Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 7, July, p. 1001–1008

doi: 10.17219/acem/68117

Publication type: original article

Language: English

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Validation of a windowing protocol for accurate in vivo tooth segmentation using i-CAT cone beam computed tomography

Babak Rastegar1,2,A,B,C,D,E,F, Brice Thumilaire3,B,C,D,E,F, Guillaume A. Odri4,C,D,E,F, Sergio Siciliano5,D,E,F, Jan Zapała6,D,E,F, Pierre Mahy7,D,E,F, Raphael Olszewski7,8,A,B,C,D,E,F

1 Service de Parodontologie, Université libre de Bruxelles, Brussels, Belgium

2 PhD student, Jagiellonian University Medical College, Kraków, Poland

3 Private practice, Libramont, Belgium

4 Service de Chirurgie Orthopédique et Traumatologique, CHU Lariboisière, Paris, France

5 Service de Stomatologie et de Chirurgie Maxillo-faciale, Clinique sainte Elisabeth, Brussels, Belgium

6 Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Rydygier Hospital, Kraków, Poland

7 Service de Stomatologie et de Chirurgie Maxillo-faciale, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium

8 Visiting professor, Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Rydygier Hospital, Kraków, Poland

Abstract

Background. Validation of three-dimensional (3D) reconstructions of full dental arches with crowns and roots based on cone beam computed tomography (CBCT) imaging represents a key issue in 3D digital dentistry.
Objectives. The aim of the study was to search for the most accurate in vivo windowing-based manual tooth segmentation using CBCT. The null hypothesis was that all applied windowing protocols were equivalent in terms of in vivo tooth volume measurement using CBCT.
Material and Methods. This retrospective study was based on preoperative CBCT images from patients who underwent further tooth extractions for reasons independent of this study. Written informed consent was obtained from all the participants, and the study was approved by the Ethics Committee of Cliniques Universitaires Saint Luc (Brussels, Belgium). The radiological protocol was I-CAT CBCT, 0.3 mm slice thickness, 8 cm × 16 cm field of view, 120 kVp, and 18 mAs. A total of 36 teeth were extracted from 14 patients between the ages of 18 and 68 years. Using 3D Slicer software, segmentations were performed twice by 2 independent observers, with a 1-month time period between the 2 segmentations to study intraand inter-observer repeatability and reproducibility. Four windowing protocols (level/window) were applied: 1. 1131/1858, 2. 2224/4095, 3. 1131/4095, and 4. AUTO, an automatic protocol provided by default by the software. A total of 576 segmentations were performed. Tooth volumes were automatically calculated using the software. To compare the volumes obtained from CBCT segmentations with a gold-standard method, we laser-scanned the extracted teeth.
Results. Excellent intraand inter-observer intraclass correlations were found for all of the protocols used. The best windowing protocol was 1131/1858 for both observers. Tooth volumes were obtained by manual segmentation of the CBCT images and using windowing protocol 1131/1858. No significantly different tooth volumes were found by laser scanning.
Conclusion. Our null hypothesis was rejected. Only windowing protocol 1131/1858 allowed for significantly closer 3D in vivo segmentation of a tooth compared to I-CAT CBCT, with excellent intra-observer repeatability and inter-observer reproducibility.

Key words

cone-beam computed tomography, grey levels, segmentation, 3-dimensional

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