3D computer-aided reconstruction of six teeth with

morphological abnormalities
G. Mikrogeorgis
1
, K. L. Lyroudia
1
, N. Nikopoulos
2
, I. Pitas
2
,
I. Molyvdas
1
& T. H. Lambrianidis
1
1
Department of Dental Pathology and Therapeutics, School of Dentistry, and the
2
Artificial Intelligence and Information Analysis
Laboratory, Department of Informatics, Aristotelian University of Thessaloniki, Thessaloniki, Greece
Abstract
Mikrogeorgis G, Lyroudia KL, Nikopoulos N, Pitas
I, Molyvdas I, Lambrianidis TH. 3D computer-aided
reconstruction of six teeth with morphological abnormalities.
International Endodontic Journal, 32, 8893, 1999.
Aim The purpose of this study was the 3D reconstruc-
tion of six teeth with morphological peculiarities using
serial cross-sections.
Methodology All the teeth were put in 3% NaOCl
solution after extraction, washed under running water
and air-dried. They were then embedded in a two-
phase polyester resin and serial cross-sections were
produced from each specimen using a special
microtome. The thickness of each section was 0.75
mm. Each section was photographed under a stereo-
scopic microscope. The photographs of the cross-
sections were digitized and the external contours of the
teeth and the root-canal outline were annotated
foreach section. Semiautomatic alignment of the
sections was achieved with the use of image-processing
techniques. Three dimensional surface representation
was used in this project to reconstruct the inner and
outer surface of the teeth.
Results The results showed in detail the internal
morphology of the teeth under investigation. The fact
that it was possible to observe and study these teeth
from different angles is one of the main advantages of
this method as the three dimensional anatomy of these
teeth was apparent.
Conclusions The 3D reconstructing method is a
useful tool for the study of the morphology of the
teeth.
Keywords: computer, dental anatomy, morphologi-
cal abnormalities, 3-D reconstruction.
Introduction
Before root canal treatment is performed, the dentist
ideally should know the morphology of the pulp
chamber of the teeth he will treat. All root canals
should be accessed, cleaned and shaped to receive an
hermetic filling of the entire root canal space.
Incomplete cleaning, shaping and obturation of any
root canal will lead to almost certain root canal
treatment failure. Anatomical variability of the teeth is
often a complicating factor in root canal treatment and
many different methods have been used to investigate
tooth morphology. These methods include sectioning of
extracted teeth (Black 1897, Green 1955), casts of the
root canals with Wood's metal (Preiswerk 1909),
celluloid (Fischer 1907) or resin (Skidmore & Bjorndal
1971), decalcification of the teeth and dye injection
(Vertucci et al. 1974), and radiographic studies in vitro
(Mueller 1933). All these methods have unavoidable
pitfalls, and many difficulties have been encountered.
In general the above mentioned methods are
complicated and time consuming. Furthermore they do
not provide the ability to study the external and
internal anatomy of teeth three-dimensionally at the
same time. The presence of artifacts in the models
produced of the internal morphology of teeth is
frequent in these methods. Also there is a danger of
International Endodontic Journal, 32, 8893, 1999 q 1999 Blackwell Science Ltd
Correspondence: K. L. Lyroudia, 23 Papafi Str., 546 38 Thessaloniki,
Greece.
88
distortion of the internal anatomy of the tooth after
using different chemicals. This paper presents a new
method for the study of the morphology of the teeth,
based on three-dimensional computer-aided recon-
struction. Six teeth with morphological peculiarities
were reconstructed using this method and the external
and internal morphology of each was studied. The
teeth were:
. a maxillary first premolar with three roots
. a maxillary molar with one root, which had an
enamel pearl at the cervical third of its distal
surface
. a mandibular lateral incisor with two roots
. a mandibular canine with two roots
. a mandibular second premolar with two root canals
. a mandibular molar, the mesial root of which was
severely sickle-shaped, curved toward the distal.
Figure 1 (a, b) Digitized stereomicroscopic image of a cross
section of the maxillary first premolar with three roots and
three root canals (left). Extracted contours of the external
surfaces of the roots and the root canals from the same
section (right). 3D reconstructions of the tooth from two
different view angles. It is clearly seen that both buccal root
and buccal root canal were divided into two separate and
distinct roots and root canals, mesially and distally, in the
middle third of the root. The external surface of the tooth is
shown as purple and the pulp chamber as yellow.
Figure 2 (a, b) Digitized microscopic image of a cross section
from the cervical third of the maxillary molar, where the
enamel pearl at the distal surface of its root is clearly seen
(left). Extracted contours of the external and internal surfaces
of the same section (right). 3D reconstructions from two
different viewpoints. It is clearly seen that mainly there were
two root canals, which were connected at the apex. The
palatal root canal had a lateral branch in its cervical third,
which was further reconnected with the main canal.
Mikrogeorgis et al. 3D reconstruction of abnormal teeth
q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 8893, 1999 89
Materials and method
After extraction all the teeth were cleaned in 3%
NaOCl solution for 24 h, washed under running water
and left to air dry. They were then embedded in a two-
component polyester resin, and from each specimen
serial cross sections were taken 48 h later using a
special microtome (Isomet, Buehler, IL, USA). The
thickness of each section was 0.75 mm. Each cross
section was photographed under a stereoscopic
microscope (Stemy SV8; Zeiss, Wetzlar, Germany).
Because of the high magnifications available from this
stereomicroscope, no single photograph could cover an
entire section. Therefore, between two and six
photographs were taken from each section, and a
montage obtained showing the entire microscopic
image of each section.
The first step toward three-dimensional reconstruc-
tion was the digitization of the photographs with a
resolution of 72 dots per inch, using an image scanner
(Epson 6000; Seiko Epson Corporation, Nagano,
Japan). The grayscale images obtained were further
processed by using contrast enhancement methods in
order to make different dental tissues more distinguish-
able and increase the visual image quality (Pitas
1993). The external boundaries of the teeth and the
outline of the root canal were identified for each
section (Figs 1a, 2a, 3a, 4a, 5a, 6a). Subsequently,
semiautomatic alignment of the sections was achieved
using image processing techniques. The aligned object
contours were finally represented as lists of points for
easier contour manipulation (Russ 1990). The next
step was the three-dimensional representation of the
outer surface of the teeth, as well as their internal
structure (root canals system), using the triangulation
method. The triangulation algorithm requires
interaction with the user in order to decide which
contours to connect between successive sections in
order to produce the 3D wireframe model.
All the above procedures, boundary extraction,
alignment and three-dimensional representation, were
implemented by using EIKONA 3D, a digital image
processing package for 3D image processing under
Microsoft Windows (EIKONA 3D, 1997).
Finally, the visualization of the 3D reconstructed
model of each tooth was performed by using surface
rendering from different angles around the 3D model,
combined with photorealistic effects such as colour
and texture addition, lighting and shading. The
colours used for the surface rendering were
transparent purple for the outer surface of the teeth
and opaque yellow matte for the pulp chamber, so
that the best visual result was achieved (Figs 1b, 2b,
3b, 4b, 5b, 6b). The visualization was made using
Autodesk 3D Studio Release 4 (Autodesk, Inc, San
Rafael, CA USA).
Results
The microscopic images of the cross sections of the
teeth under investigation and their resultant three-
dimensional models from different angles, showed their
morphology in detail.
The maxillary first premolar had three roots with
three root canals. Buccally the separation of the roots
as well as the separation of the root canals appeared in
the middle third of the root (Fig. 1 a, b).
The maxillary molar had only one root, with an
enamel pearl at the cervical third of its distal surface.
This tooth had two root canals, one buccal and one
palatal, which were connected close to the apex. The
lingual root canal had a lateral loop in its cervical
third (Fig. 2 a, b).
The mandibular lateral incisor had one root, which
divided close to the apex into two separate and distinct
roots, one buccal and one lingual. The pulp chamber
was divided into two separate and distinct root canals,
buccally and lingually, in the middle third of the root
(Fig. 3 a, b).
The mandibular canine had two roots with two root
canals, buccally and lingually. The bifurcation of the
pulp chamber was observed in the cervical third, whilst
the root was bifurcated in the middle third of the root
(Fig. 4 a, b).
The mandibular second premolar was single rooted
with two root canals, one buccally and one lingually
(Fig. 5 a, b).
The mandibular second molar had two roots with
two root canals, mesially and distally. The mesial root
and its root canal were severely ribbon-shaped, curved
towards the distal (Fig. 6 a, b).
Discussion
The method used in this work appears to be a useful
and interesting tool for the study of the external and
internal anatomy of teeth. The three-dimensional
knowledge of root canal morphology of teeth is of great
interest because of the ability to transfer this
information from the laboratory to the clinic.
One of the advantages of the method is that one
can observe the internal anatomy of the teeth from
International Endodontic Journal, 32, 8893, 1999 q 1999 Blackwell Science Ltd
3D reconstruction of abnormal teeth Mikrogeorgis et al.
90
different angles. The rendering which was used is
very important for the clinicians because through
proper lighting, colour and texture, a better under-
standing of the dental structures under investigation
can be achieved. All these factors make the method
an interesting educational tool. Also, it is possible to
obtain an animation showing movement of each
tooth around its vertical axis. This was implemented
and, as expected, proved to be an even more helpful
way of visualizing the tooth morphology.
In conclusion, this is a very interesting method,
Figure 3 (a, b) Digitized stereomicroscopic image of the 7th
cross section of the mandibular lateral incisor (left). Extracted
contours of the external and internal boundary of the root
canals from the same section (right). 3D reconstructions from
two different view angles. The apical division of the root is
clearly seen, as well as the two separate and distinct root
canals, buccally and lingually, of the tooth.
Figure 4 (a, b) Digitized microscopic image of a cross section
from the apical third of the mandibular canine, where the two
roots with two root canals are clearly seen (left). Extracted
contours of the external surfaces of the roots and the root
canals from the same section (right). Two 3D reconstructions
from different viewpoints of the tooth, where the two roots
with two root canals, buccally and lingually, are obvious.
q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 8893, 1999
Mikrogeorgis et al. 3D reconstruction of abnormal teeth
91
showing the possibilities of the application of
informatics technology in dentistry.
Acknowledgement
This study was supported by the European Union's
programme, TASTY.
References
Black, GV (1897) Descriptive Anatomy of the Human Teeth, 4th
edn. Philadelphia, USA: S. S. White Dental Mfg. Co, 115
16.
Eikona, 3d (1997) A package for 3D image processing,
analysis and visualization, in http://www.alphatecltd.com/
alphatec/eikona 3d.html.
Fischer, G (1907) Uber die feinere Anatomie der
Wurzelkanale menschlichen Zahne. Deutsche Monatsschrift
Fur Zahnheilkunde 25, 54452.
Green, D (1955) Morphology of the pulp cavity of the
permanent teeth. Oral Surgery, Oral Medicine, Oral Pathology
8, 74359.
Mueller, AH (1933) Anatomy of root canals. Journal of
American Dental Association 20, 136186.
Figure 5 (a, b) Digitized stereomicroscopic image of a cross
section from the cervical third of the mandibular second
premolar (left). Extracted contours of the external and internal
surfaces of the same cross section (right). 3D reconstructions
of the tooth from two different view angles, where it is clearly
seen that it was single rooted with two root canals.
Figure 6 (a, b) Digitized microscopic image of a cross section
of the mandibular second molar, where the two roots with
two root canals, mesial and distal, are clearly seen (left).
Extracted contours of the external surfaces of the roots and
the root canals from the same section (right). Two 3D
reconstructions of the tooth from different viewpoints, where
the extreme apical curvature of both its mesial root and root
canal toward the distal is obvious.
International Endodontic Journal, 32, 8893, 1999 q 1999 Blackwell Science Ltd
3D reconstruction of abnormal teeth Mikrogeorgis et al.
92
Pitas, I (1993) Digital image processing algorithms. London:
Prentice Hall.
Preiswerk, G (1909) Atlas and Text-Book of Dentistry.
Philadelphia, USA: W. B. Saunders Co, 512.
Russ, JC (1990) Computer-assisted Microscopy: The Measurement
and Analysis of Images. New York: Plenum Press.
Skidmore, AE, Bjorndal, AM (1971) Root canal morphology of
the human mandibular first molar. Oral Surgery, Oral
Medicine, Oral Pathology 32, 77884.
Vertucci, F, Seelig, A, Gillis R (1974) Root canal morphology
of the human maxillary second premolar. Oral Surgery, Oral
Medicine, Oral Pathology 38, 45664.
q 1999 Blackwell Science Ltd International Endodontic Journal, 32, 8893, 1999
Mikrogeorgis et al. 3D reconstruction of abnormal teeth
93