Clinical decision support systems in orthodontics: A narrative review of data science approaches.

Advancements in technology and data collection generated immense amounts of information from various sources such as health records, clinical examination, imaging, medical devices, as well as experimental and biological data. Proper management and analysis of these data via high-end computing solutions, artificial intelligence and machine learning approaches can assist in extracting meaningful information that enhances population health and well-being. Furthermore, the extracted knowledge can provide new avenues for modern healthcare delivery via clinical decision support systems. This manuscript presents a narrative review of data science approaches for clinical decision support systems in orthodontics. We describe the fundamental components of data science approaches including (a) Data collection, storage and management; (b) Data processing; (c) In-depth data analysis; and (d) Data communication. Then, we introduce a web-based data management platform, the Data Storage for Computation and Integration, for temporomandibular joint and dental clinical decision support systems.

Osteoarthritis Diagnosis Integrating Whole Joint Radiomics and Clinical Features for Robust Learning Models Using Biological Privileged Information.

This paper proposes a machine learning model using privileged information (LUPI) and normalized mutual information feature selection method (NMIFS) to build a robust and accurate framework to diagnose patients with Temporomandibular Joint Osteoarthritis (TMJ OA). To build such a model, we employ clinical, quantitative imaging and additional biological markers as privileged information. We show that clinical features play a leading role in the TMJ OA diagnosis and quantitative imaging features, extracted from cone-beam computerized tomography (CBCT) scans, improve the model performance. As the proposed LUPI model employs biological data in the training phase (which boosted the model performance), this data is unnecessary for the testing stage, indicating the model can be widely used even when only clinical and imaging data are collected. The model was validated using 5-fold stratified cross-validation with hyperparameter tuning to avoid the bias of data splitting. Our method achieved an AUC, specificity and precision of 0.81, 0.79 and 0.77, respectively.

TMJOAI: An Artificial Web-Based Intelligence Tool for Early Diagnosis of the Temporomandibular Joint Osteoarthritis.

Osteoarthritis is a chronic disease that affects the temporomandibular joint (TMJ), causing chronic pain and disability. To diagnose patients suffering from this disease before advanced degradation of the bone, we developed a diagnostic tool called TMJOAI. This machine learning based algorithm is capable of classifying the health status TMJ in of patients using 52 clinical, biological and jaw condyle radiomic markers. The TMJOAI includes three parts. the feature preparation, selection and model evaluation. Feature generation includes the choice of radiomic features (condylar trabecular bone or mandibular fossa), the histogram matching of the images prior to the extraction of the radiomic markers, the generation of feature pairwise interaction, etc.; the feature selection are based on the p-values or AUCs of single features using the training data; the model evaluation compares multiple machine learning algorithms (e.g. regression-based, tree-based and boosting algorithms) from 10 times 5-fold cross validation. The best performance was achieved with averaging the predictions of XGBoost and LightGBM models; and the inclusion of 32 additional markers from the mandibular fossa of the joint improved the AUC prediction performance from 0.83 to 0.88. After cross-validation and testing, the tools presented here have been deployed on an open-source, web-based system, making it accessible to clinicians. TMJOAI allows users to add data and automatically train and update the machine learning models, and therefore improve their performance.

Temporomandibular Joint Osteoarthritis Diagnosis Using Privileged Learning of Protein Markers.

Diagnosis of temporomandibular joint (TMJ) Osteoarthritis (OA) before serious degradation of cartilage and subchondral bone occurs can help prevent chronic pain and disability. Clinical, radiomic, and protein markers collected from TMJ OA patients have been shown to be predictive of OA onset. Since protein data can often be unavailable for clinical diagnosis, we harnessed the learning using privileged information (LUPI) paradigm to make use of protein markers only during classifier training. Three different LUPI algorithms are compared with traditional machine learning models on a dataset extracted from 92 unique OA patients and controls. The best classifier performance of 0.80 AUC and 75.6 accuracy was obtained from the KRVFL+ model using privileged protein features. Results show that LUPI-based algorithms using privileged protein data can improve final diagnostic performance of TMJ OA classifiers without needing protein microarray data during classifier diagnosis.

Automatic Segmentation of Dental Root Canal and Merging with Crown Shape.

In this paper, machine learning approaches are proposed to support dental researchers and clinicians to study the shape and position of dental crowns and roots, by implementing a Patient Specific Classification and Prediction tool that includes RootCanalSeg and DentalModelSeg algorithms and then merges the output of these tools for intraoral scanning and volumetric dental imaging. RootCanalSeg combines image processing and machine learning approaches to automatically segment the root canals of the lower and upper jaws from large datasets, providing clinical information on tooth long axis for orthodontics, endodontics, prosthodontic and restorative dentistry procedures. DentalModelSeg includes segmenting the teeth from the crown shape to provide clinical information on each individual tooth. The merging algorithm then allows users to integrate dental models for quantitative assessments. Precision in dentistry has been mainly driven by dental crown surface characteristics, but information on tooth root morphology and position is important for successful root canal preparation, pulp regeneration, planning of orthodontic movement, restorative and implant dentistry. In this paper we propose a patient specific classification and prediction of dental root canal and crown shape analysis workflow that employs image processing and machine learning methods to analyze crown surfaces, obtained by intraoral scanners, and three-dimensional volumetric images of the jaws and teeth root canals, obtained by cone beam computed tomography (CBCT).

Automatic Segmentation of Mandibular Ramus and Condyles.

In order to diagnose TMJ pathologies, we developed and tested a novel algorithm, MandSeg, that combines image processing and machine learning approaches for automatically segmenting the mandibular condyles and ramus. A deep neural network based on the U-Net architecture was trained for this task, using 109 cone-beam computed tomography (CBCT) scans. The ground truth label maps were manually segmented by clinicians. The U-Net takes 2D slices extracted from the 3D volumetric images. All the 3D scans were cropped depending on their size in order to keep only the mandibular region of interest. The same anatomic cropping region was used for every scan in the dataset. The scans were acquired at different centers with different resolutions. Therefore, we resized all scans to 512×512 in the pre-processing step where we also performed contrast adjustment as the original scans had low contrast. After the pre-processing, around 350 slices were extracted from each scan, and used to train the U-Net model. For the cross-validation, the dataset was divided into 10 folds. The training was performed with 60 epochs, a batch size of 8 and a learning rate of 2×10-5. The average performance of the models on the test set presented 0.95 ± 0.05 AUC, 0.93 ± 0.06 sensitivity, 0.9998 ± 0.0001 specificity, 0.9996 ± 0.0003 accuracy, and 0.91 ± 0.03 F1 score. This study findings suggest that fast and efficient CBCT image segmentation of the mandibular condyles and ramus from different clinical data sets and centers can be analyzed effectively. Future studies can now extract radiomic and imaging features as potentially relevant objective diagnostic criteria for TMJ pathologies, such as osteoarthritis (OA). The proposed segmentation will allow large datasets to be analyzed more efficiently for disease classification.