here has been much debate about which camera manufacturer would come out with the definitive digital camera for the orthodontic market. Throughout the industry and at all the major meetings, there has been a consensus as to what the ideal orthodontic digital camera should be, but there has been little agreement as to which currently available digital camera meets these requirements. GAC was invited to attend the Ski Philly technology expo prior to the AAO in 1997 and we had a representative from Fuji in our booth. Doctors came to our booth inquiring as to the features of the DS-220 which we had just begun to sell. Further, they let us know exactly what they did not like about the current crop of digital cameras in orthodontics. We were pleased that when we compiled a list of pros and cons, we found that the camera most suited for orthodontic use was the Fuji DS-220.

In evaluating any photography solution, perhaps the most important consideration is picture quality. However, when dealing with a digital solution and fixed storage space on the computer, this must be weighed against file size and ease of transfer to the host computer. The Minolta RD-175 has a picture resolution of 1528x1146 - the highest in this roundup. However, each picture has a file size of 5 megabytes. On a computer having two gigabytes of available hard drive space, only 400 images can be stored which amounts to approximately 50 sets of records. The Sony Mavica MCV-7 stores images on standard 1.44 MB diskettes which makes for an effortless transfer; however, the number of images that can be taken in a single session is limited by the fixed capacity of the diskettes. The Fuji DS-220 uses PCMCIA memory cards ranging in capacity from 2 megabytes to 15 megabytes and also has adjustable image quality. This allows the user to determine the individual image size which is proportional to the image quality. PCMCIA card readers for PC compatible computers are available and priced around $150. Once installed, image transfers are fast and easy.

In adapting to the orthodontic market, the capability of taking high quality intraoral photographs is essential. Of the systems we've evaluated, many have no macro setting, and of those that do, an adequate flash for orthodontics is often missing. The new Fuji DS-300 has only a fixed-length macro setting which does not offer enough flexibility for orthodontic use. The Olympus D-320L offers a macro setting, but the smallest area that can be photographed is 4.1" X 5.8". Additionally, the flash is a simple point-flash located above and to the right of the lens, producing uneven and inadequate light for close-up photography. The Sony Mavica MCV-7 has a flash in close proximity to the lens but it tends to wash-out images taken at a close distance. The Minolta RD-175 can be equipped with a ring flash but has a price tag around $6000. While it is true that with some effort one can jury-rig a lens or light to one of these cameras, the aesthetics of the actual camera and the impression the patient receives from this "solution" needs to be considered. The Fuji DS-220 has a macro kit that allows continuous range photography from 11cm to 50cm and image areas as small as 36mm X 27mm (1.4" X 1.1"). The integrated dual-flash coupled with the camera's built in point flash nicely simulates a ring flash, providing even illumination for intraoral photos without any wash-out.

The Fuji DS-220 has benefits that go beyond the minimum of a viable orthodontic digital solution. The removable LCD preview monitor allows true "through-the-lens" viewing of the subject as well as providing instant capture confirmation. Users can choose to keep the image or delete and re-shoot; you get the images you want without wasting time and effort with images you don't want. The camera also provides a standard NTSC jack to display images on a TV monitor for group viewing. Both wide-angle and telephoto lenses are integrated into the camera and are selected at the flick of a switch. The removable macro kit allows for photography as close as 11cm and provides uniform lighting in low-light situations. Other cameras may have resolutions higher than that of the DS-220, but resolution should not be the only determining factor in choosing a digital camera. There has been no agreement among orthodontists as to the need for resolutions above that of the DS-220. Further, one should consider how much memory one is willing to sacrifice to store large image files. The unique square-pixel design of the DS-220 affords premium image quality at 640 X 480 pixels while maintaining a manageable file size (five images or more per megabyte depending upon user selectable image quality). Auto-focus, auto-exposure, and automatic flash functions offer an ease of use that is normally only associated with compact "point-and-shoot" cameras. If the situation demands, both the aperture and exposure may be adjusted for optimum picture quality. The lithium ion battery allows for a no-cable solution with enough power for up to 500 exposures on a single charge.

To increase the functionality of the DS-220, GAC is proud to offer VistaDent, a complete digital imaging software solution expressly designed for the orthodontic community. There has been no consensus as to the best storage facility for digital images. The idea of storing individual patient images on separate diskettes can be quite unwieldy. The need for some sort of database is evident. VistaDent Lite maintains a database of patient data including name, address, birth date, initial visit date, referring doctor, and a free-form comments. This information can later be integrated into customizable letters which include patient images utilizing Microsoft® Word 97. Several letter templates are included with VistaDent Lite, and additional letters may be created by the doctor. The versatility of the VistaDent includes the ability to download the patient's photos in any user definable arrangement. Once pictures are taken and stored on the Fuji's memory card, the card is inserted into the computer's card reader, and with the push of one button, all of the patient's images are downloaded in the correct order and format, and a composite is generated. Since the memory cards are reusable, the two-megabyte card included with the camera is sufficient for most orthodontic offices; therefore, there is seldom a need to purchase multiple or larger, more expensive memory cards.

VistaDent Cosmetic is a viable option for the manipulation of digital images. Commercial image manipulation programs such as Adobe® PhotoShop® provide a multitude of tools for retouching and morphing images. However, due to their inherent complexity, they represent a significant investment of both time and money, and they are often very confusing since they contain far more features than would be necessary for any orthodontic practice. VistaDent Cosmetic has all the features of VistaDent Lite as well as the image manipulation tools that most orthodontists would use. The auto-flip and auto-mirror functions are indispensable when using intraoral mirrors. Free-angle sectional rotation can show a patient the difference between symmetrical and asymmetrical smiles. Slider bars are available to perform real-time adjustment of picture brightness, hue, and contrast. Utilizing the morphing and compare tools, patients can easily comprehend treatment objectives with only a few simple mouse strokes. Showing the objective sells the objective.

GAC has researched the topic of orthodontic digital solutions thoroughly in the hopes that we would be able to remove the uncertainty that comes with any cutting-edge technology. Having researched several of the digital cameras that orthodontists are using today, we feel confident that the Fuji DS-220 along with the VistaDent software offers the ideal solution. Ease of use, price, and customer support are all factors which should weigh heavily in the consideration of a digital solution. GAC is now shipping the Fuji DS-220 with a coupon for $100 off any VistaDent program. Many orthodontists have been putting off making a decision waiting for that "ideal" package that is just beyond the horizon. The DS-220 is that solution.

Here is a related article found in PC-Magazine On-line Website. ..........the editors