Items of interest from readers around the world



Items of interest from readers around the world




American Journal of Orthodontics and Dentofacial Orthopedics, 2020-09-01, Volume 158, Issue 3, Pages 464-465, Copyright © 2020 American Association of Orthodontists



Assessment request

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.


Background

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.


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Items of interest from readers around the world Sylvia A. Frazier-Bowers , Veerasathpurush Allareddy and David A. Covell American Journal of Orthodontics and Dentofacial Orthopedics, 2020-09-01, Volume 158, Issue 3, Pages 464-465, Copyright © 2020 American Association of Orthodontists Assessment request 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. Background 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. Assessment The DM company purports to offer an innovative system to facilitate a measurable way to monitor the patients' teeth. On the basis of the information provided, this claim appears to be reasonable and appropriate for the intended purpose of “monitoring” aligners. However, the evidence-based data are limited at this time and should be expanded to vet the applicability of the DM system thoroughly. Furthermore, the reality that orthodontists and dentists alike may seek novel and creative ways to deliver patient care in a post–coronavirus disease reality makes this product just that more relevant. The likelihood of synchronous and asynchronous monitoring increasing is high. The burden of how and when to implement this approach will fall on the licensed provider. It will require an understanding of the Dental Practice Act laws in their respective states and whether these laws align with the product offerings of the DM company. Invisalign has launched a software product comparable to DM that also allows for remote monitoring. Hence, this suggests that similar products will likely become more commonplace soon, with reliability being imminent. Ultimately, the onus will be on the orthodontist to enlist the appropriate treatment plan and determine what strategy fits within the limits of the plan execution. Therefore, the major aspect of reliability will be whether this remote monitoring product offers a consistent and useful adjunct to “seeing” the patient in person. Undoubtedly, this product offers an option for convenience and flexibility and may represent an acceptable adjunctive approach for the future of our specialty. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported. International items of interest are submitted by readers around the world, reproduced with permission, and presented without comment. Issued by Sylvia A. Frazier-Bowers, Veerasathpurush Allareddy, and David Covell on April 3, 2020. The content provided in this Rapid Assessment of Evidence (RAE) is expressly for the requestor and the use of the American Association of Orthodontists Foundation (AAOF). The use of this information is at the discretion of the requestor and the AAOF. Any subsequent clinical decision made by the requestor shall be made on the basis of their clinical acumen and adjudication as a licensed practitioner and not the AAOF and/or RAE Committee. Any reference made herein to a specific product, process, or service does not constitute or imply an endorsement by the AAOF and/or AAO of the product, process, or service, or its producer (provider). The AAO and/or AAOF accepts no liability associated with the use of this product. References 1. Roisin L.C., Brézulier D., Sorel O.: Remotely-controlled orthodontics: fundamentals and description of the Dental Monitoring system. J Dentofacial Anom Orthod 2016; 19: pp. 408. 2. Aggarwal J., Vemuri B., Chen Y., Medioni G.: Range Image Understanding Object modeling by registration of multiple range images. Image Vis Comput 1992; 10: pp. 145-155. 3. Dutagaci H., Cheung C.P., Godil A.: Evaluation of 3D interest point detection techniques via human-generated ground truth. Vis Comput 2012; 28: pp. 901-917. 4. Jia Y, Shelhamer E, Donahue J, Karayev S, Long J, Girshick R, et al. Caffe: Convolutional Architecture for Fast Feature Embedding. MM2014-Proceedings of the 2014 ACM Conference on Multimedia. https://doi.org/10.1145/2647868.2654889 5. Hansa I., Semaan S.J., Vaid N.R., Ferguson D.J.: . Semin Orthod 2018; 24: pp. 470-481. 6. Ohanesian V.: Reliability and Accuracy of a Novel Photogrammetric Orthodontic Monitoring System. [thesis]2018.Loma Linda University 7. Morris R.S., Hoye L.N., Elnagar M.H., Atsawasuwan P., Galang-Boquiren M.T., Caplin J., et. al.: Accuracy of Dental Monitoring 3D digital dental models using photograph and video mode. Am J Orthod Dentofacial Orthop 2019; 156: pp. 420-428.

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