Henry W Fields’s research while affiliated with The Ohio State University and other places

The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) is internationally recognized as a reliable and valid method for assessing aesthetic treatment need. The objective of this study is to use artificial intelligence (AI) to automate the AC assessment. A total of 1009 pre-treatment frontal intraoral photos with overjet values were collected. Each photo was graded by an experienced calibration clinician. The AI was trained using the intraoral images, overjet, and two other approaches. For Scheme 1, the training data were AC 1–10. For Scheme 2, the training data were either the two groups AC 1–5 and AC 6–10 or the three groups AC 1–4, AC 5–7, and AC 8–10. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for all approaches. The performance was tested without overjet values as input. The intra-rater reliability for the grader, using kappa, was 0.84 (95% CI 0.76–0.93). Scheme 1 had 77% sensitivity, 88% specificity, 82% accuracy, 89% PPV, and 75% NPV in predicting the binary groups. All other schemes offered poor tradeoffs. Findings after omitting overjet and dataset supplementation results were mixed, depending upon perspective. We have developed deep learning-based algorithms that can predict treatment need based on IOTN-AC reference standards; this provides an adjunct to clinical assessment of dental aesthetics.

Introduction: This research project aimed to compare the number of maxillary incisors and canine movement between Invisalign and fixed orthodontic appliances using artificial intelligence and identify any limitations of Invisalign. Methods: Sixty patients (Invisalign, n = 30; braces, n = 30) were randomly selected from the Ohio State University Graduate Orthodontic Clinic archive. Peer Assessment Rating (PAR) analysis was used to indicate the severity of the patients in both groups. To analyze the incisors and canine movement, specific landmarks were identified on incisors and canines using an artificial intelligence framework, two-stage mesh deep learning. Total average tooth movement in the maxilla and individual (incisors and canine) tooth movement in 6 directions (buccolingual, mesiodistal, vertical, tipping, torque, rotation) were then analyzed at a significance level of α = 0.05. Results: Based on the posttreatment Peer Assessment Rating scores, the quality of finished patients in both groups was similar. In maxillary incisors and canines, there was a significant difference in movement between Invisalign and conventional appliances for all 6 movement directions (P <0.05). The greatest differences were with rotation and tipping of the maxillary canine, along with incisor and canine torque. The smallest statistical differences observed for incisors and canines were crown translational tooth movement in the mesiodistal and buccolingual directions. Conclusions: When comparing fixed orthodontic appliances to Invisalign, patients treated with fixed appliances were found to have significantly more maxillary tooth movement in all directions, especially with rotation and tipping of the maxillary canine.

The current credentialing and privileging (C&P) climate has evolved due to a risk reduction/management awareness of increased institutional legal liability. This recognition affects dental colleges and has caused the implementation of C&P processes. Contemporary best practices for methods, processes, and structure are reported here. Data reported from the process show how and what clinicians' red flags were discovered during the process. Conclusions include the following: C&P is a significant process to introduce in terms of institutional resources and commitment. This process includes increased clinician and administrative burden that needs to have a governor. Attention to experiences of other institutions can reduce but not eliminate challenges from the clinician and some administrators. A primary data-based verification process administered by a credentialing specialist can make the process valid and workable.

Background The purpose of this study was to assess the effectiveness of training residents in an orthodontic program in the placement of miniscrews by using cone beam computed tomography (CBCT) images. A total of 90 miniscrews were placed in 15 pig mandibles over a 3-year period by 15 first-year orthodontic residents. Miniscrews were divided into three groups (Control group: no radiographs; 2D group: placement with 2D radiographs; CBCT group: placement with CBCT). Proximity of the miniscrew to the neighboring root was measured. The miniscrew success rate was examined in the graduate clinic from 2015 to 2021. Results The percentage of root contact for each group was: 36.7% (11/30), 20.0% (6/30), 0% (0/30), for the Control, 2D, and CBCT groups, respectively. The CBCT group was significantly different from the Control and 2D groups ( p < 0.05). For root proximity, the miniscrews were significantly closer to the roots in the Control ( p < 0.001) and 2D ( p < 0.001) groups compared with the CBCT group. No significant difference was observed between the Control and 2D groups ( p = 0.80). There was no significant difference among the years in the miniscrew success rate. Conclusions Training the residents in an orthodontic graduate program using CBCT may be helpful to avoid root damage and to decrease the miniscrew failure rate.

Introduction The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices. Methods A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later. Results Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P <0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge >20% was common. Conclusions Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Introduction: This study aimed to establish if there is a significant difference in effectiveness between 2 generations of Invisalign trays in terms of Peer Assessment Rating (PAR) score reduction for finished patients from a graduate orthodontic clinic. Methods: Forty-five pretreatment and posttreatment patients treated with the previous Invisalign material and 49 pretreatment and posttreatment patients treated with SmartTrack material were scored using the Peer Assessment Rating (PAR) index. Both groups were controlled for initial weighted PAR score, age, gender, and treatment time. The 2 generations were compared in regard to absolute reduction, percent reduction, and great improvement in PAR score. Results: The mean absolute reduction in weighted PAR score between the groups was not statistically significant (P = 0.526). The mean percent reduction in weighted PAR score between the groups was not statistically significant (P = 0.210). The proportion of great improvement between the groups was not significant (P = 0.526). Only 6 of the 8 components of occlusion had enough variation to be modeled. An absolute reduction in unweighted PAR score was not significantly different between the groups for maxillary anterior alignment, overjet, or mandibular anterior alignment (P = 0.996, 1.000, and 0.114, respectively). Percent reduction in unweighted PAR score was not significantly different between the 2 groups for an anteroposterior, overbite, or transverse (P = 1.000, 1.000, and 1.000, respectively) relationships. Conclusions: Our study indicates that both generations of Invisalign aligners improved the malocclusion to a similar degree according to the PAR index. Patient-centric benefits of SmartTrack aligner should also be considered by the provider.

Introduction Proper informed consent allows patients to take an active role in their own treatment decisions, and enhanced compliance might improve treatment outcomes. The objective of this research was to determine if handwritten rehearsal of core and custom consent items would increase short-term recall and comprehension. Methods A total of 90 patient-parent pairs were randomly assigned to 2 groups. After case presentation, each subject was provided 10 minutes to read a modified informed consent document. Group A received visual printouts containing the 4 core elements (root resorption, decalcification, pain, and relapse/retention) likely to be encountered by all patients and up to 4 custom elements (eg, impacted teeth, orthognathic surgery, or other case-specific treatment issues). Subjects identified and wrote what the image depicted and how it could affect treatment. Group B viewed a slideshow presentation on all 18 consent elements arranged from general to specific. All participants were interviewed, and each provided their sociodemographic data, as well as completed literacy, health literacy, and state anxiety questionnaires. The groups were compared for recall and comprehension through an analysis of covariance. Results The rehearsal intervention significantly improved recall and comprehension of the core elements (P = 0.001). Rehearsal also improved custom recall and comprehension, but not significantly. Group B performed significantly better on treatment questions (P = 0.001). Overall, as anxiety increased, correct responses decreased. Conclusions The rehearsal group improved recall and comprehension of the core and custom elements of informed consent and proved a more efficient method than an audiovisual presentation to provide informed consent. It also improved meeting legal obligations.

Background: The American Dental Association's (ADA) specialty recognition process has long been the gold standard in dentistry. Specialty advertising regulations have been challenged as inconsistent with commercial speech rights of dentists wishing to advertise as specialists in areas not recognized as ADA specialties. Commission of Dental Accreditation-approved postdoctoral education exists to support this process using standard-based education, continuous quality review and accountability. Purpose: In 2017, a federal court declared Texas dental specialty advertising rules unconstitutional noting the state did not present evidence demonstrating the public was being misled. A state dental association commissioned a professional survey to assess state residents' understanding of the term "specialist" in dental advertising. Methods: Telephone interviews conducted with 812, 18+-year-old Ohio residents focused on advertising related to dental implants and TMJ disorders (not recognized specialties) and orthodontics and oral surgery (recognized specialties). Results: Respondents indicated they would be inclined to think a dentist who advertised as a specialist had completed an accredited dental residency program and was more qualified to perform specialty care than a general dentist. Respondents also indicated that they would be less likely to choose a dentist who advertised as a specialist who did not have accredited residency training. Conclusions: Tying specialty status to completion of a residency program accredited by an agency recognized by the U.S. Department of Education is important to the public's expectations and has implications for dental education.

Introduction: The reliability of the cervical vertebral maturation (CVM) method has been questioned. The objective of this research was to evaluate the diagnostic reliability of the CVM method to diagnose the mandibular growth spurt using longitudinal records from an alternative database (Iowa Facial Growth Study [IFGS]) using established diagnostic testing methods. Methods: Cephalometric films from 43 subjects (males = 20, females = 23) with Class I or Class II skeletal pattern from the IFGS were scanned, digitized, and adjusted for magnification. At least 5 consecutive, annual films were digitized. For each subject, mandibular length (Co-Gn) was measured for each film, and the growth increment between films was calculated. The largest growth increment was the growth spurt. For each subject, the film displaying CVM stage 3 was identified by a blinded examiner viewing the films in random order. Interrater and intrarater repeatability for Co-Gn (intraclass correlation) and CVM staging (weighted kappa) were calculated. Diagnostic tests, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were carried out. The present data were compared with data previously derived from samples of the University of Michigan, Oregon, and Burlington Growth studies (UMGS, OGS, and BGS, respectively). A multilevel logistic regression analysis was also run with the mandibular growth peak as the response variable. Results: Interrater repeatability for mandibular measurements (intraclass correlation coefficient [ICC] = 0.91) and CVM staging (k = 0.88) were excellent. Intrarater repeatability for mandibular measurements (ICC = 0.98) and CVM staging (kw = 0.55) were excellent to moderate. The UMGS data demonstrated higher sensitivity with comparable specificity. Accuracy was largely similar. Their PPV and NPV had larger ranges. The OGS and BGS data, compared with the IFGS data, showed that our sensitivity and PPVs were higher, that their specificity was higher, and that the NPV and accuracy were very similar. The regression analysis was applied to age groups 10-11 years through 13-14 years. Only chronological age was significant (P = 0.04). Conclusions: Agreement between CVM stage 3 and the maximum mandibular growth spurt is inconsistent. The diagnostic capability of CVM for the mandibular growth spurt is questionable.