ORTHO BYTES

The use of computers, computer programs, and other computerized equipment to assist in the orthodontic practice will
be reported under this section of the American Journal of Orthodontics and Dentofacial Orthopedics. Manuscripts and
comments may be submitted to Dr Martin Abelson, 14720 N Shotgun Pl, Tucson, AZ 85737.

Morphing and Warping. Part I

Demetrios J. Halazonetis, DMD, MS
Athens, Greece

Morphing, to morph, comes from the Greek word p.op(~ogvog, cross-dissolve from one image to another you need to gradu-
to give shape to something. The verb originates from the noun ally change the color of each pixel, from the color of the first
/Jopq~r/which, according to a dictionary of modern Greek lan- image to the color of the final image. This will produce a
guage, 1can have eight meanings. Among these is the meaning series of images, which, when projected one after the other,
of external appearance or shape, but also, when applied to a will give the impression that the first image is fading out,
human person, the meaning of face (eg, her face-/.topq~r/ while the second image fades in. Fig 1 shows a cross-dissolve
remains engraved in my memory). It seems, therefore, highly sequence. Observe that both the initial and final images are
appropriate that this technique of computer graphics should present in the intermediate images, and appear as ghost
become a part of our diagnostic and patient-education proce- images superimposed on top of each other.
dures, as we use it to plan or predict shape changes in our To make a cross-dissolve using Morpher, load the
patients' faces. Most readers are undoubtedly familiar with the
initial and final image using the File I Import first
latest cephalometric software, where the original photograph frame and File I Import last frame commands. Make
of a patient can be transformed to give a representation of the sure that the rendering option (Mode I Image trans-
posttreatment result. Although the accuracy of such software form option...) is set to Morphing. Select Mode I Start
is debatable, the help they offer in patient-doctor communica-
rendering.., and choose the Make a digital movie
tion is undeniable.2 This article will explain the morphing pro-
action. Morpher will construct the cross-dissolve
cedure and show how you can achieve the same results using images and save them to disk as a movie. This may take
freeware or shareware programs. Other uses of morphing in
some time depending on the size of the images.
orthodontics will be discussed in Part II.
Morphing is closely related to warping, another computer The initial and final images of Fig 1 are based on the art-
graphics technique. Actually, warping is the established com- work of M. C. Escher, 3 who made several prints (woodcuts
puter jargon for the procedure we use when making a treatment and engravings) depicting the gradual transformation of one
prediction. Warping is the distortion of one static image to pro- form to another. Notable examples are the prints Develop-
duce another static image. In contrast, morphing refers to trans- ment II and Metamorphosis II. The cross-dissolve sequence
forming one image to another through a series of intermediate shown above is not particularly impressive and does not do
images, which, when projected successively, give the impres- credit to the artist. A much more effective result, using mor-
sion of a gradual "metamorphosis." Morphing is, therefore, a phing, is shown in Fig 2.
computer movie. To achieve effective morphing it is not enough
to superimpose the initial and final image and slowly fade one
WARPING
in, while fading the other out. Such a procedure, called cross- The effectiveness of the morphing sequence of Fig 2 is
dissolving, is not impressive and does not give the illusion of due to the concomitant application of warping and cross-dis-
metamorphosis. What is needed is a gradual warping of one solving. Warping distorts the image while cross-dissolving
image to the other, together with a cross-dissolve. blends each image frame smoothly to the next. During the
Let us explore these techniques in more detail and see how hexagon metamorphosis, the feet, tail, and head of the reptile
they can be applied to our profession. There are several free- seem to grow out of the hexagon. Each body part originates
ware and shareware programs for morphing images. I am going from a specific part of the hexagon. This correspondence is
to use Morpher for Windows as an example here, because it is basic to morphing and is called "mapping." In order to achieve
comprehensive enough for our needs and it can be downloaded effective morphing, we must specify the mapping relation-
from the Internet. Morpher for Windows was written by ships. This is accomplished by placing feature elements, or
Masakazu Fujimiya (e-mail, [email protected]) and is a nodes, on the images. The nodes come in pairs and identify
shareware program. You can find it at http://www.asahi- corresponding features in the initial and final images.
net.or.jp/-FX6M-FJMY/. The images and other files can be Let us assume that the image is drawn on an elastic sur-
found at my web site (http://www.dhal.com). face that we can stretch or compress. The warp procedure dis-
places the nodes from their initial to the final positions, thus
Cross-dissolving versus morphing deforming the "elastic" image surface and transforming the
Cross-dissolving is probably one of the simplest proce- picture. For a detailed description and the mathematics of the
dures that can be used to transform one image into another. To method see the classic article by Beier and Neely.4
Fig 3 shows a simple grid, which is ideal for demonstrat-
Part-time instructor, Orthodontics Department, Athens University, Greece. ing how warping transforms the image surface. A single node
Reprint requests to: D. Halazonetis, 6 Menandrou Street, Kifissia 145 61,
has been positioned at the center of the grid. If we 'pull' this
Greece; e-mail, [email protected]; Web site, http://www.dhal.com

466
American Journal of Orthodontics and Dentofacial Orthopedics Ortho bytes 467
Volume 115, Number 4

Fig 1. Hexagon is cross-dissolved into a reptile•

Fig 2. This morphing sequence was done in two separate stages, from the hexagon to the interme-
diate shape, and from there to the final reptile, so that a more realistic metamorphosis could be
achieved.

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r'T~-'T--f--a~..4.., ~....,i..ql..p~

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Fig 3. Simple grid distortion by moving one node Fig 4. Warping with two nodes.
downward.

node downwards, as shown by the arrow, the whole grid is Warping (use left image). Select Mode I Start render-
distorted. Fig 4 shows a distortion using two nodes that were ing.., and choose the Make a still image action. Move
moved in opposite directions. the Preview point to the 100 setting and click OK. Mor-
pher will construct the warped image for you.
To create a simple warp with Morpher for Windows,
load an image using the File I Import first frame com- There are a few observations that can be made from the
mand. Then load the same image with the File I Import above examples. First, the pixels beneath the nodes are
last frame command. Use the Edit node mode tool (or mapped to the new location of each node in the final image.
the command from the Mode menu) to position nodes Therefore, if you want to be sure that a particular feature of
on the left image. To position a node, double-click with the image will end up at a specific point, place a node over it
the mouse. A small square will appear on both images. and drag the corresponding node of the final image to the
After positioning the nodes, drag the nodes of the right- desired location. Second, all other pixels are influenced by the
hand-side image to other locations. Change the trans- nodes, depending on the distance of each pixel from each
form option (Mode I Image transform option...) to node. The farther away a pixel is from a node, the less it will
468 Ortho bytes American Journal of Orthodontics and Dentofacial Orthopedics
April 1999

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ary nodes for a local effect. II Ilill|t~ik~lill
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be distorted. However, the effect of each node extends a con- mmmmimmmm•mmlmmmnm
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siderable distance and may cover the whole image, if the
image is small. This means that it is not easy to get as local an
effect as we would like. For example, if we wish to move the
upper lip only, a single node on the lip will probably affect the
nose and lower lip as well. The positive aspect is that the final
image does not contain jagged edges like those produced
when cutting and pasting images, because the effect of the
node fades gradually to nothing at some distance away. Fig 6. Two-node distortion. Middle figure shows the
An easy solution to the problem of global distortion is to result without a boundary, and bottom figure shows
place more nodes but move only some of these. We can place the result with a boundary connecting the two nodes.
a node on the nose and a node on the upper and lower lips,
but reposition only the upper lip node. In this way, the fixed
nodes pin the image down and do not allow it to distort at
doubleclick on the boundary to select it and press the
those areas. Fig 5 shows this effect and demonstrates that it is
Delete button on the keyboard.
possible to achieve some locality in warping.
A further improvement in our warping capabilities can be
achieved by using boundaries. Boundaries are line segments W A R P I N G FACES
that connect the nodes to each other. You can think of a One of the main uses of warping in orthodontics is in
boundary as a string of many nodes placed next to each other. treatment prediction. Morpher for Windows can help you
If two nodes are connected with a boundary, then the effect of achieve excellent results in a reasonable amount of time. It
the nodes is not limited to themselves but spreads along the can be used even if you make your VTO prediction by the tra-
boundary. Fig 6 shows the difference between using two soli- ditional pencil and paper method. The steps that you should
tary nodes and the same nodes connected by a boundary. follow are explained below.
To connect two nodes with a boundary, switch to
E d i t b o u n d a r y m o d e from the M o d e menu, or by Initial Image
clicking the respective button on the toolbar. Position Start Morpher and load the initial image of your patient
the cursor on one node and double-click. The mouse using the File I I m p o r t first frame command. Morpher can-
cursor changes to reflect the boundary mode. Move the not connect directly to your scanner or digital camera, so you
mouse to another node and click once. A line joining must have saved the image to your hard disk under the BMP
the two nodes will be drawn. To delete a boundary, (Windows Bitmap) format. It is extremely more convenient if
American Journal of Orthodontics and Dentofacial Orthopedics Ortho bytes 469
Volume 115, Number 4

Fig 8. Screen shot shows placement of nodes. Nodes

on right-hand side image have been moved from their
original positions (dark line) to the predicted positions
(lighter line).

the image. This problem has been mentioned by Hoeltzel 5

and was solved by placing a ruler close to the patient when
taking the photograph. The same method can be used here,
but there is a more precise method, and it is based on the
fact that the second image in Morpher can be anything we
like. Why not have a millimeter grid? Take a piece of white
cardboard and draw a grid of lines 5 mm apart. Place the
cardboard in the same position as your patient was and take
a photograph of it. Then use the photograph of the grid as
your second image. Because your camera settings are con-
stant between shots, this grid can give you reliable size
information for positioning the warping nodes. The same
Fig 7. Initial image and final image containing the pre- image of the grid can be used for all your patients.
diction tracing. Maxillary advancement and mandibular The above trick is useful if your VTO prediction is done
set-back have been planned for this patient. with pencil and paper. If you have a cephalometric program
that performs the VTO, you can still use it, but a different
method may be more accurate, although more involved. With
all your facial images are taken with the same camera setup your cephalometric program and a graphics manipulation pro-
and resolution, so that size is consistent. gram (eg, PaintShop Pro, or even Microsoft PowerPoint), you
Final Image should be able to construct a composite image that shows the
patient's photograph together with the prediction tracing.
Morpher requires a second image in order to function prop-
The exact procedure depends on the specific programs that
erly. However, this image is only important for a morphing pro-
you are using. Here is a general outline of the method.
cedure, where we want the initial image to be transformed to
the final image. If we intend to do a warping transformation, From your cephalometric program, superimpose the
then the final image is not used. Its function is only to help in initial and VTO tracings on the cranial base and export
the positioning of the warping nodes and boundaries. Morpher them as a graphics file or copy them to the Windows
does not care what the image is actually showing, because no clipboard. Then, start your graphics program. Import the
information is taken from it. This is a very important fact and initial photograph of your patient and paste the compos-
it can help us significantly, as we shall see below. ite tracing on top of it. Scale and rotate the composite
Consider for a moment what we need in order to per- tracing until the soft tissue outline of the initial tracing is
form the warp. We have the initial image, we can place superimposed on the photograph profile. This should
nodes and boundaries on it, and we can move these to bring the soft tissue outline of the prediction tracing to
achieve the desired distortion. But how do we know exactly the correct position. Then, export the whole image to
where to move the nodes? The VTO prediction will give us disk as a BMP file. Several earlier articles5,6 give more
the soft tissue changes, but there is no absolute size infor- detailed instructions on using Microsoft PowerPoint or
mation on the facial image. We need a way to measure on graphics programs that work with layers.
470 Ortho bytes American Journal of Orthodontics and Dentofacial Orthopedics
April 1999

Fig 9. From left to right: initial facial photograph, warped image, actual posttreatment photograph.
Note that the warped image only shows changes of the profile. Other changes, eg, the filling-in of
the midface due to the Le Fort I procedure, cannot be simulated.

The resulting image should show the initial photograph, Do the warp
the initial soft tissue tracing, and the final VTO prediction
Change the transform option (Mode I Image transform
tracing. Load this as the second image in Morpher using the
option...) to Warping (use left image). Select Mode I Start
File I Import last frame command (Fig 7).
rendering.., and choose the Make a still image action. Move
the Preview point to the 100 setting and click OK. Morpher
Node positioning will construct the warped image for you (Fig 9).
Use the Edit node mode tool (or the command from the Usually, the result is very satisfactory, with no need for
Mode menu) to position nodes on the left image. Double- retouching, as is often necessary when cutting and pasting an
click on points along the facial profile starting from Glabella image. This is because the distortion of the warp procedure
and continuing all the way down to the neck. For each node fades out gradually at some distance from the nodes. Occa-
that you place, a second node appears automatically on the sionally, some artefacts may be present at the lips, a problem
final image, at the same location. Therefore, if your final that occurs because this is an area of large 'shearing' of the
image is the photograph-tracing composite, the nodes should image due to opposite movements of the upper and lower lip
appear on the photograph profile. nodes. Slight adjustment of the nodes may be necessary for a
For improved quality, place at least three nodes on each better result. Before closing Morpher, it is a good idea to save
lip and make sure that you have a different node for Stomion your work as a Morpher file, so that you keep the positions of
Superior and for Stomion Inferior. nodes and boundaries.

Boundaries CONCLUSIONS
Connect the nodes with boundaries using the Edit bound- Commercial cephalometric programs are increasingly
ary mode tool. Start from Glabella and connect each node to incorporating warping features. However, warping facial
the next until you reach Stomion Superior. Then start a new images for treatment prediction can now be accomplished eas-
boundary from Stomion Inferior to the neck points. ily without expensive software or hardware. The second part
of this article will discuss other uses of morphing in ortho-
Reposition the nodes dontics that can significantly enhance patient education.
REFERENCES
Next, we move over and work on the final image in order
to reposition the nodes that have been placed there automati- 1. Babiniotis G. Dictionary of modem Greek language. Lexicology Center, Athens,
Greece; 199S.
cally by Morpher. Use the Edit node mode tool and drag each 2. Ackerman JL, Proffit WR. Communication in orthodontic treatment planning: bioeth-
node to the desired location, according to the VTO. If the final ical and informed consent issues. Angle Orthod 1995;65:253-62.
3. The world of M.C. Escher. New York: Harry N. Abrams, lnc, Publishers; 1971.
image is the millimeter grid, use the measurements from the
4. Beier T, Neely S. Feature-based image metamorphosis, In: Computer graphics, New
VTO to move each node by the desired amount, using the grid York: Proceedings of SIGGRAPH 1992; vol. 26 p. 35-42.
as a measuring guide. If the image is the photograph-tracing 5. Hoehzel GR. Off-the-self digital imaging/prediction. Am J Orthod Dentofacial Orthop
1998;113:476-77.
composite, just move each node from the photograph profile 6. Halazonetis DJ. Making slides for orthodontic presentations. Am J Orthod Dentofa-
to the prediction tracing profile of the VTO (Fig 8). cial Orthop 1998;113:586-9.