DECISION SUPPORT SYSTEMS AND TECHNOLOGIES

USED IN PERIODONTOLOGY

Jorge Filipe Ribeiro

1,2

and Pedro Pereira Rodrigues

1,3

Faculty of Medicine of the University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal

Faculty of Sciences of the University of Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal

LIAAD - INESC Porto, L.A. & CINTESIS - Center for Research in Health Technologies and Information Systems

University of Porto, Porto, Portugal

Keywords: Periodontology, Periodontal disease, Decision support systems.

Abstract: The use of computer systems to aid clinical decision making is growing. Besides clinical practice, computer

applications, decision support systems or technologies can be used during dentistry and periodontology

learning. A research was made using 30 searching expressions, based on MeSH Terms. A total of 17 articles

were selected from the initial 249. Dental Students’ Ability to Assess Gingival Health Status Software

(DAAGS) and Virtual Learning Environment (VLE) are two examples of computer programs used in

Priodontology learning. 3D technologies, electronic devices and image analysis systems are tools used

during periodontal diagnosis. Dental informatics and periodontology are extremely connected, because,

many systems, technologies or electronic devices could be used during diagnose, treatment or pre-operative

phase. Computer applications could also be used to improve learning skills during pre-clinical and clinical

stages, and at same time other technologies as 3D can present more detailed data to clinician, leading to a

correct decision.

1 INTRODUCTION

Clinical dentistry has seen a slew of informatics and

Information Technologies innovations, such as

computerized charting, digital radiology, the Florida

Probe (electronic periodontal probing system), Oral

CDX (computer-assisted, brush biopsy, test for

detection of oral cancer), computer-based shade

matching, and CEREC (a modular computer-aided

design/manufacturing system for creating ceramic

restorations) (Schleyer, T.K., 2003). Besides clinical

practice, computer programs are also used during

dentistry learning (Wenzel, A., 2002). Periodontal

disease can be defined as the presence of gingival

inflammation at sites where there has been a

pathological detachment of collagen fibres from the

cementum and the junctional epithelium has

migrated apically, that would lead to the resorption

of coronal portions of tooth supporting alveolar

bone. (Savage, A., et al., 2009) Evaluation of

patient’s periodontal status requires obtaining a

relevant medical and dental history and conducting a

thorough clinical and radiographic examination with

evaluation of extraoral and intraoral (AAP, 2000),

and a sequence of interrelated steps is inherent to

effective periodontal treatment: early and accurate

diagnosis, comprehensive treatment, and continued

periodontal maintenance and monitoring. The

treatment of patients with periodontal disease is best

accomplished within the structure of a uniform and

consistent Periodontal Treatment Protocol. Such a

protocol would reinforce accurate and timely

diagnosis, treatment needs based on a specific

diagnosis, and continual assessment and monitoring

of outcomes. All effective treatment protocols begin

with a thorough and timely diagnosis Although

advancements in periodontal therapy, periodontal

diseases remain the most common cause of adult

tooth loss (Sweeting, L., et al., 2008). Diagnosis and

treatment of periodontitis continue to present

significant challenges to all practitioners regardless

of experience level (Sweeting, L., et al., 2008). The

aim of this paper is to know how decision support

systems can help dentists and periodontologists

during diagnosis and clinical practice, and at same

time evaluate the relationship between dental

informatics and periodontology, identify in

published bibliography Decision Support Systems

459

Ribeiro J. and Pereira Rodrigues P..

DECISION SUPPORT SYSTEMS AND TECHNOLOGIES USED IN PERIODONTOLOGY .

DOI: 10.5220/0003124704590462

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2011), pages 459-462

ISBN: 978-989-8425-34-8

 2011 SCITEPRESS (Science and Technology Publications, Lda.)

for diagnosis in Periodontology, know if Decision

Support Systems are frequently used in

periodontology practice and describe computer

examples of computer-based learning in

Periodontology.

2 METHODS

A research was performed between October’ 2009

an December’ 2009 in two databases – PubMed and

European Federation of Periodontology – Journal of

Clinical Periodontology, using 30 searching

expressions based on MeSH Terms. All used articles

were selected using title, abstract and full reading

filtering. They must have been published after

January 1st, 2000, and have the full text available.

From the 249 articles initially selected, 230 were

excluded based on title and abstract, and after full

text analysis 17 were selected to use in the review.

3 RESULTS

A total of 17 articles were selected and included in

this investigation. Health Informatics and Dental

Informatics are the Investigation Areas with more

articles, (n=4) each one. The geographically

distribution shows that USA (n=7) and Europe (n=8)

(UK, Switzerland and Germany with n=2, Sweden

and Denmark with n=1).

Decision Support Systems, software applications

and technologies are used in to help during

periodontology learning stage and during clinical

stage.

3.1 Decision Support

Systems/Technologies

used during Learning Stage

On learning stage those applications help students

during their pre-clinical or clinical training, Dental

Students’ Ability to Assess Gingival Health Status

Software (DAAGS) and Virtual Learning

Environment are two examples of computer

programs used in Priodontology learning. DAAGS

was used to improve dentists’, dental students’ at

different levels of education (Basic, Preclinic and

Clinic), and dental hygienists’ ability to assess the

gingival health level while using the Oral Rating

Index (ORI). The study was carried out at Ankara

University in Turkey in 2003. and was made by this

way, after explained to the students the ORI scoring

and criteria (the gold standard), a set of standard

color photos was presented using an LCD projector

set automatically (15 seconds per photo) at the

beginning of each test. Then, the students were

asked to judge each photo according to ORI criteria.

Three tests were made, test 1 and 2 same day and

test 3 after two weeks. The study performed using

DAAGS had a positive outcome, results revealed

that, without any training, there was an increase in

the number of correct answers and reproducibility

and a decrease in irrelevant answers with the

students’ increasing clinical experience, after three

application Tests. Also important is the fact that

Basic group showed a significant improvement

which indicates that the DAAGS software can be

considered an instructive tool for education. Authors

concluded that DAAGS would be useful to dental

students before clinical training and also an helpful

tool for calibration of dental employees (Camgoz,

M., et al., 2008).

Other application used on periodontoly learning

stage is the Virtual Learning Environment (VLE), a

web-based database application, divided into 6

sections (history taking, clinical examination, Xrays,

diagnosis, treatment planning and prognosis, and

log) where the learner uses free text communication

on the screen to interact with patient data. After

reviewing the patient information, the student

proposes therapy and makes prognostic evaluations

of the case in free text with simple design. Study had

positive results. Students were randomly assigned to

two groups. The experimental group (E) worked

with the virtual patient for 1 week prior to their first

patient contact whilst the control group (C) was first

allowed to use the virtual patient after their first

patient contact. Results indicated that students who

practiced with the virtual patient prior to their first

patient encounter behave more knowledgeably and

professionally compared with C group. Authors also

concluded that the use of the virtual patient and the

process of writing questions in working with the

virtual patient stimulate students to organize their

knowledge and result in more confident behavior

towards the patient (Janda, M.S., et al., 2004).

3.2 Decision Support

Systems/Technologies

used during Clinical Stage

On clinical stage, those technologies can help

clinician during diagnosis and treatment phases,

before intervention phase or after treatment or

invasive involvement. Nowadays 3D tools are useful

in Periodontology.

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460

3.2.1 3D Technologies

Walter et al in 2009, demonstrated that findings

from a 3D Cone Beam Computed Tomography

(CBCT) add substantial information about the root

form and proximity, furcation involvement (FI) and

the presence of mineralized connective tissue at

maxillary molar teeth. This study compared CBCT

data with x-ray (periapical) in 12 patients with

generalized chronic periodontitis, and showed that

application of dental CBCT enables a distinct and

more detailed assessment of FI in maxillary molars

compared with conventional clinical measurements

and periapical x-rays. The main conclusion of this

study is that CBCT images of maxillary molars may

provide detailed information of FI and a reliable

basis for treatment decision. CBCT was also used by

Park et al in 2007, where concluded that CBCT

provide effective 3-D visualization and image

analysis of the bone–tooth interface that complement

periodontal. This information is also present in a

study made by Grimard et al published in 2009,

where authors used same technology to compare the

measurements of bone defects from digital intraoral

radiographs (IR) and CBVT images with direct

surgical measurements for the evaluation of

regenerative treatment outcomes, like CBVT is an

equivalent substitution for direct surgical

measurements of bony changes occurring after bone

replacement graft procedures, especially defect fill

and defect resolution and help clinicians to measure

the volume changes of interdental papila region after

surgical and non-surgical treatment in

periodontology.

CAD/CAM 3D are an easy-to-use chair-side

method to document changes in soft tissues.

CAD/CAM method can adequately measure at

chair-side soft tissue changes of the interdental

papilla region under clinical conditions. With this

procedure it is possible to assess different surgical

and non-surgical treatments in terms of interdental

soft tissue preservation during active and

maintenance periodontal therapy or implantology

procedures in the esthetic zone.( Strebel et al, 2009).

These technologies was also used by Park et al in

2007, in a study where they concluded that 3D

Micro-Computed Tomography provide effective 3-D

visualization and image analysis of the bone–tooth

interface that complement periodontal.

3.2.2 Image Analysis System

Other example used in Periodontology is a method

based on image analysis that aims to quantify dental

plaque, published in 2001 by Smith et al. It measures

the plaque quantity using digital images taken in a

standardized illumination, head and camera

positioning. After plaque disclosure with

erythrosine, a picture was taken, then image were

analyzed and plaque area was selected, and copy to a

new image which was converted to grey levels, all

those phases were made in Adobe Photoshop. Then

with Image Pro Plus measure to real scale size of

plaque area was made. Authors concluded that the

system provides an improved method of quantifying

both simple and complex dental plaque areas with

increased accuracy without the need for a clinician.

3.2.3 Electronic Devices

Clinical practice is helped by electronic devices,

such as electronic probes, instrument that

automating the recording method and controlling the

probing pressure (Silva-Boghossian, C.M., et al.,

2008). Another example of electronic devices is an

instrument that combines a fuzzy set with an

ultrasonic scaler, which automatic recognize tooth

surfaces using a piezoceramic dental ultrasonic

scaler as an oscillatory excitation and sensor system,

combined with special pattern recognition software

based on a fuzzy classifying algorithm. Calculus,

cementum and tooth surface are automatic

recognized, which reduce the amount of tooth

substance removed and consequently decrease

dentin hypersensitivity after periodontal treatment

(Kocher et al, 2000). Other example is one based on

a conventional piezoceramic ultrasonic scaler which

detects automatically subgengival calculus based on

surface stimulation to oscillate the instruments tip.

The frequency is dependent on the substrate

characteristics, cementum or calculus. The detection

device may reduce the risk to overtreat cementum

with adhering biofilm and without calculus, because

the power setting should only be high if the insert

encounters calculus and low if there is only biofilm

(Meissner et al 2008).

4 DISCUSSION

This investigation shows that decision Support

Systems/Technologies in Periodontology are used in

two different ways: learning and clinical stage which

help students during their pre-clinical or clinical

training. DAAGS Software and VLE are two

examples of computer programs used in

Priodontology learning. On clinical practice help

clinician during diagnosis and treatment phases.

3D technologies are important partners in perio-

DECISION SUPPORT SYSTEMS AND TECHNOLOGIES USED IN PERIODONTOLOGY

461

dontology treatment, diagnosis or treatment planning

phases. Imaging analysis systems allows

identification of dental plaque. Electronic probes,

help probing during diagnosis, and ultrasonic

devices, identify hard dental tissues or subgengival

calculus help clinicians during treatment and

diagnosis phases improving diagnosis accuracy and

precision.

Also showed that decision support systems and

technologies in periodontology are useful to make

correct decisions and select better treatment based

on a correct diagnose. This work also summarized

data and showed it in a simplest way, useful

technologies, computer applications and software

used in periodontology and demonstrated that

informatics is an important helper and valuable

partner in periodontology practice. The data offered

on this review presents a few of systems or

electronic devices used actually.

More research must be done in this area, because

this review was based on 30 searching expressions

and free full text papers, that means that many other

articles with important information couldn‘t be used.

This review showed how diagnosis moment is

important in Periodontology and how new

technologies could can help clinicians during these

stage. A correct and timely diagnose leads to a

correct and benefic treatment approach or option to

patient periodontal pathology. Dental informatics is

a new research area which is helping

periodontology, because many systems, technologies

or electronic devices could be used during diagnose,

treatment or pre-operative phases. Computer

applications in periodontology could also be used to

improve learning skills during pre-clinical and

clinical stages, and lead to a correct decision. More

research must be done, however this investigation

confirm that implementation of dental informatics

into Periodontology is a reality and with these small

steps a huge walking is being done.

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Grimard, B. A., et al., Comparison of Clinical, Periapical

Radiograph, and Cone-Beam Volume Tomography

Measurement Techniques for Assessing Bone Level

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