Utility of Automated Digital Setup for Orthodontic Treatment Planning

Abstract

Digital setups (also known as treatment simulations) allow orthodontists to visualize predicted outcomes of various treatment plans. Recent integration of artificial intelligence in the treatment simulation software packages has improved the efficiency of digital setups. However, little is known about the utility of automated simulations in assisting orthodontists with treatment planning. The purpose of this study was to assess the utility of automatically generated digital setups in helping orthodontists make informed treatment decisions and to identify the strengths and shortcomings of automated setups. The perception of orthodontists towards digital treatment simulations was also analyzed to identify barriers in their implementation in the daily practice of orthodontics. This study had two parts. Part I involved an online survey sent to approximately 18,000 orthodontists through Facebook® and the American Association of Orthodontists®. The survey collected information to help understand the purpose, frequency, and modality of orthodontic treatment simulation for fixed appliances cases. The second part of this study involved orthodontist evaluation of automated treatment simulations generated for 5 patient cases using uLab® uDesign®. Orthodontists answered questions regarding the need for a diagnostic setup for each case, the helpfulness of each setup, and the quality of automated setups. From the 145 completed surveys collected, it was shown that up to 71% of orthodontists perform some setups to assist with treatment planning of patients treated with fixed appliances. The most common simulated plan was single mandibular incisor extraction. Time, cost, and effort were identified as primary barriers to creating a diagnostic treatment simulation. Evaluation of automated treatment simulations by orthodontists in Part II revealed that digital setups were helpful in 68% of treatment decision-making incidences. Significant associations were observed between helpfulness of automated setups and when there is perceived need for a setup, when the case is more difficult, when the quality of the automated setup is high, and for a single mandibular incisor extraction plan. The orthodontists judged the setups in this study as less than ideal on several parameters, and as the quality of automated setups improves, they should become even more useful. The parameters needing the most improvements were alignment and spacing as well as tip and torque of teeth. Future studies should focus on quantifying improvements in setup efficiency through automation and comparing the utility of different automated treatment simulation systems. In addition, more research is needed to determine the threshold of accuracy in automated digital setups in the decision-making process of treatment planning.