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Good Afternoon
Three Dimensional
Cephalometrics,
Morphometrics and
other recent advances
Introduction
Over the years, diagnosis and
treatment planning in orthodontics
and dentofacial orthopedics has relied
substantially on numerous
technological aids.


The gold standard that these aids (imaging,
articulators, jaw tracking and functional
analyses) attempt to achieve is the accurate
replication or portrayal of the anatomic truth.

The anatomic truth is the accurate three-
dimensional anatomy, both static and
functional, as it exists in nature.

The ultimate goal of the clinicians is to use
these technologies, either alone or in
various combinations, to delineate this
anatomic truth.

Imaging is one of the most ubiquitous tools
that orthodontists use to measure and
record the size and form of craniofacial
structures.
Imaging has been traditionally used in
orthodontics to record the status quo of
limited anatomic structures.

While the use of imaging in orthodontics
has been relatively adequate, the fulfillment of
ideal has been limited by the available
technology & the quality of the database.

These desired goals of craniofacial imaging
are closer to being achieved than ever before.

We will be seeing in detail about the Three
dimensional cephalometrics, Morphometrics
& other advances in imaging which takes us a
step closer to the realization of our goal.

Three Dimensional Cephalometry
Facial evaluation begins with a systematic,
three-dimensional assessment of the frontal
& profile views in three planes.

The deformities can then be described
three dimensionally in the frontal and profile
views as excessive, normal, or deficient.
Earlier orthodontists paid little attention to the
PA view coz the clinical problems
encountered were symmetric & appeared to
be adequately recorded by the lateral view
alone.

Recently, as orthodontists have become
"craniofacial orthopedists" treating more
severe, often asymmetric craniofacial
anomalies; the limitations of the lateral
cephalogram have become obvious.
The Broadbent-Bolton cephalostat produces
intrinsically three-dimensional information
about cranial form.

Yet in the clinical setting, this information
has been used primarily two dimensions at a
time in the separate study of lateral or
posteroanterior cephalograms.

From the very first introduction of the
cephalostat, Broadbent and Bolton stressed
the importance of coordinating the lateral with
the PA films to arrive at a distortion-free
craniofacial form.

For this purpose they described the
Orientator,an exploitation of the geometry of
the cephalostat to simulate
stereophotogrammetry.
Orientator, is an acetate overlay placed over
both cephalograms (LAT and PA) after they
were oriented jointly along their common
Frankfort horizontal plane.
History
The earliest three dimensional
measurements of the skull were made by
researchers in anatomy & anthropology,
primarily on dried specimens.

The reference planes of Frankfort, His, and
Camper and most of the anatomic landmarks
that we currently employ were defined and
measured directly prior to 1900.
The most widely known system for
measuring the spatial relationships between
the teeth and the skull in vivo was that of
P.Simon, during 1920s.

His system, like that of his predecessor Van
Loon; was essentially mechanical. It
included a maxillary clutch and a frame.
By means of this
apparatus & a wax
check bite, it was
possible to locate the
dentition within the
skull anteroposteriorly,
vertically & with
respect to the occlusal
plane orientation.
Simons conceptions of gnathostatic
measurement were essentially sound, but
the technical procedures were quite
demanding.

Simon's system is important in that it
focused sharply than did subsequent x-ray
methods upon the location of structures that
interest Orthodontists most the teeth &
alveolar process.

In the exposure of a pair of cephalograms
the patient's head is not turned, but instead
the cephalostat itself. The LAT and PA films
would occupy positions at 90 to each other.

By keeping the films with respect to the
head, one can draw the rays connecting the
x-ray source to each landmark of either film
as threads in space.
The result is a pair of pyramidal sprays of
thread, intersecting at approximately 90
throughout the interior of the space occupied
in reality by the patient's head.
The films can be flattened into one plane by
unfolding them along the "corner", with each
bundle of threads (x-ray paths) flattened to
the side of the other film at the appropriate
distance.

The Orientator is the diagram of the
flattened threads. When superimposed over
the abutted pair of films, the points in each
film that correspond to any locus in the
other can be visualized.
Broadbent & Bolton used Orientator to
correct for distortion inherent in the spread of
cephalometric x-ray beam.

In 3D cephalometry we are instead truly
reconstructing the location of landmarks in
space. The principle of the Orientator then is
identical with the ray intersection method, a
photogrammetric tool.
For a radiographic landmark to be locatable
in the space of head, it must be connected to
the x-ray source in two different projections:
the LAT & PA views.

The best landmark candidates for such
points are structures defined by means of the
vertical coordinate, which is shared between
the two views.

Many landmarks are conventionally defined
as the "top" or "bottom" points of structures:
menton, condylions, superior and inferior
orbital rims, and cusp tips.

Points uppermost or lowermost in the PA
ceph may not represent precisely the same
points in space uppermost or lowermost in
the lateral ceph.

The typical lateral tracing includes eight
landmarks conventionally taken to lie on the
midsagittal plane: S,N, ANS, supradentale,
upper & lower incisal edge, menton, and
pogonion.

Of these, supradentale is visible in the PA
film, as are the averaged incisal edges and
menton.
Sella, nasion, ANS, & pogonion have little
visibility, if any, in the PA film.

With two of their coordinates supplied by the
lateral film, the third may be taken to
correspond to the apparent position of the
midsagittal plane at the appropriate depth in
the frontal film.

Any three-dimensional reconstruction will
proceed more accurately if the bilateral
landmarks on the lateral film have not been
averaged.

Instead they should be identified individually
by a careful consideration of study models,
dental landmarks, and auxiliary
cephalometric films.

3D ceph
landmarks
x, y, & z
coordinates
found in the LAT
and PA
cephalogram
using which the
3D points are
reconstructed.
Registration of the films
The theory of the cephalostat treats
projections of the head in a pair of views
precisely to the FH plane & separated by a
90 rotation about the vertical plane.

But the real data is more or less divergent
from the ideal.

Practically heads cannot be placed precisely
in the FH plane, nor can the subject hold a
fixed orientation while rotated 90 within the
cephalostat.

In true Bolton system, the images at 90
simultaneously by are generated almost the
use of 2 x-ray systems that are themselves at
90. Modern cephalostats have lost this
crucial capability.
In particular, there is usually some element
of rotation about the ear rods, away from the
FH plane in one or both images.

Modest amounts of such positioning error
may be routinely corrected by simple
computations before one proceeds to actual
3D reconstructions.

The films corresponding to LAT and PA
projections of the same head are digitized
separately.

The digitized LAT cephalogram is rotated so
that the point midway between the two
porions lies on a horizontal line with the
midpoint of the two orbitales .

The PA film is rotated so that the line
between the two porions is precisely
horizontal.

This film is then subjected to a computed
shear correcting for failure of the midorbitale
point to lie precisely on the horizontal line
between the two porions.
Each landmark locatable on both films is
sheared by an amount corresponding to its AP
separation from porion as scaled by the AP
separation of midorbitale from midporion in the
LAT.

This is a satisfactory approximation to correct
the procedure, a three-dimensional rotation,
for all angles of rotation small enough to be
encountered in practice.
The ray intersection
method

After this calibration step, we may imagine
that the landmark locations correspond
precisely to the nominal geometry of the
cephalostat.

Each lies on one of a pair of film planes in
precisely known spatial relation at 90 to
each other.

The landmark images are at a known
distance from x-ray source whose central
rays are at 90 to each of the films & which
intersect in space, exactly halfway between
the pair of porions.

As in Orientator, each landmark location on
film is now replaced by the path in space that
the x ray must have followed to arrive there: a
thread connecting that digitized location to
the source.

In this way the distortion
inherent in each
cephalometric projection is
corrected by the
combination of points from
both films.

This three-dimensional
constellation of landmarks
may be joined by straight
lines and rotated for
viewing in all directions.
Advantages
The 3D method supports the usual
biometrics of landmark locations & takes
advantage of a normative data base that is
suited for semiautomatic analysis of
syndromic data.

In comparison with CT, it involves low
radiation dose, simpler to obtain, has an
available normative data base, & is more
practical for long-term serial analysis.

When compared with conventional
cehalometrics, the 3D evaluation for one new
methodology, (Acuscape & Sculptor) was
more precise within approximately 1mm of
the gold standard.

The sculptor program was found to be 4 to
5 times better than the 2D approach.
Disadvantages
The principal drawback of the method is its
inability to represent curving form in three
dimensions.

One fundamental difficulty is associated with
the assumption that "corresponding"
landmarks in LAT and PA films actually
pertain to the same three-dimensional point
on the skull.

Some inherent flaws and errors of this
scheme include tracing and digitizing errors,
failure of the porions to superimpose in the
lateral film, and the finite size of the x-ray
source.

It is difficult to compensate for the differences
in enlargement (termed "projective
displacement'') of structures which lie at
different distances from the frontal and lateral
film surfaces.
Empirical problems have prevented the
routine clinical use of this Broadbents
"biplanar" 3D method, notwithstanding its
obvious conceptual brilliance.

To overcome the problems Sheldon
Baumrind and colleagues at the University of
California devised another method, The
Three-dimensional x-ray stereometry from
paired coplanar images.
The two basic and important problems faced
by the biplanar method of Broadbent were:

1.Difficulty in identifying the same landmarks in
both films with confidence.
and
2. Projective displacement.
Since both the LAT & PA are taken at 90
o
to
each other i.e, biplanar the same anatomic
structures take up different size and shape,
making it difficult to precisely identify the
landmark.

This was overcome by this coplanar method
where both the films are taken more or less in
the same plane making landmark
identifications lot easier.
It is difficult to
compensate for the
differences in
enlargement
("projective
displacement'') of
structures which lie at
different distances from
the frontal and lateral
film surfaces.

That is to say that all the anatomic structures
lying in each "para-film" plane will have the
some magnification factor, no matter what
their anatomic nature.

Conversely, if two planes are at different
distances from the film surface, their
enlargement factors will be different, no
matter what the anatomy.
Broadbent system is in essence a spatial and
temporal composite of the two views.

It follows that the enlargement factor for any
given anatomic landmark will differ from the
lateral projection to the frontal projection
unless by coincidence that the structure is at
same distance from both the film surfaces.

In order to deal with the problem of
differential enlargement, a number of
investigators have constructed specialized
mechanical devices.

These include the "orientator" of Broadbent,
the "compensator" of Wylie and Elasser, and
the "modified compensator" of Vogel.
This new method put forward by Baumrind to
overcome these difficulties was based on an
engineering tool called Photogrammetry.

Photogrammetry -- discipline devoted to
solving the problems of making 3D
measurements from paired 2D images, esp.
used for reconstructing terrestrial maps from
photos taken from space.
The basic principle is the stereoscopic vision
used by eye to recognize the 3D information
of the object.

When we view points at some distance from
us, our eyes rotate slightly to align and focus
on the points.
Line segments can
readily be drawn from
each point through
the optical center of
the lens of each eye.
The included angle
between the pair of
such lines is known
as the "parallactic
angle'' of the point.
Points at different distances will have
different parallactic angles. Differences in
parallactic angle are interpreted by the brain
as differences in distance.

The alternative way of measuring the
parallax is by using linear rather than
angular measurement. The distance
between two points on the connecting lines
in the same plane will also depict the
parallax of the point.
In other words viewing the points along the
line with each eye focusing only on one
points, the brain will perceive it to be a single
point at the actual depth.

Similarly, looking at a same point in two
pictures, with each eye concentrated on one
point, the brain will perceive the depth of the
structure.
But this procedure puts extensive strain on
the eyes and though with dificulty the
clinician can assess the 3D info in mind, it is
not possible to quantify the information and
set up a database.

To overcome this, Photogrammetry uses
STEREOSCOPE for viewing the picture and
then by calculating the distance between the
points, i.e, parallex the depth information is
quantified.
Each matched pair of photographs is called a
stereopair or a diapositive.

When this technique is used for quantitative
purposes, the distance between each
matched (or "conjugate") pair of points is
measured with a device known as a "parallax
bar.

The focal spot of x-ray tube is equivalent to
the optical center of camera lens. In each
case, the radiation travels in straight line
between the object & the nodal point.

Thus, a conventional single x-ray film is the
geometric equivalent of a single conventional
photograph except that the subject lies ''within"
the camera instead of beyond it.

Making of the stereopairs
The subject would be positioned in a head
holder; and an exposure would be made from
"camera station L1.''

The central ray would pass through the
porion-porion axis, the focal spot to
"midsagittal plane" would be maintained at 60
inches, and a length scale would be
incorporated upon the film surface.

Immediately after exposure, the film would
be removed and a new film would be shifted
into the same position by some cassette-
changing device.

The second film would then be exposed from
"camera station L2.

This produces a stereopair, one of which is a
standard cephalogram. This procedure
produces a coplanar image.
The advantage of the coplanar image over
the biplanar is that both x-rays are more or
less similar & hence landmark identification is
a lot easier & reliable.

Though the biplanar images have the
strongest mathematical correlation, its
advantage is offset by the projection error
and landmark identification.

As we will be seeing the coplanar images still
retain a strong correlation.
A biplanar system
with rays orthogonal
and film in 2 planes.
B films placed in
single plane.
C head is rotated by
90
o
. Both are not
standardized films.
D orthogonal rays are
made to be acute.
One of the systems dedicated for producing
coplanar images for 3D stereometry with 2
cassette holders.
The following parameters must be known if
3D maps are to be made from pairs of two-
dimensional images:

1. The principal point of both the films.
2. The distance between the two stations (
L1 and L2 called base B).
3. The perpendicular distance from the film to
the source.
1.Principal point -- The location on the film of
the point of contact of central ray from x-ray.
The principal point of L1 is needed to define
the origin of coordinate system. L2 is needed
to define X axis.

2.The perpendicular distance from each
exposure station to the film plane is
designated "H" (for height) & should, in
simple case, be equal for both x-rays.
Knowing these values, by using simple
mathematical calculations the three
coordinates for the points are measured, and
using these coordinates a 3D wire diagram is
reconstituted.

The origin of the coordinates can be
controlled, and the reconstituted figure can
be standardized, for future comparison and
evaluation.
Advantages
More precise than the Broadbent and Bolton
system.

Errors from patient movement can be
corrected by using reference landmarks,
whose definite relation we know.

The projective displacement is not there.

Can take use of the available normative
database.
Disadvantages
Again cannot represent curving forms.
Needs a dedicated special x-ray apparatus
with precise calibration.

Needs complex patient positioning arrays to
avoid errors.
Without calibration the reliability degrades
rapidly.
Morphometrics
Introduction
Analysis of size and shape for diagnosis,
evaluation, comparison, and future reference
forms an integral part of orthodontic
diagnosis.

The methods currently available to evaluate
craniofacial from include Anthropometry,
Photogrammetry, Cephalometry, Computed
tomography, magnetic resonance imaging,
etc.
Invariably cephalometry continues to be the
most versatile technique for investigation of
the craniofacial skeleton because of its
validity and practicability.

Despite the inherent distortion and
differential magnification, in comparison with
newer imaging techniques the cephalogram
produces a high diagnostic yield at a low
physiological cost
There are 2 distinct groups of analytical
methods used in cephalometry:

Landmark based techniques and
Boundary outline methods.

Landmark-based techniques are dependent
on cephalometric landmarks.
Boundary outline techniques survey only the
perimeter of the structure.
The use of algebraic measurements in
traditional ceph analyses is known as
conventional ceph analysis (CCA).
It is a landmark based technique.

Linear distance measurements between two
landmarks.
Angles,
Areas & ratios are the parameters used by
CCA.
Limitations of CCA
Relies on the use of a reference structure for
orientation and superimposition: that is
assumed to be biologically constant but in
reality not so.

Measurements calculate the magnitude of
vectors between landmarks, ignoring their
direction.

Only size is measured, not the shape.
To overcome all these, newer methods of
cephalometric analysis were developed in
place of CCA. Morphometrics is one such.

Morphometrics = morph + metrikos (Gr).
form + measurement.
Morphometrics = Measurement of form.

In reality it consists of procedures which
facilatate mapping of visual information into a
mathematical representation.
Morphometrics is measurement of form.

What is form?
Form, fundamentally is the displacement of
space by area or volume due to an object
that is subject to scale difference.

Simply stated,

Form = Size + Shape + Structure.
Types of morphometrics
Morphometrics in representation of form,
mapping of visual information into a
numerical representation, viable for statistical
analysis.

The different types are:
1. Multivariate Morphometrics.
2. Co-ordinate Morphometrics.
3. Boundary Morphometrics.
4. Structure Morphometrics.
Multivariate Morphometrics
This type of morphometrics is applied to
datasets composed of distances, angles and
ratios.

Multivariate Morphometrics (MM) is defined
as the use of quantitative methods to
discover the structure of interrelationships of
multiple measurements.
MM evolved to meet the need for procedures
aimed at measuring the degree of similarity
within and between two or more forms using
multiple measurements.

It is based on the concept that simultaneous
utilization of numerous variables provides
more information than a large number of
individual variables being assessed
seperately.
Usually MM are based on measurement
system composed of distances, angles and
ratios, the Conventional Metric Approach
(CMA).

MM (CMA) does not quantify the form
boundary or textural considerations.
Used as an adjunct to Co-ordinate
Morphometrics.
This method is extremely useful for gaining
insights about :

1. How variables are structured?

2. How the groups are related?

Some applications include :

1. Establishing the similarity between different
forms.
2. Measuring the variation that is present
using set of uncorrelated variables.
3. Investigating the structure of measurements
used to describe form.
4. Identifying the components of size and
shape.
Four commonly used methods for dealing with
form difference between groups are:

1. Discriminant functions.
2. Mahalanobis D
2
statistic.
3. Canonical variate analysis.
4. Cluster analysis.
Discriminant functions
This assist in placement of unknown
specimens in to known groups.

This is done by increasing the discrimination
between groups based on a set of commonly
held measurements.
Discrimination is achieved by finding a
transformation in form which maximizes
between group differences while minimizing
within group variation.

Group identity and membership within the
group must be known in advance otherwise
cluster analysis is indicated.
The discriminants were computed to
maximize the between group variance
relative to the within group variance.

The discriminant function for the specimen is
the sum of all linear distance of how far apart,
each multiplied by a weighing co-efficient.

Each discriminant function score is
orthogonal with respect to all others.
Mahalanobis D
2
statistic
The distance between groups is measure
and squared .

This squared distance between groups is
termed the generalized distance or D
2

statistic of Mahalanobis".

It describes the relatedness or similarity
between forms based on multiple
uncorrelated measurements.
Canonical variate analysis
The form of an subject to be assessed is
taken, rotated through an axis so that within
group variation is minimized.

The image is rescaled, transformed and
deformed until within group variation is made
circular.

The image or the form is rotated again
through an axis this time such that between
group variations is maximized.

Both the rotated & rescaled axis is called the
Canonical Axis for that image.

These axes are orthogonal to each other.
They are in fact the representation for the
image or the group.

Cluster analysis
This method deals with the identification of
group structures.

That is given a collection of objects are there
recognizable subgroups?

More than one clustering method has to be
used to get a reliable result.
There are two methods to find the difference
within groups:

1. Factor analysis.
2. Principal component analysis. (PCA).
Both of these deals with differences and
interrelationships within the variables
themselves.

These give an idea about the structure of the
underlying variables and how they vary with
each other.

Identify which of those uncorrelated variables
are in turn the primary determinants of form
and reduce the statistical load.
Procrustes superimposition
It is a variant of the landmark based
morphometric method, and a superimposition
method.

Procrustes a robber in Greek mythology,
belived his iron bed to be unique and as a
standard of length.

His victims if small were stretched, those taller
were chopped off their legs to fit the size of the
bed.
His one size fits all concept was utilized in
the superimposition method.

Each form is represented by a series of
landmark co-ordinates forming a figure
known as configuration.

Each configuration is scaled first to the same
size.
The Procrustes superimposition algorithms
translate the configurations to superimpose
the centroids and rotate the configurations to
minimize the differences.

This is essentially the position of best-fit.
After the superimposition, the mean
configuration called the consensus is
computed.

For each land mark the Procrustes residual
is calculated as the diff between the location
of landmarks in each form, and its position in
the consensus.

These can be plotted to display the shape
variance.

Procrustes superimposition has been used
for evaluation of normal and syndromic
craniofacial growth.
Co-ordinate morphometrics
Based solely on the data points composed of
2D or 3D co-ordinates, usually in the
Cartesian system.

It ignores the boundary of the form.

Most of these are based on DArcy
Thompsons Transformation grids.
This includes the following methods:

1. Conventional Metric Approach (CMA)
including the Conventional Ceph Analysis.
2. Biorthogonal Grids (BOG).
3. Finite Element Method (FEM).
4. Thin Plate Spline Analysis (TPS).
5. Euclidean Distance Matrix Analysis
(EDMA).
Conventional Metric Approach
Based on distances, angles and ratios.

Homologus points should be taken for
plotting.

CMA and its CCA both are incomplete
mapping, not describing the shape or shape
changes.
Biorthogonal grids
The BOG is developed by Bookstein.
This also uses the homologus point
representation.

The foundation of the BOG method is
comparison between two 2D forms.

One form is designated as the base form and
the other as one which reflects the shape
changes from the base form.
The shape changes are viewed as
deformations from the basic form.

The base form is constructed with landmarks
of our interest, whose shape change we are
going to study.

The base form is usually a triangle, though
any polygon can be used.
The triangle is constructed and a circle is
drawn inside the triangle touching the
boundary.

Once this triangle transforms in to another
triangle, the circle gets transformed in to an
ellipse.
Base triangle Deformed triangle
The major and minor axes of the ellipse and
the corresponding diameters of the circle are
the representations of shape changes.

They represent the principal dilatations or
estimates of maximum stretch or shrinkage
due to the deformation.
The cross denoting the centre of the ellipse
with its major and minor axes represents a
tensor for that shape change.

The ratio of major axis to minor axis is
considered as the estimator of shape change.
The BOG is used by Bookstein for studying
shape changes in craniofacial anomalies.
When BOG is used for biological subjects it
is called Tensor Biometrics.

The disadvantage is that it measures shape
change rather than the shape as such.
Like CMA it cannot represent curves.
Finite Elements Method
This is similar to BOG if not identical.

It is also based on homologus landmarks and
is invariant with respect to the co-ordinate
system.

Very similar to BOG, but that many triangles
(Finite Elements) are constructed.
The average shape change of all the
triangles is computed for the shape change
for the whole form.

The principal dilatations in BOG are called as
strain measures here.

The triangles are the basic forms used in 2D
FEM.
The triangles are replaced by hexahedrons in
3D FEM.

Each cube is represented by 8 homologus
points in the Cartesian system.

The cubes are non-homogenous unlike
triangles and hence represent spatially
varying tensor fields.
FEM on Face FEM on Tooth
FEM based Ceph analysis
Discretization of the
craniofacial
complex in to finite
elements based on
the normal
biometric
landmarks.

FEM depicting
size and
shape changes
using colour
coding for
easy
comprehension
Thin Plate Spline Analysis
TPS analyze shape change using theory of
surface spline interpolations.

The TPS function colloquially known as
bending energy is visualized as an infinetely
thin metal sheet draped over a set of
landmarks, extending infinitely in all
directions.
The configurations of two forms are matched
exactly to minimize the bending energy.

If two forms are identical bending energy is
zero.

The magnitude and location of bending
energy can be identified depending upon the
size and position of the deformation of the
plate.
The thin plate
where shape
changes, i.e,
bending energy is
depicted by the
colour gradient.
In affine transformations the parallel lines in
the plate remain parallel.

The bending energy of the affine
transformation is zero and only the tilting of
the plate may occur.

In non-affine transformations the there will be
local deformations, these are represented as
partial warps.
Shape changes can be statistically analyzed
using multivariate statistical techniques, based
on partial warp scores.

TPS has been applied to three dimensions for
studying changes in cranial base.
Euclidean distance matrix analysis
This was developed by Lele at the John
Hopkins.

Utilizes 3D Cartesian co-ordinates of the
homologus points to identify local areas of
shape change.

Initially a mean form from distances of all
possible landmarks is computed.

These distances are the EDM
representations which is averaged to yield a
mean matrix for the sample.

Calculation of a distance difference matrix
using ratio of similarity between forms on pair
wise distances is calculated.
This distance difference matrix is then sorted
to identify the areas of maximum and
minimum change.

These EDMA does not distinguish between
size and shape individually.

The results obtained are similar to FEM.
Boundary morphometrics
These techniques takes boundary outlines,
and not points.

Very useful in assessing shape where
landmarks are scarce.

Indispensable if boundary outline is the
primary area of interest.
The advantages of boundary outline methods
are that:

Recreation of the boundary precisely is
possible.

It is an information preserving method.

A combination of boundary outline form can
incorporate homologus points also.
There are six boundary outline methods:

1. Median Axis Function.
2. Fourier Descriptors.
3. Eigen Shape Analysis.
4. Fourier Transforms.
5. Wavelets.
Median Axis Function
It is also called as symmetric axis or line
skeleton.

MAF is defined as the locus of points which
lie in the interior of the form, exactly
equidistant from the border of the outline.
It is a method of collapsing of a 2D outline in
to a curve or a line.

Consists of embedding a series of
overlapping circles or discs that touch the
outline such that they are tangential to the
borders of the outline.

The centers of those circles now define those
two points and when we join the centers we
get a stick figure.
Stick figure of a mandible
using MAA
The circle usually touches two points in the
periphery.
If it touches three points it encloses a
bifurcation.

The circles contains two variants
(determinants) :
The structure of the median axis (stick
figure).
Radius of the circle i.e, width of MAF at the
tangent points.
Circles are used in a 2D structure, where as
it can converted to spheres and used in 3D
measurements.

MAF is not unique, it is possible for classes
of similar shapes to have an identical medial
axis.

The radius function must be computed
regularly to have an individual representation.
Conventional Fourier Descriptors
The approach of Fourier analysis can be
viewed as a transformation of data from one
domain to another.

In biology it refers to the transformation from
spatial domain to the frequency domain.
This is also termed as decomposition of the
spatial configuration (Boundary) in to
frequency components (amplitude & phase
relationships).

This procedure of decomposition is called
Fourier analysis or Harmonic analysis.

The inverse process of recreation of an image
from data is called Harmonic synthesis.
Two types of FD approaches have been
widely used, both convert the data to polar co-
ordinates prior to analysis.

One is based on measurements from a center
within the form, preferably a centroid.

The other uses angular functions based on
points located on the outline.
How many harmonics are needed to achieve
a satisfactory fit of the FD as an expected
function to the boundary outline (observed
form).

The residual of fit is calculated and is used
for comparison between FDs.

Elliptical Fourier Functions have now
superseded the conventional FDs.
Eigen Shape Analysis
The use of ESA facilitates the reduction of
the morphological shape space to a
comparatively few dimensions that contain
most of the differences in shape.

So it is claimed to have reduced the
minimum number of factors necessary for
recognizing subtle shape differences.
This utilizes Fourier functions using tangent
functions.

So basically uses angular measurements
when compared to Conventional FDs which
utilizes the sine and the cos data.

There is no need for centroid, and is
basically a single valued function.
Elliptical Fourier Functions
EFF is also a type of pattern recognition.

The EFF technique was developed originally
for military aircraft identification and like
conventional Fourier functions is a curve-
fitting procedure.

The basic principle involves embedding a set
of closely spaced observed measurements
on an objects boundary into a mathematical
function.

EFF is a parametric solution to shape
description, deriving a pair of equations as
functions of a third variable
The first harmonic represents an ellipse, with
higher harmonics detecting increasingly
localized shape differences.

The accuracy of the procedure can be
determined by calculating a residual value-
the difference between the observed data &
the predicted values derived from the EFF.
EFF is very loyal in representing the shape
and shape differences.

It is one of the most commonly used
boundary representation method.

Though currently it is used only for the 2D
data, it has been developed for use in 3 d
forms also.
Fourier Transformations
These are the recent developments of the
Conventional Fourier descriptions.

There are 2 types of Fourier transformations
1. Discrete Fourier transform (DFT).
2. Continuous Fourier transform
(CFT).
FTs are bit complicated in their calculations,
but software has developed to compute them
automatically.

They have the ability to reproduce even
minor details of shape changes.

To reduce the computer computation times,
newer tech like Fast Fourier Transform (FFT)
& Short Time Fourier transform (STFT) are
developed.
Wavelets
These are similar to the FTs.

Unlike the FTs which are continuous
representations over the period - to +,
wavelets are limited duration.

Similarly they are of two types
1. Continuous wavelet transform (CWT).
2. Discrete wavelet transform (DWT).
Though both FTs and the wavelets are the
currently developed geometric morphometric
methods which are highly versatile, their
regular use in biologic morphometrics is yet
to be realized.

Both can represent many functions and
characteristics of the object, rather than like
the primitive methods.
Structural Morphometrics
These are techniques that numerically
describe the characterizing of the surface or
the internal structure of the form.

Structure is also that, which is inside the
boundary outline.

It can be both internal or external structure of
the object.

It can be either surface texture or roughness,
or the internal structures like the bony
trabaculae, or the chemical structures the
crystal lattices.

There are three approaches:

1. Fourier Transforms.
2. Wavelets.
3. Optical Data analysis/ Coherent
Optical Processing.

They are also yet to influence the field of
biologic morphometrics.
Recent Advances
Change is the only thing that does not
change.

Yes there are many recent advances in the
field of Orthodontics and especially in the
area of Craniofacial Imaging.

Few of them have really a great potential to
be developed especially for Craniofacial
imaging.
Digital Imaging
The interest in digital imaging has resulted
due to a number of different reasons.

In terms of necessity, utilization of digital
imaging provides the ability for the computer
to manipulate data to allow complex
introduced techniques may reduce patient
radiation exposure.
The elimination of hard-copy X-ray film may
decrease storage needs and enable
teleradiology, or the transmittance, of images
over the phone and internet.

The digital process is a collection of
information of binary form, resulting in the
construction of a computerized image.
In most types of digital radiography,
electromagnetic energy (X-radiations) is
converted to an electrical charge by an X-ray
sensor.

These sensors include charge-coupled
devices (CCDs), amorphous silicon and
amorphous selenium chips are arranged in
an array when used in large X-ray
applications.
Another method of converting the X-ray into
an electrical charge for digital use is the
storage based phosphor plate.

These plates are thin, wireless, flexible
plates similar to intensifying screens.

The re-usable phosphor plates store the
energy from X-ray beam, and are then read
by a laser scanner which detects the intensity
& location of the stored energy.
Once the X-ray energy has converted to an
electrical charge, a computer with a frame-
grabber circuit board (digitizer) sample the
photosensor value (voltage) and converts
(digitizer) them into a picture element array
(pixels).

Since the information is in digital form, it can
be integrated together with other digital
information such as intraoral & extraoral
photographs & tomographs to form
composite profile.
Teleradiology
Early 1982 marked the initial meeting of the
First International Conference and Workshop
on Picture Archiving and Communications
Systems (PACS) for Medical Applications.

This electronic transport of the images will
continue to meet challenges as new
technology surface
3D CT
The CT images can be manipulated to
undergo a three-dimensional reconstruction
of the image.

The final image can be fed through a
computer aided design system and either
viewed on a computer screen or processed
into plastic via milling machines or laser
stereolithography.
The technique is sophisticated enough to be
able to extract an element out of the image,
such as the mandible, and view it in isolation
from other structures.
Microcomputed Tomography
MicroCT is principally the same as CT except
that the reconstructed cross sections are
confined to a much smaller area.

The future of microCT lies in being able to
sample data over a much smaller volume
than full body volume, thereby significantly
reducing the radiation exposure to the
patient.
This technique can now measure bone
connectivity in all three dimensions and even
record anisotropy, both of which are not
possible even with histology.

This method has been used clinically to
evaluate osteoblastic/osteoclastic alveolar
remodeling as well as bone dehiscences and
root resorption.
Tuned-aperture Computer
Tomography
TACT system is able to convert multiple two-
dimensional images created from multiple
arbitrary projection source positions into a
three-dimensional image.

The future of TACT will lie in its ability to
assist in the evaluation of alveolar bone &
detection of root resorption.
MR Spectroscopy
MRI works by obtaining a resonance signal
from the hydrogen nucleus, and therefore is
essentially an imaging of water in the tissue.

MR spectroscopy works in a similar manner,
but allows the imaging of any molecule or
compound in the tissue.
MR spectroscopy is useful for the study of
skeletal muscle physiology.

This approach has been applied for the study
of phosphate metabolism in muscles of
children with bruxism.

They have applications to a better
understanding of changes in muscle
functions.
Structured Light
Structured light scanning enables the
topology of the face to be digitized simply,
and without ionizing radiation.

The result is a three-dimensional shell of
the patients face, viewable on a computer
monitor.
The eventual goal of this technique is to
merge the facial shell and underlying X-ray
data from other sources to complete the 3D
structure for diagnosis, treatment planning
and assessment.

3D facial analyses are now a possibility, and
3D superimposition revealing treatment effect
& outcome will soon be a reality.
Cone Beam Computerized
Tomography
It is a type of CT that is more or less similar
to the DPT in function.

This has tremendous potential to be used in
orthodontics, and is expected to replace all
other imaging modalities in the near future.
In contrast to the CT it uses a low energy
fixed anode tube with a cone shaped X-ray
beam.

The image sensors used are solid state
image sensor or an amorphous silicon plate.

CBCT uses 1 rotation sweep of the patient
similar to the DPT. Image data can be
collected for a complete maxillofacial volume
or limited areas.

The accuracy is very high coz the projection
is orthogonal and the rays are parallel with
each other. The object is also very near to
the sensor producing a 1 to 1 measurements.
Picture of a CBCT image
Discussion
What is an ideal imaging?

The underlying principle of ideal imaging is the
determination of anatomic truth in terms of
accurate portrayal of spatial orientation, size,
form, and relationship of desired structures of
features.
The ideal imaging modality is the one
which maximizes the desired
information and minimizes the
physiological risk and economical
cost to the patient.
c
o
n
c
l
u
s
i
o
n
Despite the inherent distortion &
differential magnification, in comparison
with newer imaging techniques, the
cephalogram produces a high diagnostic
yield at a low physiological cost, the
ideal with the techniques available now.

The newer techniques has to be simplified
for the practicing orthodontist to emerge as
an alternative to cephalmetrics.

For the every day clinician cephalogram will
continue to be the imaging tool, where newer
methods are useful for research and study of
ethnographical data.

Thank You
References
Morphometrics for the life sciences ----- lestrel.
AJO_DO OCT 1983 3D Ceph.
OCT 1988 3D Ceph.
MAY 2004 morphometrics.
SEPT 2004 3D imaging.
DEC 1981 Photogrammetry.
AO 1999 NO 6 review of imaging.
1994 NO 5 FEM based Ceph Analysis.
EJO 2003 25 size and shape
measurements.

Thank you

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