EOTRH Syndrome in Polish Half-Bred Horses - Two Clinical Cases

An application of the density standard and scaled-pixel-counting protocol to assess the radiodensity of equine incisor teeth affected by resorption and hypercementosis: preliminary advancement in dental radiography

BACKGROUND

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome is a dental disease where the radiographic signs may be quantified using radiographic texture features. This study aimed to implement the scaled-pixel-counting protocol to quantify and compare the image structure of teeth and the density standard in order to improve the identification of the radiographic signs of tooth resorption and hypercementosis using the EOTRH syndrome model.

METHODS AND RESULTS

A detailed examination of the oral cavity was performed in 80 horses and maxillary incisor teeth were evaluated radiographically, including an assessment of the density standard. On each of the radiographs, pixel brightness (PB) was extracted for each of the ten steps of the density standard (S1-S10). Then, each evaluated incisor tooth was assigned to one of 0-3 EOTRH grade-related groups and annotated using region of interest (ROI). For each ROI, the number of pixels (NP) from each range was calculated. The linear relation between an original X-ray beam attenuation and PB was confirmed for the density standard. The NP values increased with the number of steps of the density standard as well as with EOTRH degrees. Similar accuracy of the EOTRH grade differentiation was noted for data pairs EOTRH 0-3 and EOTRH 0-1, allowing for the differentiation of both late and early radiographic signs of EOTRH.

CONCLUSION

The scaled-pixel-counting protocol based on the use of density standard has been successfully implemented for the differentiation of radiographic signs of EOTRH degrees.

Application of Two-Dimensional Entropy Measures to Detect the Radiographic Signs of Tooth Resorption and Hypercementosis in an Equine Model

Dental disorders are a serious health problem in equine medicine, their early recognition benefits the long-term general health of the horse. Most of the initial signs of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome concern the alveolar aspect of the teeth, thus, the need for early recognition radiographic imaging. This study is aimed to evaluate the applicability of entropy measures to quantify the radiological signs of tooth resorption and hypercementosis as well as to enhance radiographic image quality in order to facilitate the identification of the signs of EOTRH syndrome. A detailed examination of the oral cavity was performed in eighty horses. Each evaluated incisor tooth was assigned to one of four grade-related EOTRH groups (0-3). Radiographs of the incisor teeth were taken and digitally processed. For each radiograph, two-dimensional sample (SampEn2D), fuzzy (FuzzEn2D), permutation (PermEn2D), dispersion (DispEn2D), and distribution (DistEn2D) entropies were measured after image filtering was performed using Normalize, Median, and LaplacianSharpening filters. Moreover, the similarities between entropy measures and selected Gray-Level Co-occurrence Matrix (GLCM) texture features were investigated. Among the 15 returned measures, DistEn2D was EOTRH grade-related. Moreover, DistEn2D extracted after Normalize filtering was the most informative. The EOTRH grade-related similarity between DistEn2D and Difference Entropy (GLCM) confirms the higher irregularity and complexity of incisor teeth radiographs in advanced EOTRH syndrome, demonstrating the greatest sensitivity (0.50) and specificity (0.95) of EOTRH 3 group detection. An application of DistEn2D to Normalize filtered incisor teeth radiographs enables the identification of the radiological signs of advanced EOTRH with higher accuracy than the previously used entropy-related GLCM texture features.

Equine Odontoclastic Tooth Resorption and Hypercementosis

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a recently described painful and progressive condition of unknown etiology that occurs in middle-aged and geriatric equines. It predominantly affects the permanent incisor and canine teeth and, less commonly, the premolar and molar dentition. EOTRH was first reported in peer-reviewed literature in 2008, with subsequent publications of case reports, histological studies and retrospective case series. There have been few significant research developments related to this disease. The existing studies have primarily involved single case studies or small sample sizes, without control groups. This review aimed to report current information about EOTRH in terms of clinical, histopathological, diagnostic, radiological, and therapeutic aspects, by searching the available peer-reviewed scientific literature.

Selection of Filtering and Image Texture Analysis in the Radiographic Images Processing of Horses' Incisor Teeth Affected by the EOTRH Syndrome

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is one of the horses’ dental diseases, mainly affecting the incisor teeth. An increase in the incidence of aged horses and a painful progressive course of the disease create the need for improved early diagnosis. Besides clinical findings, EOTRH recognition is based on the typical radiographic findings, including levels of dental resorption and hypercementosis. This study aimed to introduce digital processing methods to equine dental radiographic images and identify texture features changing with disease progression. The radiographs of maxillary incisor teeth from 80 horses were obtained. Each incisor was annotated by separate masks and clinically classified as 0, 1, 2, or 3 EOTRH degrees. Images were filtered by Mean, Median, Normalize, Bilateral, Binomial, CurvatureFlow, LaplacianSharpening, DiscreteGaussian, and SmoothingRecursiveGaussian filters independently, and 93 features of image texture were extracted using First Order Statistics (FOS), Gray Level Co-occurrence Matrix (GLCM), Neighbouring Gray Tone Difference Matrix (NGTDM), Gray Level Dependence Matrix (GLDM), Gray Level Run Length Matrix (GLRLM), and Gray Level Size Zone Matrix (GLSZM) approaches. The most informative processing was selected. GLCM and GLRLM return the most favorable features for the quantitative evaluation of radiographic signs of the EOTRH syndrome, which may be supported by filtering by filters improving the edge delimitation.

Application of Hyperbaric Oxygen Therapy (HBOT) as a Healing Aid after Extraction of Incisors in the Equine Odontoclastic Tooth Resorption and Hypercementosis Syndrome

Hyperbaric Oxygen Therapy (HBOT) is a stress-free, relatively safe method supporting the treatment of many different diseases. Although it is widely used in human medicine (including dentistry), in veterinary medicine, especially in the treatment of horses, there are not many scientifically described and documented cases of its use. Equine Odontoclastic Tooth Resorption and Hypercementosis syndrome is a disease that affects older horses and significantly reduces their quality of life. The only effective treatment for this condition is extraction of the incisors. The described case compares the recovery process of the alveolar area after extraction of incisors during the course of EOTRH syndrome without and with the use of a chamber, in horses with the same clinical picture of the disease, of the same age, and living in the same conditions. According to the authors' knowledge, the presented case describes the use of a chamber in equine dentistry for the first time.