested. Here we are offering some quick tips and suggestions for taking good quality clinical photographs.


  • To take good quality photos you'll need the following materials:

    • Digital camera (a camera with ring flash and a dedicated macro lens will produce the best results for intraoral photography)
    • Cheek retractors 
    • Intraoral mirrors (full arch and lateral view in both adult and children sizes)
    • A solid white wall or background (poster or foam board can be purchased and used instead of a wall). This helps make sure that the patient's facial features are clear in the photo.

         Optional, but preferred:

    • A wall-mounted back light equipped with a "slave" flash is preferred, instead of a wall or other background (For example, the "Image Minder Back Flash and Dental Light Box" offered by Photodent USA)
    • A vertically adjustable stool or chair 

photo materials


For all extra-oral photos the patient should be at a comfortable, direct, 90-degree angle to the camera. For taller patients that may mean that the camera needs to be raised or the patient lowered and vice versa for shorter patients. An adjustable stool or chair enables the assistant or photographer to properly orient the patient's mouth to the camera. 

Full face (not smiling) 

  • Frame the patient's face from the top of the head to the middle of their neck, with the camera oriented vertically
  • Camera distance from the patient is determined by optimum focus at the lens' focal length providing the maximum depth of field (each lens may be different)
  • Patient's head should be oriented vertically in a natural and relaxed position
  • Patient should look straight ahead directly into the camera lens
  • Patient should have their lips, jaw, and teeth in their natural and relaxed position with lips together
photos 1

Full face (smiling) 

Same as above, plus:

  • Patient's smile should be natural
  • Teeth should be visible
 photos 2

Profile (not smiling) 

  • Patient's body is turned 90-degrees to their left so that their right shoulder is pointed directly at the camera and only the right side of their face is visible to the camera
  • Patient's head should be in a natural and relaxed position
  • Patient's eyes should be horizontal and looking straight ahead
  • Patient's hair should be pulled back, behind their ear, if long
DSC_4010 v2 

For all intra-oral photographs the patient can/should be in the dental chair. The patient and/or a dental assistant can help with the cheek retractors.

Front view 

  • Use cheek retractors to pull lips away from the teeth and gums
  • Lips and cheek retractors should not obscure any of the teeth
  • Camera should be horizontal, with the occlusal plane level in the center of the frame
  • The buccal corridors (the area between the buccal teeth and the inside of the cheek) should be well-lit and visible
  • Proper depth of field (determined by the lens) will provide focus from the central incisors to the first molars; operator should focus on the canines/first premolars
  • The upper and lower gingival sulcus should be visible
DSC_4381 v3

Right lateral view 

  • Have patient turn their head to their left so the right side of their face is towards the photographer
  • Use one cheek retractor to pull the right lip away from the teeth and gums, so that the right central to the last erupted molar is visible (if possible). Note: Try to do this step just before taking the picture so the patient is only uncomfortable for a few seconds and so that you can get as far back as possible.
  • Camera should be horizontal, and be pointed in a perpendicular angle to the buccal surface of the teeth with the occlusal plane level in the center of the frame
  • If the lips cannot be retracted far enough, with the help of another person or the patient, position a buccal mirror to capture the mesial of the second molars (if erupted), then repeat the previous step
  • Crop the frame so there is a minimum of distracting retractors and lips (see photos)
DSC_4369 v3

Left lateral view 

  • Have patient turn their head to their right so their left side of their face is towards the photographer
  • Repeat the steps in the previous section
DSC_4373 v3

Upper occlusal view 

  • Use a retractor to pull the upper lip away from the teeth
  • Insert the wide end of the arch mirror to capture the arch. Note: Pulling down slightly on the mirror can help to get the whole arch up to the last molar.
  • Patient may tilt their head forward so photographer can get the camera 90-degrees to the mirror plane
  • The framing should be square to a vertical line down the midline of the palate
  • Show the full occlusal surface of the arch
  • Try to get as little of the retractor in the picture as possible
DSC_0569 v4

 Lower occlusal view 

  • Use a retractor to pull the lower lip away from the teeth
  • Insert the wide end of the arch mirror to capture the full arch. Note: Pushing upward slightly on the mirror can help to get the whole arch up to the last molar
  • Patient may tilt their head backward so photographer can get the camera 90-degrees to the mirror plane
  • The framing should be square to a vertical line down the midline of the lower arch
  • Show the full occlusal surface of the arch
  • Try to get as little of the retractor in the picture as possible
DSC_0573 v4

Tips on taking photos

With most cameras, pressing the shutter button (the button that takes the photo) half way (before you feel that main resistance before the "click") before actually snapping the photo will help to focus the photo. Snapping the photo without first giving the lens a chance to focus usually results in blurry photos.

Light is your best friend. It's what makes photography possible. So it's always best if you can take your photos in the most well-lit area of your office. A ring flash matched to your digital camera and mounted on the front of the lens is the best way to adequately provide enough light for intraoral photos. 

Avoid getting too close to what you're photographing. Many cameras have a hard time focusing on things that are extremely close; in addition, if you have to use flash, the flash will wash out a lot of the detail in the shot if you're too close. Instead, take a tiny step back and simply zoom in on the subject.

Before and after photos

You already have to take the "before" photos when you submit a case to us. Upon placing the final retainer, we always encourage doctors to take a series of "after" photos, to keep a record of how effective the treatment was.

To submit after photos, simply take photos using the same angles you used in the submission process and send them to

We love seeing those new smiles, and doctors who take the trouble to take an extra series of photos are always glad they did! Great treatment outcomes are the strongest tool you have for growing the clear aligner aspect of your business.

Tech Tip: Impressions FAQ

Despite the increase in intraoral scanners available today, many doctors still prefer to use impressions to submit their cases to ClearCorrect. Here are answers to some of the FAQs about impressions and ClearCorrect. 

Our terms & conditions state: 

"Alginate impressions, stone models, and metal impression trays will be rejected. These and all other submitted materials become the property of ClearCorrect and will not be returned."

no metal trays-1Why doesn't ClearCorrect accept alginate material for impressions?

Alginate dries out and the material itself can shrink or expand depending on environmental factors. This can make the aligner too big or too small, depending on any changes.

Why can't I submit my case with metal trays?

ClearCorrect does not accept metal trays because they're incompatible with our scanning process. 

Why do you need both arch impressions/scans for a single-arch case?

We need both arches for a couple reasons:

  • We need to know where the opposing teeth are located to prevent inter-arch collision or hyper-occlusion when moving teeth to their final position.
  • When improving the overjet, overbite, midlines, canine, premolar, and/or molar relationships, we need to have the opposing arch to setup the correct relationships.

How does the impression tray size and material affect the fit of the aligners?

An impression tray that is too small can have several ramifications:

  • Prevents all teeth from being fully captured in the impression. 
  • The molars may lift from the tray which can ultimately skew the tooth shape and arch form.
  • Can potentially cause the patient to cut through the impression material all the way to the tray and leave holes in the impression.
  • Can prevent capturing the full gingival margin.

impression holes

If a tray is too big, the impression material may be spread too thin, which may make it difficult to fully capture the gingival margins. 

Using too much light-body material, using too little material, or not using light-body at all can also reduce impression accuracy. These procedural errors may cause voids or thin walls, among other issues, which affect the fit of the aligner. 

impression incorrect

Why can't we send stone models?

stone model

Stone models don't always survive the shipping process. There is usually some sort of chipping, especially along the cusps/incisal edges. Sometimes this can be a whole tooth, but most of the time it will be something minor that's hard to detect but can still affect the fit of the aligners. 

Also, with stone models, we can't control the quality of the stone model. The impression might be perfect, but if the pour-up is bad the scan will be compromised. Things like air bubbles can be filled in, but it leaves us guessing at what the shape of the tooth is actually like.

no bite registrationWhy aren't bite registrations required with my ClearCorrect case submission?

Bite registrations are not required to submit your case because our software automatically articulates the arches in maximum intercuspation. For the vast majority of cases, this is as accurate as (or more accurate than) aligning models based on a bite registration. Our technicians also double-check the occlusion against the photos you provide. 

Bite registrations will not be scanned unless specifically requested (either in the prescription form or in response to the technician in a setup decline).

When taking impressions, I have difficulty getting the distal of the last molars. Do you have any suggestions on an easy way to capture these?

Posterior distortion of the most distal teeth in the arch is 3rd on the list of most common impression issues. It can be difficult to get a good impression since it's hard to see back there. There are a couple of ways to avoid this problem:

  1. Make sure that you're using a correctly-sized tray. It should extend past the last tooth in the arch without touching the gums.
  2. Before inserting the tray containing light body, add some light body directly to the occlusal and distal portion of the last tooth in the arch, ensuring that the last tooth is completely covered with impression material.

Check out our Help Center for more information on the topic of impressions:

Tech Tip: Clear aligners and bisphosphonates

We sometimes get questions about the use of bisphosphonates while undergoing clear aligner treatment.  Here's our take on this topic:


Bisphosphonates are a class of drugs that are used to treat osteoporosis and other diseases involving bone fragility and/or loss of bone mass. These drugs effect bone metabolism by inhibition of osteoclastic activity.


The disruption of bone metabolism may have as small of an effect as slowing the rate of tooth movement during orthodontic treatment to as drastic an effect as bone failing to heal post-extraction. Much depends on the individual, drug dosage parameters, time and duration of bisphosphonate therapy, pharmocokinetics and other variables.

The option for the patient to be treated with clear aligners for orthodontic movement depends upon the dentist's evaluation of the totality of the patient's condition and the severity of the involved mitigating circumstances. 

Variables including (but not limited to) patient medical history, overall oral health and the treatment being performed, are all factors that can affect the decision of whether or not to perform orthodontic treatment on a patient who is taking or has taken bisphosphonates. 

It is the dentist's responsibility to be informed and familiar with their patient’s medical history and any interactions the patient’s medications may or may not have upon the orthodontic treatment. Consultation with the patient's physician may help to answer specific questions.

What effects do bisphosphonates have on clear aligner treatment?

The relatively gentle pressures associated with tooth movement caused by clear aligners generally does not disturb this activity sufficiently to result in osteonecrosis (the death of bone tissue) of the jaw. However, if your patient is taking or has taken medications containing bisphosphonates, be advised that these drugs may interfere with the patient’s bone’s ability to remodel normally, which may affect the efficacy of the aligners to move teeth.

A helpful literature reference for more information about bisphosphonates and how they may affect different types of orthodontic treatments can be found here

Bottom line: A history of bisphosphonate therapy does not automatically preclude orthodontic treatment with clear aligners. However, it is the dentist's responsibility to determine if clear aligner therapy is appropriate for that particular patient.  

Tech Tip: Staff incentives

Playing team games and offering staff incentives is a great way to boost clear aligner cases in your practice and get the team motivated. You may already have some in place, but we thought we'd offer a few from some of our providers that have proven successful for them. 


Sample bonus programs

First appointment referrals

Provide a bonus for first appointment referrals - getting your staff to promote your practice to friends, family, anything outside the office, where it results in a first appointment referred by them.

This can be easily managed with referral cards, which should always be kept available to be handed out. The referral cards can offer a free service, for example a free exam, X-rays and consultation, showing the cost value ($200).

Or implementing a bonus structure for all staff to provide incentive for starting cases: for example, with every new case approved putting $100 in a pot that the staff evenly split each quarter. 

Online reviews

Provide a bonus for reviews solicited by staff on Google, Yahoo, Yelp, Healthgrades, Reputation building sites.pngRatemd, etc. 

  • Staff documents the solicitation and submits for a bonus
  • Can establish a bonus scale; higher bonuses for Google, Yahoo & Yelp reviews

Production bonuses/games

Establish weekly, monthly or quarterly bonuses based on practice metrics reflecting improvement.

  • Set a specific case submission goal for the whole team and award the entire team if the goal is met or exceeded
  • Bonus for the staff with the highest number of referrals
  • Bonus for the staff with the highest number of case starts

Tip: Pay out bonuses immediately. Do not let them accumulate or pay them at the end of the week or monthly. The instant return for good work well done inspires more of the same.

Additional incentive ideas

  • Clear aligners for staff or their family members
  • Individualized incentives (something specific the staff wants to request)
  • Annual retreat/Team trips (cruises, amusement parks, etc.), if yearly production quota for clear aligner cases is met. 

Tech Tip: Class II corrections

Can ClearCorrect treat class II cases?

We consulted with our Clinical Advisor, Dr. Ken Fischer for the answer.

ClearCorrect aligners can treat class II cases, with or without elastics, as well as any other aligner product. It has been assumed by some, that due to the fact that ClearCorrect has chosen to not manufacture ‘slits’ or ‘cutouts’ in the aligners for the attachment of elastics, that we cannot treat class II cases. What is important to know is that this decision does not preclude us from supporting alternative methods for using elastic traction in the correction of class II discrepancies.

Other aligner manufacturers believe and promote manufacturing aligners with cutouts in each aligner, when requested by the doctor, so the doctor can ask the patient to attach elastics to them whenever it is time to correct the class II imbalance. The cutouts can irritate the patient’s soft tissues and cause the aligners to be displaced downward when the elastics are attached.

ClearCorrect primarily supports the method of class II correction where buttons are bonded to the teeth for the attachment of the elastics. This method applies force directly to the teeth and supporting structures, promoting more effective tooth movement, hence the class II correction. Doctors approve of this method because they only have to modify the exact number of aligners needed to make the correction; this modification can be done easily and quickly by the dental assistant.

In addition to the above, the doctor can use a plier designed to cut slits in the aligners for the attachment of elastics to be worn to make the class II correction. These slits can be cut into the aligners so that buttons need not be bonded to the teeth. One must understand that any method that uses elastics connected to the aligners vs. the teeth, results in much of the elastics’ forces being quickly dissipated by the aligner’s contact with the rest of the teeth in the dental arch, retarding the correction of the class II malocclusion.

We also must not ignore the other methodologies of correcting class II occlusions, i.e. by distalizing the upper posterior teeth into a class I relationship, or extracting upper first molars, advancing the upper second molar into a class I relationship with the lower molars, and allowing the upper third molar to erupt into a functional relationship with the lower teeth. Any of these treatments can be accomplished very satisfactorily by ClearCorrect clear aligners.

To anyone wondering if ClearCorrect can correct class II malocclusions, the answer is: yes!

ClearCorrect can provide the doctor a number of ways to correct class II problems depending upon the needs and conditions of the patient and the techniques the doctor chooses to use, from elastic traction attached to the teeth via bonded buttons or to the aligners via cutout or slits in the aligners, to distalization of the upper posterior teeth. ClearCorrect aligners can treat class II cases, with or without elastics, as well as any other aligner product!

Thanks for the clarification, Dr. Fischer!

For more information on the technique for using buttons & elastics for class II correction, check out our article in the Help Center. 

Tech Tip: Patient objections & challenges

Patients can have all sorts of objections and challenges to doing clear aligner treatment. Here are some suggestions for addressing these issues so that your patients can experience the benefits of clear aligners.


“The aligners are uncomfortable” doctor and patient chair.png

Other than the temporary discomfort caused by tooth movement, a well-fitting aligner will only be uncomfortable if there is a rough edge, which can be smoothed at home with a fingernail file, or at the office by an assistant.

“They’ll make me talk funny”

Some patients develop a temporary lisp when they first try aligners, but this usually goes away very quickly.

“They cost too much money”

A new and beautiful smile should be a highly valued aspect of one’s appearance and everyone must determine that value on his or her own. Since orthodontic treatment is considered a time and materials intensive procedure, it is reasonably priced in a range where most patients appreciate the opportunity to make payment arrangements with the practice.

“I don’t like the little bumps (engagers)"

In many cases, the number of engagers can be reduced. However, if the patient requests to avoid the use of engagers altogether, they must accept that the treatment may take longer and specific movements may be more difficult to accomplish.

“I don’t want to have IPR done on my teeth”

If a patient refuses IPR, the doctor must consider other methods for creating the required amount of space, such as expansion or extractions. You can explain to the patient the difference between IPR with a handpiece and manually with a diamond strip. Some patients are apprehensive because of the dental handpiece and may accept other manual approaches to IPR. 

“I don’t think I can wear them 22 hours a day"

If the patient can't or won't wear the aligners 22 hours a day, both the doctor and patient must agree upon how many hours of wear will be acceptable to each party, with the understanding that the treatment may take longer or be less effective. If an agreement cannot be made, they can consider other methods for correcting the malocclusion, such as traditional braces.


Financing is one of the top challenges for patients to start treatment. Offering a patient financing solution in your office is a great way to make treatment more affordable. Offering budget friendly payment options is another way to help. Here are some options that may be helpful to you:

  • Free exams and consultations
  • Down payment, interest-free monthly payment arrangements that are acceptable to both patient and the practice
  • Third party financing, such as beWell by FTL Finance
  • Credit cards with  or without a monthly Autopay feature
  • Health Saving Accounts
  • Split down payments
  • Extended monthly payment option with interest

Length of treatment can be a concern for some patients. While you might know that treatment with clear aligners is usually shorter, more affordable and aesthetic than traditional braces, your patient may not. Here are some suggestions for resolving this objection:

  • Clear aligner treatment may be faster than the alternative (traditional braces)
  • The length of treatment is primarily determined by the treatment goals; if treatment length is a serious objection, revise the treatment goals

Pregnancy Except during periods of nausea and vomiting, a pregnant woman can wear her aligners without any negative consequences.

Patients who travel constantly (military, jobs that require travel, college students, etc.) When it is inconvenient or impossible for the patient to be near the doctor’s office for visits, the patient can continue to wear stages of the aligners until they can return for a checkup or delivery of new aligners. 

Clear aligner benefits - talking points

Talking to your patient about clear aligners will be different with each case. Some patients know they want to straighten their teeth, and know they don’t want traditional braces. However, it’s not every day a patient like that comes through the door.

The truth is, while the majority of your patients could benefit in some way from straighter teeth, most of them don’t know it. Some of these benefits and advantages are bound to resonate more than others.

Following are some sample talking points about clear aligners that you and your staff can use to bring up or talk to patients about clear aligner treatment.

The esthetic angle patient and doctor.png

“How would you rate your smile on a scale of 1-10?"

"A lot of our patients want just want a perfect, beautiful smile, and clear aligners are a great way to get teeth into their proper position.”

“Did you know that your facial structure can be affected by teeth that are misaligned? You can minimize these effects by preventing and correcting misaligned teeth with clear aligners.”

“Did you know that a beautiful smile is associated with good wealth and well-being? Clear aligners are a simple option for correcting teeth that are misaligned and without anyone noticing that you’re in treatment.”

“Clear aligners have social advantages – people form strong impressions of each other within a few seconds of meeting, with a focus on the individual’s eyes and mouth. With a straight and beautiful smile you can make great new impressions.”

The health angle

“Did you know that misaligned teeth can cause you all sorts of dental & facial problems? Clear aligners are a simple way to fix your teeth without people even knowing you’re in treatment.”

“Clear aligners can help improve the function of your teeth so that they fit together naturally, interfere with each other less and it can even be easier to chew food & it doesn’t get stuck in your teeth as much.”

“Teeth wear down over time regardless but did you know that it accelerates for teeth that are not properly aligned? Clear aligners can help correct misaligned teeth and help with graceful aging.”

The financial angle

“I see that you have ____ (issue). Did you know that fixing your teeth today is less expensive than repairing potential damage in the future if left untreated?”

“Straightening your teeth with clear aligners could help prevent expensive complications like premature wear, receding gums, loss of attachment and loss of bone support.”

The "it's so easy, why not just do it" angle

“This system is a series of comfortable, removable, clear trays that replaces traditional braces and wires attached to your teeth.”

The "if you're already thinking about doing it, do it here" angle

“Our practice is one of the premier offices offering clear aligners to patients in our community.”


For more successful actions on prioritizing aligners in your practice, check out our checklist for clear aligner success.

Tech Tip: Dental prosthetics and implants

Although patients with any of the conditions listed below can be treated with clear aligners, it can make treatment more complex. Be sure and indicate in your prescription form if you are treating a patient with any of these conditions. Here are some of the reasons for added complexity:

  • Crowns usually can't retain engagers
  • Bridges can create undercuts that may make it difficult to insert or remove the aligners due to too much retention. 
  • Dentures are designed to fit together with the opposing arch. If any of the teeth move, the dentures will probably need to be replaced or adjusted.
  • Partial dentures will most likely need to be replaced, because moving teeth in anarch with a partial denture can cause it to not fit. If you want to proceed with treating a patient with a partial denture, then you will need to take an impression or intraoral scan without the partial. We would advise not to wear the partial while in treatment, as it could interfere with movements.
  • Implants cannot be moved because they are fused to the bone. Make sure you have noted all implants in your prescription form so that no movement is planned for that tooth, putting the implant at risk.

2017: Year in review

Happy New Year! We hope you had a great holiday season.

Our 11th year was pretty big for us so we thought we might compile some of the highlights from 2017 for posterity.

New features




  • We sent out 47 new Tech Tips that addressed a wide range of topics. (ICYMI: Our two most popular Tech Tips were Ankylosed teeth and  IPR - Contouring).
  • We introduced our new workshops with our Clinical Advisor, Dr. Ken Fischer, and Clinical Advisory Group member, Dr. Duane Grummons.  We hosted day-long courses in Austin, Las Vegas, New York, Orlando, and Chicago.
  • For our providers who prefer to learn at their own pace, we updated our e-course offerings to include more of the information from the live workshops.
  • 2017’s live workshops were so popular that we doubled our speakers, widened our topics, and will be hosting 12 all-new workshops in 2018.

2018 is going to be an even bigger with more news around the corner.

Thanks for another great year!