Jaw tissues segmentation in dental 3D CT images using fuzzy-connectedness and morphological processing

The success of oral surgery is subject to accurate advanced planning. In order to properly plan for dental surgery or a suitable implant placement, it is necessary an accurate segmentation of the jaw tissues: the teeth, the cortical bone, the trabecular core and over all, the inferior alveolar nerve. This manuscript presents a new automatic method that is based on fuzzy connectedness object extraction and mathematical morphology processing. The method uses computed tomography data to extract different views of the jaw: a pseudo-orthopantomographic view to estimate the path of the nerve and cross-sectional views to segment the jaw tissues. The method has been tested in a groundtruth set consisting of more than 9000 cross-sections from 20 different patients and has been evaluated using four similarity indicators (the Jaccard index, Dice's coefficient, point-to-point and point-to-curve distances), achieving promising results in all of them (0.726 ± 0.031, 0.840 ± 0.019, 0.144 ± 0.023 mm and 0.163 ± 0.025 mm, respectively). The method has proven to be significantly automated and accurate, with errors around 5% (of the diameter of the nerve), and is easily integrable in current dental planning systems.