Reliability of Artificial Intelligence-Based Cone Beam Computed Tomography Integration with Digital Dental Images

Summary

A process of registering cone-beam computed tomography scans and digital dental images has been presented using artificial intelligence (AI) -assisted identification of landmarks and merging. A comparison with surface-based registration shows that AI-based digitization and integration are reliable and reproducible.

Abstract

This study aimed to introduce cone-beam computed tomography (CBCT) digitization and integration of digital dental images (DDI) based on artificial intelligence (AI)-based registration (ABR) and to evaluate the reliability and reproducibility using this method compared with those of surface-based registration (SBR). This retrospective study consisted of CBCT images and DDI of 17 patients who had undergone computer-aided bimaxillary orthognathic surgery. The digitization of CBCT images and their integration with DDI were repeated using an AI-based program. CBCT images and DDI were integrated using a point-to-point registration. In contrast, with the SBR method, the three landmarks were identified manually on the CBCT and DDI, which were integrated with the iterative closest points method.

After two repeated integrations of each method, the three-dimensional coordinate values of the first maxillary molars and central incisors and their differences were obtained. Intraclass coefficient (ICC) testing was performed to evaluate intra-observer reliability with each method's coordinates and compare their reliability between the ABR and SBR. The intra-observer reliability showed significant and almost perfect ICC in each method. There was no significance in the mean difference between the first and second registrations in each ABR and SBR and between both methods; however, their ranges were narrower with ABR than with the SBR method. This study shows that AI-based digitization and integration are reliable and reproducible.

Introduction

Three-dimensional (3D) digital technology has broadened the scope of diagnosis and planning for orthodontic or surgical-orthodontic treatment. A virtual head constructed from a facial cone-beam computed tomography (CBCT) image can be used to evaluate dentofacial and dental abnormalities, plan orthognathic surgery, fabricate dental wafers and implant surgical guides using computer-aided design and manufacturing^1,2,3,4. However, CBCT scans have a low representation of dentition, including dental morphology and interocclusal relationship, ....

Protocol

This retrospective study was reviewed and approved by the Institutional Review Board of Seoul National University Bundang Hospital (B-2205-759-101) and complied with the principles of the Declaration of Helsinki. Digital Imaging and Communications in Medicine (DICOM) files from CBCT and DDI in Standard Tessellation Language (STL) format from the dental cast were utilized in the study. The need for informed consent was waived due to the retrospective nature of the study.

1. CBCT and Digit.......

Discussion

Using the presented protocol, digitization of landmarks and integrating CBCT and DDI can be easily accomplished using machine-learned software. This protocol requires the following critical steps: i) reorientation of the head in the CBCT scan, ii) digitization of CBCT and DDI, and iii) merging CBCT images with the DDI. The digitization of five landmarks for the reorientation of the head is critical because it determines the 3D position of the head with reference planes in spatial areas. Three landmarks (R-/L-U6CP and R U.......

Materials

Name	Company	Catalog Number	Comments
G*Power	Heinrich Heine Universität, Dϋsseldorf, Germany	v. 3.1.9.7	A sample size calculuation software
Geomagic Qualify®	3D Systems, Morrisville, NC, USA	v 2013	3D metrology feature and automation software, which transform scan and probe data into 3D to be used in design, manufacturing and metrology applications
KODAK 9500	Carestream Health Inc., Rochester, NY, USA	5159538	Cone Beam Computed Tomograph (CBCT)
MD-ID0300	Medit Co, Seoul, South Korea Seoul, Korea	61010-1	Desktop model scanner
ON3D	3D ONS Inc., Seoul, Korea	v 1.3.0	Software for 3D CBCT evaluation; AI-based landmark identification, craniofacial and TMJ analysis, superimposition, and virtual orthognathic surgery
SPSS	IBM, Armonk, NY, USA	v 22.0	A statistic analysis program