Histogram Equalization for class-identification of

Dental Disease Using Digital Radiography

Anjali Naik1, Shubhangi Vinayak Tikhe2, Dr. S. D. Bhide3
Department of Computer Engineering, Cummins College of Engineering for Women, Karve Nagar, Pune, India
1

Department of Computer Engineering, Cummins College of Engineering for Women, Karve Nagar, Pune, India
2
3
Department of Electronics and Telecommunication Engineering, Cummins College of Engineering for Women, Karve Nagar, Pune,
India
1
anjalm@gmail.com , 2svtikhe@rediffmail.com, 3sd_bhide@hotmail.com

Abstract- Digital radiography is the latest advancement in dental given task there is some image processing operation improving
imaging. It is more comfortable in terms of technique and diagnostic efficiency.
interpretation. Dynamic appearance of digital radiograph is The true opportunity offered by digital imaging and
supportive for image analysis and enhancements like image computer-aided diagnosis is development of tools that add value
sharpening, coloring, contrast and density adjustments, depending to manage image data for solving diagnostic problems. It is
on the diagnostic task. The objective of the paper is to study use
histogram equalization to enhance the digital radiographs for important that these soft tools should be simple to use by the
classifying assessment of various problems in dental care. dental surgeon and aid in patient’s education and motivation.
Various commercial soft tools are available to support image
Keywords - Digital radiology, dental care, image processing enhancements in accurate dental diagnosis. It is interesting to
techniques, histogram equalization, image filtering. find why digital radiography is more accepted advancement in
dental field over conventional radiography. Understanding of
I. INTRODUCTION anatomy of the teeth and commonly found dental diseases
Traditionally, dental surgeons and clinicians have been using according to dental clinicians and surgeons help to find
x-ray imaging for identifications of varied dental deformities for diagnostic applicability. The paper gives information about exact
diagnosis and its line of treatment. The x-ray method - despite its place of image enhancements in frequency domain pertaining to
health hazards has been a relatively simple and low cost method. image processing. As enhancements are task specific, major
New alternative to x-ray imaging – a digital radiography has challenge for doctors is to get expertise in the software to make
become already available where dental image is obtained directly decision to select proper enhancement for a disease which will
on computer screen. Dynamic appearance of digital radiograph is give better visual effect. The focus is on study of frequency
supportive for image analysis and enhancements like image response of a two dimensional image signal for routine dental
sharpening, coloring, contrast and density adjustments, diseases.
depending on the diagnostic task. This helps in accurate and
faster diagnosis. Digital image enhancement techniques when
applied to digital radiograph in dentistry provide improvement in
the visual quality of diagnostic images in various branches of
dentistry, like conservative dentistry (endodontic), pediatric
dentistry, periodontics, maxillofacial surgery, etc. Several studies
have shown that various digital image enhancements increase
diagnostic accuracy in the detection and monitoring of lesions [1,
2, 3, 4, 5] and estimation of lesion depth and improve detection of
thin file tips in root canal treatment [6]. Improvement can also be
found in analysis of gum diseases, finding deformity of head-
neck-face, enhancing features of trauma to facial bone, finding
progress in cancer of oral region and deciding treatment
involving dental diseases of children. Image enhancements like
digital contrast enhancement and filtering, modify attributes of an Fig. 1: Tooth anatomy
image to make it more suitable for a given task and to a specific
observer. It is undisputed that diagnostic impact depends on the
task at hand, the quality of source data, and the kind of image
processing applied. However, this does not imply that for any

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Fig. 2: Right half of lower dental arch, seen from above
Fig. 3: Proximal tooth surfaces and spaces
A. Advantages of Direct Digital Radiography Compared with
Conventional Film:
Digital images are dynamic. Their contrast and density can
be varied according to the diagnostic task which is not the case
with conventional film radiography. Their wider dynamic range
(latitude) than that of film, in principle, reduce the number of
retakes. According to dental surgeon, coloring facilities for image
enhancement help in accurate diagnosis. Digital images do not
require wet processing using chemical solutions as needed by
conventional film helping to reduce retakes and also the
environmental problems. Digital radiography reduces human and
processing error as compared to film radiographs, as, majority
times conventional films are processed manually. The cost of
film and chemicals is eliminated. Working time needed right
from image exposure to display is reduced considerably. As
compared to conventional radiography, the direct digital systems
require 50% of the dose needed to create an acceptable image
quality. Further, the x-ray tube will last longer [1]. According to
dental surgeon, the exposure time for normal dental digital
radiograph is 0.4 seconds, while for a conventional film, it is 1.4
seconds. Actually, the harm to patients is much less than a dental
surgeon or personnel working in the clinic. Because patient gets
exposed to doses only once and dental surgeon get exposed to
indirect radiation for multiple times, that is for every patient’s x-
ray. Thus, the biggest advantage of less exposure needed for
digital radiography is more for doctors and personnel working in
the clinic. Digital image data storing and communication is easier
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with digital networking. Storage and maintenance of digital
radiograph, as history of a patient, are better as films may change
color after few years. Films require more physical storage space.
Digital radiograph is useful as a proof in medico-legal matter.
B: Routine Dental Diseases:
Fig. 1 shows the cross section of a tooth and figs. 2 and 3
give naming convention of tooth. Majority of the times patient
goes to a dental surgeon when there is tooth decay (caries), pain
in teeth, gum diseases, traumatic injuries to the teeth and/or the
surrounding regions, or need of routine checkup.
Of all these diseases which affect the teeth and surrounding
areas, caries remains one of the most common diseases
throughout the world. It is the primary pathological cause of
tooth loss in children. Around 29% to 59% of adults over the age
of fifty experience caries. Dental surgeons classify caries in to
five classes according to the surfaces where they are seen [7].
In dental terminology an "impacted" tooth refers to a tooth
that has failed to emerge fully into its expected position. Most
commonly impacted tooth is the wisdom tooth (third molar). The
failure to erupt properly might occur because there may not be
enough room in the person's jaw to accommodate the tooth, or
because the angulations of the tooth are improper. These
impacted teeth may cause damage to the adjacent teeth. Hence
their removal becomes necessary.
Any trauma to jaws can cause fracture of bones and/or teeth.
Normal film radiography allows visualization of the fracture line.
However, the disadvantage of this conventional film is that, it
also shows artifacts, ghost images, and superimposition of
surrounding structure. In contrast to this, digital radiograph
allows visualizing only the area of interest with much better
clarity and the added advantage of zooming.
Pathological conditions like cyst or tumor, routine checkup
or overall evaluation are all special cases.
When patient is examined, some clinical findings indicate
that there is a need for radiographic examination. Radiographs
are prescribed by dental surgeon to gather useful information
which will influence the plan of treatment. Clinical information is
used to select the type of radiograph and later to aid in their
interpretation [8].
C: Digital Image Processing in Frequency Domain and special
domain :
Digital image processing is development of methods for
recognition of individual objects. Fundamental steps in digital
image processing are image acquisition (preprocessing like
scaling), image enhancement (highlight details or interest), image
restoration (to improve appearance of the image), morphological
processing (dealing with the tools of extracting image
components that are useful in representation and description of
shapes), segmentation ( subdividing image into various objects),
representation and description (converting image data suitable for
computer processing), recognition (assigning a label to an object
based on its descriptor). Image enhancement approach falls in
two broad categories: 1) Image enhancement in special domain:
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manipulation of image at pixel level. 2) Image enhancement in
frequency domain: manipulation of image using Fourier
transforms [9].
Fourier transform is a mathematical function that separates
input image into various frequency components. As digital image
with image function f(x,y) with (M × N) size is a discrete signal,
its discrete Fourier transform is calculated using following
equation:
M-1 N-1
F(u,v) = (1/MN)Σ Σ f(x,y) e –j2Π(ux/M + vy/N)
x=0 y=0

where, u=0,1,...M-1 and v=0,1,...N-1 are frequency

Fig 4: a: Original image showing bone loss, b: Image after histogram
components for image f(x,y). Inverse Fourier transform can also equalization
be calculated to get back the image from above separated
frequency components using following equation:

M-1 N-1
F(x,y)= Σ Σ f(u,v) e j2Π(ux/M + vy/N)
u=0 v=0

Various frequency components in frequency domain can be

related with patterns of intensity variations in an image. Low
frequency component represents slowly varying components of
an image. These can be non-edge regions like floor or bony area
in a radiograph. High frequency component represents faster and Fig 5: a: Original image showing caries, b: Image after histogram
equalization in frequency domain, c: Image after histogram equalization in
faster gray level changes in an image. These are edges of the spatial domain
objects and other components of an image characterized by
abrupt changes in the gray level such as noise. Filter H(u, v) in
frequency domain is used to suppress certain frequencies in the
transform F(u,v) leaving others unchanged. Thus, filtered image
in transform domain G(u,v) can be obtained using element by
element multiplication of H and F as follows:
G(u,v) = H(u, v) F(u,v)
The filtered image can be obtained by taking inverse
transform of G(u,v) using the formula given above.
In special domain, histogram is a graph showing the number
of pixels in an image at each different intensity value found in
that image. For an 8-bit grayscale image there are 256 intensities.
The histogram of a gray scale image graphically displays 256 Fig 6: a: Gaussian high pass filter applied on figure 5, b: Gaussian low pass
levels showing the distribution of pixels amongst those grayscale filter applied on figure 5.
values. Histogram equalization is the technique by which the
dynamic range of the histogram of an image is increased.
Histogram equalization assigns the intensity values of pixels in
the input image such that the output image contains uniform
distribution of intensities. The goal of histogram equalization is
to obtain a uniform histogram and improve the contrast. In
histogram equalization, each pixel is assigned a new intensity
value based on its previous intensity level. The histogram
equalization is operated on a histogram of an image. New
intensity values are calculated for each intensity levels and are
replaced.
Fig 7: a: Original image showing bone healing after implant, b: Image after
histogram equalization in frequency domain, c: Image after histogram
equalization in spatial domain

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Fig 8: a: Original image showing periapical lesions, b: Image after
histogram equalization in frequency domain
Fig 9: a: Original image showing root canal procedure, b: Image after
histogram equalization in frequency domain
Fig 10: histogram of figure 8a
Fig 11: histogram of figure 8b after applying histogram equalization
Histogram equalization is useful in images with backgrounds
and foregrounds that are both bright or both dark. Equalization
can lead to better views of bone structure in radiographic images,
and to show details in over or under-exposed photographs.
Disadvantage of the method is that it is indiscriminate. It may
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increase the contrast of background noise, while decreasing the
usable signal. Fig. 10 and 11 demonstrates distribution of gray
scale intensities after equalization.
Previous research showed that frequency domain
representation of digital dental radiographs was useful for edge
enhancement with high pass filter and noise removal was
possible using low pass filter. Depending on the nature of noise
and its association with the image receptor, imaging modality,
and anatomy of interest, several models have been proposed and
examined. Edge enhancement in the frequency domain can be
achieved through a combination of suppressing the low
frequency content or stressing the high frequency band [10].
Another study showed that wavelet transform could be used to
enhance chest x-ray. Two images were achieved in this study,
one with low pass filter to show gray regions of interest and other
with high pass filter to show vascular structures of interest [11].
II. METHOD
MatLab 6.5 software was used to process digital radiographic
images showing common diseases. Various filters like Gaussian
low pass, Gaussian high pass, and histogram equalization
methods were used to study images in frequency domain.
Histogram equalization, high pass and low pass filter were
applied on images showing caries, bone loss, periapical lesions,
impacted teeth, root canal treatment and images with implants.
[12]. Visual representation of images before and after applying
functions was shown to dental clinicians for their judgment.
III. RESULTS
Following are the results which summarize above image
enhancement procedures and their sensitivity to improve area of
interest in visual aspects of superior diagnosis. Problem areas in
the figures are marked by red rectangle.
The digital radiographic images give good quality pictures.
Thus, the noise in image is almost negligible. Low pass filter
blurs the image and is powerful for known noise removal [10].
When low pass filter was applied on images showing routine
dental diseases mentioned above, blurring of the image was
observed. Fig. 6b shows Gaussian low pass filter applied on fig.
5. This effected in loss of image features. Thus low pass filter
was not much useful to improve visual effects.
Fig. 4a is an image showing bone loss. After sharpening the
image clear view of bone loss is seen in fig. 4b. Fig. 5a shows
caries. The decay touching the pulp area is seen clear in the
enhanced image 5b. fig. 5c shows histogram equalization in
special domain. Fig. 5b and 5c results are similar. Fig 6a shows
Gaussian high pass filter applied on figure 5. Though the image
is sharpened, its clarity is less as compared to histogram
equalization method. Fig 6b shows Gaussian low pass filter
applied on figure 5. The image is blurred and surrounding
features are lost. Fig. 7 shows image showing bone healing after
implant, 7b shows image after histogram equalization in
frequency domain, 7c shows image after histogram equalization
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in spatial domain. Implant is a metallic material whose intensity
is different as compared to intensity of oral region. Thus
histogram equalization shows loss in image data. Fig. 8 and fig. 9
show cases regarding periapical lesions and root canal treatment.
In both the cases details regarding infection at root and thin tip at
root of tooth are not enhanced up to mark using histogram
equalization.
IV. DISCUSSION
Low pass filtering, high pass filtering and histogram
equalization was carried on few images showing caries, implants,
and bone loss. Histogram equalization was useful in
enhancement of caries. Further enhancement techniques can be
explored to clearly identify the need of root canal treatment.
The discussion below will focus on diseases mentioned in
introduction A and a need of image enhancement techniques for
accurate diagnosis. The diseases selected for this paper are more
common problems found with the patient.
Several laboratory experiments have shown that radiography
is more accurate than clinical inspection for lesions in dentine.
Out of many researches, selection of above mentioned
enhancements may be useful in routine work. In majority of these
cases of caries, radiography is necessary and its enhancement
adds to more accuracy in diagnosis and treatment planning.
Radiography plays a part in monitoring lesion development
over time, since early treatment procedures can arrest or reverse
progression of the lesion. The evidence for dental caries is not
restricted to the levels of surface cavitation, and radiography can
add information about many of the clinical stages of the caries
process at proximal surfaces and the more advanced stages on
occlusal surfaces.
In impacted teeth problem, digital radiograph will definitely
show the position and angulations of the impacted teeth. When
surgery for such problem is planned, it is important to visualize
properly the relation of the tooth with surrounding structures like
arteries and nerves. In radiographic image its clear visualization
is not possible. This can be done using image enhancement
techniques. These enhanced images will be a guideline for a
dental surgeon to plan a surgery.
In case of accidents involving the facial bones, image
enhancements are useful to visualize and enhance minute details
and smallest cracks in the bone which may be missed on a plain
film radiograph.
Gum diseases, also called as gingivitis, are an infection to
gum. In this disease, there is a severe loss of bone surrounding
the teeth. The level of bone loss can be visualized in a better
manner in digital radiograph. When the treatment is complete in
gum diseases or cyst trouble, patient is recalled at periodic
intervals for assessment of bone healing. Digital radiographs
taken at such periodic intervals helps the surgeons to monitor the
effectiveness of the treatment rendered to the patient. Digital
radiograph definitely gives good view of bone healing. Various
image comparison algorithms could be considered as an area of
interest for researchers.
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Pathological condition like cyst or tumor, routine checkup or
overall evaluation are all special cases and can be considered as
separate areas of research. These diseases require radiographic
helps to visualize the exact extent of these pathologies.
Radiographic images of these diseases give precise view of bone
destruction caused by tumor or cyst. These cases are not
considered here.
Content based image retrieval has the potential to become an
important technology for radiology practice. These image
retrieval systems allow access to and navigation of
extremely large visual archives and extraction of
hidden information without the high cost of manual
annotation and codification of databases. The
systems need to include as much medical
knowledge as possible. Close cooperation between
medical practitioners and medical computer
scientists is necessary to achieve this goal. Here,
there is a need to identify image enhancement
algorithms on the basis of components for image
retrieval [13].
Image being the data, is needed to be managed in an
appropriate way along with various image processing techniques.
As image data is different than text data, its formal understanding
and classification is required, that is, mining of data is needed. Or
content based image data management is needed here. The shift
from mainly text-based data management to an image content-
based processing is a development for future medical information
systems in the field of imaging informatics.
Surgeon’s diagnosis becomes more accurate because of
his/her intelligence, knowledge, tremendous hard work and
abundant experience. Findings were that though using
enhancements were beneficial, selecting the proper one could be
time consuming. Using enhancements requires the surgeons to
browse through enhancement techniques and subjectively select
those that have the best possibilities for perfect diagnoses [10]. To
give this similar intelligence of a dental surgeon and expertise, to
a soft tool for selecting proper enhancement technique
automatically, various parameters need be considered by a
program. Thus, this will require various techniques like data
mining algorithms, use of artificial neural network, use of fussy
logic techniques and content based image data retrieval.
V. CONCLUSION
Histogram equalization, low pass filtering and high pass
filtering are not just enough procedures to assist dental surgeons.
Various image enhancement algorithms are required to process
radiographs for extracting features. After feature extraction
procedure, representation of these features and then its labeling
using descriptors is required to retrieve the image feature data
stored in the computer.
Digital imaging algorithms have a significant impact on
diagnostic utility, as well as treatment planning and patient
education. In conclusion, digital imaging has become the
standard in dental radiology. Further work is needed to
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investigate the effects of single and multiple enhancements to
assist the diagnosis of each of the above disease. It may be that
dental surgeons are awaiting some computer automated
intelligence which will work on multiple radiographs at a time as
per daily needs to manage and assist image data.
ACKNOWLEDGMENT
The authors wish to express their sincere gratitude to Dr.
Mrs. Madhavi Vaze (B. D. S.) and Dr. Suhas Vaze (M. D. S, oral
and maxillofacial surgery) for sharing their experiences of past
twenty five years in the field of dentistry. Dr. Kapil Kshirsagar
(P. G. Oral and maxillofacial surgery) for sharing his views and
domain expertise, and Dr. Rohit Behare (Postgraduate Student,
Oral Medicine and Radiology) for sharing valuable information
on dental caries.
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