CA3179033A1 - The device combined artificial intelligence to diagnose and planed treatment in all steps of orthodontics without an explorer patient to x-ray - Google Patents

Description

The proposed device works without radiation and will not expose the patient.
This device combines: an intra-oral CAD-CAM scanner, ultrasound system (US), and artificial intelligence for 3D vision without exposing patients to any x-ray radiation. Moreover, it will be used for diagnosis, treatment plans, case monitoring, and result assessment. Specifically, the proposed device provides extra diagnosis visibility and predicts measurement forces during the treatment.
Also, it will have more accuracy compared to radiography and the highest sensitivity to show pathologies( Cavities, abscesses, tumors, oral cancer, cyst, periodontal lesions.), important anatomical points for orthodontics, and provide the information for planning treatment like; size, position, and length of the roots and size jaws, also position and form of teeth ( extra, missing, impact), and bone structure. Moreover changes in soft and hard tissue will be visible during treatment. This device monitors treatment progress and determines how long treatment can continue without causing further damage.
Furthermore, it predicts and avoids any complications during treatment and will notify the orthodontist.
The most crucial specify this device compared to the standard 3D method used in orthodontics is:
= CBCT (cone beam computerized tomography).
= Sterophotogrametry or 3D surface imaging systems.
All these functions mentioned above will be without exposing patients to any x-ray.
Background As we know, one of the most important factors parents face at the Orthodontics treatment is exposure to radiation for diagnosis, and this radiation is associated with health dangers for children. These risks are high because children are vulnerable, and we should be concerned about them.
Radiographs are considered essential for orthodontic treatment. Among other indications, radiographs and cephalometric analysis are used for assessing the interrelationships among the maxillofacial skeleton, dentition, and soft tissues :'-15,26]
However, the diagnostic value of orthodontic radiographs an n itions for their use are still debatable, and studies that investigated the validity of the cephalometric analysis and its influence on orthodontic diagnosis and treatment planning showed inc istent results.
Moreover, the minimum set of records required for orthodontic diagnosis a ' treltment planning has never been solidly established or defined in the literature [25-27]. At the same time, radiation exposure is associated with health risks for patients and staff. These risks, more specifically, the somatic stochastic effects, are widely acknowledged, and no radiation exposure, even in small doses, is free of risk, particularly in children [28, 29], the frequency with which diagnostic tests are prescribed with exposure to ionizing radiation, a cause of biological damage, has been studied, and with much more attention, patients are subjected to these diagnostic tests for diagnosis and follow-up. (12) Date Recue/D ate Received 2022-10-10 The possibility of applying ionizing-radiation-free diagnostic exams in dentistry, overcoming the limits of this application, has led scientific research in this area to obtain exciting results that bode well for the future. (13) Moreover, the possibility of applying ionizing-radiation-free diagnostic exams in dentistry, overcoming the limits of this application, has led scientific research in this area to obtain interesting results that bode well for the future. Magnetic resonance imaging (MRI) and ultrasound imaging represent the most interesting evolution of this topic, as underlined by numerous pieces of evidence obtained in every branch of dentistry from the application of these diagnostics exams (14,15).
The main disadvantage of this examination remains the complex visualization of tissues poor in water, which has proven to be correctable by dedicated software and can lead to excellent results.
For patients who have claustrophobia, the presence of devices that prevent the examination from taking place, artifacts from materials and movements, the cost, the lack of availability, and the long examination time represent other disadvantages that will need to be improved in the future( ..,,...,).
During Orthodontics treatment, doctors rely on the information obtained from the impression, 2D
and 3D radiography, such as the Cephalometric, PA (periapical), the OPG
(orthopantomogram), and CBCT (cone-beam computed tomography). They should consider the health, age, teeth, jaws, bone structure, and soft and hard tissue, and after, the orthodontics determines the planning treatment. They should follow up on all the process treatments, compute their forces, and avoid future damages. With ultrasound (US) and intraoral CAD-CAM scanner, the proposed device will provide data to the artificial intelligence system, which will automatically recognize the non-visible internal parts and form hard and soft tissues and structure face jaws, bone system, and teeth.
This device is available for diagnosing, recording, measuring the forces, and predicting and proposing incoming ideal planning forces for Orthodontics cases treatment.
Specifically, the proposed device provides extra diagnoses visibility and predicts measurement forces during the treatment.This device will have more accuracy compared to radiography and the highest sensitivity to show pathologies( Cavities, abscesses, tumors, oral cancer, cyst, periodontal lesions), important anatomical points for orthodontics, and changes that need for planning treatment like; size, position, and length of the roots and size jaws, also position and form of teeth ( extra, missing, impact), and bone structure, Also changes soft tissue during treatment.
This device monitors treatment progress and determines how long treatment can continue without causing further damage.
This device can predict and avoid any complications during treatment and will notify the orthodontist.
The most crucial specify this device is that all these functions without exposing passion to any x-ray.
Date Recue/D ate Received 2022-10-10 The proposed device can be fast, cost-effective, reproducible, and simultaneous imaging of hard and soft tissue. It is a non-invasive, non-ionizing, inexpensive, and painless imaging tool.
Compared to 2D and 3D radiology, which is widely used in Orthodontics.
Ultrasonography and Artificial intelligence Ultrasonography (US) is a non-invasive, non-ionizing, inexpensive and painless imaging Tool. US are fast, cost-effective, reproducible, real time and simultaneous imaging of both hard and soft tissue, and easy tolerability by patient.
US has been used to discover its capability to identify caries lesions, tooth fractures, soft tissue lesions, periodontal bony defects, maxillofacial fractures, and temporomandibular disorders.
Ultrasound refers to oscillating sounds with frequencies of 2 to 20MHz, which is beyond the upper limit that humans can hear. Ultrasonography (US), also known as real-time echography or sonography, is an imaging technique based on the propagation and reflection of ultrasound waves in the tissues. The transducer includes an electrically stimulating piezoelectric crystal that converts electrical impulses to high-frequency sound waves, which are transmitted into the tissues being examined. As this sound passes through tissues with different acoustic impedances (ie, blood and muscle), part of it is absorbed within the medium; another part of it continues to penetrate and travel through the tissues. Finally, a portion of the sound is reflected back to the transducer and smaller portions of it may be scattered and lost. Echo is the part of the sound wave that is reflected back toward the surface of the body. The reflected echoes are collected by the transducer and reconverted into electrical impulses, amplified, processed, and displayed as grayscale images on a computer screen(17) Ultrasound imaging (UT) techniques are being widely used in the medical field. UT uses the reflection of ultrasound waves at the interfaces of tissues with different acoustic properties ( I 2). These acoustic waves are generated by electromechanical transducers and piezoelectric materials. Unlike X-ray, ultrasound requires a medium to transmit energy. The propagation of sound waves is faster in solids than in liquids and slowest in gases. Because soft tissues behave like viscous fluids, the energy transportation is mainly via longitudinal waves.
Variations in the speed of sound are caused by temperature changes or terogeneity of soft tissues (3). Nevertheless, hard tissues, such as tooth and bone, are more complex and vary more in the speed of sound than soft tissues. Not only longitudinal waves but also shear modulus dependent waves develop in hard tissues. The associated interface effects and energy loss between different tissue types may be a limiting factor for brightness mode imaging (4). The reflected waves, in the same direction as the original waves, are captured and converted into radiofrequency voltage traces and images. This technique is called pulse echo ultrasound. Brightness mode imaging, in which electrical energy is transformed into a light spot using a grayscale on a monitor, is the preferred display mode for dental purposes. Diagnostic ultrasound frequencies are expressed in MHz. Lower frequencies are less absorbed and penetrate deeper into tissues but have a lower image resolution.
High-frequency waves penetrate less into tissues and produce high-resolution images of more superficial tissues(5). who tried to visualize the internal structures of teeth with a transducer. Many other applications of UT in dentistry have been explored since, such as the detection of caries, Date Recue/D ate Received 2022-10-10 dental and maxillofacial fractures, crack visualization, soft tissue lesions, periodontal defects, temporomandibular and implant disorders, and the measurement of muscle and gingival thickness (3, 7).The most promising use of ultrasound is the ability to make a differential diagnosis of bone defects of pathologic origin in the jaw (5) UI is of growing interest because of the following advantages: it is noninvasive, inexpensive, and painless. In comparison with conventional radiography (CR) and computed tomographic imaging, UI does not cause ionizing radiation. (9, 10).
The percentage accuracy of diagnosing periapical lesions using conventional radiography was 47.6%, digital radiography 55.6%, and ultrasound 95.2%. Ultrasound had the highest sensitivity and specificity: 0.95 and 1.00, respectively.
Conventional and digital radiography enable diagnosis of periapical diseases, but not their nature, whereas ultrasound provides accurate information on the pathologic nature of the lesions, which is of importance in predicting the treatment outcome. Therefore ultrasound can be used as an adjunct to conventional or digital radiography in diagnosing periapical lesions.(n) Generally, ultrasound with frequencies between 3 MHz and 12 MHz is used in Dentistry( 1 8). The most regularly used dental display modes are amplitude mode (A-mode) and brightness mode (B-mode).( k-mod .._ sound is the most fundamental display mode after plotting the lency (RF) signal and was used often in early US. It uses a single ') generate a 1-aimensional picture with the echo amplitude, displayed vert Ind the echo time, displayed horizontally. Currently, a standard screen image created by US machines is in B-mode. B-mode ultrasound images can be performed by moving an ultrasound probe (transducer) on a trajectory, receiving RF-echo signals from each probe location, and then transforming electrical energy into a light spot using grayscale on a monitor.(19-20) On the other hand, determination of soft tissue thickness has clinical importance for the ability to identify different structures of the oral cavity and to make treatment plans in fields such as orthodontics (ie, proper orthodontic miniscrew selection)21. The development of technology applicability in dentistry and the trend towards digitalization with regard to all the potential benefits that come with it have brought great improvements in the intraoral scanners (I0S), making them more accurate and reliable than ever before [34-35].The improvements of the intraoral scanners allow obtaining digital impressions with marginal gaps within the clinically acceptable range for various types of restorations and clinical situations [34-36]considerably decreasing the time needed for impression making, while undeniably improving the comfort of the patient [34-37-38].
Three-dimensional technologies have been widely used in different areas of dentistry including orthodontics. In both orthodontics and maxillofacial surgery, the implementation of these systems has gradually changed the way clinicians perform their diagnosis, treatment plans, case monitoring and result assessment. These technologies replicate anatomical structures in order to present tridimensional anatomy with accuracy [3 0,3 1].
Digital impressions have been introduced, and successfully used, for a number of years in orthodontics I
Ever since research and development sectors at a lot of companies have improved the technologies and created in-office intraoral scanners that are increasingly user-friendly and Date Recue/D ate Received 2022-10-10 produce precisely fitting dental restorations. These systems are capable of capturing three-dimensional virtual images of tooth preparations; from such images restorations may be directly fabricated (using CAD/CAM systems) [32,33]
Generally speaking such scanners try to face with problems and disadvantages of traditional impression fabrication process such as, in particular, mould instability, plaster pouring, laceration on margins, geometrical and dimensional discrepancy between the die and the mould.
The main advantages in the employment of those devices are: high fidelity models, creation of 3D archives and surgery simulation and a process simplification. Existing devices are driven by several noncontact optical technologies such as confocal microscopy, optical coherence tomography, photogrammetry, active and passive stereovision and triangulation, interferometry and phase shift principles. Basically, all these devices combine some of the cited imaging techniques to minimize the noise source related to the scanning inside an oral cavity.
(3 Artificial intelligence (AI) is a technology that utilizes machines to mimic intelligent human behavior. To appreciate human-technology interaction in the clinical setting, augmented intelligence has been proposed as a cognitive extension of AT in health care, emphasizing its assistive and supplementary role to medical professionals. While truly autonomous medical robotic systems are still beyond reach, the virtual component of AT, known as software-type algorithms, is the main component used in dentistry. Because of their powerful capabilities in data analysis, these virtual algorithms are expected to improve the accuracy and efficacy of dental diagnosis, provide visualized anatomic guidance for treatment, simulate and evaluate prospective results, and project the occurrence and prognosis of oral diseases. Potential obstacles in contemporary algorithms that prevent routine implementation of AT include the lack of data curation, sharing, and readability; the inability to illustrate the inner decision-making process; the insufficient power of classical computing; and the neglect of ethical principles in the design of AT
frameworks. It is necessary to maintain a proactive attitude toward Alto ensure its affirmative development and promote human-technology rapport to revolutionize dental practice. Several studies outline the progress and potential dental applications of Al in medical-aided diagnosis, treatment, and disease prediction and discuss their data limitations, interpretability, computing power, and ethical considerations, as well as their impact on dentists, with the objective of creating a backdrop for future research in this rapidly expanding arena.22 AT is machine learning (ML), which "learns" intrinsic statistical patterns in data to eventually ilst predictions on unseen data. Deep learning is an ML technique using multi-layer mathematical operations for learning and inferring complex data like imagery. This succinct narrative review describes the application, limitations, and possible future of AI-based dental diagnostics. 23 The machine learning algorithms developed to perform well and allow for clinical implementation and utilization by dental and non-dental professionals.24 Date Recue/D ate Received 2022-10-10 Objective:
The proposed methodology will be an experimental design. The research question would be the effect of this proposed device on patients and the field of orthodontics . The hypothesis and variables will be determined later.
Claim:
During Orthodontics treatment, doctors rely on the information obtained from the impression, 2D
and 3D radiography, such as the Cephalometric, PA (periapical), the OPG
(orthopantomogram), and CBCT (cone-beam computed tomography). They should consider the health, age, teeth, jaws, bone structure, and soft and hard tissue, and after, the orthodontics determines the planning treatment. They should follow up all the process treatments and compute the forces in treatments and avoid future damages. The proposed device, with the use of ultrasound (US) and intraoral CAD-CAM scanner that will provide data to the artificial intelligence system.
We assume that the proposed device can significantly benefit the patients and the orthodont's.
Below are the potential benefits that this device can offer:
1- Eliminate the exposure of the patient to X-ray radiations.

2- Eliminate impression, while undeniably improving the comfort of the patient, Specially children.

3- Usage for diagnosing soft tissue and hard tissue simultaneously without any exposure to X-ray radiation.

4- Data processing with artificial intelligence.

5-Process and provide different assumptions treatments.

6-Provide 3D image vision with out radiation.

7- Give the 3D treatment plan.

8- Give the expecting result.

9- This device monitors treatment progress and determines how long treatment can continue without causing further damage.

10- This device capable to predicts and avoids any complications during treatment and will notify the orthodontist.

11-This device available to measuring the forces, and predicting and proposing incoming ideal planning forces for Orthodontics cases treatment.
Date Recue/Date Received 2022-10-10 Reference 1. Maylia E, Nokes LDM. The use of ultrasonics in orthopaedics ¨ a review.
Technol Health Care 1999;7:1-28.
2. Tikku AP, Kumar S, Loomba K, et al. Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery. J Oral Sci 2010; 52:411-416.
3. Marotti J, Heger S, Tinschert J, et al. Recent advances of ultrasound imaging in dentistry ¨ a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2013;115:819-832.
4. Salmon B, Le Denmat D. Intraoral ultrasonography: development of a specific high- frequency probe and clinical pilot study. Clin Oral Investig 2012;16:643-649.
5. Musu D, Rossi-Fedele G, Campisi G, et al. Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2016;122:e19-29.
7. Culjat MO, Goldenberg D, Tewari P, et al. A review of tissue substitutes for ultra-sound imaging. Ultrasound Med Biol 2010;36:861-73.
8. Ultrasound Assessment of Bone Healing after Root-end Surgery: Echoes Back to Patient's Safety.
9. Setzer FC, Shah SB, Kohli MR, et al. Outcome of endodontic surgery: a meta-analysis of the literature - part 1: comparison of traditional root-end surgery and endodontic microsurgery. J Endod 2010;36:1757-65.
10. Torabinejad M, Landaez M, Milan M, et al. Tooth retention through endodontic microsurgery or tooth replacement using single implants: a systematic review of treatment outcomes. J Endod 2015;41:1-10 11-Comparison of the efficacy of conventional radiography, digital radiography, and ultrasound in diagnosing periapical lesions.

12-Ultrasound Imaging in Dentistry: A Literature Overview Rodolfo Reda 1 , Alessio Zanza 1 , Andrea Cicconetti 1, Shilpa Bhandi 2, Gabriele Miccoli 1,*, Gianluca Gambarini 1 and Dario Di Nardo 1

13-Bornstein, M.M.; Scarfe, W.C.; Vaughn, V.M.; Jacobs, R. Cone beam computed tomography in implant dentistry: A systematic review focusing on Date Recue/Date Received 2022-10-10 guidelines, indications, and radiation dose risks. Int. J. Oral Maxillofac.
Implant.
2014, 29, 55-77. [CrossRef]

14-Patil, S.; Alkahtani, A.; Bhandi, S.; Mashyakhy, M.; Alvarez, M.; Alroomy, R.;
Hendi, A.; Varadarajan, S.; Reda, R.; Raj, A.; et al. Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review.
Diagnostics 2021, 11, 1208.

15- Reda, R.; Zanza, A.; Mazzoni, A.; Cicconetti, A.; Testarelli, L.; Di Nardo, D.
An Update of the Possible Applications of Magnetic Resonance Imaging (MRI) in Dentistry: A Literature Review. J. Imaging 2021, 7, 75.

16- Di Nardo, D.; Gambarini, G.; Capuani, S.; Testarelli, L. Nuclear Magnetic Resonance Imaging in Endodontics: A Review. J. Endod. 2018, 44, 536-542.
= 17- Pallagatti S., Sheikh S., Puri N., et. al.: To evaluate the efficacy of ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings. Eur J Radiol 2012; 81: pp. 1821-1827.
=
= 18- Sandhu S.S., Singh S., Arora S., et. al.: Comparative evaluation of advanced and conventional diagnostic AIDS for endodontic management of periapical lesions, an in vivo study. J Clin Diagn Res 2015; 9: pp. ZC01-ZCO4.
= 19- Marotti J., Heger S., Tinschert J., et. al.: Recent advances of ultrasound imaging in dentistry¨a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;
115: pp. 819-832.
= 20- Musu D., Rossi-Fedele G., Campisi G., et. al.: Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122: pp. e19-29.
= 21- Parmar R., Reddy V., Reddy S.K., et. al.: Detennination of soft tissue thickness at orthodontic miniscrew placement sites using ultrasonography for customizing screw selection. Am J Orthod Dentofacial Orthop 2016; 150: pp. 651-658.
22- T. Shan, F.R. Tay, L. Gu Application of Artificial Intelligence in Dentistry October 29, 2020 23- F. Schwendickel, W. Samek2 , and J. Kroisl Artificial Intelligence in Dentistry:
a. Chances and Challenges 2020 24- The machine learning algorithms developed to perform well and allow for clinical implementation and utilization by dental and non-dental professionals.
25-American Academy of Oral and Maxillofacial Radiology (2013) Clinical recommendations regarding use of cone beam computed tomography in orthodontics. [corrected]. Position statement by the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol 116(2):238-26-Rischen RJ, Breuning KH, Bronkhorst EM, Kuijpers-Jagtman AM (2013) Records needed for orthodontic diagnosis and treatment planning: a systematic review.
PLoS
ONE 8(11):e74186.
Date Recue/Date Received 2022-10-10 27-. Nijkamp PG, Habets LL, Aatiman IH, Zentner A (2008) The infuence of cephalometrics on orthodontic treatment planning. Eur J Orthod 30(6):630-635.
28-. Devereux L, Moles D, Cunningham SJ, McKnight M (2011) How important are lateral cephalometric radiographs in orthodontic treatment planning? Am J Orthod Dentofac Orthop 139(2):e175¨e181.
29- European Commission (2004) Radiation Protection no 136. European guidelines on radiation protection in dental radiology. Ofce for Ofcial Publications of the European Communities, Luxemburg.
30- Martin, C.B.; Chalmers, E.V.; McIntyre, G.T.; Cochrane, H.; Mossey, P.A.
Orthodontic Scanners: What's Available? J.
Orthod. 2015, 42, 136-143.
31- Impellizzeri, A.; Horodynski, M.; De Stefano, A.; Palaia, G.; Polimeni, A.; Romeo, U.; Guercio-Monaco, E.; Galluccio, G.
CBCT
and Intra-Oral Scanner: The Advantages of 3D Technologies in Orthodontic Treatment. Int. J. Environ. Res. Public Healthy 2020, 17, 9428.
32- A Comparative Analysis Of Intraoral 3d Digital Scanners For Restorative Dentistry S
Logozzo, G Franceschini, A Kilpeld, M Caponi, L Governi, L Blois.
33- . Birnbaum NS, Aaronson HB, Stevens C, Cohen B: 3D Digital Scanners: A
High-Tech Approach to More Accurate Dental Impressions. Inside Dentistry; 2009; 5: 70-74.
34- F. Mangano, A. Gandolfi, G. Luongo, and S. Logozzo, "Intraoral scanners in dentistry: a review of the current literature," BMC Oral Health, vol. 17, no. 1, 2017.
35- G. V. Duello, "Intraoral scanning for single-tooth implant prosthetics:
rationale for a digital protocol," Compendium of Continuing Education in Dentistry, vol. 39, no. 1, 2018.
36- H. Kihara, W. Hatakeyama, F. Komine et al., "Accuracy and practicality of intraoral scanner in dentistry: a literature review," Journal of Prosthodontic Research, vol.
64, no. 2, pp. 109-113, 2020.
37- E. Yuzbasioglu, H. Kurt, R. Turunc, and H. Bilir, "Comparison of digital and conventional impression techniques: evaluation of patients' perception, treatment comfort, effectiveness and clinical outcomes," BMC Oral Health, vol. 14, no. 1, 2014.
38- M. Pecciarini, A. Biagioni, and M. Ferrari, "A systematic review of clinical trials on digital impression of prepared teeth," Journal of Osseointegration, vol. 11, no. 2, 2019.
Date Regue/Date Received 2022-10-10 Date Recue/Date Received 2022-10-10

Claims

Claims:
The proposed device works without radiation and will not expose the patient.
This device combines: an intra-oral CAD-CAM scanner, ultrasound system (US), and artificial intelligence for 3D vision without exposing patients to any x-ray radiation. Moreover, it will be used for diagnosis, treatment plans, case monitoring, and result assessment.
Specifically, the proposed device provides extra diagnosis visibility and predicts measurement forces during the treatment.
Also, it will have more accuracy compared to radiography and the highest sensitivity to show pathologies( Cavities, abscesses, tumors, oral cancer, cyst, periodontal lesions.), important anatomical points for orthodontics, and provide the information for planning treatment like;
size, position, and length of the roots and size jaws, also position and form of teeth ( extra, missing, impact), and bone structure. Moreover changes in soft and hard tissue will be visible during treatment. This device monitors treatment progress and determines how long treatment can continue without causing further damage.
Furthermore, it predicts and avoids any complications during treatment and will notify the orthodontist.
The most crucial specify this device compared to the standard 3D method used in orthodontics is:
= CBCT (cone beam computerized tomography).
= Sterophotogrametry or 3D surface imaging systems.
All these functions mentioned above will be without exposing patients to any x-ray.