Manual tracing versus smartphone application (app) tracing: a comparative study

Accuracy and tracing time of cephalometric analyses on a tablet or desktop computer : A prospective study

BACKGROUND

This prospective study aimed to evaluate the influence of the computer type (tablet or desktop) on accuracy and tracing time of cephalometric analyses.

METHODS

Dental students used a web-based application specifically developed for this purpose to perform cephalometric analyses on tablet and desktop computers. Landmark locations and timestamps were exported to measure the accuracy, successful detection rate and tracing time. Reference landmarks were established by six experienced orthodontists. Statistical analysis included reliability assessment, descriptive statistics, and linear mixed effect models.

RESULTS

Over a period of 8 semesters a total of 277 cephalometric analyses by 161 students were included. The interrater reliability of the orthodontists establishing the reference coordinates was excellent (ICC > 0.9). For the students, the mean landmark deviation was 2.05 mm and the successful detection rate for the clinically acceptable threshold of 2 mm suggested in the literature was 68.6%, with large variations among landmarks. No effect of the computer type on accuracy and tracing time of the cephalometric analyses could be found.

CONCLUSION

The use of tablet computers for cephalometric analyses can be recommended.

Preferences and Satisfaction Toward an Orthodontic Clinical App

OBJECTIVES

 To promote the development of professional orthodontic apps and to grow app engagement, many contributing factors should first be scrutinized. The main purpose of this research was to assess whether gap analysis facilitates strategic app design.

MATERIALS AND METHODS

 Gap analysis was first conducted to reveal users' preferences. Then, the OrthoAnalysis app was developed on an Android operating system using Java programming language. Finally, a self-administered survey was issued to 128 orthodontic specialists to assess their satisfaction toward usage of the app.

STATISTICAL ANALYSIS

 The content validity of the questionnaire was ascertained using an index of Item-Objective Congruence of more than 0.5. The reliability of the questionnaire was also analyzed with Cronbach's Alpha reliability coefficient (ɑ = 0.87).

RESULTS

 Besides the most important factor, "content," many issues were listed, and all were required to engage users. A strong and engaging app should show accurate, trustworthy, and practical clinical analysis that operates smoothly and fast with ease, along with a user-friendly, appealing, and trustworthy interface. In short, because of the preliminary gap analysis that was done to evaluate the potential app engagement power prior to app design, the result of the satisfaction assessment showed that nine traits including overall satisfaction were of high levels.

CONCLUSIONS

 Orthodontic specialists' preferences were assessed using gap analysis and an orthodontic app was designed and appraised. This article presents the orthodontic specialists' preferences and summarizes the process of achieving app satisfaction. Therefore, to create a clinical app with strong engagement power, a strategic initial plan using gap analysis can be recommended.

Agreement of the Newly Developed Moyers' Equations and Moyers' Tables

OBJECTIVE

 This study aimed to develop the Moyers' prediction equation to be used with tooth widths predicting app on smartphone.

MATERIALS AND METHODS

 Four equations were developed separately for sex and dental arches. Internal validation with Moyers' table was finished. External validation on 37 subjects with agreement test of both Moyers' prediction equations and Moyers' prediction tables was performed.

STATISTICAL ANALYSIS

 A general linear model procedure was used to create four prediction equations. Internal validation was evaluated using the coefficient of determination. External validation was performed using Bland and Altman (BA) test.

RESULTS

 Four equations were developed for OrthoAnalysis app on smartphone. The overall coefficient of determination of all equations and prediction table was 0.998 (p < 0.05) indicating good agreement of the two methods. The agreement test on the 37 subjects was that the BA test revealed the BA limits of agreement between the residuals of two predictions was -0.001 mm and ranged from -0.143 to 0.140 mm with almost all plots lying inside this difference interval.

CONCLUSIONS

 In summary, four novel estimation equations were developed and showed very low difference to the well accepted original Moyers' prediction tables. Therefore, the equations used in the orthodontic app for predicting unerupted tooth width were verified and valid for clinical use.

Accuracy of Manual and Virtual Predictive Tracings in Patients Submitted to Orthognathic Surgery

Cephalometric tracing done manually was considered gold standard for the cephalometric analysis in the last decades. The digital radiographs began to be commonly used in order to make that in a digital way. The objective was to define the accuracy of the predictive and final cephalometric tracings performed manually and virtually. The authors selected 20 patients submitted to bimaxillary orthognathic surgery. The data were collected from lateral cephalometric radiographs, in the preoperative and postoperative periods. The interest were: points, angles (Sella-Nasion to A point angle; Sella-Nasion to B point angle; Frankfurt plane to Mandibular plane angle; Frankfurt plane to occlusal plane angle; Upper and lower central incisors long axes angle; Incisor to Mandibular plane angle; Upper incisor axis to Sella-Nasion plane angle) distances (Co-A; Co-Gn). Data were submitted to the Shapiro-Wilk, analysis of variance, and Kruskal-Wallis tests. The measurement differences were compared using a t test. Descriptive statistics were performed in Excel 2013 and SPSS software, P <0.05 being considered significant. No statistically significant difference was found between the mean values predictive and postoperative of the angles and distances within the manual and digital groups. When comparing the means of the differences between the predictive values and the final values, only the 1:1 angle presented a statistically significant difference, indicating a greater accuracy of the digital predictive tracing for this measure. In conclusion, both methods for obtaining predictive tracings are accurate, which shows that clinical results can be successfully simulated by the most accessible technique.

Evaluation and comparison of smartphone application tracing, web based artificial intelligence tracing and conventional hand tracing methods

AIM

The aim of this study was to compare and evaluate the reliability of three different cephalometric assessment methods: Smartphone Application Tracing Method CephNinja (SATM), Web Based Artificial Intelligence (AI) Driven Tracing Method WebCeph (WATM) and Conventional Hand Tracing Method (CHTM).

METHODS

110 lateral cephalometric radiographs were enrolled in the study and 4 linear and 7 angular parameters were traced and measured by one examiner using CephNinja, WebCeph and conventional hand tracing methods. Independent-samples Kolmogorov-Smirnov and Shapiro Wilks tests were used to compare the mean values of intra-examiner differences. Both intra-method and inter-method correlations were evaluated.

RESULTS

There were statistically significant differences between the methods in terms of SNA (p:0.003; p < 0.05); SNB measurements (p:0.001; p < 0.05); SN-MP angle (p:0.001; p < 0.05); U1-SN angle (p:0.001; p < 0.05); L1-NB(mm) (p:0.007; p < 0.05) and E Line-Upper Lip(mm) measurements (p:0.013; p < 0.05). All intra-method correlation coefficients are 80% and above. In terms of inter-method coefficients the lowest coefficient of agreement is 0.170 and it is the coefficient of agreement between CHTM and SATM for measurement of U1-NA. The highest coefficient of agreement is 0.884 which is between WBTM and SATM for SNB measurement.

CONCLUSIONS

The null hypothesis was rejected. There were statistically and clinically significant differences in various measurements among groups.

Evaluation of the accuracy and reliability of WebCeph – An artificial intelligence-based online software

Objectives:

Landmark identification is of utmost importance in cephalometric analysis but it turns out to be the main source of error. With modern inventions in the field of artificial intelligence (AI), it becomes essential to assess the reliability of computer-automated programs. A greater deal of time can be conserved with fully automated programs such as WebCeph, which uses an AI-based algorithm that performs automated and immediate cephalometric analysis. This study aimed to evaluate the accuracy, reliability, and duration of tracing cephalometric radiographs with WebCeph, an AI-based software in comparison to digital tracing with FACAD and manual tracing. The null hypothesis proposed is that there is no statistically significant difference among the three methods with regard to accuracy of cephalometric analysis.

Material and Methods:

Pre-treatment cephalometric radiographs of 25 patients (14 males and 11 females, mean age of 18 ± 3.2 years) were selected randomly from the dental information archiving software of Saveetha University, Department of Orthodontics, Chennai. Composite analysis with skeletal, dental and soft-tissue parameters was selected and cephalometric analysis was done with all three methods – Manual tracing (Group 1), digital tracing using FACAD (Group 2), and fully automated AI-based software WebCeph (Group 3). The timing for each method of analysis was calculated using a stopwatch in seconds. Values were tabulated in an Excel sheet and statistical analysis including one-way analysis of variance and post hoc Tukey test were performed.

Results:

No statistically significant difference was found between the three methods for cephalometric analysis, P > 0.05. The time taken for measurement using the three different methods was the least while using WebCeph (30.2 ± 6.4 s) and the maximum while manual tracing (472 ± 40.4 s).

Conclusion:

WebCeph is a reliable, faster and practical tool for analyzing cephalometric analysis in comparison to digital tracing using FACAD and manual tracing.

Artificial Intelligence in Orthodontic Smart Application for Treatment Coaching and Its Impact on Clinical Performance of Patients Monitored with AI-TeleHealth System

BACKGROUND

Treatment of malocclusion with clear removable appliances like Invisalign^® or Spark™, require considerable higher level of patient compliance when compared to conventional fixed braces. The clinical outcomes and treatment efficiency strongly depend on the patient's discipline. Smart treatment coaching applications, like strojCHECK^® are efficient for improving patient compliance.

PURPOSE

To evaluate the impact of computerized personalized decision algorithms responding to observed and anticipated patient behavior implemented as an update of an existing clinical orthodontic application (app).

MATERIALS AND METHODS

Variables such as (1) patient app interaction, (2) patient app discipline and (3) clinical aligner tracking evaluated by artificial intelligence system (AI) system-Dental monitoring^® were observed on the set of 86 patients. Two 60-day periods were evaluated; before and after the app was updated with decision tree processes.

RESULTS

All variables showed significant improvement after the update except for the manifestation of clinical non-tracking in men, evaluated by artificial intelligence from video scans.

CONCLUSIONS

Implementation of application update including computerized decision processes can significantly enhance clinical performance of existing health care applications and improve patients' compliance. Using the algorithm with decision tree architecture could create a baseline for further machine learning optimization.

Reliability of mobile application-based cephalometric analysis for chair side evaluation of orthodontic patient in clinical practice

OBJECTIVES:

The purpose of this study was to evaluate the accuracy and reliability of Mobile Application-Based Software for chair side cephalometric analysis.

MATERIALS AND METHOD:

Pretreatment lateral cephalograms of 20 patients (10 males and 10 females) were selected randomly and were traced manually and also using Application-based software (One Ceph). 20 angular and three linear parameters were measured both manually and with the software in all the patients. Inter and intra-operator reliability of one ceph was evaluated and the measured parameters were statistically compared with the manual method (Gold Standard).

RESULT:

The accuracy of angular and linear values was compared for all 23 parameters and our results showed no significant difference in the two methods used for most of the measurements. Three of the measurements [Angle of convexity (N-A; A-Pog); ANB angle; Upper Incisor to NA (Angular)] did show a statistically significant difference though these were clinically irrelevant.

CONCLUSION:

Application-based cephalometric analysis can be an effective clinical diagnostic tool for chair-side cephalometric evaluation of orthodontic patient.

Evaluation of accuracy and reliability of OneCeph digital cephalometric analysis in comparison with manual cephalometric analysis-a cross-sectional study

Introduction

Lateral cephalometric analysis continues to be one of the gold standard diagnostic aids in orthodontics, with various software available to enhance this.

Aim

This study was done to evaluate the accuracy and reliability of linear and angular measurements obtained from OneCeph digital cephalometric tracing and manual tracings in lateral cephalometry.

Methodology

This is a cross-sectional study done on twenty pre-treatment lateral cephalometric radiographs of subjects who reported to the postgraduate orthodontic clinic for orthodontic treatment over one month. Cephalometric tracings were done using OneCeph digital software and manual tracing method to evaluate nine parameters of Steiner’s cephalometric analysis. An Independent T-sample test was done between the mean values of manual and OneCeph tracing. Intra operator reliability was evaluated by paired T-test after a week.

Results

No significant statistical difference was observed as the p-value was greater than 0.05 for all the parameters in the two groups.

Conclusion

The reliability and accuracy of OneCeph software application was found to be at par with manual cephalometric tracing

The reliability and reproducibility of an Android cephalometric smartphone application in comparison with the conventional method

OBJECTIVES

To assess the reliability and reproducibility of linear and angular measurements of the cephalometric smartphone Android application OneCeph in comparison with the conventional method.

MATERIALS AND METHODS

A total number of 22 landmarks were registered, and 26 skeletal and dental cephalometric parameters were measured on 30 pretreatment cephalograms. The measurements for both digital (OneCeph) and conventional tracings were performed twice with a 4-week interval. The reliability (intraexaminer error) was evaluated by using the Pearson correlation coefficient. The variation in measurements between the tracing techniques (reproducibility) was determined by paired t-test.

RESULTS

The Pearson correlation coefficients of all cephalometric measurements for each tracing technique were ≥ 0.95. Significant differences between the two tracing techniques were detected in five measurements (SNB angle, N I to Pog linear measurement, U1-Apoint linear measurement, U lip to S line, and nasiolabial angle; P < .05).

CONCLUSIONS

Using 26 measurements to compare both tracing methods, all mean differences between the digital (OneCeph) and conventional methods were below 1 degree/1 mm, indicating that differences between the tracing methods were clinically insignificant. The U1-A point measurement was an exception for the digital method (OneCeph) with a clinically significant difference of 1.25 mm (P < .01); the difference was a result of wrongly measuring the distance from the A line to the incisor edge of the upper central incisor rather than the facial surface of the upper incisor. This leads to the conclusion that both tracing methods were reliable for daily clinical practice.

Smartphone applications used in orthodontics: A scoping review of scholarly literature

Mobile applications (apps) play an increasingly important role in day to day life. With the number of orthodontic-related apps continuing to increase, and the rapid development of artificial intelligence, the potential to yield tremendous benefits to both clinicians and patients is apparent. However, if orthodontic apps are to become mainstream and obtain greater acceptance, scientific validation and investigation of these apps are to be undertaken. This scoping review aimed to determine the scope and extent of the published literature on mobile apps in orthodontics, as well as identify the types of studies published, and summarize the outcomes studied- thus also giving direction for future research in a rapidly evolving subject area.

Concurrent validity and reliability of cephalometric analysis using smartphone apps and computer software

OBJECTIVES

To assess the diagnostic accuracy of two smartphone cephalometric analysis apps compared with Viewbox software.

MATERIALS AND METHODS

Pretreatment digital lateral cephalograms of 50 consecutive orthodontic patients (20 males, 30 females; mean age, 19.1 years; SD, 11.7) were traced twice using two apps (ie, CephNinja and OneCeph), with Viewbox used as the gold standard computer software program. Seven angular and two linear measurements, originally derived from Steiner cephalometric analysis, were performed.

RESULTS

Regarding validity, intraclass correlation coefficients (ICCs) ranged from .903-.983 and .786-.978 for OneCeph vs Viewbox and CephNinja vs Viewbox, respectively. The ICC values for intratool reliability ranged from .647-.993. None of the CephNinja measurements was below the recommended cutoff values of ICCs for reliability.

CONCLUSIONS

OneCeph has a high validity compared with Viewbox, while CephNinja is the best alternative to Viewbox regarding reliability. Smartphone apps may have a great potential in supplementing traditional cephalometric analysis.

Evaluation of an online website-based platform for cephalometric analysis

BACKGROUND

The purpose of our study was to assess the reproducibility of linear and angular measurements of cephalogram tracings made with an online website-based platform CephX® vs. tracings made using the FACAD® computer software.

METHODS

Thirty cephalometric radiographs were selected randomly to be used in this study. A total of 16 landmarks and 16 measurements (8 linear and 8 angular) were defined. We used paired t-test to compare mean differences between both methods. Concordance Correlation Coefficient (CCC) and Bland-Altman analyses were used to evaluate reproducibility of measurements. The level of statistical significance was set at P < 0.05.

RESULTS

We did not find a statistically significant mean difference between the two methods except for two angular measurements SNA, FMA and one linear measurement Pg to NB. The highest magnitude of the difference between sample means was 1.9° and 0.78 mm for the angular and linear measurements respectively. The SE value was less than 0.1° for the angular measurements and less than 0.3 mm for the linear measurements. All parameters except POG to NB showed moderate to almost perfect agreement (>0.90).

CONCLUSION

The measurements obtained by both softwares FACAD® and CephX® are reproducible. Although significant differences were detected for some measurements, all differences were not clinically significant.