Accuracy of Remote Dental Monitoring Tooth Tracking Technology in Orthodontics

Introduction Dental Monitoring™ (DM™) is a multi-platform telehealth application system designed to aid orthodontists with tracking patient care at a distance. The software facilitates asynchronous interpersonal interactions through a HIPPA compliant system. It is touted for its ability to track tooth movement, identify emergencies and encourage oral hygiene improvement. The software relies on the patients to record photos of their dentition on a weekly basis and upload them to the Dental Monitoring™ app on their smartphone. From there the Dental Monitoring™ software engages deep learning AI technology through their patented tooth tracking algorithm and communicates the treatment progression to the orthodontist and the patient. Although this technology has been evaluated by others, to date there has yet to be an in-vivo study utilizing fixed orthodontic treatment corroborating the ability of this technology to track tooth movement. Study Significance The significance of this study is underscored by the recent challenges encountered during the Covid-19 pandemic. Teleorthodontic systems are being utilized due to the increased need without validation in the literature. We envision the results from this study will provide greater insight into the efficacy and scope of DM™’s AI facilitated remote tracking technology. Specific Aim The primary aim of this study is to examine the Dental Monitoring™ AI driven remote monitoring (AIRM) technology in an active clinical setting. Our objectives are to compare the accuracy and validity of STL files remotely generated from the Dental Monitoring™ application to STL files generated from the iTero® Element™5D intraoral scanner of patients’ dentition during in-vivo fixed orthodontic treatment. Null Hypotheses H0A: There are no mean differences between 3D digital dental models remotely reconstructed by the Dental Monitoring™ application on patient smart phones and the 3D digital dental models generated by the iTero® Element™ 5D intraoral scanner during in-vivo fixed orthodontic treatment. H0B: There are no significant differences in average deviation between the maxilla and mandible when the 3D digital dental models remotely reconstructed by the Dental Monitoring™ and the 3D digital dental models generated by the iTero® Element® 5D intraoral scanner are superimposed. Methods Patients undergoing fixed orthodontic treatment with traditional brackets or bands at the UIC COD Department of Orthodontics were recruited to participate in this study. Of the 26 patients enrolled, 24 completed the study. The participants ranged from 14-55 years of age. Treatment was tracked across an average of 13 months. A chart for each patient subject was created within the DM™ account and linked to the patient’s smartphone app. Both arches of each patient were scanned with an iTero®Element™ to produce an initial 3D model prior to tooth movement. The STL file of each arch was uploaded to the patient’s DM™ chart and used as a baseline reference for the software’s calculations. A DM™ scan and iTero® scan was taken at treatment initiation both with (T1) and without (T0) the fixed orthodontic appliances and at every future in-person adjustment appointment (T2-T10). Patients also continued the Dental Monitoring™ scans remotely from home once a week throughout the study period. The 3D STL file produced from the remotely reconstructed models from the DM™ scans and the 3D STL file from the iTero® Element™ reconstructed models were then superimposed using the 3D-compare analysis in Geomagic Control-X 2020 (3D Systems, Rock Hill, SC) 3D inspection and metrology software to calculate the global deviation between the two models based on the best fit alignment of the dentition. Descriptive analysis was used to determine the mean deviation at each time point for the maxillary and mandibular arches. One-sample t tests were used to compare the maxilla and mandible mean deviations at each time point to the null hypothesis mean of 0 mm. The paired mean of the average at each time point in the sample was compared between the maxilla and mandible using the paired sample t test. Conclusion The findings of this in-vivo investigation revealed there was no clinically significant difference between the reconstructed digital models generated by the iTero® Element™ 5D intraoral scanner and the remotely reconstructed digital dental models generated by the Dental Monitoring™ application. Clinical significance was set to +/-0.5mm based on the American Board of Orthodontics (ABO)–determined standard¬s.