WO2011076416A1 - Procédé et système de production d'images radiographiques sans distorsion pour le diagnostic en odontologie ou en orthodontie - Google Patents

Procédé et système de production d'images radiographiques sans distorsion pour le diagnostic en odontologie ou en orthodontie Download PDF

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Publication number
WO2011076416A1
WO2011076416A1 PCT/EP2010/007904 EP2010007904W WO2011076416A1 WO 2011076416 A1 WO2011076416 A1 WO 2011076416A1 EP 2010007904 W EP2010007904 W EP 2010007904W WO 2011076416 A1 WO2011076416 A1 WO 2011076416A1
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WIPO (PCT)
Prior art keywords
ray
image
teeth
patient
measuring device
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PCT/EP2010/007904
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German (de)
English (en)
Inventor
Herbert Häntsch
Martin DÜRRSTEIN
Herbert Gebhardt
Walter Bauer
Frank Hatzfeld
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DüRR DENTAL AG
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Priority to RU2012131268/14A priority Critical patent/RU2012131268A/ru
Publication of WO2011076416A1 publication Critical patent/WO2011076416A1/fr
Priority to FI20125813A priority patent/FI20125813A/fi

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/51—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for dentistry
    • A61B6/512—Intraoral means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0088—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for oral or dental tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/025—Tomosynthesis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A61B6/0487—Motor-assisted positioning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/542—Control of apparatus or devices for radiation diagnosis involving control of exposure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/547—Control of apparatus or devices for radiation diagnosis involving tracking of position of the device or parts of the device
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/58—Testing, adjusting or calibrating thereof
    • A61B6/582—Calibration
    • A61B6/585—Calibration of detector units
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/58—Testing, adjusting or calibrating thereof
    • A61B6/587—Alignment of source unit to detector unit
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/58—Testing, adjusting or calibrating thereof
    • A61B6/588—Setting distance between source unit and detector unit
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • A61C19/04—Measuring instruments specially adapted for dentistry
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C9/00—Impression cups, i.e. impression trays; Impression methods
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01B—MEASURING LENGTH, THICKNESS OR SIMILAR LINEAR DIMENSIONS; MEASURING ANGLES; MEASURING AREAS; MEASURING IRREGULARITIES OF SURFACES OR CONTOURS
    • G01B11/00—Measuring arrangements characterised by the use of optical techniques
    • G01B11/24—Measuring arrangements characterised by the use of optical techniques for measuring contours or curvatures
    • G01B11/25—Measuring arrangements characterised by the use of optical techniques for measuring contours or curvatures by projecting a pattern, e.g. one or more lines, moiré fringes on the object
    • G01B11/2545—Measuring arrangements characterised by the use of optical techniques for measuring contours or curvatures by projecting a pattern, e.g. one or more lines, moiré fringes on the object with one projection direction and several detection directions, e.g. stereo
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T5/00—Image enhancement or restoration
    • G06T5/80—Geometric correction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/16—Details of sensor housings or probes; Details of structural supports for sensors
    • A61B2562/17—Comprising radiolucent components
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4417—Constructional features of apparatus for radiation diagnosis related to combined acquisition of different diagnostic modalities
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C9/00—Impression cups, i.e. impression trays; Impression methods
    • A61C9/004—Means or methods for taking digitized impressions
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/10—Image acquisition modality
    • G06T2207/10116—X-ray image
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/20—Special algorithmic details
    • G06T2207/20212—Image combination
    • G06T2207/20221—Image fusion; Image merging
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30036—Dental; Teeth

Definitions

  • the invention relates to a method and a system for producing rectified X-ray panorama magnification images for dental or orthodontic diagnostics.
  • panoramic images For diagnostic purposes, in dentistry and orthodontics, it is often desirable to have panoramic images that show the entire dentition and the entire periodontium of a patient. With such panoramic images, almost exclusively the technology of panoramic tomography (PSA) is used.
  • the exposure of the image carrier for example an X-ray film or a storage film, takes place from behind through the skull of the patient. It is ensured by the imaging geometry that only the areas of interest of the skull, namely the teeth with the periodontium apparatus, are sharply imaged.
  • the image carrier is exposed through a slit diaphragm which moves around the patient's jaw from outside.
  • the X-ray source is simultaneously pivoted around the back of the patient's head. In this way, the respectively illuminated areas of the dentition are projected approximately parallel to the image carrier.
  • the dentition appears on the radiograph as a development of the dentition, which greatly facilitates the diagnosis of a doctor.
  • Thyroid or eye lenses exposed to X-rays Thyroid or eye lenses exposed to X-rays.
  • the spatial resolution is usually between 2 and 4 line pairs per millimeter and the thickness of the layer shown is low, so that, for example, obliquely grown teeth are often difficult to see.
  • the X-ray light does not pass through the entire skull of the patient, but only those parts that limit the oral cavity to the front and to the side.
  • the term panoramic magnification image PVA
  • PVA panoramic magnification image
  • operating X-ray devices are no longer in use.
  • the main reason for this is that the x-ray tubes introduced into the mouth had an operating voltage of only about 55 kV, the electron beam current being at 5 mA and
  • Beam filters made of copper were used. Under such operating conditions, a greater portion of the radiation is emitted at relatively long wavelengths, which are very much absorbed by the soft tissue of the oral cavity and therefore result in a high local radiation dose.
  • x-ray sources that can be inserted in the mouth have been developed that can be used in the range of 50 to 85 kV with currents of 0.1 mA and smaller.
  • the filters made of copper can be replaced by more suitable materials.
  • the proportion of long-wave radiation is smaller, which also reduces the radiation dose.
  • the diameter of the focal spot is less than 0.1 mm, and the typical exposure times are between 0.1 and 5 seconds. This enables a resolution of 5 line pairs per millimeter, with which caries can be detected by X-ray examination.
  • this object is achieved by a method comprising the following steps: a) placing an X-ray source in the oral cavity of a
  • the invention is based on the finding that, if one knows the position of the X-ray source and the X-ray detector and makes certain typifying assumptions with respect to the position of the teeth to be examined, it is possible to carry out a computational equalization of the X-ray image within certain limits. However, since the position of the teeth relative to the X-ray source and the detector device in such By specifying assumptions is estimated only, can be obtained with such an equalization no X-ray images from which, for example, size ratios can be read correctly, as is required for many diagnostic tasks.
  • the equalization can be carried out so that the proportions of the transilluminated structures are reproduced correctly on the rectified X-ray image.
  • the X-ray detector used according to the invention can be a digital X-ray detector which contains, for example, a CCD sensor or a CMOS sensor. As an X-ray detector, however, everyone else is here
  • Image carrier for example, a classic X-ray film or a storage film called. Since the rectification is computer-aided and therefore a digital X-ray image is needed, X-ray images generated on classical X-ray films must first undergo digitization.
  • the x-ray detector must extend around the entire mandibular arch of the patient from the outside.
  • the x-ray detector will be adapted to the approximately parabolic shape of the mandibular arch.
  • the X-ray detector can also follow a different course, for example the path of a circle or an ellipse.
  • the X-ray detector has an exchangeable image carrier, for. B. a storage film or an X-ray film, it may be advantageous if the Röntgendetek- tor is composed of a plurality of plate-shaped elements which enclose an angle at their joints.
  • a subdivision of the X-ray detector into individual curved segments for the upper or lower mandibular arch and / or the right or left half of the dentition can be useful in many cases. Particularly advantageous is an arrangement in which a segment is provided for each row of teeth and the two segments in an vertical plane an angle, z. B. of about 160 ° include.
  • the only prerequisite is that the position and shape of the X-ray detector is known with sufficient accuracy, since this information is required for the equalization in step g).
  • the measuring points whose coordinates are measured by means of the measuring device can be distributed in different ways on the teeth.
  • the distribution of the measuring points can be regular or irregular, loose or dense.
  • the measurement points may also be limited to parts of the denture, which experience has shown that the distortion is particularly large or in which a measurement is easier to perform.
  • the measuring points can be arranged linearly and in particular form a line grid. It may even be sufficient to measure the coordinates of only a few measuring points on a few teeth, eg. B. from measuring points on the cutting edges of the incisors. If the coordinates of the measuring points are measured with a measuring device, this is itself a reference system for the coordinates.
  • a bite point of the patient can be determined. This is understood to mean a specific point, usually located on the incisors, relative to which both the X-ray source and the X-ray detector as well as the measuring device can be aligned. For this purpose, it is generally sufficient to attach a bite bar to the corresponding components, which is provided with a notch into which the respective incisors can engage in a defined position.
  • step g) it is possible to determine from the measured coordinates of the teeth an object surface arranged between the X-ray source and the X-ray detector, in which the teeth are arranged.
  • the rectified X-ray image is then determined by back-projection of the X-ray image onto the object surface.
  • This procedure is particularly simple and leads to an equalized X-ray image, which appears similar to a processed under parallel projection processing. It is exploited that the X-ray radiation in the PVA technique, the teeth pass through more perpendicularly due to the arrangement of the X-ray source in the oral cavity and the inclination of the teeth, as is the case with the PSA technique.
  • step f Since it is not always easy to perform a measurement of the teeth according to step f) from the oral cavity and thereby to maintain a precisely defined position relative to the x-ray source and the x-ray detector, methods can also be used in which such an absolute reference is not required , These procedures In addition, they set the target perspective freely within certain limits.
  • the step g) comprises the following steps: ga) determining a desired perspective for the equalized
  • gb equalizing the X-ray image in such a way that the X-ray image appears from the desired perspective determined in step ga).
  • step gb) comprises the following steps: gba) generating an edge image of the x-ray image using an edge detection algorithm; gbb) deriving a three-dimensional surface relief of the teeth from the coordinates obtained at the measurement points; gbc) representation of the surface relief from the desired perspective determined in step ga); gbd) selection of vertices on the surface relief depicted in step gbc) and assignment of the vertices to corresponding points on the edge image generated in step gba); gbe) deriving a transformation rule which converts the corresponding points on the edge image into the vertices selected in step (bbd); gbf) Apply the transformation rule to the in
  • the desired perspective in which the three-dimensional surface relief of the teeth derived from the measuring points is represented in step gbc), can be fixed unchangeably by the programming, but can also be freely selected by a user within certain limits.
  • different target perspectives can be defined for individual parts of the surface relief, so that, for example, each individual tooth is represented centrally in perspective.
  • the escape point can be freely selected, for example at the height of the tooth crown or tooth root.
  • the desired perspective can also be individual parallel perspective for each tooth, resulting in a developed representation as in conventional panoramic images. Depending on the task in diagnostics, one or the other perspective may be more favorable, so that a choice opens up improved diagnostic options.
  • the transformation instruction contains several partial instructions which convert partial areas of the X-ray image.
  • possibly more distorted molars may require a different transformation than cutting teeth, which are penetrated approximately perpendicularly by the X-ray radiation.
  • a measuring device for measuring the coordinates of the measuring points lying on the teeth can be made of a variety of distance sensors, which are known per se in the prior art.
  • Triangulation sensors or ultrasound sensors with one or more ultrasound sources are also well suited for intraoral measurement.
  • a plurality of overlapping camera images can be taken from different intraoral positions and the coordinates of the measuring points derived therefrom. This can be done, for example, using a 3D camera having two mutually offset image pickup. However, the different camera images can also be recorded by one and the same camera if they are taken by different locations at different times. Also with a camera and a light mouse projected onto the teeth. ter, z. As a light grid, coordinates of measuring points can be determined.
  • the use of cameras additionally has the advantage that additional intraoral images are available for the diagnosis, which can provide additional information on the status of the teeth.
  • the cameras may be configured as endoscopes, 'which transmit the image information optically through a fiber bundle on an imager.
  • endoscopes which transmit the image information optically through a fiber bundle on an imager.
  • video endoscopes in which the image recorder is located in the recording head and the data transmission is electrical, are also possible.
  • a light pattern for. As a dot or stripe pattern, generated on the teeth and detected by directional optical sensors. In contrast to the use of a triangulation sensor whose light beam passes over the teeth like a scanner, in this way the coordinates of the measuring points lying on the light pattern can be detected in a single measurement process.
  • a calibration step is provided in which an X-ray image without patients is initially recorded. Then, pixel-wise or uniformly for areas of pixels is determined by which correction amounts the intensity must be changed to obtain a constant intensity across the X-ray image. Later generated X-ray images of teeth are then corrected for their intensity taking into account the correction amounts. In this way, it is ensured that any parts of the measuring device which are located in the beam path of the x-ray radiation and which cause the
  • X-rays (even if only slightly) absorb, are not visible on the later X-ray images.
  • a sol- rather a calibration step further prevents other influences from leading to unwanted brightness differences in the X-ray images. These influences include, for example, the generally non-spherical shell shape of the X-ray detector, which lead to different distances between locations on the X-ray detector and the X-ray source, but also spatially inhomogeneous radiation of the X-ray source and local fluctuations in the sensitivity of the X-ray detector.
  • Such a calibration step can advantageously also be carried out inde pendent of the ' steps f) and g).
  • the Applicant therefore reserves the right to claim protection in a divisional application for a method for the production of X-ray images for dental or orthodontic diagnosis, which comprises the following steps: a) placing an X-ray source in the oral cavity of a patient; b) arranging an X-ray detector such that it extends from the outside at least around a part of the mandibular arch of the patient; c) examining the patient's teeth with X-radiation; d) detecting the incident on the X-ray detector X-ray radiation; e) generating a digital X-ray image on the basis of the X-ray radiation detected by the X-ray detector; f) taking an X-ray image without patients; g) image or area determination to which
  • the x-ray detector has an exchangeable image carrier, in particular a storage film or an x-ray film
  • a marking object can be arranged in the beam path of the x-ray radiation which is imaged on the image carrier.
  • the position of the image carrier relative to the X-ray source can then be determined from the position of the image of the marking object on the image carrier. This measure is particularly advantageous if there is a risk that the interchangeable image carrier is not exactly aligned in a recording provided for him. Such an exact alignment is often not guaranteed because the image carrier with sufficient play must be inserted into the recording, so that no exact target position of the image carrier is guaranteed.
  • the marking object according to the invention the position of which is fixed relative to the X-ray source, then makes it possible to detect such deviations of the actual position of the image carrier from its nominal position and, if appropriate, to correct the remaining image accordingly.
  • Such a marking object can advantageously also be introduced into the beam path of the X-radiation independently of a measurement of the teeth according to steps f) and g).
  • the Applicant therefore reserves the right
  • Protection in this application or a divisional application for a method of producing X-ray images for the dental medical or orthodontic diagnostics comprising the steps of: a) placing an X-ray source in the oral cavity of a patient; b) arranging an X-ray detector such that it extends from the outside at least around a part of the patient's dental arch, the X-ray detector having an exchangeable image carrier, in particular a storage film or an X-ray film; c) arranging a marking object in the beam path of the X-ray radiation which is imaged on the image carrier; d) X-raying the patient's teeth; e) detecting the incident on the X-ray detector
  • X-rays X-rays
  • f generating a digital X-ray image on the basis of the X-ray radiation detected by the X-ray detector
  • g determining the position of the image carrier relative to the x-ray source from the position of the image of the marking object on the image carrier
  • h equalizing the digital X-ray image using the position determined in step g).
  • the x-ray detector has an exchangeable image carrier, in particular a storage film or an x-ray film
  • this image carrier can carry a plurality of markings which, when the image carrier is read out onto the digital image carrier X-ray image to be transmitted. It can then be seen from the location of the markings on the digital X-ray images inhomogeneities of the image carrier and correct mathematically in the equalization.
  • this measure is independent of a measurement de teeth in steps f) and g) applicable, so that the applicant reserves the right to seek protection for a method for the production of X-ray images for dental or orthodontic diagnostics in a divisional application, the the steps of: a) placing an X-ray source in the oral cavity of a patient; b) arranging an X-ray detector such that it extends from the outside at least around a part of the mandibular arch of the patient, wherein the X-ray detector has an exchangeable image carrier, in particular a storage film or an X-ray film, which carries a plurality of markings which are present when the image carrier is read the digital X-ray image is transmitted; c) examining the patient's teeth with X-radiation; d) detecting the incident on the X-ray detector X-ray radiation; e) generating a digital X-ray image on the basis of the X-ray radiation detected by the X-ray detector; f) equalizing the digital X
  • a system which comprises: a) an x-ray source which can be arranged in an oral cavity of a patient; b) an X-ray detector which can be arranged such that it extends from the outside at least around a part of the patient's dental arch, and with which X-radiation impinging on the X-ray detector can be detected; c) a digital memory for storing an X-ray
  • image that has been taken by the X-ray detector after examining teeth of the patient d) a measuring device for measuring coordinates of a plurality of measuring points located on the teeth; e) an equalization device adapted for computer-aided equalization of an X-ray image using the measured coordinates.
  • the measuring device may comprise an optical triangulation sensor and / or an ultrasound sensor and / or an SD camera.
  • the measuring device comprises a light source, with which a light pattern can be projected onto the inner or outer surface of the teeth, and an (possibly direction-resolving) optical sensor for detecting the light pattern.
  • the measuring device is configured for an intraoral arrangement. This has the advantage that even the molars can be surveyed well, which appear particularly distorted in panoramic magnification shots. As far as “set up” is mentioned here, this means that the measuring device will often not be permanently located at the relevant location (in the oral cavity of the patient), but only during the measuring process. At other times, the relevant parts of the measuring device can be dismantled, weggesehwenkt or otherwise removed.
  • the measuring device is set up for an extraoral arrangement.
  • This has the advantage that not in addition to the X-ray source other devices must be introduced into the oral cavity of the patient, which can cause a malaise or even a choking reflex in this.
  • a mechanical roller switch which can be firmly connected to the X-ray machine and before or after the fluoroscopy, the series of teeth of the patient descends and detects the coordinates of the worn teeth.
  • the measuring device can be arranged during the measurement process so that parts which are impermeable to X-radiation are arranged at locations which pass through such X-rays during fluoroscopy which also penetrate teeth and other structures of interest. In this case it is necessary that these parts of the measuring device can be swung out of the beam path of the X-ray radiation or removed in any other way. In this context, parts which absorb more than 50% of the incident X-ray radiation are considered to be opaque to X-ray radiation.
  • the measurement of the teeth takes place simultaneously with their fluoroscopy. In this way, it is ensured that the patient does not move between the measurement of the teeth and their fluoroscopy and thus possibly distorts the equalization of the X-ray images. In this case, however, it must be ensured that the measuring device does not affect the X-ray image.
  • parts of the measuring device which are impermeable to X-radiation can preferably be arranged in a plane which, with the patient's mouth open, extends between its upper and lower rows of teeth. Since the patient must have opened his mouth slightly anyway because of the introduction of the X-ray source, a relatively large gap remains between the rows of teeth, which ne arrangement of radiopaque parts of the measuring device is available.
  • the measuring device can generally be set up, at least in part, for an arrangement between the patient and the X-ray detector. Such an arrangement has the advantage that the X-ray detector does not interfere with the measurement of the teeth.
  • a measuring device can, for. B. comprise a contour measuring arc, which extends in a measuring plane and has contact surfaces for engagement with a row of teeth up. The shape of the contour measuring arc is adjustable in the measuring plane in order to bring the contact surfaces into contact with the row of teeth.
  • the measuring device further comprises means for determining the shape of the contour measuring arc.
  • the contour measuring arc is preferably permeable to X-ray radiation so that the contour measuring arc can remain in place during transillumination.
  • Such a contour measuring arc is also advantageous insofar as it can be pushed under the lips of the patient with an appropriate design, so that some back teeth can be measured, which are otherwise not accessible or at least not readily accessible to an extraorally arranged measuring device.
  • the means for determining the shape of the contour measuring arc may be sensors that are integrated in the contour measuring arc. If, for example, the contour measuring arc has a plurality of contact members which are connected to one another by joints, then the sensors integrated in the contour measuring arc can be provided to determine the deflections of the joints. The shape of the contour measuring arc can then be derived from the deflections of the joints.
  • the means for determining the shape of the contour measuring arc can also be used with the contour measuring arc associated absorption.
  • the absorption bodies are arranged in such a way that X-ray radiation, which is absorbed by the absorption bodies, has not previously illuminated through teeth.
  • the position of the absorption bodies can then be determined by the equalization device, which allows an immediate conclusion to the shape of the contour measurement arc.
  • the expense of a sensor that is integrated into the contour measuring arc is eliminated.
  • the contour measuring arc can comprise a plastically deformable carrier. This is then simply applied to the patient's row of teeth for measurement and deformed in such a way that the largest possible area is achieved over the entire length of the contour measurement arc.
  • the measuring device is at least partially set up for an arrangement on a rear side facing away from the patient of the X-ray detector.
  • Such an arrangement has the advantage that comparatively much space is available for the arrangement of the measuring device.
  • the X-ray detector should, however, if possible only have a detection surface there where teeth and other structures of interest can be imaged. In the already mentioned space between the two rows of teeth of the patient, an X-ray detector is not needed, so that there may be arranged advantageously the measuring device.
  • the X-ray detector can have an opening which is arranged in such a way that X-ray radiation which has passed through the opening has not previously illuminated through teeth.
  • the measuring device is then behind the X-ray arranged detector in the region of the opening, that the opening allows a visual connection between the measuring device and the teeth.
  • the measuring device can have a reflector which is set up for an arrangement between the patient and the X-ray detector and is reflective for light or sound waves and transparent for X-ray radiation. Since the reflector can be arranged in an optimal position relative to the measuring teeth, so that the teeth can optically or by means of ultrasonic waves u. U. even better measured, as if the corresponding sensors of the measuring device between the rows of teeth of the patient are arranged.
  • the measuring device comprises a spatially resolving upbeat sensor by means of which the coordinates of a contact surface of a tooth and / or the lip of the patient can be measured at least along one direction.
  • the contact surface of a tooth will most often be the cutting edge of the incisors; in principle, however, a detection of the adjacent canines is also considered if the Aufbisssensor has a sufficient width.
  • Only a few teeth can be measured with such a spatially resolving Aufbisssensor and also for this only measuring points that lie on the contact surface, but at least the important information is obtained as far as the incisors of the X-ray source is removed.
  • the bite sensor has a bite element that is displaceable along an adjustment direction and provided with a bite notch.
  • the bead sensor comprises a position sensor with which the position of the bite element along the adjustment direction can be measured.
  • a bite-on notch in the bite sensor reduces the risk of the patient unintentionally leaving a position relative to the x-ray source due to minor jaw movements, which has previously been adjusted and provides the basis for the subsequent equalization of the x-ray image.
  • the bite sensor may include a motor for displacing the bite element. In this way, a desired distance between the incisors of the patient and the X-ray source can be input via an input device. The X-ray system will then stand on its own
  • bite element has exactly one bite notch on each side, there is no danger of the patient accidentally placing their incisors in the wrong bite-kerf or changing them shortly before candling through smaller jaw movements.
  • the motor is designed as a servomotor, this can also serve as a position sensor.
  • the bite element can have a sleeve-shaped base body which is displaceably arranged along an insertion axis of the insertion device on an insertion part of the x-ray device which contains the x-ray source.
  • the insertion part at the same time serves as a guide for the bite element, which simplifies the construction of the Aufbisssensors.
  • the bite sensor may comprise at least one sensor element and a carrier which carries the at least one sensor element and is partially insertable into the oral cavity of the patient. At least the coordinates of the contact surface along a reference direction can be determined by the at least one sensor element. In this case, the attack
  • the patient's incisors are not inserted in a bite-off notch, but are resting against the bite sensor at any location with their cutting edge. This location is detected by the at least one sensor element.
  • Such an embodiment is particularly advantageous if the measurement of the coordinates of the incisors is performed simultaneously with the fluoroscopy. In this case, there is no danger that the patient accidentally changes a previously set position of the incisors on the up to the moment of the X-ray.
  • the at least one sensor element may comprise a plurality of pressure or proximity sensors successively arranged along the reference direction, the size and arrangement of which determines the spatial resolution with which the coordinates of the contact surface can be measured.
  • piezo elements are particularly suitable as pressure sensors.
  • proximity sensors in particular capacitive sensors come into consideration, which can be specifically designed so that they respond only to teeth, only on lips or on the lips and teeth.
  • the at least one sensor element is designed as a linear potentiometer, which has a resistance surface and an elastic electrode. A movable tapping point of the linear potentiometer can be produced where the elastic electrode is deflected by a tooth and / or the lip of the patient so far that the electrode rests against the resistance surface.
  • Such a linear potentiometer has a simple structure and requires fewer electrical leads than a plurality of successively arranged pressure or proximity sensors.
  • the carrier for the at least one sensor element is preferably fastened on an insertion part, which contains the X-ray source, and may for example be designed as a sleeve, which is pushed onto the insertion part.
  • Figure 1 is a vertical section through an inventive X-ray examination system in use;
  • Figure 2 is a horizontal section through that in the figure
  • FIG. 3 shows a schematic illustration for illustrating a distortion arising on an X-ray image
  • Figure 4 is a schematic representation similar to Figure 3, but with undistorted image
  • Figure 5 is a schematic representation similar to that in the
  • Figure 6 is a schematic representation similar to that in the
  • FIG. 3 but with emphasis on an object plane
  • FIG. 7 shows an enlarged illustration of the geometric relationships that are present in the projection of teeth on the sensor surface of an X-ray detector of the X-ray examination system shown in FIGS. 1 and 2 for explaining a first exemplary embodiment of a method according to the invention
  • Figure 8 is a vertical section through a triangulation sensor used as a measuring device, which is inserted into the oral cavity of a patient;
  • FIG. 9 is a front view of that shown in FIG.
  • Figure 10 is a vertical section through a 3D stereoscopic camera inserted into the oral cavity of a patient
  • FIG. 11 is a front view of that shown in FIG.
  • Figure 12 is a generated by a light source regular
  • FIG. 13 shows the light grid according to FIG. 12 when projected onto teeth
  • FIG. 14 shows one for the implementation of the invention
  • Method suitable measuring device which has to carry out a triangulation of multiple light sources and a plurality of detectors
  • FIG 15 is a schematic representation of essential
  • FIG. 16 is a flowchart showing essential steps of the method according to the invention.
  • FIG. 17 shows a vertical section through an inventive X-ray examination system according to an embodiment, in which a measuring device is attached to a distal end of an insertion part;
  • FIG. 18 is a horizontal section through an inventive X-ray device according to an embodiment in which the measuring device is arranged between the patient and the X-ray detector;
  • FIG. 19 is a front view of that shown in FIG.
  • Measuring device at the height of the line XIX-XIX, wherein the X-ray detector and a holder connected thereto are not shown;
  • FIG. 20 shows a horizontal section through an inventive X-ray apparatus in which a measuring device is shown. is arranged on a side facing away from the patient side of the X-ray detector;
  • FIG. 21 is a front view of that shown in FIG.
  • Measuring device at the height of the line XXI-XXI, wherein the X-ray detector and a holder associated therewith are not shown;
  • FIG. 22 shows a vertical section through an inventive X-ray device according to an embodiment, in which reflectors are arranged between the patient and the X-ray detector;
  • Figure 23 is a horizontal section through a fiction, according ⁇ X-ray apparatus according to an embodiment, in which the measuring means comprises a hingedly formed contour measuring sheet with integrated sensors;
  • FIG. 24 is a front view of that shown in FIG.
  • FIG. 25 shows a horizontal section through an inventive X-ray device according to an exemplary embodiment, in which the measuring device comprises a plastically deformable contour measuring arc with absorption bodies carried therefrom;
  • FIG. 26 is a front view of that shown in FIG.
  • Measuring device at the height of the line XXVI-XXVI, wherein the X-ray detector and a holder connected thereto are not shown;
  • FIG. 27 shows a vertical section through an inventive X-ray apparatus according to an embodiment. game, wherein the measuring device comprises a Aufbisssensor with a plurality of successively arranged pressure sensors;
  • FIG. 28 an enlarged detail from FIG. 27, in which the arrangement of the pressure sensors designed as piezo elements can be recognized;
  • FIG. 29 is a fragmentary view of the figure 28
  • FIG. 30 is a fragmentary view of the figure 28
  • Figures 1 and 2 show an inventive and generally designated 10 X-ray examination system for dental and orthodontic diagnostics in a vertical or horizontal section.
  • the x-ray examination system 10 has an x-ray device 12, which is connected to a computer 16 via a data line 14.
  • a computer 16 may also be a specially developed for the X-ray examination system 10
  • Evaluation unit may be provided which has a data memory and a computing unit.
  • the X-ray device 12 has a protective housing 18, which consists of an electrically and thermally insulating material and is divided into a cuboid main part 20 and a tubular insertion part 22.
  • the insertion part 22 is detachably fastened to the main part 20 via a fastening device, not shown, and receives an x-ray tube which, for the sake of clarity, is not shown in greater detail in FIGS. 1 and 2.
  • an electron beam source 24 is arranged, with which an electron beam can be generated.
  • the electron beam source 24 has for this purpose in a conventional manner a cathode and an anode, which are connected to a high voltage source, which is also accommodated in the main part 20 of the protective housing 18.
  • a cathode and an anode which are connected to a high voltage source, which is also accommodated in the main part 20 of the protective housing 18.
  • electrons are emitted from the cathode and accelerated in the electric field that forms between the cathode and the anode.
  • the electrons leave the electron beam source 24 through a hole provided in the anode and form an electron beam 26 in the x-ray tube.
  • the X-ray device 12 further has an X-ray detector 32, which is formed in the illustrated embodiment as a digital X-ray detector and is attached by means of a holder 31 to the main part 20 of the protective housing 18.
  • the x-ray detector 32 has a CCD or a CMOS sensor whose pixels are arranged on a sensor surface 33 which is curved both in the sectional plane according to FIG. 1 and in the sectional plane according to FIG.
  • the curvature in the horizontal sectional plane according to FIG. 2 is chosen such that it approximately follows the typical course of a human dental arch. Describe the detector surface of the X-ray detector 32 by moving a circular arc along an approximately parabolic path. Behind the X-ray detector 32, a shield may be arranged (not shown), which prevents that not absorbed by the X-ray detector X-ray propagates in the examination room.
  • the signals generated by the pixels of the sensor surface 33 are transmitted by the X-ray device 12 via the data line 14 to the computer 16 and there processed to form an X-ray image, which is stored in a memory, which is indicated at 39. Equalization of the X-ray image also takes place in the computer, which is explained in more detail below in sections 2 and 3.
  • the sensitivity of the X-ray detected by the pixels of the X-ray detector 32 depends thereby on the amount and the nature, in particular the density, the Ge ⁇ tissue disorders from which they pass on their way from the x-ray source 28 to the X-ray detector 32, the X-rays.
  • the X-ray source 28 By suitable design of the X-ray source 28, it is ensured that the X-rays 30 cover both in the vertical direction (sectional plane of FIG. 1) and in the horizontal direction (sectional plane of FIG. 2) an angle which ensures the complete fluoroscopy of all the teeth 38 and the associated ones Ensuring dental restraints of the patient.
  • On the sensor surface 33 of the X-ray detector 32 a panorama-like image of the tissue penetrated by the X-rays 30 thus results. Since the X-ray source 28 is approximately point-shaped and relatively close to the tissue to be screened, the image formed on the sensor surface 33 during fluoroscopy obeys the rules of central projection.
  • FIG. 3 shows a cube-shaped grid 39 which is illuminated by a radiation source 40 assumed to be punctiform.
  • a radiation source 40 assumed to be punctiform.
  • On an image plane 42 emerges from the shadow of the grid 39 an image 139 according to the rules of central projection.
  • the parallelism of lines which, as assumed here, are arranged in planes which run parallel to the image plane 42 remains in the image 139.
  • projection beams are indicated by dashed lines and for the three corners behind them by dotted lines.
  • the radiation source 40 is not centered with respect to the grid 39, but slightly offset to the bottom left.
  • the image 139 produced on the image plane 42 is distorted.
  • Such an evaluation is only possible if the image 139 arises from a perspective known to the viewer and particularly suitable for an assessment.
  • FIG. 1 Such a known perspective is shown in FIG.
  • the radiation source 40 ' is located exactly on a central axis of the grating 39, ie on a line which passes through the centers of two opposite faces of the grating 39 (see rear view on the right-hand edge of FIG.
  • the image formed on the sensor surface 33 of the X-ray detector 32 when the teeth 38 are illuminated will also generally be distorted.
  • the doctor knows such a parallel perspective, for example, from conventional panoramic images in which the X-ray source is moved around the patient behind the head (and thus relatively far away from the teeth) and an X-ray film or other X-ray detector is exposed through a wandering slit diaphragm.
  • the shape of the grating 39 can not yet be inferred.
  • FIG. 5 shows this using the example of a warped grating 41: With otherwise identical projection ratios, ie position of the radiation source 40 and the image plane 42, the projected image 141 can not be distinguished from the image 139 of the undrawn grating 39 from FIG. 3.
  • FIG. 1 One way to deduce the actual shape of the grating 39 and thus obtain an equalized image is shown in FIG. It is assumed here that the position of a first object plane 46, in which the four corners of the grating 39 facing the radiation source 40 are arranged, is known relative to the radiation source 40 and the image planes 42. If the position of the first object plane 46 is known, the arrangement of the front corners of the grating 39 can be reconstructed in a simple manner by connecting beams emanating from the image 139 to the radiation source 40. The puncture points on the object plane 46 of these beams are then the front four corners of the grid 39 fixed. In this way, in the object plane 46, by back projection of the image 139 onto the object plane 46, an equalized original image of the image 139 is created.
  • the position of the second object plane would have to be known, in which the four corners of the grid 39 facing away from the radiation source 40 are arranged.
  • the error that arises from estimating the distance of this second object plane to the first object plane is relatively small. Applied to the projections of the teeth 38, this means that one can easily determine the position of the second object plane by displacing the first object plane by the typical "thickness" of a row of teeth.
  • FIG. 7 illustrates the corresponding relationships as they exist when the X-ray image is recorded with the X-ray apparatus 12 shown in FIGS. 1 and 2.
  • 48 designates here an object surface whose three-dimensional shape has been determined such that the surfaces of the teeth 38 facing the x-ray source 28 abut the object surface 48 approximately tangentially. Distanced behind it is the Sensor surface 33 of the X-ray detector 32 indicated.
  • the object surface 48 thus corresponds to the object plane 46 and the sensor surface 33 of the image plane 42 in the representation of FIG. 6.
  • the image 138 of a tooth 38 is indicated as an example, which is produced on the sensor surface 33 by projection as a result of fluoroscopy with x-rays 30. If, by calculation, these points lying on the sensor surface 33 are projected back onto the object surface 48, then an equalized original image of the tooth 38 is produced.
  • This procedure requires that the coordinates of the sensor surface 33 relative to the position of the X-ray source 28 are known exactly. Furthermore, the position of the object surface 48 must also be known in this reference system. The position of the sensor surface 33 relative to the x-ray source 28 is structurally fixed to one another in the x-ray device 12. However, the position of the object surface 48 in this reference system is initially unknown, since the shape of the mandibular arch and the arrangement of the teeth 38 held therefrom can deviate considerably from one patient to another.
  • the straightened X-ray image is also to be used to determine particular proportions of the teeth or periodontal ligaments, it generally does not suffice for all patients to have the same location of the object area 48 or about a limited number of different object areas 48 of equalization based on which one is selected according to the age of the patient.
  • the position of the object surface 48 is metrologically determined in this embodiment by determining coordinates of the teeth 38 at a plurality of measuring points lying on the teeth 38 with the aid of a measuring device. Possible measuring methods used in this are suitable, are described in more detail below with reference to Figures 8 to 12.
  • the measuring device is a triangulation sensor 50 which is introduced into the oral cavity 34 of the patient 36.
  • the triangulation sensor 50 shown in FIG. 9 shows, it has one
  • Light source 52 for example, a laser diode or an LED, and a directionally resolved image sensor 54.
  • Imager 54 typically includes a microlens and a CCD sensor for this purpose.
  • the light source 52 and the image sensor 54 are arranged on a cross member 56, which is rotatable about a vertical axis 58 by means of a small servomotor (not shown) relative to a longitudinal member 60.
  • a small servomotor (not shown) relative to a longitudinal member 60.
  • the cross member 56 about a horizontal axis 61 by means of another servo motor (also not shown) can be tilted. In this way, the light beam generated by the light source 52 by pivoting about the vertical
  • Axis 58 and the horizontal axis 61 are guided according to a defined scanning pattern on the triangulation sensor 50 facing inner surfaces of the teeth 38. This results in a grid-like arrangement of measuring points whose coordinates can be accurately determined by triangulation relative to each other.
  • the longitudinal member 60 of the triangulation sensor 50 is provided with a bite bar 62 which is provided on its underside with a notch into which the lower
  • FIGS. 10 and 11 show, in similar representations to FIGS. 8 and 9, an intraoral stereoscopic SD camera which is used as a measuring device for determining the coordinates on the teeth.
  • the 3D camera designated as a whole by 64, comprises two intraoral cameras 66, 68 which, as can be seen in FIG. 11, are arranged on a common cross member 70.
  • the cross member 70 is attached to the end of a longitudinal member 72 which is provided on its underside again with a Aufbisssteg 74.
  • the distance between the intraoral cameras 66, 68 on the one hand and the recorded teeth 38 on the other hand can be determined by way of image processing (eg by photogrammetry methods) ,
  • the intraoral camera 66 In a modified measuring method, only the intraoral camera 66 is used.
  • the other intraoral camera 68 is replaced by a light source provided with a grating shutter and capable of projecting a regular light grating 69 onto the teeth 38, as shown in FIG. If this regular light grid 69 is projected onto teeth 38, the intraoral camera 66 takes an image, as shown by way of example in FIG. Due to the curvature of the teeth 38, the originally straight lines of light are also curved. The distance between the light lines is a measure of the distance of the teeth 38 to the intraoral camera 66. By evaluating the distorted light line image, as shown in FIG. 13, it is also possible to obtain a surface relief of the teeth 38.
  • FIG. 13 By evaluating the distorted light line image, as shown in FIG. 13, it is also possible to obtain a surface relief of the teeth 38.
  • the measuring device 73 has a longitudinal member 72, which is dimensioned so that it can be inserted into the oral cavity 34 of the patient 36.
  • a detector latch 76 is arranged, on which a plurality of detector elements 78, for example photodiodes, are arranged parallel to one another.
  • each detector element 78 is assigned a cylindrical sleeve 80, which causes light incident on the detector element 78 to be detected only substantially parallel to the longitudinal axis of the sleeve 80.
  • the detector elements 78 thus form together with the sleeves 80 direction-resolving optical sensors.
  • the detector latch 76 in turn carries a laser bar 82, which comprises a plurality of laser diodes 83 arranged next to one another.
  • the laser diodes 83 of the laser bar 82 are driven in the measurement so that they generate a laser beam 84 at short time intervals.
  • the directional characteristic of the detector elements 78 only certain detector elements 78 can detect the laser light reflected by the teeth 38. In FIG. 14, this is indicated for two detector elements 78 by dashed lines.
  • the pivotable head of the triangulation sensor 50 shown in FIGS. 8 and 9 is replaced by a fixed arrangement of a plurality of light sources and a plurality of detectors. 5.
  • the undistorted original image can be reconstructed from a distorted image 139 if the position of the object plane 46 is known.
  • an equalization is also possible if the shape is known at least from a part of the object, here the cube 39, without knowing its position relative to the image plane 42 and to the radiation source 40 exactly.
  • the transformation rule which mathematically describes the equalization or equalization, can be assumed to be the same for smaller objects in a good approximation. With a tooth this can be assumed with good approximation; So if you know how to equalize the crown, you can equalize the neck of the tooth with the same transformation rule.
  • FIG. 15 the steps performed for equalization in this embodiment are shown separated by arrows.
  • the starting point is the distorted X-ray image taken by the X-ray detector.
  • such an X-ray image is designated by 90;
  • the images 138 of two teeth 38 are shown.
  • an edge image 92 of the teeth 38 is obtained from the X-ray image 90, which is done using known edge detection algorithms.
  • the identifiable on the X-ray image 90 teeth 38 are measured.
  • a surface relief 94 is obtained, which is indicated in FIG. 15 by curved lines 96 on teeth 38.
  • the surface relief 94 is now from a pre-determined
  • Planned perspective shown.
  • This desired perspective can be fixed by the X-ray examination system 10, but can also be freely selected by an operator.
  • the desired perspective can be determined individually for individual teeth or groups of teeth, so that the rectified X-ray image is composed of a plurality of partial images, which appear to be taken from different perspectives and are composed without gaps to form a panoramic image.
  • a centrally centered central perspective as indicated in FIG. 4, or a parallel perspective may be considered. It has been assumed in FIG. 15 that the surface relief 94 is already shown in the desired desired perspective.
  • This determination is preferably carried out automatically by subjecting the surface relief 84 shown in the desired perspective to edge detection, and then selecting characteristic points of the edges, such as corners or strong curvatures, as support points 88.
  • a transformation instruction is defined, which converts the points 98 'to the interpolation points 98.
  • the term "transformation rule” here means any collection of rules. with which a linear or nonlinear distortion or equalization can be described for a group of pixels. If the transformation rule is designated as matrix T in FIG. 15, this represents a rough simplification, because with a matrix alone, the transformation of a larger group of pixels will generally not be described.
  • the transformation rule is now applied to the entire X-ray image 90, whereby the teeth 138 'shown therein are equalized and displayed so that they appear taken from the desired desired perspective.
  • the result is an equalized x-ray image 100, in which the tooth roots and necks of the teeth, which were not detectable during the measurement, also appear from the desired target perspective.
  • This process can be repeated for each individual tooth or groups of teeth that can apply the same transformation protocol.
  • FIG. 16 shows, in the form of a flowchart, essential steps of the method according to the invention, which are common to both exemplary embodiments.
  • a step Sl the X-ray source 28 is placed in the oral cavity 34 of the patient 36.
  • the X-ray detector 32 is arranged such that it extends around the mandibular arch of the patient 36 from the outside.
  • a third step S3 the teeth 38 of the patient 36 are X-rayed.
  • a fourth step S4 the X-radiation impinging on the X-ray detector 32 is detected.
  • a digital X-ray image is generated on the basis of the X-radiation detected by the X-ray detector 32.
  • step S6 coordinates of a plurality of measuring points lying on the teeth 38 are measured with the aid of a measuring device, for example the triangulation sensor 50, the 3D camera 64 or the measuring device 73.
  • step S7 the digital X-ray image generated in step S5 is equalized using the coordinates measured in step S6.
  • the teeth of the patient 36 can be measured either before or after the acquisition of the X-ray image.
  • a simultaneous measurement is hardly practical, since the
  • measuring devices which make it possible to carry out the surveying and the fluoroscopy of the teeth 38 simultaneously or in succession so that no modifications of the X-ray device, eg a pivoting away of certain parts of the measuring device, are required.
  • Simultaneous measurement and fluoroscopy reduce the susceptibility to error, because the simultaneity ensures that the measurement in the condition in which the patient's teeth are illuminated.
  • a simultaneous measurement requires that no or at least no parts of the measuring device that are impermeable to X-rays are arranged in the beam path of the X-radiation such that the images of these parts cover the images of the teeth and other structures of interest on the recorded X-ray images. In the embodiments of measuring devices described below, this is achieved in different ways.
  • FIG. 17 shows, in a vertical section, an exemplary embodiment of an x-ray device 12 in which two of the stereoscopic 3D cameras shown in FIGS. 10 and 11 are fastened to the distal end of the insertion part 22.
  • the 3D cameras denoted by 64a, 64b in this exemplary embodiment each comprise two intraoral cameras 66, 68, as shown in FIG. 11 (in the vertical section of FIG. 17, only the intraoral cameras 66 facing the observer are discernible).
  • the two 3D cameras 64a, 64b are mounted so far behind the X-ray source 28 that they do not hinder the propagation of the X-rays in the direction of the teeth 38 of the patient 36.
  • the teeth 38 can be simultaneously illuminated and measured with the aid of the two SD cameras 64a, 64b. Since the insertion part 22 in comparison to the side member 72 has relatively large dimensions, neither of the two 3D cameras 64a, 64b both rows of teeth of the patient 36 can be optically detected simultaneously. For this reason, two independent SD cameras 64a, 64b are provided in this exemplary embodiment, each of which measures the row of teeth lying on its side. Alternatively, it is possible to provide only a 3D camera 64a which can be swiveled through 180 ° about the longitudinal axis of the insertion part 22, so that the two rows of teeth can be measured sequentially by a 3D camera 64a.
  • the intraoral cameras 66, 68 which are part of the 3D cameras 64a, 64b, may be endoscope cameras. This has the advantage that the intraoral cameras 66, 68 can have very small dimensions, which makes the recording of the 3D
  • the captured by the intraoral cameras 66, 68 images can, for. B. are transmitted via a fiber optic to the main part 20 of the X-ray device 12. A free-ray transmission with the aid of angle optics is also considered for this purpose.
  • the intraoral cameras 66, 68 can also be designed as so-called video endoscopes, in which electronic image sensors are arranged in the receiving heads of the intraoral cameras.
  • the image transfer to an evaluation, the z. B. can be configured as software executable in the computer 16, then takes place not on optical but electronic way. The same applies to the intraoral cameras of the embodiment shown in Figures 10 and 11.
  • a marker object is indicated at reference numeral 102, which is impermeable to X-rays and in the illustrated embodiment, the shape of a small ball, which has a short foot is attached to the insertion part 22.
  • the marking object 102 is arranged so that it does not lie in the beam path of X-ray radiation that penetrates the teeth or other structures of interest in the jaw region of the patient 36. As a result, the image of the marker object 102 does not overlap the images of the structures of interest. Since the patient 36 has to keep his mouth open anyway in order to be able to receive part of the insertion part 22 into his oral cavity 34, a central strip always remains on the X-ray image between the two illustrated rows of teeth on which the marking object 102 should preferably appear.
  • the X-ray detector is not a CCD or a CMOS sensor, but the X-ray detector is an interchangeable image carrier, for example a CCD.
  • the X-ray detector is an interchangeable image carrier, for example a CCD.
  • B a storage film or an X-ray film having.
  • the image carrier is not positioned exactly in a suitable receptacle. Since the equalization according to the invention requires that the position of the X-ray detector 32 relative to the X-ray source 28 be known exactly, such replacements of a replaceable image carrier may result in the rectification being erroneously performed and the teeth 38 of the patient 36 thus not being correct the rectified X-ray image appear.
  • the computer 16 can determine the position of the image carrier relative to the X-ray source 28 from the position of the image of the marking object 102 on the replaceable image carrier , Dodge the picture of the marking object 102 from its nominal position on the image carrier, the image carrier was not exactly aligned in its recording during the X-ray exposure. From the displacement of the actual image relative to the desired position of the image, the computer 16 can then determine the amount and direction of the misalignment and correct the other pixels accordingly. In order to increase the accuracy of the correction, it is also possible to provide a spatially extended marking object or a plurality of distributed marking objects.
  • FIG. 18 shows, in a horizontal section, an exemplary embodiment of an X-ray device 12 according to the invention, in which the measuring device is arranged not intraorally but extraorally between the teeth 38 of the patient and the X-ray detector 32.
  • the measuring device comprises four triangulation sensors 50a, 50b, 50c, 50d, whose measuring apertures are indicated in each case by gestri ⁇ smiled lines.
  • the triangulation sensors 50a to 50d are fastened to a support 104, which in turn is fixed to the insertion part 22 in a manner not shown.
  • FIG. 19 shows the measuring device in a front view at the level of the line XIX-XIX, wherein the X-ray detector 32 is indicated only with its outline for the sake of clarity, and the holder 31 with which the X-ray detector 32 is attached to the main part 20 of the X-ray device 12 , not shown at all.
  • the carrier 104 is oriented in the vertical direction such that both the carrier 104 itself and the triangulation sensors 50a to 50d carried thereon extend along a gap left between the two rows of teeth of the patient 36. The height of this gap is in the sentlichen determined by the diameter of the insertion part 22 and the dimensions of the Aufbissstege 63.
  • the measuring device is indeed imaged with the X-ray image, but their image covers neither the teeth 38 themselves nor other structures of the mandibular arch, which may be of interest. Nevertheless, the central arrangement between the two rows of teeth makes it possible to optically measure them simultaneously with the triangulation sensors 50a to 50d.
  • the carrier 104 does not extend over the entire length of the patient's dental arch. This is due to the fact that in an extra-oral optical measurement, even if the patient's lips are pushed up or down, the molars of the patient can not be measured, since they are covered by the cheeks. However, the position of those molars can be extrapolated with sufficient accuracy, it being possible to resort to statistical data of patients of the same age and sex or other typifying parameters.
  • FIGS. 20 and 21 show, in illustrations similar to FIGS. 18 and 19, an exemplary embodiment of an X-ray device 12 according to the invention, in which the triangulation sensors 50a to 50d are also arranged extraorally but on a rear side of the X-ray detector 32 facing away from the patient.
  • the X-ray detector 32 has a central strip-shaped opening 105 which is located in that bene between the two rows of teeth, in which the triangulation sensors 50a to 50d of the embodiment shown in Figures 18 and 19 are arranged. This ensures that X-radiation which strikes through the opening 105 has not been previously illuminated by teeth 38 or other structures of the mandibular arch of interest.
  • the opening 105 it is possible to extend the opening 105 to the two shorter transverse sides of the X-ray detector 32, so that it is divided into two halves, which are spaced apart.
  • FIG. 22 shows, in a vertical section, an exemplary embodiment of an X-ray device 12 according to the invention, in which the measuring device has reflectors 106a, 106b, which are arranged between the patient 36 and the X-ray detector 32.
  • the measuring device has two 3D cameras for each row of teeth, each of which comprises two individual cameras, one of which is shown in FIG. 22 for each row of teeth and designated 66a and 66b.
  • the cameras 66a, 66b are arranged on the two upper and lower longitudinal edges of the X-ray detector 32 and are therefore located outside the beam path of the X-radiation.
  • the reflectors 106a, 106b are located in the path of the X-radiation, which also passes through the teeth 38 of the patient 36. Therefore, the reflectors 106a, 106b for X-ray must be at least largely transparent. This also applies to feet 110a, 110b, on which the reflectors 106a, 106b are supported on the insertion part 22. For a wearer of the reflectors 106a, 106b and the feet 110a, 110b, for example, plastic may be considered as the material.
  • a strapped on the straps inflective coating of the reflectors 106a, 106b may for example consist of aluminum, which only weakly absorbs X-rays.
  • the supports of the reflectors 106a and 106b are planar plates that extend across the entire width of the mouth of the patient 36.
  • the cameras 66a, 66b can receive an undistorted image of the teeth of the patient 36 lying in the region of the mouth opening.
  • two likewise strip-shaped support surfaces 108a, 108b are attached to the X-ray detector 32, over which the patient's lips are pushed and made of a material permeable to both visible light and X-radiation is, for. Glass.
  • FIGS. 23 and 24 show, in illustrations similar to FIGS. 18 and 19, an exemplary embodiment of an X-ray device 12 according to the invention, the measuring device of which comprises an upper and a lower contour measuring arc 110a or 110b.
  • Each contour measuring arc 110a, 110b in turn has a plurality of abutment members 112, which are connected to each other via joints 114.
  • the joints 114 thereby enable a deflection of the abutment members 112 perpendicular to a measuring plane in which the contour measuring arcs 110a, 110b respectively extend.
  • each hinge 114 is associated with an angle encoder 116.
  • This generates an electrical output signal in dependence on the angle formed between the abutment members 112, which are connected to each other via the respective joint 114.
  • the electrical output signals of the angle sensor 116 are connected via a not shown electrical signal line supplied to the computer 16. If the electrical signal lines consist of X-ray radiation only weakly absorbing material such as aluminum, they may be guided along the back of the contact members 112 facing away from the teeth 38. Otherwise, it is possible to guide the signal lines in the space between the rows of teeth of the patient.
  • the ganglieder- 112 and the joints 114 consist of a permeable to X-ray material.
  • the angle encoders 116 are arranged at the end of the joints 114 so that they are located in the space between the two rows of teeth of the patient during the measuring process.
  • the angle encoders 116 must therefore contain materials that are impermeable to X-rays.
  • each contour measuring blade 110a, 110b is fixedly connected to the insertion part 22 of the X-ray apparatus 12 via one of the webs 118a or 118b (see FIG. 24) and constitutes a stop for the incisors of the patient Engage the patient's incisors on the central abutment member 112, the rest of the abutment members 112 are pivoted by means of the joints 114 that to the teeth 38 facing bearing surfaces 120 of the abutment members 112 are brought into contact with the row of teeth of the patient.
  • the angle changes occurring during the adjustment of the joints 114 are detected by the angle transmitter 116 and transmitted to the computer 16.
  • FIGS. 25 and 26 show, in illustrations similar to FIGS. 23 and 24, an exemplary embodiment of an X-ray device 12 according to the invention in which the contour measuring arcs 110a, 110b each have a plastically deformable carrier 122, its inner surface facing the teeth 38 as abutment surfaces 120 are formed.
  • Each carrier 122 carries a plurality of absorbent bodies 124 which are secured by feet 126 to the respective carrier 122.
  • the feet and the carrier 122 are made of a material transparent to X-ray light material, while the absorption body 124, which may for example have the form of small balls, X-rays almost completely absorbie ⁇ ren.
  • the legs 126 are dimensioned so that the absorption body 124 in the space between the rows of teeth are arranged, as can be seen in the figure 26. As a result, when the teeth 38 are illuminated, the absorption bodies are detected by the X-ray detector 32, without their images, however, covering the images of the teeth 38.
  • the contour measuring arches 110a, 110b are fixed on the insertion part 22 via webs 118a, 118b, so that the middle section of the contour measuring arcs 110a, 110b serves in each case as a stop for the rows of teeth of the patient. If the carriers 122 are shaped in such a way that they can be plugged onto the rows of teeth in a self-clamping manner, the webs 118a, 188b can be dispensed with. The plastically deformable supports 122 are now bent so that their contact surfaces 120 come into contact with the teeth 38, as can be seen in FIG.
  • FIG. 27 shows a first embodiment of a bite sensor in a horizontal intersection.
  • the Aufbisssensor 130 generally designated 130 has a tubular and closed at its distal end sleeve 132 which is pushed onto the likewise tubular insertion part 22 end and locked in a manner not shown.
  • a plurality of pressure sensors designed as piezoelectric elements are arranged one behind the other in the longitudinal direction of the sleeve 132, which will be explained in more detail below with reference to FIG.
  • FIG. 28 shows an enlarged section of the wall of the sleeve 132 designated 134.
  • the sleeve wall 134 has over a section of a few centimeters an elastic outer wall 136 and a fixed inner wall 138, between which the piezo elements designated 140 are arranged.
  • Each piezo element 140 is designed as a so-called stacked piezo element, in which two piezoelectric crystals 142a, 142b are sandwiched between three metal electrodes.
  • One of the two outer metal electrodes is in each case on the elastic outer wall 136, while the other metal electrode is supported in a manner not shown on the fixed inner wall 138.
  • the biting pressure generated in this case is transmitted via the elastic outer wall 136 to those piezoelements 140 which are located near the exiting point.
  • the pressure applied to the respective piezoelectric element 140 generates an electrical signal, which is transmitted via signal lines 144 is transmitted to the computer 16. From the height and the assignment of the signal to the relevant piezoelectric elements 140, the computer 16 can close the location at which the tooth 38 rests against the elastic outer wall 136 of the bite sensor 130.
  • the coordinates of the contact surfaces of the incisors can be measured in this manner with an accuracy that depends in this embodiment on the number of per unit length longitudinally provided piezoelectric elements 140.
  • the longitudinal direction of the bite sensor 130 in this embodiment coincides with an insertion direction along which the insertion member 22 is inserted into the oral cavity 34 of the patient 36 together with the bite sensor 130 pushed thereon.
  • the part of the sleeve wall 134 which is diametrically opposite to the cutout shown in FIG. 28 and serves to measure the biting surfaces of the lower incisors, has the same construction and the same function.
  • the piezo elements 140 of the embodiment shown in FIGS. 27 and 28 can also be replaced by other pressure sensors. It is also possible to replace the pressure sensors with proximity sensors. In this way, additionally or exclusively, the position of the lips of the patient 36 along the insertion direction can be measured, since the lips of the patient may not even touch the bite sensor 130 when the mouth is slightly open.
  • FIG. 29 shows a detail of an embodiment of a bite block in a representation similar to FIG. 28, in which a plurality of proximity sensors are arranged one behind the other along the insertion direction in the sleeve wall 134, which act as capacitive proximity sensors 146 are formed.
  • the outer wall 136 of the sleeve wall 134 need not be deformable in this case, since the proximity sensors 146 are responsive only to approach, but not pressure of body tissue, so that at the same time the position of a lip 148 and an adjacent incisor 38 can be detected.
  • Proximity sensors 146 may also be designed to respond only to the approach of hydrous tissue so that incisor 38 is not detected.
  • the density of the Nä ⁇ herungssensoren 146 determines the spatial resolution of the Aufbisssensors 130 in the insertion direction. In the in Figs. 28 and
  • the spatial resolution can be increased when interpolated between electrical signals generated by adjacent piezo elements 140 or proximity sensors 146.
  • FIG. 30 shows a detail of a sensor element of the stem sensor 130, which is designed as a linear potentiometer 150 in a representation similar to FIGS. 28 and 29.
  • the linear potentiometer shown only schematically in FIG. 30 has a resistance surface 152 extending along the insertion direction and an elastic electrode 154 guided parallel thereto at a small distance, which is connected in common with the resistance surface 152 in the manner of a voltage divider circuit.
  • the movable tapping point required with a linear potentiometer is generated at the linear potentiometer 150 where the elastic electrode 154 is deflected by a tooth 38 or the patient's lip through an elastic outer wall 136 so that the elastic electrode 154 contacts the resistance surface 152 is present.
  • the Position point represents the tapping point of the linear potentiometer.
  • the position of the point of attachment along the insertion direction can then be derived from the measured voltage with high accuracy in a conventional manner.
  • FIG. 31 shows in a manner similar to FIG. 27
  • the sensory impression in the patient 36 is quite different with smaller jaw movements, depending on whether his incisors engage in the bite notches 160a, 160b or (accidentally) rest on the smooth hard surface of the sleeve 12 next to them.
  • the sleeve 132 is by means of a servomotor 164 along its . Displaced longitudinally.
  • the servomotor 164 is in turn driven by the computer 16.
  • the control of the servomotor 164 takes place in such a way that it is given a desired distance between the bite notches 160a, 160b on the one hand and the x-ray source 28 on the other hand.
  • This desired distance can be calculated in the computer 16 by a program, the patient-specific parameters such as age, gender o. ⁇ . Are supplied.
  • the nominal distance can, however, also be predefined directly to the computer 16 with the aid of suitable input means.
  • the servomotor 164 moves the sleeve 132 with the bite notches 160a, 160b arranged thereon so that the desired setpoint distance is achieved.
  • Servomotor 164 serves as a position sensor at the same time, so that the computer 16 is always aware of the actual distance between the bite notches 160a, 160b and the X-ray source 28.
  • the up-gauge sensor shown includes an additional position sensor 166 for measuring the position of sleeve 132 relative to insertion portion 122 along the longitudinal direction thereof.
  • the position sensor 166 optically scans one in this embodiment
  • the servo motor 164 is replaced by a locking device, which may be manually or electrically operated.
  • Position sensor 166 outputs the measured position tion preferably to a well-recognizable display device on which an operator can read the distance between the Aufbisskerben 160a, 160b on the one hand and the X-ray source 28 (or another derived therefrom size).
  • the locking device is then actuated by the operator or by a command from the computer 16, whereby the sleeve 132 detected and thus can not be moved in the direction of the double arrow 162.

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Abstract

L'invention concerne un procédé de production d'images radiographiques sans distorsion pour le diagnostic en odontologie ou en orthodontie. Une source de rayons X (28) est introduite dans la cavité buccale (34) d'un patient (36). Un détecteur de rayons X (32) est disposé de manière à s'étendre de l'extérieur au moins autour d'une partie de l'arc maxillaire du patient (36). Les dents du patient (36) sont ensuite éclairées par le rayonnement X et le rayonnement X frappant le détecteur de rayons X (32) est recueilli. Une image radiographique numérique est produite sur la base du rayonnement X détecté par le détecteur de rayons X. Selon l'invention, les coordonnées de plusieurs points de mesure situés sur les dents (38) sont mesurées à l'aide d'un dispositif de mesure (50; 64; 73; 50a à 50d; 106a, 106b, 66a, 66b; 110a, 110b; 130). L'image radiographie numérique est finalement corrigée de ses distorsions à l'aide de ces coordonnées.
PCT/EP2010/007904 2009-12-24 2010-12-23 Procédé et système de production d'images radiographiques sans distorsion pour le diagnostic en odontologie ou en orthodontie WO2011076416A1 (fr)

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RU2012131268/14A RU2012131268A (ru) 2009-12-24 2010-12-23 Способ и система для создания рентгеновских снимков с устранением искажений для стоматологической или ортодонтической диагностики
FI20125813A FI20125813A (fi) 2009-12-24 2012-07-19 Hammaslääketieteelliseen tai leuan ortopediseen diagnostiikkaan tarkoitettujen, oikaistujen röngtenkuvien valmistukseen tarkoitettu menetelmä ja systeemi

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DE102009060390A DE102009060390A1 (de) 2009-12-24 2009-12-24 Verfahren und System zur Herstellung von entzerrten Röntgenbildern für die zahnmedizinische oder kieferorthopädische Diagnostik
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DE102010009276A1 (de) 2010-02-25 2011-08-25 Dürr Dental AG, 74321 Röntgenröhre sowie System zur Herstellung von Röntgenbildern für die zahnmedizinische oder kieferorthopädische Diagnostik
DE102010013591A1 (de) 2010-03-31 2011-10-06 DüRR DENTAL AG Röntgengerät und Verfahren zur Herstellung von Röntgenbildern für die zahnmedizinische oder kieferorthopädische Diagnostik

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CN113226213A (zh) * 2019-06-27 2021-08-06 登士柏希罗纳有限公司 口腔内咬合设备和通过使用该口腔内咬合设备记录患者的解剖特征的方法
CN113226213B (zh) * 2019-06-27 2024-03-15 登士柏希罗纳有限公司 口腔内咬合设备和通过使用该口腔内咬合设备记录患者的解剖特征的方法

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