Here you will find everything related to cephalometric analysis, digital radiography, Dental imaging basically everything ceph-related.
Orthodontists have always had an interest in the upper airway, whether it’s the relationship between the airway and facial type, airway shape, or the airway volume. Most airway volume analysis is conducted using 2-dimensional (2D) cephalograms, which create a 2D airway analysis. This method provides limited data, like angular and linear measurements. A more sophisticated 3D airway analysis can be conducted by using 3D technology as the airway is part of a 3D structure. The most recent tool that can reveal the airway in 3D is cone-beam computed tomography (CBCT). The reason for orthodontists needing this information is so they can measure the airway volume for patients with obstructive sleep apnea, in relation to malocclusions, and also in those patients who have had orthodontic treatment.
2D lateral cephalograms
The older lateral cephalograms cost less than CBCT and are easy to use, but they are just limited to two-dimensional imaging, which doesn’t help to view structures in 3D. The use of CBCT has revealed that its reliability and accuracy of craniofacial measurements are far better than to 2D lateral cephalograms.
The use CBCT in the field of dentistry
This 3D diagnostic tool has in recent years become more accessible to the field of dentistry. It is now a reputable and well-acknowledged imaging technique for diagnosing oral and maxillofacial problems. It has in part become the preferred technique because it’s faster so it means the patient is subject to lower radiation doses. CBCT technology is so advanced that it can segment and visualise hollow structures in 3D such as airway volumes and surface areas.
Once the scan or digital image has been taken, the dentist, orthodontist or doctor needs to view the findings in a DICOM viewer, as DICOM is the file format accepted for a medical image. A DICOM viewer allows for a total analysis of any CBCT scan such as measuring airway volume and segmenting. When an image of an airway is segmented and structured this means delineating and removing any surrounding structures so that there is a clearer image which is easier to analyse.
Airway volume analysis and sleep apnea
The orthodontic community has a great interest in airway volume and respiratory function because studies have revealed airway problems are often related to different sorts of malocclusion and it’s been found that nasal obstruction is one of the main aetiological factors for dento-facial anomalies. Also, evaluation of airway volume is one of the diagnostic steps for patients who experience breathing disorders for example obstructive sleep apnoea (OSA) where the victims have marked craniofacial differences, like the position and size of the mandible, enlargement of the posterior airway space, and size of the soft palate and tongue. In these patients, airway volume analysis assessment has been performed, mostly using 2D lateral cephalograms, by identifying specific landmarks and measuring different areas and lengths in the airway region.
Airway volume analysis and malocclusion
Studies have shown that Class 11, division 1 malocclusion occurs because of an obstruction in the upper pharyngeal airway and mouth breathing. However, other research such as de Freitas et al. (2006), drew the conclusion that the width of the lower and upper pharyngeal airway width is not related to either Class I or Class II malocclusions. A further study by Kirjavainen and Kirjavainen in 2007 discovered that with Class II malocclusion, there is a definite association with the upper airway structure being narrower even in the absence of retrognathia.
Many of these studies to do with airway anatomy and its relationship to craniofacial development and growth face limitations because they have been using 2D frontal or lateral cephalograms which are not able to identify the contour of soft tissue in 3D which limits their ability to evaluate both volumes and areas in the upper airway. More and more practitioners take advantage of advances in computed tomography (CT) imaging and the 3D technology which allow them to better visualize the airway and volumetric analysis.
Clinicians are able to undertake the volumetric measurements and calculate the cross-sections of the airway in 3 planes of space, which are axial, coronal and sagittal. The axial plane, which can’t be seen on a lateral cephalogram, is considered to be the most relevant plane from a physiological perspective because it’s perpendicular to the airflow. CBCT systems have been specifically developed for the maxillofacial area.
Easy and accurate evaluation of the anatomy of the airway has been made possible using CBCT. Although there have been many studies published using CBCT to evaluate airways, not many have addressed its accuracy. Recent studies concentrated on evaluating both the reliability and accuracy of the airway volume which was measured on CBCTs digitally and at the most constricted part in the airway. This was compared to the manual measurements carried out on an airway model. They came up with varying results.
What we do at CephX
Our aim at CephX is to assist orthodontic practitioners worldwide to save valuable time by providing accurate analyses of dental imagery. The services we offer are automated, which is the highest quality analyses that helps you to improve the productivity and efficiency of your practice. Currently, we offer a cephalometric analysis service of 2D cephalometric x-rays or of CBCT scans, and 3D teeth segmentation. All the dental practitioner has to do is to upload the patient’s scan, and in no time at all he or she will be in receipt of the full analysis. Another key service we intend to add soon is automatic and instant 2D and 3D airway volume analysis using AI which will be available online.
Artificial intelligence (AI) isn’t actually a recent invention as it has been around since 1956, when intelligent machines were discussed at a conference for researchers. So, more than half a century later, AI has become part of our lives. It’s so pervasive that it is used in dentistry and for good reason, too. If as a dentist you are presented with a patient suffering from a toothache, first of all you are likely to quiz the patient on the exact location of the pain, take an x-ray and use the patient’s dental history and your experience to determine the actual site of the decay. No dentist gets every diagnosis right. Caries can’t always be seen with the naked eye. However, AI is in the process of changing all that.
Machine learning and big data
Machines using big data inputted into them are getting closer and closer to obtaining a perfect score when confronted with having to give a diagnosis. But they do have to be fed a huge amount of data which provides them with sufficient information to come up with a useful diagnosis. Fortunately, the ability to store huge amounts of data has been mastered. In fact, just in the last 5 years, big data with cloud computing provides easy access to massive data sets and at little cost. The machine can sift through the data and select what it thinks is needed to solve a problem it’s been asked to do.
The new era of deep learning
This is considered to be the most cutting edge of AI in the machine learning field. Deep learning is more intelligent than early machine learning as it makes its own rules, even when additional data is included. This feature means it’s well suited for interpreting unstructured data, such as disease detection, earthquakes and for the diagnosis of medical issues. Dentists like you may already be accessing a deep-learning AI platform for diagnosing caries without even realising it.
AI on the dental horizon with deep learning
Artificial intelligence is of great use to the medical and dental fields because so often a diagnosis is dependent on what experience the dentist has had of a similar situation before. IBM’s Watson can read upwards of 500,000 research papers in just 15 seconds. This sort of deep learning can delve into so much depth that it can recommend diagnoses and suggest the best treatment options. In a study published recently results were presented for detecting caries by a dentist and by a machine.
The AI machine outperformed dentists in sensitivity, which measures the percentage of caries predicted correctly. In the next year or two it’s expected that a reliable deep learning AI tool will be available to dentists. Not long after that, a tool for diagnosing periodontal disease and associated bone loss should be on the cards. So far ORCA Dental AI has developed ceph-tracing algorithms which can instantly offer a custom tracing and ceph analysis report. With cephalometric analysis, orthodontists are able to construct treatment plans for their easily and accurately so there is no delay in starting orthodontic treatment. ORCA’s cutting edge cephalometric analysis and tracing service assists practitioners like you to provide more efficient treatment. Your patients will see the immediate results from your state of the art treatment and they benefit while your revenue grows.
CephX and AI
In the last 4 years CephX discovered the growing importance of AI in the dental community. It hasn’t wasted any time and has responded by creating the first intelligent algorithm capable of automatic and instant cephalometric analysis on an x-ray scan. Most recently CephX introduced a new algorithm which is cephalometric tracing on a CBCT scan. Its AI teeth segmentation solution is no doubt the star of the show offering instant and automatic teeth segmentation. This allows far more accurate and faster treatment for your patients.
What’s in it for your patients?
A lot more than one could imagine, as AI and big data score highly for the patient too. If one of your patients feels a debilitating jab of pain in a tooth they will soon be able to get their smart brush out, put it in the mouth and link it to a smart phone. In an instant it collects information about the painful tooth which is stored in cloud. Using big data and AI the data is analysed and a diagnosis is revealed, which ends up on your desktop. It’s then up to your practice to organise an appointment and go ahead with treatment.
Your dental practice and big data analytics
Big data analytics is a bit more than big data and it goes a step further in dental care. It has the ability to analyse vast amounts of data which includes a patient’s personal data and demographic data. This can give you an insight into likely dental problems that could affect your patients in the future because it discovers the common dental problems in a particular area. You can advise your patients of possible preventative measures they could use to halt the occurrence of one of these common dental problems.
As more and more AI and smart technology is added to dentistry the role of you as a dentist and your patient will ultimately change and it should lead to better oral health outcomes for your patients because they will be able to link with you in real time instead of waiting for a physical appointment. You will be able to offer state of the art AI diagnostic tools enabling you to come up with just the right diagnosis and treatment plan. You could even become the most sought after dentist in your area.
In the near future, it’s likely that tools for deep learning analysis for images will assist in diagnosing and suggesting treatment plans for periodontal disease because it will be able to far sooner early loss of bone and bone density changes. In orthodontics, it’s expected there will be far more sophisticated prediction models for movement of teeth tooth which will most likely improve drastically digital treatment plans. When applied to oral cancer a deep learning image analysis will improve earlier detection and offer more accurate diagnoses which will improve life’s outcome.
CephX works continuously on creating cutting edge solutions and services for orthodontic practitioners. To receive additional information regarding existing or new upcoming orthodontic services and solutions, please contact us at email@example.com.
What is Artificial Intelligence?
Artificial intelligence (AI) isn’t a new concept. In fact, it was first mentioned in the 1950s by Minsky and McCarthy, who were considered to be pioneering experts in the field. They referred to AI as a task performed by a machine or programme that, if a human was to carry out exactly the same activity, the person would have to use intelligence to succeed in completing the task. The sorts of tasks could be anything to do with planning, reasoning, the sharing of knowledge and problem-solving.
Since those early days computers have increasingly taken over tasks normally associated with humans. This has enabled industries of all types to manufacture products more efficiently. AI is now so well developed that medicine is using it in a multitude of situations, enabling better outcomes for patients. When a patient visits an emergency room, diagnosis is faster and more accurate. This means the right treatment is given, which means less delay than might happen if doctors have to discuss a case before deciding on a diagnosis.
AI is also being used to improve communication between medical personnel. In the long run, this all means that by patients getting the right treatment in the fastest time frame reduces time spent in hospital so reducing the stress levels of family and friends.
How the Watson platform uses AI to help the medical profession
The Watson platform was introduced by IBM into medical facilities to assist oncologists to come up with the most appropriate treatment for patients. All the doctor has to do is input a patient’s diagnosis into Watson which at a touch of a button instantly recommends the best treatment suited to the data it has about the patient. It has already been fed with information provided by medical journals. With this huge amount of accumulated knowledge, its AI allegedly comes up with the best treatment plan.
AI for dentistry makes its mark
AI is now being used to improve the efficiency of dentistry. Dr. John Kois has developed a similar AI model to IBM’s Watson called Evidentiae. It focuses more on using cloud-based dental software. It concentrates on information processing at the patient level, starting with an online patient history form and all the data relevant to the patient’s treatment.
Evidentiae’s algorithm has been designed to extract data from both medical and dental histories which have been inputted into it and charted examination findings. This enables the technology to generate a full overview of the dental health status of your patient. It has been so well developed that it is able to come up with a valuable diagnosis for periodontal issues and dento-facial alterations. It’s the best AI assistance yet invented for the dental profession.
A few years ago CephX understood the need for artificial intelligence in the dental industry. In response, they created the first cephalometric analysis intelligent algorithm. It enabled orthodontic practitioners to upload their patients’ cephalometric scan and to receive in a matter of seconds a full cephalometric tracing and analysis. This technology improved dramatically the way it was done, because now dentists could instantly receive a full and accurate analysis.
AI and Big Data in Dentistry
With AI and big data making inroads into dentistry soon algorithms will be diagnosing dental problems and the diagnosis will be sent directly to you. This is a step ahead of CephX and cephalometric analysis which is currently helping you with instantly tracing and analysing cephalometric scans. However, it is starting to move quickly as it is developing more intelligent algorithms for the orthodontic industry. One of them is the algorithm that can instantly segment all of your patient’s teeth.
Deep-learning in machine learning is becoming relevant to Dentistry
Advanced technologies that are disrupting all of our lives are also helping to revolutionize dentistry in numerous ways. Deep learning, which is an AI cutting-edge technique in machine learning, is using layered neural networks which are patterned on a human’s brain. Traditionally machine-learning relies on rules that have been handcrafted but defined by experts in human domain but do not improve with bigger datasets. Deep learning has the capacity to create its own unique rules that do improve when more data is added, making it particularly suited at interpreting unstructured data that’s required for more advanced applications like self-driving cars, the prediction of earthquakes, detection of disease and diagnosis and recommendations for treatment in medicine. Dentists do actually have some access to an AI deep learning platform for the detection of cavities today.
AI that can read CT scans for dentistry
Research and development of AI is progressing at such a fast rate that software are already able to read and interpret CT scans and other dental images. In the near future, it will suggest the best diagnosis and treatment which it has gleaned from its ability to review and analyse countless images that have been stored in numerous patients’ databases. What’s particularly important to dentistry is the speed and accuracy that emerges from the use of AI.
The medical profession is presently benefiting a lot from VisualDx, an AI technology that doctors can use to input patient symptoms and any relevant images and within a matter of seconds plausible diagnoses can be retrieved. This AI is soon likely to penetrate the dental industry.
The future of AI in the next decade
In the medical field at least AI is going to become increasingly relevant. This will result in administrative practices being far more streamlined. This, in turn, leads to a reduction in costs. It’s expected that there will be a far higher chance that any unnecessary medical procedures will be avoided, which should heighten patient satisfaction. This is all due to the way information is being inputted and the way humans are communicating with devices.
In the early stages of storing information, a human had to manually enter data. Graphical user interface (GUI) came next, followed by the development of the touch screen and the rapid evolution of mobile devices. All this, coupled with massive improvements in internet connectivity, has brought us to where we are today.
The dentist and a virtual assistant
Human voice recognition is increasingly being used to input information into an AI device. In a decade or so, dentists and others in the medical community will be communicating with AI devices using their own voices. AI will be able to assimilate and analyse data and recommend the best treatment options. This will be happening in the dentist’s chair, where communication with the dentist and the AI device will sound quite natural and not stilted.
It won’t be just a computer standing side by side with the dentist, but a virtual assistant using AI. It will be provided with so much data to analyse that it will come up with just the right treatment in orthodontics and other dental procedures and the future care requirements for the patient, dependent on data that it has been given to analyse. The virtual assistant will be able to make recommendations regarding future care requirements which will depend on the genetic data of the patient.
In the near future, AI will be able to help the dental practitioner spot a possible tumor, or other irregularities in teeth or gums, through an X-ray or CT scans. Artificial intelligence is already used in some medical centers to improve the efficiency of health care delivery. Software is being further developed to make surgery and imaging test timetabling more efficient by predicting how long each scheduled procedure will take. This and other innovative solutions can easily be adapted for use in a dental practice. CephX’s technologies which are all based on AI are trying to achieve exactly that.
Before orthodontic treatment can begin, it is important to obtain the precise mesiodistal angulation and faciolingual inclination for all teeth being treated. Current technology focuses the most on crown angulation and inclination in general, while the roots do not receive as much attention as they should. Positioning roots correctly is necessary for any orthodontic treatment that is of any use, but because orthodontists tend to focus on the position of the crown, not the root, optimum teeth alignment doesn’t always take place.
The roots are typically overlooked because roots do not directly affect the preferred esthetics of the face that an orthodontic patient is ultimately striving for. Research has indicated that it is still reasonable to suggest that positioning the roots in their right places in the basal bone may reduce the amount of relapse occurring after orthodontic treatment, which is a plus in itself.
Up to now, orthodontists have discovered that problems which occur with crown alignment which have been observed through radiographs are due to incorrect root angulation. It is of utmost importance that these problems are corrected sooner rather than later, as the whole aim of administering orthodontic treatment is to achieve proper and stable teeth positioning. This involves all parts of the tooth, including crowns and roots. However long it takes, patients are looking for a favorable facial appearance as the outcome.
Panoramic x-rays versus cone-beam computed tomography (CBCT) to determine root position
Throughout orthodontic treatment, panoramic x-rays have been used extensively to check root position, even though they are not known for their accuracy. This inaccuracy is allegedly due to distortions found in panoramic radiographs because of non-orthogonal x-ray beams that are directed at the targeted teeth.
Cone-beam computed tomography (CBCT) is a new and more accurate approach for getting images of the position and angulation of the teeth’s roots. They are able to take a 3D image of all the teeth and the roots with minimal exposure to radiation. This breakthrough should be of great interest to the orthodontic community and fulfils the main aim of orthodontic treatment, which is to manipulate misaligned teeth from malocclusion to being more esthetic, so that the complete tooth, crown and root are positioned so as to be both more functional and more esthetic.
A well used way to ensure ideal occlusion is Andrew’s six keys. Four of these keys, namely faciolingual, mesiodistal, occlusal gingival positions and axial rotation, are solely governed by the teeth’s crowns, which are generally relatively easy to monitor clinically. Despite this, crowns do not always indicate accurately enough the complete tooth inclination and angulation.
Mesiodistal angulation and faciolingual inclination can be better established if the orthodontist can get a 3D view throughout the orthodontic treatment process. It is not good enough to depend on imagery found from panoramic radiographs, as the images are often distorted. CBCT provides the accuracy that the orthodontic community really needs to minimize the treatment time of orthodontic teeth alignment solutions.
Why root angulations are important to the orthodontist
Detecting root angulation is important because the optimum position of the roots needs to be achieved so that each root sits independently from others and stands in a parallel position in relation to adjacent roots. It has been found that panoramic x-rays don’t necessarily show the root’s positions with enough accuracy. Some orthodontists notice issues in crown alignment after observing improper root angulations using radiographs. The American Board of Orthodontics issued a recommendation that assessing root angulations should be carried out. This assessment necessitates root parallelism and takes away points if the roots of adjacent teeth are not parallel to one another or make contact with one another. If the angulation of the roots can be detected they can be corrected by the orthodontist.
The process for using CBCT scans and software for detecting tooth angulation/inclination
Accurate diagnostic imaging is important for both orthodontic diagnosis and the planning of treatment. It is also an essential tool that permits the orthodontist to monitor closely the progress of orthodontic treatment. Today, CBCT is more frequently used to provide more complete images of orthodontic patients’ teeth and roots than the use of panoramic images and cephalograms. CBCT scanners have been in use for fifteen years. Orthodontists and dentists can locate inclination/angulation of the teeth using CBCT and compatible software. This is not necessarily a quick process, as it may take some time to locate and segment the roots.
Quality of CBCT scans for root angulation
The orthodontist may see some discrepancies in 3D CBCT images of root positions, but in contrast panoramic radiographs tend to offer false information. This makes 3D CBCT scans far more reliable than anything that has come before it to detect root angulation as well as images of the teeth and crowns.
Coming soon for orthodontists
At CephX, our aim is to help orthodontic practitioners globally to save valuable time by offering accurate dental imagery analyses. We offer an instant service which is made up of the highest quality cephalometric analysis that helps to improve productivity and efficiency in your practice. Currently, we provide a cephalometric analysis service for 2D cephalometric x-rays. The dental practitioner uploads the patient’s cephalometric x-ray scan, and within a matter of seconds he or she will receive the full cephalometric analysis. There are 2 more services we will be adding soon which offer automatic and instant results too. These are:
- A cephalometric analysis service for 3D cephalometric scans using CBCT.
- Teeth segmentation, including Root Recognition which provides information about every tooth, root direction, impacted tooth position and supernumeraries, using CBCT.