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Politehnica University of Bucharest

Automatic recognition
of teeth

Professor
Dr.Ing Nicu Goga
Criv Ana-Maria,
Software
Engineering Master

Contents
Abstract......................................................................................................................... 3
1.Introduction................................................................................................................. 5
The objectives that will be followed............................................................................... 6
2. Methods.................................................................................................................... 8
2.1. Step 1: Pre-processing and segmentation...............................................................8
2.2. 1. Location of the dental work...............................................................................22
3. Results.................................................................................................................... 25
4.References................................................................................................................ 27

Abstract

The finite element analysis represents an effective method to study the strength
and predict the fracture risk of endodontically-treated teeth and also to predict and to
diagnose different teeth pathologies. This paper presents a rapid method developed to
generate a comprehensive tooth model using data retrieved from micro-computed
tomography (CT). With this method, the inhomogeneity of material properties of
teeth was included into the model without dividing the tooth model into different
regions. The material properties of the teeth were assumed to be related to the
mineral density. The micro-CT images of teeth were processed by a Matlab software
programme and the CT numbers were retrieved. The teeth contours were obtained
with thresholding segmentation.
It was observed that the two degree grayscale differential method can
significantly simplify the pattern recognition process for teeth. Compared to the
popular recognition method like PCA and HDM, this method is a lot more simple,
runs faster and the identification rate is better. The new approach will reduce the
traditional reliance on CT image to get information and make dental decision. The
new approach is tested and will be used in the dental decision making software to do
preliminary dental advising for potential patients. An image of teeth are used as an
example here; all types of teeth (molars, canines), individual or in pairs can be
processed the same way.

The common process consists of two major components. The subjective component
mainly focuses on the patient's current health and relevant clinical history prior to the
current condition, recording all significant information required for further analysis.
The objective component refers to physical examination like CT scans or radiological
scans. The assessment represents the differential diagnosis for the purpose of the
medical visit, while the plan consists of the treatment that the patient is prescribed.
Although the subjective and objective components take a significant amount of time,
the most time-consuming steps are the assessment and plan, requiring thorough
interpretation of the CT scans performed, and often being based on computerized 3D
reconstruction which might be problematic to analyse on the computer screen under
certain circumstances.
This research is one which combines two different types of science: dentistry and
computer science. University research, products and patents show that current
solutions target only dental implants or orthodontic treatment forgetting some other
important aspects. The distinctive features that will advance the knowledge in this
domain are the followings: a) Integrated dental treatment planning for different types
of dental problems, some which are not covered currently (carries, dental crown, etc.)
and b) use of other medical information relevant to the treatments, not only CT (for
example patient with diabetes cant undergo certain dental procedures. This project
proposes new techniques for software dentistry, software treatment planning and
dental problems identification.
Marketing studies show a growth in dental market and software. According to IBIS
World Industry Report the dental market performed well during the economic
recession having an annual grow between 2008 and 2013 of 1.5%. Similar tendency
is remarked for dental software. This favorable context assures also a good market
for the product developed within this project proposal.
The project aims at the improvement of the medical dentistry practice beneficial for
both dentists and patients. From the dentists point of view , the time developing the
product and dental planning will be reduced, and more time will be spent on
management and precise dental treatment. From the patients point of view, the
patient will benefit from accurate and faster healthcare treatment.
- University of Medicine and Pharmacy Carol Davila Bucharest (UMF):
expertise in dental research and treatment
- OSF Global Services (OSF): expertise in software development
4

- Politehnica University of Bucharest (UPB): good expertise in medical


informatics development and research

1.Introduction
Project topic This project proposal addresses the research topic Informatics systems
for health and environment (e-health).The purpose of the project is to build an
intelligent e-health system to help dentists and their patients to benefit from an
improved dental health care system. The project has an interdisciplinary nature
because it merges computer science and medical dentistry, being based on digital
image processing.

Problem Nowadays, developing an initial assessment and devising a treatment plan


in dentistry takes between 4 to 12 hours for each individual patient. The assessment
involves a thorough radiological investigation along with its interpretation, followed
by visual examination and, prior to devising a treatment plan, a lot of paperwork is
involved. Our project aims to address this practical problem through an assistant
system for treatment planning.
Before presenting the algorithms and expected results end product, it is necessary to
present some background theory in the dental field.

The present research project wants to implement an integrated decision support


platform in the dental diagnosis processes by building upon state of the art digital
image processing, image mining technologies and. Its aim is to help develop the
current computer-aided detection techniques in dentistry with the goal of building
and exploiting models that embed knowledge about the discriminative elements
between normal medical imaging scans (CT) and scans of dental pathologies.
So we can state that the project aims to analyse the existent visual elements present in
the CT scans and to identify the certain types of pathologies that are usually
associated with. These computerized models are discovered by going through large
amounts of annotated medical imaging scans, and analysing the visual elements in
images. Using the new patterns, we will be able to process the patient's medical
imaging scans and suggest the most probable diagnoses and corresponding treatment
plans greatly reducing the period of time and effort by up to 6 hours per patient.

The objectives that will be followed


1 Automating the process of creating a personalized treatment plan fully integrated
in the SOAP protocol;
2 In-depth analysis, selection and further development of image mining methods for
discovery of discriminative models;
3 Analysis, selection and further development of knowledge inference methods for
processing new images and predicting, based on the mined models, the probability
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4
5
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that the patients scans indicate the presence of an oral pathology;


Development of semantic annotation techniques for associating patients scans
with valuable semantic information which can be employed in the knowledge
inference process along with visual content information;
3D model collection useful as teaching material for a 3D atlas of case studies and
with direct application in prosthodontics, implantology and orthodontics;
Generating a treatment plan that will include therapeutic indications in a logical
order so that the medical practitioner will be able to save time and to take proper
care of the patients needs while respecting medical decisions according to
personal expertise of the doctor.
Deploying an experimental pilot in a real clinical environment aimed at studying
the effectiveness and applicability of the framework in order to create the
opportunity of simulating the project in interaction with real users because they
will be able to provide essential feedback for advancing the solution towards a
user-friendly and highly accurate clinical decision support platform.

Dental biometrics is used in forensic dentistry to identify or verify persons


based on their dental radiographs. This paper presents a method for identifying and
numbering a humans teeth based on dental work information. The proposed method
works with three main processing steps: segmentation (feature extraction), creation
of a dental code, and matching. In the segmentation step, seed points of the dental
works are detected by thresholding. The final segmentation is obtained with a snake
(active contour) algorithm.

The dental code is defined from the position (upper or lower), the size of the
dental works, and distance between neighboring dental works. The matching stage is
performed with the Edit distance (Levenshtein distance). The costs for the insertion,
deletion and substitution operations were adapted to make the matching algorithm
more sensitive. The method was tested on a database including 50-60 dental
radiographs and the results are pretty encouraging.
7

Biometrics is the science and technology of identification, i.e. establishing the


identity of an individual, by measuring the subjects physical or behavioral traits. The
term is derived from the Greek words "bios" for life and "metron" for to measure .
The method of dental biometrics is used in forensic medicine (forensic dentistry) to
identify persons by matching post-mortem radiographs (acquired after a person is
deceased), with ante-mortem radiographs (acquired before a person is deceased) in a
database, but can also be used to match two ante-mortem or two post-mortem radiographs .In some cases (plane crashes, fire accidents, etc.) biometric features such as
faces or fingerprints are destroyed and it is not possible to work with conventional
identification methods like fingerprint or face recognition. In such cases, dental
biometric is an appropriated method, because bones and teeth with their dental works
(DWs), e.g. inlays, are very resistant to modest force effects and high temperatures
(amalgam fillings up to 1000C, endodontic treatments up to 1100C ) and also has
good biometric properties. Dental records have been used to identify the victims of
disasters, such as the 9/11 bombing and the Asian tsunami or Fukushima nuclear
incident from 2011.
The objective of this work is to develop and implement a dental biometric
method for human identification based on dental work information. The algorithm
performs dental work matching onto registered panoramic dental radiographs and is
implemented in MatlabTM.

2. Methods
The proposed method for human identification consists of three main processing
steps:
1 Pre-processing of the dental scans and segmentation.
2 Creation of a dental code out of the information of the detected scans
including position (jaw bone and mandible), size and distance between
neighboring teeth.
3 Matching of a particular dental code with other existing dental codes in a
database.
2.1. Step 1: Pre-processing and segmentation
In order to obtain a clearer image of the patients scan we applied a texturizing
algorithm that will later improve the percentage of teeth numbering and disease
recognition. After trying a lot of algorithms, it was decided to apply a texturizing one.
This kind of algorithm characterizes a certain region in an image because it is able to
differentiate the texture context. The texturizing algorithm simply quantifies
intuitively the qualities given by the pictures smooth, silky, or bumpy texture
represented by the spatial variation in the pixels intensity.This kind of algorithm is
usually used in a great variation of applications, including medical ones, especially
8

image processing. Usually texture analysis can help separate texture boundaries
known as texture segmentation. The algorithm is used to replace threshold algorithms
in images that the later can not be applied.The algorithm includes some texture
analysis functions which are applied to the image in order to filter it using static
measurements. This type of measurements will define the texture of an image
providing data about the local variability of the intensity value of pixels in a fragment
of an image. For example, in areas with smooth texture, the range of values in the
neighborhood around a pixel will be a small value; in areas of rough texture, the
range will be larger. Similarly, calculating the standard deviation of pixels in a
neighborhood can indicate the degree of variability of pixel values in that region. For
the algorithm to be applied to the image a certain number of steps must be respected.
First the image must be read, specifying it type:
E=imread('32a00a333042.bmp');
figure, imshow(I)
figure,imshow(I);

Next step is represented by trying to establish the images gradient magnitude.


For this to happen it is necessary to apply a filter. After using different filters like
Canny it was established that the most appropriate filter to use was Sobel. Based on
this one-dimensional analysis, the theory can be carried over to two-dimensions as
long as there is an accurate approximation to calculate the derivative of a twodimensional image. The Sobel operator performs a 2-D spatial gradient measurement
on an image. Typically it is used to find the approximate absolute gradient magnitude
at each point in an input grayscale image. The Sobel edge detector uses a pair of 3x3
convolution masks, one estimating the gradient in the x-direction (columns) and the
9

other estimating the gradient in the y-direction (rows). A convolution mask is usually
much smaller than the actual image. As a result, the mask is slid over the image,
manipulating a square of pixels at a time. The actual Sobel masks are shown below:

The magnitude of the gradient is then calculated using the formula:


An approximate magnitude can be calculated using:
|G| = |Gx| + |Gy|
The code for the Sobel edge detector is shown below and uses the above
gradient approximation.

hy = fspecial('sobel');
hx = hy';
Iy = imfilter(double(I), hy, 'replicate');
Ix = imfilter(double(I), hx, 'replicate');
gradmag = sqrt(Ix.^2 + Iy.^2);
figure
imshow(gradmag,[]), title('Gradient magnitude (gradmag)')

10

On the next step the images texture is created using the entropyfil function.
This function returns an array where each output pixel contains the entropy
value of the 9-by-9 neighborhood around the corresponding pixel in the input
image I. Entropy is a statistical measure of randomness. Afterwards
the mat2gray function is applied with the purpose of rescaling the texture
image so that its values are in the default range for a double image.
hy = fspecial('sobel');
hx = hy';
Iy = imfilter(double(I), hy, 'replicate');
Ix = imfilter(double(I), hx, 'replicate');
gradmag = sqrt(Ix.^2 + Iy.^2);
figure
imshow(gradmag,[]), title('Gradient magnitude (gradmag)')
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Next we will try to create rough mask for one of the structures. This is done by
thresholding the rescaled image to segment the textures. A threshold value of
0.8 is selected because it is roughly the intensity value of pixels along the
boundary between the textures. We then obtain a binary image with segmented
objects that we can clearly see that they have the color white. If you
compare BW1 to I, you notice the top texture is overly segmented and the
bottom texture is segmented almost in its entirety. You can extract the bottom
texture using the function bwareaopen.

E=entropyfilt(gradmag);
Eim=mat2gray(E);
imshow(Eim);
BW1= im2bw(Eim, .8);
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imshow(BW1);
figure,imshow(I);
BWao=bwareaopen(BW1,2000);
imshow(BWao);

The last step is followed by mask creating. First we use the function imclose to
smooth the edges and to close any open holes in the object in BWao. A 9-by-9
neighborhood is selected because this neighborhood was also used by the entropyfilt
function. Then we apply imfill to fill holes in the object in closeBWao.

nhood=true(9);
closeBWa0=imclose(BWao,nhood);
imshow(closeBWa0);
roughMask=imfill(closeBWa0,'holes');

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Then we will apply the rough mask function to segment the texture. What this
function does is comparing the binary image roughMask to the original image I.
imshow(roughMask);
figure,imshow(I);
I2 = I;
I2(roughMask) = 0;
imshow(I2);

Then we use entropyfilt to calculate yje texture image and we will threshold it using
graytresh function.
E2=entropyfilt(I2);
E2=mat2gray(E2);
E2im=mat2gray(E2);
imshow(E2im);
BW2=im2bw(E2im,graythresh(E2im));
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imshow(BW2);
figure, imshow(I);
mask2=bwareaopen(BW2,1000);
imshow(mask2);

Afterwards the segmentations results will be displayed by using mask 2 to extraxt


the two structures.
texture1=gradmag;
texture1(~mask2)=0;
texture2=I;
texture2(mask2)=0;
imshow(texture1);
figure,imshow(texture2);
boundary=bwperim(mask2);
segmentResults=I;
segmentResults(boundary)=255;
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imshow(segmentResults);
S=stdfilt(I,nhood);
imshow(mat2gray(S));
R=rangefilt(I,ones(5));
imshow(R);

In the future a mask will be created from scan number 43 and applied to all the
other scans in order to obtain a clearer image. It is desirable to obtain clear scans that
will make teeth recognition possible and also disease detection easier.

16

The dental scan is converted into a gray-scale image and median filtering is performed to reduce noise in the image. Because of different lightning conditions in the
dental scans, the image is subdivided into two regions of interest (ROIs): left (ROI 1)
and right (ROI 2).

The algorithm determines a gray value threshold in the left and the right region
of interest of the dental scan. Typically the images has a certain feature that makes
the highest intensities in the image and appear as a distinct, relatively small but
pronounced, mode in the upper range of the gray-scale histogram. After smoothing
the histogram with a moving average filter, the threshold is set to the gray-value at
the location of the left valley at the rightmost mode, which indicates the dental work .
The threshold is used to binarize the gray-value image (see next Figure.). The results
of the conversion are used as initial contours for the segmentation stage. Each region
represents a possible dental problem.
A snake (active contour) algorithm is used to perform the final segmentation of the
dental work. Snakes can be used to segment objects with fuzzy border contours
where traditional edge-detection will fail. Snakes are curves that can move under the
influence of internal forces (elasticity and bending forces) coming from within the
curve itself and external forces (potential forces) computed
from the image data. The internal and external forces are defined so that the final
snake will con-form to an object boundary . The external force field is computed
from the gradient image, as shown in . A snake needs to be initialized with an initial
curve (e.g. circle) and is an itera-tive procedure which stops after a defined number
of iterations. The better the initialization curve, the better the performance of the
algorithm and the final segmentation results.

17

Figure showing threshold used to do Snake Segmentation by active contours

Figure showing the difference between normal teeth and dental work
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Snake algorithm

I =double(imread('32a00a333043.bmp'));
x=[163 166 207 248 210];
y=[182 233 251 205 169];
P=[x(:) y(:)];
Options=struct;
Options.Verbose=true;
Options.Wedge=2;
Options.Wline=0;
Options.Wterm=0;
Options.Sigma1=8;
Options.Sigma2=8;
Eext = ExternalForceImage2D(I,Options.Wline, Options.Wedge,
Options.Wterm,Options.Sigma1);
Fx=ImageDerivatives2D(Eext,Options.Sigma2,'x');
Fy=ImageDerivatives2D(Eext,Options.Sigma2,'y');
Fext(:,:,1)=-Fx*2*Options.Sigma2^2;
Fext(:,:,2)=-Fy*2*Options.Sigma2^2;
if(Options.Verbose)
h=figure; set(h,'render','opengl')
subplot(2,2,1),
imshow(I,[]);
hold on; plot(P(:,2),P(:,1),'b.'); hold on;
title('The image with initial contour')
subplot(2,2,2),
imshow(Eext,[]);
title('The external energy');
subplot(2,2,3),
[x,y]=ndgrid(1:10:size(Fext,1),1:10:size(Fext,2));
imshow(I), hold on;
quiver(y,x,Fext(1:10:end,1:10:end,2),Fext(1:10:end,1:10:end,1));
title('The external force field ')
subplot(2,2,4),
imshow(I), hold on; plot(P(:,2),P(:,1),'b.');
title('Snake movement ')
drawnow
end
S=SnakeInternalForceMatrix2D(Options.nPoints,Options.Alpha,Options.Beta,Options.
Gamma);
h=[];
for i=1:Options.Iterations
P=SnakeMoveIteration2D(S,P,Fext,Options.Gamma,Options.Kappa,Options.Delta);
% Show current contour
if(Options.Verbose)
if(ishandle(h)), delete(h), end
h=plot(P(:,2),P(:,1),'r.');
c=i/Options.Iterations;
plot([P(:,2);P(1,2)],[P(:,1);P(1,1)],'-','Color',[c 1-c 0]); drawnow
end
end
if(nargout>1)
J=DrawSegmentedArea2D(P,size(I));
end

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Results

20

Figure showing Initial curve of a snake computed out of the binary imag

21

2. 2. Step 2: Creation of the dental code


Based on the dental work contour, a dental code is created. The dental
incorporates information about the position (upper jaw and mandible), the size of the
teeth and the distance between two neighboring teeth.

2.2. 1. Location of the dental work


An algorithm was implemented to sort all dental work from left to right based on the
center of mass point of each individual dental work (see next Figure).

Figure showing dental work mask with sorted dental works from left to
right.

For the dental code it is also important to know whether the tooth belongs to the
maxilla (upper jaw) or to the mandible (lower jaw). Therefore, a border between the
maxillary and the mandibular teeth is detected. A stripe in the intensity image is cut
with the width of the current region. Next, the intensity sum of all horizontal rows in
the stripe is calculated. The highest intensity represents the area of the dental work.
The algorithm detects the first valley on the left and on the right site of the highest
intensity point. The valley with the lower intensity represents the border between the
mandibular and maxillary teeth.
22

Figure showing areas

2.2. 2. Size of the dental restoration


The proposed method uses registrated dental records. Useful image information,
including mandibular and maxillary teeth, is cut and resized to a size of 1000x300
pixels. According to this, the amount of pixels in a dental record is always the same,
which means that the size of a dental work (amount of pixels) is a percentage of the
total amount of pixels in the dental record.
2.2. 3. Distance between two dental works
To make the matching algorithm more sensitive, also the distance (amount of pixels)
between two neighboring DWs is included into the DC. The distance is defined by
the amount of pixels between the center of mass points of the two DWs. The distance
of the leftmost DW (d1) is set to zero to make the algorithm more stable against
small deviations in the manually registration of the DRs (see Figure 10). The value
for the distance is given in percentage of the total width of the DR, which is always
1000 pixels. To have a better overview in the DC, the distance is multiplied by 102.

23

2.2. 4. Step 3: Matching


After the DC is created, it can be compared to other DCs in a database. These can be
different codes of the same person or codes of different persons. Matching between
radiographs of the same subject is called genuine matching and matching between
radiographs belonging to different subjects is called impostor matching.
An algorithm was implemented which works with the Edit distance (The Edit
distance is often used to compare gene sequences or strings. The Edit distance
between two strings is given by the minimum number of operations needed to
transform one string into the other, where an operation is an insertion, deletion, or
substitution . Every operation is associated with certain costs. Because of the
structure of the DC, it was necessary to restructure the algorithm of the Edit distance.
Not only the letters U and L have to be compared, but also the size of the dental
work and the distance between neighboring teeth. The costs of the operations
insertion, deletion, or substitution were adapted to improve the results of the
matching algorithm.
If the compared sizes differs more than 100%, the cost is set to 25. In the other case,
the cost for comparing the size is set according to the percentage difference of the
two compared dental works.If the compared distances differs more than 15%, the
cost is set to 25. In the other case, the cost for comparing the distances is set
according to the percentage difference of the two compared dental works.

24

3. Results
A database including approximately 60 dental records was used in the experiments to
evaluate the proposed dental biometric method.The images were manually registrated
to obtain comparable conditions. In cases of over- or under segmentation of the
dental records, the segmentation result had to be corrected manually. Also, if they are
not detected by thresholding, an area of interest has to be selected manually in the
dental record to perform local thresholding.

Table : Costs for insertion, deletion and substitution in the Edit


distance.
Operation
insertion
deletion

Cost
60
60
Comparing the size:

0, difference between 0..10%


1, difference between 10..20%

10, diff. between 90..100%


25, difference > 100%
substitution
Comparing the distance:
0, difference between 0..1%
1, difference between 1..2%

15, difference between 14..15%


25, difference > 15%

25

Because the amount of images in the database is low, it is not possible to make a
clear statement about the performance and effectiveness of the proposed method.
In future work, the proposed method will be assessed on a larger database. Also, in
future work, the proposed method will be fused to other methods based on
different tooth features, like crown and root shapes, and the seg-mentation method
will be replaced by a method based on image-foresting transform, more effective
for segmentation of bad quality images, with minimum human intervention.

26

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