Augmented reality implementations in stomatology

Augmented reality has a wide range of applications in many areas that can extend the study of real objects into the digital world, including stomatology. Real dental objects that were previously examined using their plaster casts are often replaced by their digital models or three-dimensional (3D) prints in the cyber-physical world. This paper reviews a selection of digital methods that have been applied in dentistry, including the use of intra-oral scanning technology for data acquisition and evaluation of fundamental features of dental arches. The methodology includes the use of digital filters and morphological operations for spatial objects analysis, their registration, and evaluation of changes during the treatment of specific disorders. The results include 3D models of selected dental arch objects, which allow a comparison of their shape and position during repeated observations. The proposed methods present digital alternatives to the use of plaster casts for semiautomatic evaluation of dental arch measures. This paper describes some of the advantages of 3D digital technology replacing real world elements and plaster cast dental models in many areas of classical stomatology

Three-dimensional modeling of the human jaw/teeth using optics and statistics.

Object modeling is a fundamental problem in engineering, involving talents from computer-aided design, computational geometry, computer vision and advanced manufacturing. The process of object modeling takes three stages: sensing, representation, and analysis. Various sensors may be used to capture information about objects; optical cameras and laser scanners are common with rigid objects, while X-ray, CT and MRI are common with biological organs. These sensors may provide a direct or an indirect inference about the object, requiring a geometric representation in the computer that is suitable for subsequent usage. Geometric representations that are compact, i.e., capture the main features of the objects with a minimal number of data points or vertices, fall into the domain of computational geometry. Once a compact object representation is in the computer, various analysis steps can be conducted, including recognition, coding, transmission, etc. The subject matter of this dissertation is object reconstruction from a sequence of optical images using shape from shading (SFS) and SFS with shape priors. The application domain is dentistry. Most of the SFS approaches focus on the computational part of the SFS problem, i.e. the numerical solution. As a result, the imaging model in most conventional SFS algorithms has been simplified under three simple, but restrictive assumptions: (1) the camera performs an orthographic projection of the scene, (2) the surface has a Lambertian reflectance and (3) the light source is a single point source at infinity. Unfortunately, such assumptions are no longer held in the case of reconstruction of real objects as intra-oral imaging environment for human teeth. In this work, we introduce a more realistic formulation of the SFS problem by considering the image formation components: the camera, the light source, and the surface reflectance. This dissertation proposes a non-Lambertian SFS algorithm under perspective projection which benefits from camera calibration parameters. The attenuation of illumination is taken account due to near-field imaging. The surface reflectance is modeled using the Oren-Nayar-Wolff model which accounts for the retro-reflection case. In this context, a new variational formulation is proposed that relates an evolving surface model with image information, taking into consideration that the image is taken by a perspective camera with known parameters. A new energy functional is formulated to incorporate brightness, smoothness and integrability constraints. In addition, to further improve the accuracy and practicality of the results, 3D shape priors are incorporated in the proposed SFS formulation. This strategy is motivated by the fact that humans rely on strong prior information about the 3D world around us in order to perceive 3D shape information. Such information is statistically extracted from training 3D models of the human teeth. The proposed SFS algorithms have been used in two different frameworks in this dissertation: a) holistic, which stitches a sequence of images in order to cover the entire jaw, and then apply the SFS, and b) piece-wise, which focuses on a specific tooth or a segment of the human jaw, and applies SFS using physical teeth illumination characteristics. To augment the visible portion, and in order to have the entire jaw reconstructed without the use of CT or MRI or even X-rays, prior information were added which gathered from a database of human jaws. This database has been constructed from an adult population with variations in teeth size, degradation and alignments. The database contains both shape and albedo information for the population. Using this database, a novel statistical shape from shading (SSFS) approach has been created. Extending the work on human teeth analysis, Finite Element Analysis (FEA) is adapted for analyzing and calculating stresses and strains of dental structures. Previous Finite Element (FE) studies used approximate 2D models. In this dissertation, an accurate three-dimensional CAD model is proposed. 3D stress and displacements of different teeth type are successfully carried out. A newly developed open-source finite element solver, Finite Elements for Biomechanics (FEBio), has been used. The limitations of the experimental and analytical approaches used for stress and displacement analysis are overcome by using FEA tool benefits such as dealing with complex geometry and complex loading conditions

An Implicit Parametric Morphable Dental Model

3D Morphable models of the human body capture variations among subjects and are useful in reconstruction and editing applications. Current dental models use an explicit mesh scene representation and model only the teeth, ignoring the gum. In this work, we present the first parametric 3D morphable dental model for both teeth and gum. Our model uses an implicit scene representation and is learned from rigidly aligned scans. It is based on a component-wise representation for each tooth and the gum, together with a learnable latent code for each of such components. It also learns a template shape thus enabling several applications such as segmentation, interpolation, and tooth replacement. Our reconstruction quality is on par with the most advanced global implicit representations while enabling novel applications. Project page: https://vcai.mpi-inf.mpg.de/projects/DMM

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

A multi-scale imaging approach to understand osteoarthritis development

X-ray phase-contrast imaging is an innovative and advanced imaging method. Contrary to conventional radiology, where the image contrast is primarily determined by X-ray attenuation, phase-contrast images contain additional information generated by the phase shifts or refraction of the X-rays passing through matter. The refractive effect on tissue samples is orders of magnitude higher than the absorption effect in the X-ray energy range used in biomedical imaging. This technique makes it possible to produce excellent and enhanced image contrast, particularly when examining soft biological tissues or features with similar X-ray attenuation properties. In combination with high spatial resolution detector technology and computer tomography, X-ray phase-contrast imaging has been proved to be a powerful method to examine tissue morphology and the evolution of pathologies three-dimensionally, with great detail and without the need of contrast agents. This Thesis work has focused on developing an accurate, multi-scale X-ray-based methodology for imaging and characterizing the early stages of osteoarthritis. X-ray phase-contrast images acquired at different spatial resolutions provide unprecedented insights into cartilage and the development of its degeneration, i.e., osteoarthritis. Other types of X-ray phase-contrast imaging techniques and setups using spatial resolutions ranging from micrometer down to nanometer were applied. Lower spatial resolutions allow large sample coverage and comprehensive representations, while the nanoscale analysis provides a precise depiction of anatomical details and pathological signs. X-ray phase-contrast results are correlated to data obtained, on the same specimens, by standard laboratory methods, such as histology and transmission electron microscopy. Furthermore, X-ray phase-contrast images of cartilage were acquired using different X-ray sources and results were compared in terms of image quality. It was shown that with the use of synchrotron radiation, more detailed images and much faster data acquisitions could be achieved. A second focus in this Thesis work has been the investigation of the reaction of healthy and degenerated cartilage under different physical pressures, simulating the different levels of stress to which the tissue is subject during daily movements. A specifically designed setup was used to dynamically study cartilage response to varying pressures with X-ray phase-contrast micro-computed tomography, and a fully volumetric and quantitative methodology to accurately describe the tissue morphological variations. This study revealed changes in the behavior of the cartilage cell structure, which differ between normal and osteoarthritic cartilage tissues. The third focus of this Thesis is the realization of an automated evaluation procedure for the discrimination of healthy and cartilage images with osteoarthritis. In recent years, developments in neural networks have shown that they are excellently suited for image classification tasks. The transfer learning method was applied, in which a pre-trained neural network with cartilage images is further trained and then used for classification. This enables a fast, robust and automated grouping of images with pathological findings. A neural network constructed in this way could be used as a supporting instrument in pathology. X-ray phase-contrast imaging computed tomography can provide a powerful tool for a fully 3D, highly accurate and quantitative depiction and characterization of healthy and early stage-osteoarthritic cartilage, supporting the understanding of the development of osteoarthritis.Röntgen-Phasenkontrast-Bildgebung ist eine innovative und weiterführende Bildgebungsmethode. Im Gegensatz zu herkömlichen Absorptions-Röntgenaufnahmen, wie sie in der Radiologie verwendet werden, wird der Kontrast bei dieser Methode aus dem Effekt der Phasenverschiebung oder auch Brechung der Röngtenstrahlen gebildet. Der Brechungseffekt bei Gewebeproben ist um ein Vielfaches höher als der Absorptionseffekt des elektromagnetischen Spektrums der Röntgenstrahlen. Diese Methode ermöglicht die Darstellung von großen Kontraste im Gewebe. Unter Verwendung eines hochauflösenden Detektors und in Kombination mit der Computer-Tomographie, ist Phasenkontrast-Bildgebung eine sehr gute Methode um Knorpelgewebe und Arthrose im Knorpel zu untersuchen. Diese Arbeit beschreibt primär ein Verfahren zur Darstellung arthrotischen Knorpels im Anfangsstadium. Die mit verschiedenen Auflösungen und 3D-Phasen-Kontrast-Methoden produzierten Aufnahmen ermöglichen einen noch nie dagewesenen Einblick in den Knorpel und die Entwicklung von Arthrose im Anfangsstadium. Hierbei kam die propagationsbasierte Phasenkontrastmethode mit einer Auflösung im mikrometer Bereich und die (Nano)-Holotomographie-Methode mit einer Auflösung im Submicrometer Bereich zum Einsatz. Durch Auflösung im mikrometer Bereich kann ein großes Volumen im Knorpel gescannt werden, während die Nano-Holotomographie Methode eine sehr große Detailauflösung aufweißt. Die Phasenkontrast-Aufnahmen werden mit zwei anderen wissenschaftlichen Methoden verglichen: mikroskopische Abbildungen histologisch aufgearbeiteter Knorpelproben und Aufnahmen eines Transmissionselektroskop zeigen sehr große Übereinstimmungen zur Röntgen-Phasenkontrast-Bildgebung. Desweiteren wurden Phasenkontrast-Aufnahmen von Knorpel aus unterschiedlichen Röntgenquellen verglichen. Hierbei zeigte sich, dass mit Hilfe des Teilchenbeschleunigers (Synchrotron) detailreichere und schnellere Aufnahmen erzielt werden können. Bilder aus Flüssig-Metall-Quellen zeigen sich durchaus von guter Qualität, erfordern jedoch sehr lange Aufnahmezeiten. In dieser Arbeit wird zudem das Verhalten von Knorpelgewebe, welches ein Anfangsstadium von Arthrose aufweist, unter physikalischem Druck untersucht. Hierfür wurden 3D-Computertomographie-Aufnahmen von komprimiertem Knorpelgewebe angefertig und mit Aufnahmen ohne Komprimierung verglichen. Ein quantitativer Vergleich machte Veränderungen des Verhaltens der Knorpelzellstruktur (Chondronen) sichtbar. Es konnte gezeigt werden, dass Chondrone bei arthrotischem Knorpel ein verändertes Kompressionsverhalten haben. Der dritte Fokus dieser Arbeit liegt auf der automatisierten Auswertung von Aufnahmen gesunden und arthrotischen Knorpelgewebes. Die Entwicklungen im Bereich der Neuronale Netze zeigten in den letzten Jahren, dass diese sich hervoragend für Bildklassifizierungsaufgaben eignen. Es wurde die Methode des transferierenden Lernens angewandt, bei der ein vortrainiertes Neuronales Netz mit Knorpelbildern weitertrainiert und anschließend zur Klassifizierung eingesetzt wird. Dadurch ist eine schnelle, robuste und automatisierte Gruppierung von Bildern mit pathologischen Befunden möglich. Ein derart konstruiertes Neuronales Netz könnte als unterstützendes Instrument in der Pathologie angewandt werden. Röntgen-Phasenkontrast-CT kann ein leistungsstarkes Werkzeug für eine umfassende, hochpräzise und quantitative 3D-Darstellung und Charakterisierung von gesundem Knorpel und athrotischem Knorpel im Frühstadium bieten, um das Verständnis der Entwicklung von Osteoarthritis zu erweitern

Explore the Dynamic Characteristics of Dental Structures: Modelling, Remodelling, Implantology and Optimisation

The properties of a structure can be both narrowly and broadly described. The mechanical properties, as a narrow sense of property, are those that are quantitative and can be directly measured through experiments. They can be used as a metric to compare the benefits of one material versus another. Examples include Young’s modulus, tensile strength, natural frequency, viscosity, etc. Those with a broader definition, can be hardly measured directly. This thesis aims to study the dynamic properties of dental complex through experiments, clinical trials and computational simulations, thereby bridging some gaps between the numerical study and clinical application. The natural frequency and mode shapes, of human maxilla model with different levels of integrities and properties of the periodontal ligament (PDL), are obtained through the complex modal analysis. It is shown that the comprehensiveness of a computational model significantly affects the characterisation of dynamic behaviours, with decreasing natural frequencies and changed mode shapes as a result of the models with higher extents of integrity and preciseness. It is also found that the PDL plays a very important role in quantifying natural frequencies. Meanwhile, damping properties and the heterogeneity of materials also have an influence on the dynamic properties of dental structures. The understanding of dynamic properties enables to further investigate how it can influence the response when applying an external stimulus. In a parallel preliminary clinical trial, 13 patients requiring bilateral maxillary premolar extractions were recruited and applied with mechanical vibrations of approximately 20 g and 50 Hz, using a split mouth design. It is found that both the space closure and canine distalisation of the vibration group are significantly faster and higher than those of the control group (p<0.05). The pressure within the PDL is computationally calculated to be higher with the vibration group for maxillary teeth for both linguo-buccal and mesial-distal directions. A further increased PDL response can be observed if increasing the frequency until reaching a local natural frequency. The vibration of 50 Hz or higher is thus approved to be a potential stimulus accelerating orthodontic treatment. The pivotal role of soft tissue the PDL is further studied by quantitatively establishing pressure thresholds regulating orthodontic tooth movement (OTM). The centre of resistance and moment to force ratio are also examined via simulation. Distally-directed tipping and translational forces, ranging from 7.5 g to 300 g, are exerted onto maxillary teeth. The hydrostatic stress is quantified from nonlinear finite element analysis (FEA) and compared with normal capillary and systolic blood pressure for driving the tissue remodelling. Localised and volume-averaged hydrostatic stress are introduced to describe OTM. By comparing with clinical results in past literature, the volume average of hydrostatic stress in PDL was proved to describe the process of OTM more indicatively. Global measurement of hydrostatic pressure in the PDL better characterised OTM, implying that OTM occurs only when the majority of PDL volume is critically stressed. The FEA results provide new insights into relevant orthodontic biomechanics and help establish optimal orthodontic force for a specific patient. Implant-supported fixed partial denture (FPD) with cantilever extension can transfer excessive load to the bone surrounding implants and stress/strain concentration which potentially leads to bone resorption. The immediate biomechanical response and long-term bone remodelling outcomes are examined. It is indicated that during the chewing cycles, the regions near implant necks and apexes experience high von Mises stress (VMS) and equivalent strain (EQS) than the middle regions in all configurations, with or without the cantilever. The patient-specific dynamic loading data and CT based mandibular model allow us to model the biomechanical responses more realistically. The results provide the data for clinical assessment of implant configuration to improve longevity and reliability of the implant-supported FPD restoration. On the other hand, the results show that the three-implant supported and distally cantilevered FPDs see noticeable and continuous bone apposition, mainly adjacent to the cervical and apical regions. The bridged and mesially cantilevered FPDs show bone resorption or no visible bone formation in some areas. Caution should be taken when selecting the FPD with cantilever due to the risk of overloading bone resorption. The position of FPD pontics plays a critical role in mechanobiological functionality and bone remodelling. As an important loading condition of dental biomechanics, the accurate assignment of masticatory loads has long been demanded. Methods involving different principles have been applied to acquire or assess the muscular co-activation during normal or unhealthy stomatognathic functioning. Their accuracy and capability of direct quantification, especially when using alone, are however questioned. We establish a clinically validated Sequential Kriging Optimisation (SKO) model, coupled with the FEM and in vivo occlusal records, to further the understanding of muscular functionality following a fibula free flap (FFF) surgery. The results, within the limitations of the current study, indicates the statistical advantage of agreeing occlusal measurements and hence the reliability of using the SKO model over the traditionally adopted optimality criteria. It is therefore speculated that mastication is not optimally controlled to a definite degree. It is also found that the maximum muscular capacity slightly decreases whereas the actual muscle forces fluctuate over the 28-month period

Thermal analysis of wood-steel hybrid construction

Main goal of this work is to present a numerical model to study the thermal necrosis due a dental drilling process, with and without water irrigation. Also an experimental methodology is used to measure the thermal occurrence in a pig mandible. Motivation, the assessment of bone damage, using the temperature criterion (above 55ºC

Management of bone defects with Bio-oss

Introduction: The defects in the alveolar bone might appear as a result of congenital malformations, traumatic injuries, periodontal disease, surgical traumas, chronic periapical changes and tumors from benign or malignant origin. The aim of this study was to provide solid and healthy area with application of Bio-Oss in the defect. Materials and methods: Based on the clinical diagnosisestablished by previously taken history, clinical examination and radiographic images oral-surgery interventions was made. To realize the aim of this work, augmentative material was implicated in the bone defects made in the patients after removal of follicular cyst, chronic periapical lesion, and parodontopathia. During the first and seventh day of the interventions, the patients have been followed through from aspect of possible development of local and general complications after the oral-surgery intervention. After period of one, three and six mount control x-ray was made. Results: Obtained results confirmed that: volume of the socket and defect of the bone was kept, fast revascularization was achieved, bone formation and slow resorption of the augmentative material was achieved, and period of normal healing without infection was also achieved. Conclusions: The augmentative materials used for treatment of bone defects besides their basic chemical and physical characteristics referring to their solubility in the body fluids, the transformation, modulation and resorption must be completely safe or secure, i.e. not to bring any risk of infection, immunological risk, physiological intolerance or inhibition of the process of restitutio ad integrum. In our study Bio-Oss was confirmed as augmentative material who had this characteristics. Keywords: bone defect, resorption of the bone, augmentative material, Bio-Os

A Textbook of Advanced Oral and Maxillofacial Surgery

The scope of OMF surgery has expanded; encompassing treatment of diseases, disorders, defects and injuries of the head, face, jaws and oral cavity. This internationally-recognized specialty is evolving with advancements in technology and instrumentation. Specialists of this discipline treat patients with impacted teeth, facial pain, misaligned jaws, facial trauma, oral cancer, cysts and tumors; they also perform facial cosmetic surgery and place dental implants. The contents of this volume essentially complements the volume 1; with chapters that cover both basic and advanced concepts on complex topics in oral and maxillofacial surgery