A request was submitted by a member for an assessment by the American Association of Orthodontists Foundation Rapid Assessment of Evidence (RAE) Committee to determine the “reliability” of the Dental Monitoring (DM) product (Dental Monitoring, Paris, France). Specifically, the requestor indicated that the company claimed that “DM is the most innovative help to aligner treatment in at least 10 years. The true revolution is in finally providing doctors with a measurable way to monitor their patients' aligners.” The specific question posed was, “How reliable are dental monitoring devices?” The inquiring member does not appear to have a financial interest in this product nor any competing interest. The potential for this type of product is apparent, particularly when unexpected circumstances make it difficult or impossible to see a patient in person. However, the product's usefulness depends on its reliability. This product loosely fits into the “teledentistry” category of products intended to allow remote monitoring and reduce routine visits. In addition, the product is ideally positioned to complement clear aligner therapy (CAT) because CAT does not require the use of elastic modules and other auxiliary appliances. However, although this assessment of evidence will focus on the DM system related to CAT progress, it should be noted that DM devices may also be used for monitoring of traditional orthodontic appliances to determine progress (ie, space closure, impacted canine eruption, compliance, hygiene, etc).
The challenge with determining reliability is that it may depend on what the practitioner hopes to accomplish with the product. If by reliable, the requestor means that they want to determine how consistently and reproducibly the product performs, then it is important to establish how the provider will be using the product. This review assumes that the goal in question is to monitor and guide the sequential use of CAT progress.
DM is a software-based program composed of 3 integrated platforms that allows practitioners to monitor patients' treatment progress remotely. The primary functionality is through the use of the patient's mobile phone and mobile app, a patented movement tracking algorithm, and an online Doctor Dashboard that allows receipt of updates from the patient ( https://dental-monitoring.com/smilemate/ ). There are limited evidence-based publications focused on the DM product, but a summary is as follows:
Roisin et al provided a summary of the DM concept, but no information is provided on reliability or validity. The article asserts that DM “provides precise measurements from settings outside the clinic, and in between appointments.” Roisin et al cited 3 articles in support of the science behind the “precise measurements.”
Furthermore, an article published by Hansa et al evaluated the application of remote monitoring. Although the study revealed patient-perceived benefits including “better communication,” “increased convenience,” and “reduced number of appointments,” the findings are based on preliminary results in which notably only 3 patients in the experimental group had completed their treatment regime.
In a study, published in fulfillment of a master's of science degree, Ohanesian evaluated 30 patients undergoing orthodontic treatment in which the DM system was compared with a traditional intraoral scanner. The study demonstrated a high level of accuracy when comparing movements tracked by the DM system against those of the reference scanner. The report also concluded that there were no macrolevel differences detected in the accuracy of the proprietary system when comparing maxillary vs mandibular arches or anterior vs posterior sextants. However, the study did find that microlevel differences were noted in that a greater deviation was associated with first molars compared with central incisors and canines—although these differences were deemed not clinically significant. It was concluded that the proprietary system exhibited high levels of both intra- and inter-user reliability.
Furthermore, 2 additional thesis projects from students in the same graduating class assessed the DM system and found it to be no different when compared with models generated from an iTeRO Element intraoral scanner (Align Technology, San Jose, Calif) versus those generated from the DM application in video mode. They also found that 3-dimensional digital dental models produced by DM had increases in “global deviations.” Thus, the technology became less accurate over successive exams (ie, >300); however, these global deviations were deemed not clinically significant. Taken together, this now published work showed that 3-dimensional digital dental models generated by the DM smartphone applications in photograph and video modes are accurate enough to be used for clinical applications.