The invention is directed to an interactive workstation and associated computerized techniques, including software applications and web based applications for facilitating practice benchmarking, clinical benchmarking, care planning, or providing other services for the benefit of the practitioner and/or the patient. These include but are not limited to, trouble shooting, education, and gaining clinical expertise with said techniques.
One way to straighten teeth and improve smiles is to use removable dental appliances such as aligners that are personalized for each patient. Clear, polymer aligners are used to move teeth in small increments. Each aligner is designed to apply controlled force on the patient's teeth. The specific teeth to be moved and the amount of movement will depend on the patient, and will be determined by the treating doctor.
Each aligner is worn for several weeks, and can be removed to eat, brush, floss, and be removed for special occasions. During wear, the patient's teeth are gently moved to their ideal position. The length of the process depends on the patient's malocclusion(crooked teeth), willingness of the patient to wear aligners, physical feasibility of aligners to impart correct forces onto the teeth and the results the patient wants to achieve. The advantages of aligners are: Clear—most patients find them very esthetic in comparison to traditional fixed appliances(braces); Comfortable—aligners have a smooth surface that is gentle in the patients mouth and compared to braces do not cause as much pain during adjustments; Removable—patients can take them out to eat or brush, then put them back in again, giving the patient a sense of power over the process of tooth movement; Hygienic recent university studies show that clear plastic appliances are better for dental health when compared to fixed appliances.
Historically, clinical usage of clear plastic appliances that are vacuum formed have been in use in dentistry since the 1970's. These appliances have generally been done in house by the dentist or orthodontist and required much manual labor. In recent years, computer-based approaches have been proposed for aiding orthodontists and dentists in producing series of clear plastic appliances utilizing modern computerized techniques in manufacturing. These approaches are disclosed in Andreiko, U.S. Pat. No. 6,015,289; Snow, U.S. Pat. No. 6,068,482; Kopelmann et al., U.S. Pat. No. 6,099,314; Doyle, et al., U.S. Pat. No. 5,879,158; Wu et al., U.S. Pat. No. 5,338,198, and Chisti et al., U.S. Pat. Nos. 5,975,893 and 6,227,850, the contents of each of which is incorporated by reference herein. Additionally, computerized tools for orthodontic modeling and treatment planning are marketed by companies such as Align Technology, Inc., Santa Clara, Calif.; OrthoClear, Inc., San Francisco, Calif.; Ormco Corporation, Orange, Calif.; Cadent Inc., Carlstadt, N.J., and OraMetrix, Inc., Richardson, Tex.
US Application Serial No. 20050038669 discloses an interactive, unified workstation or web application which unifies in a single system a multitude of functions pertaining to an orthodontic or dental practice that would otherwise require disjointed, more expensive, and less efficient individual workstations dedicated to a specific, limited task or a sub-set of tasks. The application discloses benchmarking for a practitioner's business practice, and for clinical aspects of treatment planning; and integrating overall patient care planning functions. The unified workstation further facilitates access to archived database resources and facilitates both knowledge base services to practitioners and also hybrid treatment planning, wherein different types of appliance systems (fixed, such as brackets and wires, or removable, such as aligning shells) may be used during the course of treatment.
In one aspect, a method to evaluate orthodontic care and treatment of a patient includes receiving an orthodontic treatment plan, applying a clinical knowledge database that matches, at least approximately, the orthodontic condition of the patient; and generating a. problem list and generating treatment plan options.
Implementations of the above aspect may include one or more of the following. The report can be comprises one or more of the following: text, audio clip, visual display, and animation. The method can include analyzing arch movement. The method can include determining overall movement of teeth within an arch and can also include analyzing tooth movement based on points on one or more teeth. The method can include evaluating crown and root tip. The method can include evaluating crown and root torque. The method can include evaluating tooth rotation along an axis. The method can include evaluating tooth extrusion and intrusion. The method can include evaluating posterior tooth movement and anterior movement. The method can include determining likelihood of tipping, distalization or incisor root torque and by extension likely hood of failure of the appliance. The method can include applying historical patient response data and clinical experience with the various types of orthodontic appliances. The method can also include monitoring the progress of a patient in response to the treatment, and comparing the monitored progress to an expected progress for the patient. The treatment plan can be adjusted with a change in an appliance type. For example, the method can use a first type of orthodontic device during a first portion of a hybrid treatment plan, and a second type of orthodontic device during a second portion of the patient treatment plan.
In another aspect, a system with a central processing unit and a memory storing a clinical knowledge database executes software for receiving an orthodontic treatment plan, applying a clinical knowledge database that matches, at least approximately, the orthodontic condition of the patient; and generating a report for the treatment plan.
Implementations of the system can have the software provide instructions for aiding a practitioner in determining whether a treatment plan satisfies a patient's objectives. The system can also aid the practitioner in determining their risk level when it comes to assessing the likelihood that clear plastic appliances will necessitate the use of fixed appliances in addition to the clear appliances to obtain a satisfactory outcome. The software can also aid a practitioner in (a) monitoring and tracking said patient's progress in response to a treatment plan, and (b) in making adjustments to the treatment plan. The system will also help in education of clinicians and decrease the time of trial and error that usually accompanies a new technique in a doctor's office.
Advantages of the system may include one or more of the following. The system interactively guides practitioners on the expected effectiveness of their treatment plan and appliance. The system is manufacturer-independent and provides an unbiased review of treatment expectations. The system facilitates practice and clinical benchmarking, and unifying other functionalities of a practice such as for planning of care for medical and dental patients.
The system will facilitate education and help identify patient treatments that are not necessarily going to benefit from clear vacuum formed appliances. The system will decrease overall failure of said appliances by identifying potential problems before said appliances are used. The system will also work within the doctor's experience or level of risk, to evaluate the treatment, so the doctor can gain confidence in identifying future successful treatments
In one embodiment, a physical model can be scanned with a laser or other optical scanner, or other type of scanner, preferably a non-contact scanner. The scanning produces a three-dimensional digital model of the teeth in the patient's mouth. Alternatively, the scanning of the model can be carried out by a person at a doctor or orthodontist's office or digital information can be derived from a full oral scan directly of the patient's mouth. The scanning can be done with a laser scanner or white light scanner, among others, or can be done with contact scanners as well.
In another embodiment, the set-up 10 can be produced using X-ray images of the patient anatomy. The X-ray images can be 2D images or alternatively can be 3D images such as those produced using tomography scanners. In tomography, an x-ray beam source and an x-ray film are moved in predetermined directions relative to one another. The angular disparity produced by relative motion between x-ray source and x-ray detector is used to selectively isolate a region, the location of which can be varied by controlling motion relative to the tissues of interest. In computed tomography, the projection geometry is characterized by a fan-shaped x-ray beam which lies in the same plane as a detector. This geometry renders details in one focal plane independent from those in another focal plane, but at the expense of having the plane of the source and detector motion coincident with the focal plane. The tomography scanner can scan a physical model of the patient's jaws and teeth, or alternatively, the tomography scanner can scan the patient in vivo and bypass the need to take an impression or mold of the patient's teeth. Other techniques for obtaining 3D models of the patient's teeth can be used as well.
In yet another embodiment, the 3D model can be generated using an intra-oral scanner such as the SureSmile OraScanner which is based on white light and active triangulation. The SureSmile software includes visualization tools for precise diagnosis, treatment planning, and therapeutic design and allows interactive 3-D viewing of the malocclusion and target occlusion from any angle or magnification. As disclosed in U.S. Pat. No. 6,495,848, the content of which is incorporated by reference, the system detects the spatial structure of a three-dimensional surface by projection of a pattern on to the surface along a projection direction which defines a first axis, and by pixel-wise detection of at least one region of the pattern projected on to the surface, by means of one or more sensors in a viewing direction of the sensor or sensors, which defines a second axis, wherein the first and the second axes (or a straight line parallel to the second axis) intersect at an angle different from 0.degree. so that the first and the second axes (or the straight line parallel thereto) define a triangulation plane, wherein the pattern is defined at least upon projection into a plane perpendicularly to the first axis by a varying physical parameter which can be detected by the sensor (sensors), and wherein the pattern is such that the difference in the physically measurable parameter, measured between predeterminable image pixels or pixel groups, along a predeterminable pixel row which is preferably parallel to the triangulation plane, assumes at least two different values.
Once the 3D model of the patient's teeth has been digitized, a course of treatment can be done using the 3D model. This can be done by morphing teeth movement over a plurality of stages, with each stage manifesting as one aligner. Alternatively, individual 3D model of each tooth can be created from the digitized model, and each tooth can be moved a predetermined distance (such as about 2 mm) per stage in accordance with a dentist or orthodontist's prescription.
Aligners and other computer based orthodontic devices typically require treatment experience in order to arrive at a positive outcome. Some practitioners might assume that clear plastic appliances will be 100% successful when in fact it may be 10% successful. Success in using aligners is based on what the current state of the teeth is and where the treating doctor plans treatment to go. Success is also determined by the doctor's ability to know how these clear appliances behave clinically and how teeth react to them and how to trouble shoot problems, use other products to enhance these appliance's shortcomings. One significant aspect of success is the doctor's ability to communicate with the patient to inform the patient of outcome possibilities and be synchronized with what the patient's idea of success. To enhance the success rate, the 3D set-up is processed in an outcome checking system 20, and the system produces a series of outputs (30) including text, audio information, visual information, or animation that aids practitioners in arriving at the right treatment decision.
The outcome checking system 20 applies software processes and algorithms to the 3D computer set-up data file 10 and other measurements which help predict positive or negative outcomes in 3D graphical computer orthodontic set-ups. The computer system 20 helps the doctor or patient identify potential problems that may create the need for further treatment or bad outcomes. The doctor or patient will then be able to decide if this is the right treatment for them. The system enables the doctor and the patient to determine the probability that this series of clear appliances move teeth as planned when the patient reaches the end of the series. There will also be user defined parameters that can be used to identify the areas of comfort the doctor or patient wants tolerate. That is taking into account the fact that the patient and doctor have all ready planned to make the adjustment to traditional fixed appliances at some point during treatment.
In one embodiment, the system 20 is an expert system based on clinical history and trials have identified a number of movements that are less predictable than others. In this embodiment, a series of analysis is performed on each input. The input to the expert system is the computerized orthodontic set-up made of two arches, their relationship to each other, an initial position, all movements, and a final position. It may also include various other inputs such as photographs, x-rays, photographs of models, digital models, treatment plans or other user input that can help with the process.
In one analysis shown in
In one implementation, this plane can be defined by picking three points A, C and D on the occlusal surface of teeth such as on teeth posterior to the canine. This plane intersects an axis, which runs down the center of the tooth from the crown to the extreme end of the tooth or apex. This central axis is defined by two points. One point is placed at the tip of the tooth crown close to the center of the surface of the tooth when viewed from the occlusal (A). The second of the two points is placed at the apex of the tooth or the tip of the tooth, which is in the bone of the patient (B) and can come from x-ray inputs for the appliances. The second point can be estimated by the plane that is more or less parallel to the occlusal table of the tooth, intersecting the axis defined above and placing point B an average tooth length into the bone, perpendicular to the plane defined above.
Referring to
Three categories (Low Risk, Medium Risk, and High Risk) will be created to place these outputs and to communicate these outputs to the user. If movements are less than a certain value, they will be deemed Low Risk. Higher movements will be deemed Medium Risk and excessive movements will be deemed High Risk. Low Risk is defined as movements below a predetermined first level, Medium Risk are those above the first level and a second level and High Risk will be those with outside the second level.
In yet another analysis shown in
In
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The data collected is provided to a classifier to provide analysis of the individual movements. In one embodiment, the classifier is a k-Nearest-Neighbor (kNN) based prediction system. The prediction can also be done using Bayesian algorithm, support vector machines (SVM) or other supervised learning techniques. The supervised learning technique requires a human subject-expert to initiate the learning process by manually classifying or assigning a number of training data sets of image characteristics to each category. This classification system first analyzes the statistical occurrences of each desired output and then constructs a model or “classifier” for each category that is used to classify subsequent data automatically. The system refines its model, in a sense “learning” the categories as new images are processed.
Alternatively, unsupervised learning systems can be used. Unsupervised Learning systems identify groups, or clusters, of related image characteristics as well as the relationships between these clusters. Commonly referred to as clustering, this approach eliminates the need for training sets because it does not require a preexisting taxonomy or category structure.
Rule-Based classification can also be used where Boolean expressions are used to categorize significant output conditions. This is typically used when a few variables can adequately describe a category. Additionally, manual classification techniques can be used. Manual classification requires individuals to assign each output to one or more categories. These individuals are usually domain experts who are thoroughly versed in the category structure or taxonomy being used.
It is to be understood that various terms employed in the description herein are interchangeable. Accordingly, the above description of the invention is illustrative and not limiting. Further modifications will be apparent to one of ordinary skill in the art in light of this disclosure.
The invention has been described in terms of specific examples which are illustrative only and are not to be construed as limiting. The invention may be implemented in digital electronic circuitry or in computer hardware, firmware, software, web based application or combinations of them.
Apparatus of the system for evaluating treatment outcome may be implemented in a computer program product tangibly embodied in a machine-readable storage device for execution by a computer processor; and method steps of the invention may be performed by a computer processor executing a program to perform functions of the invention by operating on input data and generating output. Suitable processors include, by way of example, both general and special purpose microprocessors. Storage devices suitable for tangibly embodying computer program instructions include all forms of non-volatile memory including, but not limited to: semiconductor memory devices such as EPROM, EEPROM, and flash devices; magnetic disks (fixed, floppy, and removable); other magnetic media such as tape; optical media such as CD-ROM disks; and magneto-optic devices. Any of the foregoing may be supplemented by, or incorporated in, specially-designed application-specific integrated circuits (ASICs) or suitably programmed field programmable gate arrays (FPGAs).
The classifier can be implemented as software. Each computer program is tangibly stored in a machine-readable storage media or device (e.g., program memory or magnetic disk) readable by a general or special purpose programmable computer, for configuring and controlling operation of a computer when the storage media or device is read by the computer to perform the procedures described herein. The inventive system may also be considered to be embodied in a computer-readable storage medium, configured with a computer program, where the storage medium so configured causes a computer to operate in a specific and predefined manner to perform the functions described herein.
Portions of the system and corresponding detailed description are presented in terms of software, or algorithms and symbolic representations of operations on data bits within a computer memory. These descriptions and representations are the ones by which those of ordinary skill in the art effectively convey the substance of their work to others of ordinary skill in the art. An algorithm, as the term is used here, and as it is used generally, is conceived to be a self-consistent sequence of steps leading to a desired result. The steps are those requiring physical manipulations of physical quantities. Usually, though not necessarily, these quantities take the form of optical, electrical, or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It has proven convenient at times, principally for reasons of common usage, to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like.
It should be borne in mind, however, that all of these and similar terms are to be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities. Unless specifically stated otherwise, or as is apparent from the discussion, terms such as “processing” or “computing” or “calculating” or “determining” or “displaying” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical, electronic quantities within the computer system's registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices.
The present invention has been described in terms of specific embodiments, which are illustrative of the invention and not to be construed as limiting. Other embodiments are within the scope of the following claims. The particular embodiments disclosed above are illustrative only, as the invention may be modified and practiced in different but equivalent manners apparent to those skilled in the art having the benefit of the teachings herein. Furthermore, no limitations are intended to the details of construction or design herein shown, other than as described in the claims below. It is therefore evident that the particular embodiments disclosed above may be altered or modified and all such variations are considered within the scope and spirit of the invention. Accordingly, the protection sought herein is as set forth in the claims below.