2009 World Congress on Computer Science and Information Engineering
Design and Implementation of a Knowledge Engineering-based Dental
Diagnostic Expert System (DDES)
Haiguang Zhang
Rapid Manufacturing Engineering Center,
Shanghai University, Shanghai 200444,
China
College of Mechanical Engineering,
Inner Mongolia University of Technology,
Hohhot, 010051, China
haiguangdd@shu.edu.cn
Abstract
In this paper, we propose an expert system which is
based on Knowledge Engineering named DDES -
Dental Diagnostic Expert System. Besides, a hybrid
knowledge acquisition strategy is proposed to
efficiently elicit the knowledge from experienced
dentists and construct the medical ontology. The
system fulfills the storage of dental photos and X-ray
images, typical cases, patients’ information and
concerned data. It enables the complex query for
combined conditions and the display of requisite
results by interactive interface between user and
computer. For those teeth by root canal therapy, we
can not only differentiate the 3D images between pre
and post treatment, but also analyze force condition of
every tooth. Theses query and analysis results supply
dentists with diagnostic basis. The DDES uses
Artificial Intelligence, Knowledge Engineering,
Database and Computer technology and acts as a
consultant role to help dentists diagnose some dental
diseases. For the students of dental academy and
practical dentist, the DDES is a useful learning and
aided diagnosis tool.
1. Introduction
It’s very important for a better life to own healthy
teeth. The dental diseases trouble many patients. The
ratio of dentists and total population is only maintained
at 1:100000, so the number of dentists can’t satisfy the
people’s needs in China. Besides, the stomatology is a
very strong technical and operable science, so it is
necessary to exercise skills and accumulate
978-0-7695-3507-4/08 $25.00 © 2008 IEEE
DOI 10.1109/CSIE.2009.589
Qingxi Hu, Yuan Yao, Qi Wang
Rapid Manufacturing Engineering Center,
Shanghai University, Shanghai 200444,
China
huqingxi@shu.edu.cn
experiences constantly[1]. The number of experienced
dentists is relatively limited, so induce some young
doctors who are short of experiences to participate in
diagnosis. Obviously, it is necessary that many
ordinary dentists can share abundant experiences and
knowledge which are owned by a few specialists.
If the expert system is built through digging special
knowledge and experiences from human experts’ brain,
it isn’t limited by time or space and supply
consultation and assistance for workers who are in the
fields [2]. In almost thirty years, the medical expert
systems have been researched and developed at home
and abroad [3] [4]. Up to now, it has already made a
great evolution, but there are a few systems using for
dental consultation and diagnosis [5] [6]. Most of
expert systems which are related with teeth are mainly
aim to dental electronic medical record [7] ，dental
digital image processing [8] or information
management of dentistry. The functions of them are
too simple to satisfy the needs of dentists.
Dental Diagnostic Expert System (DDES)
integrates Artificial Intelligence, Knowledge
Engineering, Database and Computer technology. It
can fulfill knowledge acquire automatically, complex
query for combined conditions, intelligent diagnosis of
dental diseases. It acts as a consultant role to help
dentists diagnose some dental diseases.
2. The whole framework of DDES
DDES adopts modularized frame which includes
inference engine, dental knowledgebase and general
database module, explaining module, human-machine
interface and knowledge acquisition module. The
modularized structure is convenient to debugging and
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maintenance of the program and expansion of the
system. The structure and relationship inter-modules of
DDES are shown in Figure 1.
Figure 1. The whole framework of DDES
2.1 Human-machine interface module
The human-machine interface module is used to
input and output data. The users aren’t mainly versed
in computer, such as dentists or patients, so a friendly
interface must be required. The user interface of DDES
is developed by JSP. Because of web-based, it is easy
to operate. Different page is used respectively to query,
diagnosis, analysis, suggestion and discussion.
2.2 Database module
The database module of DDES is composed of
dental knowledgebase and general database.
The general database mainly storages a large of
data and information relating with teeth and dental
diseases, including glossary, the name and functions of
teeth, the name and features of dental diseases, and
images, shape photos, cross-section photos, X ray
images and micro-CT scanning data of teeth.
The dental knowledgebase includes knowledge and
rules using for decision-making, symptoms of normal
dental diseases, intermediate processing results,
diagnosis results, typical cases, and therapeutic
schemes. It is a critical factor to implement
knowledge-base expert system.
2.3 Knowledge acquisition module
This module can acquire knowledge effectively
form dental experts, and then transform the knowledge
acquired into apprehensible form by computer and
input to the dental knowledgebase.
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2.4 Inference module
The inference engine can simulate thinking or
reasoning process of dental experts to control and
execute problem-solving. The traditional inference
methods include forward, reverse and hybrid inference.
The inference module of DDES adopts uncertainty
reasoning. According to symptoms known, DDES can
reason and diagnosis through transferring the data from
database and using knowledge and rules in
knowledgebase.
2.5 Explaining module
The explaining module can illuminate the process
how the diagnostic results generate and what the main
reasons cause the disease. This module needs support
form inference engine and dental knowledge.
3. Key technologies and implementation
procedure
3.1 Hybrid knowledge acquisition strategy
Knowledge acquisition (KA) and knowledge
representation are the fundamental building blocks of
knowledge-based systems. The stomatology is a very
strong technical and operable science, so relative
knowledge is acquired difficultly. But it is very critical
to get knowledge from dental experts. KA has always
been regarded as the bottleneck in developing an
expert system. Some commonly used approaches are
interviews, observations, taking experts through case
studies, and rule induction by machines learning [9].
In order to help extracting knowledge from dental
experts and constructing the corresponding medical
ontology hierarchy, we propose an efficient KA
scheme to fast conceptualize medical domain
knowledge by using a hybrid method. Firstly, through
questionnaire surveys and interviews to patients and
dental experts, we can collect a large number of raw
data describing symptoms and construct concept
model. Meanwhile we can adopt KA tools to assist in
eliciting knowledge automatically which includes
object-oriented KA editor and web-based KA interface.
These tools are often easier and more accurate to
enumerate critical factors and construct ontology
hierarchy. Finally, dental expert or knowledge engineer
will merge these data and information to a whole
dental medical ontology. The implementation
procedure of hybrid dental knowledge acquisition is
shown in Figure 2.
Figure 2. Hybrid dental knowledge acquisition
3.2 Construction of Database
Database of dental diseases plays an important role
of the DDES. It is used for storing all the information
needed for diagnosis. We must classify information
collected and add to corresponding sub-database
gradually. The databases of DDES are realized by
using Access. Figure 3 shows some databases used in
the DDES.
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Figure 3. Sample databases
Database is a necessary condition if users want to
complex query for combined conditions. Namely,
dentists can input combined conditions through
human-machine interface, DDES will search matched
data or information and feed results found back to
users in reports or images forms.
(1) General database is composed of four sub-
databases which are glossary, information, photos and
CT data. They separately sore relative data. For
example, if user wants to query the information of the
maxillary premolar, he just inputs name of the teeth or
click on corresponding poison in occlusion image.
Figures 4 shows information found in general database.
Shape photos Cross-section photos
X ray images
Figure 4. Results in general database
(2) Knowledgebase is composed of facts database,
cases database, diagnosis rules database and
therapeutic schemes database. The facts database stores
symptom, analysis result of teeth and intermediate
processing results. The cases database stores old
experiences and typical cases. The diagnosis rules
database stores relative dental diseases knowledge and
therapy experiences of dental experts. The therapeutic
schemes database stores causes of disease, actions
needed to execute, prescriptions and prevention
schemes.

3.3 Auxiliary Diagnosis Module

The dental caries is the most common dental

disease. Now root canal therapy is its main therapeutic
method. Even the same position tooth, different patient
has obvious shape difference of tooth and different
degree and position of cavity. If dentists adopt the
same therapy scheme with that of old cases to deal
with tooth, it is very possible to make mistakes.
Aiming to solve this problem, DDES adds auxiliary
diagnosis module. The functions of the module include
two parts:
(1) Force analysis
For the tooth diagnosed to dental caries, we will
scan pre and post treatment tooth with Micro-CT and
store scanning data into CT database. Then using these
data to realize 3D reconstruction by Simpleware and
analyze force by Ansys. The analysis results can Figure 6. Extraction and analysis for middle of
display on the interface of DDES and supply dentists root canal
with important factor to modify existing methods and
decide new therapy scheme. Figure 5 shows handling
process of force analysis module.
4. Work flow of DDES
(2) Extraction and analysis for midline of root canal
The dentists must input patient’s main symptoms

Figure 5. Handling process of force analysis module

During the process of root canal therapy, curing
machines may injure root canal. For the dentists who
are lack of experiences, the probability of misoperation
is higher. If the dentists can clearly know difference
between pre and post treatment, they can select better
therapy scheme. DDES can extract the midline of root
canal and analyze deviation, as if figure 6.
through human-machine interface at first, and then
DDES will check the description. If the main
symptoms are not matching dental diseases
characteristics, system will reply the “Wrong Input”
message to dentists. Otherwise, system will move on to
diagnostic processes. DDES will automatically reason
by using diagnosis knowledge and rules stored in
knowledgebase. After successful matching completed,
DDES will identify the class and name of dental
disease and the system will generate conclusions of the
diagnosis, treatment methods and prescriptions. At the
same time, the explaining module will get all records
and information about the inference processes. The
diagnosis processing and result will display in HTML
file format on the interface, so the dentists may clearly
know diagnosis of DDES.

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 The working process of the DDES is shown in
Figure 7.
Figure 7. Working flowchart of DDES
5. Conclusion
In this paper, we have presented a knowledge-
based dental diagnostic expert system named DDES.
The DDES integrates Artificial Intelligence,
Knowledge Engineering, Database, Computer and
stomatology technologies. DDES is a high-efficiency
and practical computer aided medical expert system.
Our experience has shown the effectiveness of this
system. Specially, hybrid knowledge acquisition
strategy, complex query for combined conditions,
intelligent diagnosis of dental diseases and auxiliary
diagnosis module are characteristics in the DDES.
DDES can serve as not only an educational tool to the
students of stomatological colleges and practical
dentist but also an assistant to dentists diagnosing
dental diseases and inquire relative material. In a word,
DDES can improve quality and level of serves. It has a
wide application prospect and commercial value.
Acknowledgments
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This paper has been supported by Graduate
Innovative Foundation of Shanghai University.
Authors are also grateful to reviewers for the
thoughtful suggestions that helped improve the
manuscript.
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