[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.

197]

Original Article Identification of pulpitis at dental X‑ray periapical

radiography based on edge detection, texture
description and artificial neural networks

Bernard Y. Tumbelaka, Fahmi Oscandar1, Faisal Nur Baihaki, Suhardjo Sitam1,

Mandojo Rukmo2
Departments of Physics, Faculty of Mathematics and Natural Sciences, 1Radiology Dentistry, Faculty of
Dentistry, University of Padjadjaran, Jatinangor, 2Conservative Dentistry, Faculty of Dentistry, University of
Airlangga, Surabaya, Indonesia

Key words:
Artificial neural networks, dental X-ray,
edge detection, image entropy, mean
square error, periapical radiography,
pulpitis, texture description
Address for correspondence:
Prof. Bernard Y. Tumbelaka,
Faculty of Mathematics and Natural
Sciences, University of Padjadjaran,
Jatinangor, Indonesia.
E‑mail: btumbelaka@ymail.co
ABSTRACT
Objectives: The aim of the present research was to identify pulpitis
through periapical radiography by applying edges as basis image
features, the texture description and the artificial neural networks (ANNs).
Materials and Methods: Input image data records of 10 molar and 10 canine
teeth were used. The clinical diagnosis of interest cases were represented
as normal pulp, reversible and irreversible pulpitis, and necrotic pulp. The
following image processing steps were done. First, the data records were
converted digitally and preprocessed as its original image using the Gaussian
Filter to obtain the best smoothed intensity distribution. Second, the local
image differentiation was used to produce edge detector operators, e(x,y)
as the image gradient; ∇f(x,y) providing useful information about the local
intensity variations. Third, these results were analyzed by using the texture
descriptors to obtain digitally the image entropy, H. The fourth step, all were
characterized by the ANNs. Results: The edge detection carried important
information about the object boundaries of pulpal health and pain conditions
in the dental pulp significantly. The image entropy which was identified, the
diagnostic term, was obtained from texture descriptors in the segmentation
regions where the curves of pulp states tent convergence with the normal pulp
line from 4.9014 to 4.6843 decreasing to the reversible and the irreversible
pulpitis line include the nectrotic pulp line from 4.6812 to 4.5926 and then
inputting to the ANNs analysis at the same of mean square error around
0.0003. Conclusions: Referred to these results, the correlation of the
image entropy and the ANNs analysis could be linearly classified with the
critical point of 4.6827. Finally, it could be concluded that the direct reading
radiography is better to be digitized in order to provide us the best choice
for diagnosis validation.

INTRODUCTION conservative intervention. Currently in Indonesia,

dental decay has often been diagnosed using

I t is a fact that there has been almost no one

to pay attention earlier until the stage in the
decay process is usually too late for preventive and
radiographic techniques.[1] Until now it is impossible
to detect and monitor the stages of dental decay
process of pulpitis by periapical radiography which
Access this article online
has the sensitivity for this type of lesion. Eventually
Quick Response Code: the diseased tissue has been strangling the blood
Website:
vessels of the dental pulp that leads to death. At
www.saudiendodj.com
this point, pulpitis has become the most common
DOI:
cause of toothache followed by death of the pulp
10.4103/1658-5984.138139
and spread of infection through the apical foramina
into the periapical tissues.[2,3] This could be found
Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3 115
[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.197]

Tumbelaka, et al.: Identification of pulpitis at dental X‑ray

among all ages especially younger people due to several
unhygienic factors like smoke, hormonal disturbance in
woman, diabetes, stress, cancer, AIDS, genetic factors,
insufficiently nutrients, and drugs.[4]
An attempt to find a new method in radiography that
could identify this inflammation of tooth pulp in soft
tissue is worth to try it. The pulp is the inner part of
the tooth that consists of blood vessels, nerve endings,
and connective tissues. The primary objective of pulp
therapy is to maintain the integrity and health of the
teeth and their supporting tissues. The indications are
based on the clinical diagnosis of normal pulp, reversible
pulpitis (pulp is capable of healing), symptomatic or
asymptomatic irreversible pulpitis (vital inflamed pulp is
incapable of healing) and nectrotic pulp or pulpless (pulp
do not respond to vitality test).[5‑8] It might be interesting
to try to find these indications that could be obtained
from radiographic evidence of periapical radiolucency
to diagnose pulpitis. It was impossible to achieve an
accurate diagnosis of the state of the pulp on the basis
of clinical proof alone. The only accurate method is to
do a histological examination.[9] Therefore, numerous
classifications of pulp disease had only identified by a
limited number of clinical diagnostic tests before effective
dental treatment is performed. Therefore, our research
interest was aimed to identify pulpitis in the regions of
interest through periapical radiography by applying edges
as basis image features, the texture description and the
artificial neural networks (ANNs).
MATERIALS AND METHODS
separate the pulpitis. It could be also separated the
infected line in two regions of interest as the reversible
pulpitis and the irreversible pulpitis. The process used
weight input generated that was always trained until
reached the result of learning appropriate data same as
identified. For the first training as compared variables
let amount of database. Furthermore, these selected
number of database input   would be very influence the
analysis results because the identification error would
be able corrected if only if the weight input database
were more added.
Experimental setup
These research works were arranged for the
preprocessing and processing of the original image to
obtain the best intensity distribution using Gaussian filter
and to identify the tooth in the next step by the edge
detection as the basic image features of the disinfected
and infected tooth regions of image segmentation
separately to find the deterministic processing [Figure  1].
When the non‑deterministic cases were obtained, it was
needed to apply the ANNS analysis.
Gaussian filter
It was needed to apply a very commonly used filter,
which smoothly, reduces noise and gets small details.
Equation[1] of a Gaussian function in two dimensions
was the product of two of one‑dimensional Gaussians,
one in each dimension, Gσ(x, y) as follows:
1 −X 2 + Y 2
Gσ(X, Y) = exp [1]
2 πσ 2 2σ 2

Input image data of 10 molar and 10 canine teeth of

periapical radiography of X‑ray were used. The clinical
diagnosis of interested cases was separated into four
tooth conditions of pulpal diagnose states: normal
pulp, reversible and irreversible pulpitis and necrotic
pulp. The following image processing steps were
done: The first step, the data records were converted
digitally and preprocessed as its original image using
the Gaussian filter [10,11] to obtain the best smoothed
intensity distribution. The second step, the local image
differentiation technique was used that can produce
edge detector operators, e(x,y) as the image gradient;
∇f(x, y) providing useful information about the local
intensity variations. The third step, these results were
analyzed by using the texture descriptors based on
mean and variance analysis that could be used in order
Figure 1: Preprocessing and processing of the original image using
to obtain digitally the image entropy, H.[12‑14] The fourth Gaussian filter and the edge detection as the basic image features
step, all was characterized by the ANNs. [15] We can of the disinfected and infected tooth regions of image segmentation

116 Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3

[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.197]
Tumbelaka, et al.: Identification of pulpitis at dental X‑ray
where: x is the distance from the origin in the horizontal
axis, y is the distance from the origin in the vertical axis,
σ is the standard deviation of the Gaussian distribution.
It was also needed to use the discrete convolution of
equation [2] as follows:
f ∗ g = ∑ f i g x − i [2]
i
where: f is the image function, g is the Gaussian
function
When it was applied to the edge detection, it might
be a derivative of a noisy signal that could cause
more noise. Therefore, it was needed to apply the
Gaussian filter before taking a smoothed derivative. The
differentiation and convolution of equation [3] both
linear operators where they commuted together as
d df dg
(f ∗ g ) = ∗ g = f ∗ [3]
dx dx dx
Edge detection
Image edges were the form of local variations of image
intensity that can produce local image differentiation
techniques defined as edge detector operators, the image
gradient, ∇f(x,y) could be written as equation [4]:
∇f(x,y) = [fx fy] T, [4]
where: f x = ∂f/∂x and f y = ∂f/∂xy are the gradient
operators, T is the matrix transpose
This gave useful information about local intensity
variations. The edge detector, e(x,y) was obtained
as the magnitude of f (x, y) that can be written as
equation [5]:
e(X, Y) = fx 2 ( X 1Y ) + fy 2 ( X 1Y ) [5]
The sum of the absolute values of partial derivatives fx,
fy could be employed simply as equation [6]:
e (x, y) = |fx(x, y)| + |fy(x, y)| [6]
The local intensity direction could be described by the
direction angle of the phase of f(x,y) as follows in
equation [7]:
φ(x, y) = arctan (fx, fy) [7]
Texture descriptor analysis was based on the edge
detection features related to the image entropy.
Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3
Texture descriptors
Mostly, an image characteristic depend on its texture
used in the region segmentation. There were several
important simple texture descriptors such as the image
histogram pf  (fk), the arithmetic mean, µ in equation [8]
and the variance of the standard deviation square, σ2 in
equation [9] and the image entropy, H in equation [10]
as a scalar value representing the entropy of gray scale
image, fk having B pixels are given by:
Mean : µ = ∑Bfkpf(fk) [8]
k =1
Variance : σ2 = ∑ B (fk − µ ) pf (fk )
2
[9]
k =1
Image Entropy: H ( B )=− ∑ B pf (fk ) ln pf (fk ) [10]
k =1
where: pf(fk) – the image histogram, fk  – is the various
image intensity levels, 0  ≤  f   ≤  2 B, k – is the pixel
location, k = 1, 2,…., B, B – gray scale unit, 2 bits, 4
bits,….
Usually, entropy was a statistical measure of
randomness that can be used to characterize the texture
of the input image histogram. The image histogram was
calculated within an image region, f.
The relation between the average codeword length, L(f),
and the image entropy was very close that could be
written as equation [11]:
H  (B) ≤ L(f) ≤ H(B) +1 [11]
Entropy of the gray scale image contained of thousand
bits of information, representation of intensity. Entropy
converted any class other than logical to unit 8 for the
histogram count calculation so that the pixel values
were discrete and directly correspond to a bin value.
Using these texture descriptors, it was deterministic
analysis  that could refuse several descriptor cause
the reversible and the irreversible problems both the
disinfected and the infected tooth regions. Therefore,
it was needed to use the ANNs analysis to be the
non‑deterministic (random) analysis.
Artificial neural networks
Pulpitis identification was done through ANNs
analysis, where accuracy was the percentage of
number of true classified compared to all final
result classified using mean square error  (MSE)
defined as follows in equation [12]:
117
[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.197]

Tumbelaka, et al.: Identification of pulpitis at dental X‑ray

1 pulp, reversible and irreversible pulpitis, and necrotic

MSE =  ∑( Ti − O i )2 [12] pulp. There could be several results described as follow.
N i =1
where: N  − number of database, i  =  1,2,3., N, First, the edge detection carried important information
T  −  final data output, O -  true data output. about the object boundaries as normal pulp, reversible
and irreversible pulpitis, and necrotic pulp significantly
RESULTS which could be valuable for the pulp interpretation as
shown in Figures 2a and b.
Results are summarized in Table 1 and Figures 2‑6.
Ten tooth radiographs were used according to the ROI Second, as shown in Figures 3 and 4 and  Table 1,
(region of interest) of 10 cropped samples for normal first by using mean analysis was obtained directly
for normal pulp of region 1 (171.3669) to region
Table 1: The relationship between variance and
8 (171.5720), and normal pulp to pulptis line separated
mean regions for normal pulp, reversible and by reversible of region 8 to region 12 (186.7028),
irreversible pulpitis, necrotic pulp regions irreversible of region 12 to region 17 (185.5005).
Normal Pulpitis Dead Second, variance analysis was also used for normal
tooth tooth pulp of region 1 (62.9592) to region 8 (54.8623), and
Normal Reversible Reversible Irreversible Necrotic normal pulp to pulpitis line separated by reversible
pulp pulp
1 to 8 8 to 11 11 to 12 12 to 17 18 to 20
of region 8 to 12 (55.2579), irreversible of region
Variance 62.9592 54.8623 to 55.2579 to 46.5700 12 to 17 (46.5700). In Figure 5, by using image
to 55.2579 46.5700 to entropy obtained from texture descriptors by mean and
54.8623 38.4427 variance analysis[15] as deterministic and random curve.
Mean 171.3669 171.572 to 186.7028 to 185.5005
to 186.7028 185.5005 to
The curves of normal pulp and pulpitis regions were
171.572 183.4223 figured convergence with normal pulp line from 4.9014
Image 4.9014 to 4.6812 to to 4.6843 decreased to pulpitis line from 4.6812 to
Entropi 4.6843 4.5926
4.5926 with MSE around 0.0003, as shown in Figure 6.

b
Figure 2: Original Images, Gaussian filter images, cropping and edge detection at normal pulp (a) reversible and irreversible pulpitis (b) tooth
regions of image segmentations

118 Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3

[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.197]
Tumbelaka, et al.: Identification of pulpitis at dental X‑ray
9DULDQFH







                   
Figure 3: Curves of variance and mean analysis for normal pulp, reversible, irreversible, necrotic
Figure 4: Correlation between ROI of f and ROI of disinfected and
infected by pulpitis based mean and variance
The results could be inputting and expanding our
observation figured convergence at the normal pulp
and pulpitis regions with normal pulp line decreased
to pulpitis line with the critical point by the texture
description and the ANNs analysis at the same of
MSE around 0.0003. Figure 6 gave the nonlinearity
of the MSE cur ve representing the accuracy of
final output over the true output during the training.
Pulpitis identification was done through ANN analysis,
where accuracy was the percentage of number of
true classified compared to all final result classified.
For observation that resulted with the reaching true
accuracy below 80% gave the identification still wrong.
Therefore, it was needed to increase the level of true
accuracy into limit of 95% that means to have to reach
the MSE equal to 0.0003.
The current research had owned the advantage
diagnosis to obtain the regions of interest more
precisely. We could separate the normal pulp line into
two regions of interest as the pure normal pulp (4.9577
to 4.8442) and the impure pulp called the regular
pulpitis (4.8442 to 4.6827). We could also separate
the pulpitis line into two regions of interest as the
Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3
0HDQ





                   
Figure 5: Curve of image entropy of normal pulp, reversible and
irreversible pulpitis, and necrotic pulp
reversible pulpitis (4.6827 to 4.6565) and the irreversible
pulpitis (4.6565 to 4.3973).
DISCUSSION
Even though the periapical radiographic film was of
high quality, there might be more important information
that could not be directly detected in regard to the pulp
disease states. The present research involved to reduce
the diagnosis suspect and to gain accurate diagnosis that
could be used to increase the probability of a successful
clinical outcome. The biological states of the pulpal
tissues had a tendency to give correlating symptom
and radiographic diagnosis. Digital image analysis
as part of image technology has been enormously
developed in dentistry that aimed to interpret periapical
radiograph.[16,17] In endodontics, the quality of the image
is very important as it facilitates accurate interpretation
of the morphology of the root and the root canal
space before establishing the treatment and the during
the treatment as well as postoperative and long‑term
evaluation of the outcome of endodontic treatment.[18‑21]
119
[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.197]
Tumbelaka, et al.: Identification of pulpitis at dental X‑ray
Figure 6: Diagnose the best training performance in 32 × 32 iterated at
epoch 7 of data testing simulation using by ANNs analysis
The principles for diagnosis of the condition of the
dental pulp are no different from those applied to the
management of other disease conditions. One of the
essential methods is radiographic examination which is
an important complement to the clinical examination. It
provides information about the presence and severity of
caries, deep restorations in relation to the dental pulp as
well as root fractures and periapical changes.
Our research started with the dental image quality
problem that was usually degraded because of its
mechanical, optical and electronic noises from its
medical tools were utilized. A  Gaussian filter smoothes
an image by calculating weighted averages in a filter
box. [22] Therefore, we had to perfor m the image
pre‑processing using a Gaussian filter approximated to
its original image as the best intensity distribution that
analyzes its image identification and feature parameters
linked with the features on object represented in
the image. The image features of edge detection
represented and correlated with means and variances
identifying the state of normal pulp, pulpitis and
necrotic pulp as a deter ministic solution. These
indicated ambiguous results. A nondeteministic solution
was needed using the texture description of the grey
level image analysis statistically by the image entropy.
The probability results were represented by the image
entropy, H(B). It has owned the advantage diagnosis
to obtain the regions of interest (ROI) using image
entropy H(B) more precisely than diagnoses radiography
film directly even though compared with the EPT
standard.[23,24] It could expand our observation at the
curves of normal pulp, reversible and irreversible
pulpitis, necrotic pulp state regions figured convergence
with normal pulp state line decreases to pulpitis line
120
with the critical point by the texture description and
the ANNs analysis. It might be interesting to develop
a learning process from number of database changed
for user’s needs with high flexibility and standardization.
Although there were always some exceptions, the
different symptoms usually detect that a patient presents
with the pulpal diseases. Image entropy could be
expanded to multivariate function where the pulp pain in
higher sensitivity degenerated to the state of dead pulpal
tissue. This will be our new and future research goal.
CONCLUSIONS
The correlation of the image entropy and the ANNs
analysis could be linearly classified with the critical point
of 4.6827. Finally, it could be concluded that the direct
reading radiography is better to be digitized in order to
provide us the best choice for diagnosis validation.
ACKNOWLEDGMENTS
We acknowledge the great collaboration between Faculty of
Dentistry and Faculty of Mathematics and Natural Sciences
of University of Padjadjaran and Faculty of Dentistry,
University of Airlangga, Indonesia.
REFERENCES
1. Mulyani D, McIntyre J. Caries inhibitory effect of fluoridated
sugar in a trial in Indonesia. Aust Dent J 2002;47:314‑20.
2. Gutmann JL, Baumgartner JC, Gluskin AH, Hartwell GR,
Walton RE. Identify and define all diagnostic terms for
Periapical/Periradicular health and disease states. J Endod
2009;35:1658‑74.
3. Dos Santos Guimarães C, Sampaio GC, Barros de Almeida E,
Silva LB, Mourato AP, Alves DF. Influence of Apical Foramen
Cleaning on Periapical Lesion Repair. Rev Fac Odontol Porto
Alegre 2011;52:45‑7.
4. Mayo Clinic, Oral health: A window to your overall health,
Mayo Foundation for Medical Education and Research. Available
from: http://www.mayoclinic.org/dental/[Last accessed on
2013 May 11].
5. Abbott P, Yu C. A clinical classification of the status of
the pulp and the root canal system. Aust Dent J
2007;52 1 Suppl:S17‑31.
6. Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify
and Define All Diagnostic Terms for Pulpal Health and Disease
States. J Endod 2009;35:1645‑57.
7. Newton CW, Hoen MM, Goodis HE, Johnson BR,
McClanahan SB. Identify and determine the metrics, hierarchy,
and predictive value of all the parameters and/or methods used
during endodontic diagnosis. J Endod 2009;35:1635‑44.
8. Endodontics: Colleagues for Excellence Newsletter. Endodontic
Diagnosis. Ame Assoc Endod. Available from: http//:www.aae.
org/colleagues [Last accessed in 2013].
9. Seltzer S, Bender IB, Ziont ZM. The dynamics of pulp
inflammation: Correlations between diagnostic data and actual
Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3
[Downloaded free from http://www.saudiendodj.com on Monday, September 30, 2019, IP: 182.0.231.197]

Tumbelaka, et al.: Identification of pulpitis at dental X‑ray

histological findings in the pulp. Oral Surg Oral Med Oral
Pathol 1963;16:969‑77.
10. Mathematica, Gaussian Filter function. Available from: http://
www.reference.wolfram.com/mathematica/ref/GaussianFilter.
htm. [Last accessed on 2012].
11. Fisher R, Perkins S, Walker A, Wolfart E. Spatial Filters:
Laplacian of Gaussian. Available from: http://www.homepages.
inf.ed.ac.uk/rbf/HIPR2/log.htm [Last accessed on 2003].
12. Conners RW, Harlow CA. A Theoretical comparison of texture
algorithms. IEEE Trans Pattern Anal Mach Intell 1980;2:204‑22.
13. Pitas I. Digital image processing algorithms. United States:
Prentice-Hall, Inc. Upper Saddle River, NJ, USA. 1993
14. Gonzalez RC, Woods RE, Eddins SL. Digital image processing
using Matlab, NJ. Chap 11. United States: Prentice Hall; 2003.
15. Matlab products. Available from: http://www.mathworks.com/
matlabcentral/fileexchange/26694‑gray‑level‑run‑length‑matrix/
content/GLRLM.[Last accessed on 2012 Dec 12].
16. Nair MK, Nair UP. Digital and Advanced Imaging in
Endodontics: A Review. J Endod 2007;33:1‑6.
17. Abella F, Patel S, Duran‑Sindreu F, Mercadé M, Bueno R,
Roig M. An evaluation of the periapical status of teeth with
necrotic pulps using periapical radiography and cone‑beam
computed tomography. Int Endod J 2014;47:387-96.
18. Nance R, Tyndall D, Levin LG, Trope M. Identification of root
canals in molars by tuned‑aperture computed tomography. Int
Endod J 2000;33:392‑6.
19. Lozano A, Forner L, Llena C. In vitro comparison of root‑canal
measurements with conventional and digital radiology. Int Endod
J 2002;35:542‑50.
20. Jung M, Lommel D, Klimek J. The imaging of root canal
obturation using micro‑CT. Int Endod J 2005;38:617‑26.
21. Yoshioka T, Kobayashi C, Suda H, Sasaki T. An observation of
the healing process of periapical lesions by digital subtraction
radiography. J Endod 2002;28:589‑91.
22. Liu Ce, Szeliski R, Kang SB, Zitnick CL, Freeman WT.
Automatic Estimation and Removal of Noise from
a Single Image. IEEE Trans Pattern Anal Mach Intell
2008;30:299‑314.
23. McClanahan SB, Johnson JD, Blundell RE Jr. Pulpal and
periradicular diagnostic terminology, Naval Postgrad Dental
School National Naval Dental Center, Bethesda, Maryland,
Clinical Update, Vol. 24, No. 1 January 2002.
24. American Academy of Pediatric Dentistry (AAPD), Guideline
on Pulp Therapy for Primary and Immature Permanent Teeth,
Reference Manual, IV 34, No 6, 12/13, 2009. p. 222‑9.
How to cite this article: Tumbelaka BY, Oscandar F, Baihaki FN,
Sitam S, Rukmo M. Identification of pulpitis at dental X-ray periapical
radiography based on edge detection, texture description and artificial
neural networks. Saudi Endod J 2014;4:115-21.
Source of Support: Nil. Conflict of Interest: None declared.

Announcement
Android App
A free application to browse and search the journal’s content is now available for Android based
mobiles and devices. The application provides “Table of Contents” of the latest issues, which
are stored on the device for future offline browsing. Internet connection is required to access the
back issues and search facility. The application is compatible with all the versions of Android. The
application can be downloaded from https://market.android.com/details?id=comm.app.medknow.
For suggestions and comments do write back to us.

Saudi Endodontic Journal • Sep-Dec 2014 • Vol 4 • Issue 3 121