DenTiUS Plaque, a Web-Based Application for the Quantification of Bacterial Plaque: Development and Usability Study

Abstract

Background In the dentistry field, the analysis of dental plaque is vital because it is the main etiological factor in the 2 most prevalent oral diseases: caries and periodontitis. In most of the papers published in the dental literature, the quantification of dental plaque is carried out using traditional, non-automated, and time-consuming indices. Therefore, the development of an automated plaque quantification tool would be of great value to clinicians and researchers. Objective This study aimed to develop a web-based tool called DenTiUS and various clinical indices to evaluate dental plaque levels using image analysis techniques. Methods The tool was executed as a web-based application to facilitate its use by researchers. Expert users are free to define experiments, including images from either a single patient (to observe an individual plaque growth pattern) or several patients (to perform a group characterization) at a particular moment or over time. A novel approach for detecting visible plaque has been developed as well as a new concept known as nonvisible plaque. This new term implies the classification of the remaining dental area into 3 subregions according to the risk of accumulating plaque in the near future. New metrics have also been created to describe visible and nonvisible plaque levels. Results The system generates results tables of the quantitative analysis with absolute averages obtained in each image (indices about visible plaque) and relative measurements (indices about visible and nonvisible plaque) relating to the reference moment. The clinical indices that can be calculated are the following: plaque index of an area per intensity (API index, a value between 0 and 100), area growth index (growth rate of plaque per unit of time in hours; percentage area/hour), and area time index (the time in days needed to achieve a plaque area of 100% concerning the initial area at the same moment). Images and graphics can be obtained for a moment from a patient in addition to a full report presenting all the processing data. Dentistry experts evaluated the DenTiUS Plaque software through a usability test, with the best-scoring questions those related to the workflow efficiency, value of the online help, attractiveness of the user interface, and overall satisfaction. Conclusions The DenTiUS Plaque software allows automatic, reliable, and repeatable quantification of dental plaque levels, providing information about area, intensity, and growth pattern. Dentistry experts recognized that this software is suitable for quantification of dental plaque levels. Consequently, its application in the analysis of plaque evolution patterns associated with different oral conditions, as well as to evaluate the effectiveness of various oral hygiene measures, can represent an improvement in the clinical setting and the methodological quality of research studies.

Short-term anti-plaque effect of a cymenol mouthwash analysed using the DenTiUS Deep Plaque software: a randomised clinical trial

“…The digital quantification of the bacterial plaque in the photographic images was carried out using an image processing program of our design named DenTiUS Deep Plaque [ 37 ]. This was developed by USC’s Oral Sciences Research Group (OSRG) and the Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS).…”

“…The non-visible plaque is defined as a plaque whose green channel pixel value is higher than that of a reference time (professional dental cleaning) but is not higher than the blue channel value, although both values are close. Lastly, the sum of the two plaques is known as the total plaque [ 37 ].…”

“…However, the inherent subjectivity of visual examinations, the laborious recording process, and the high degree of inaccuracy when plaque levels are too low or too high [ 33 ] may produce imprecise results and, as a consequence, complicate comparisons between chemical agents [ 34 ]. These factors have led to an exponential increase in using automated approaches to objectively quantify dental biofilm in recent years [ 35 – 37 ]. These tools include a clinically validated version developed by our research group: DenTiUS Deep Plaque software [ 37 ].…”

“…These factors have led to an exponential increase in using automated approaches to objectively quantify dental biofilm in recent years [ 35 – 37 ]. These tools include a clinically validated version developed by our research group: DenTiUS Deep Plaque software [ 37 ]. Nonetheless, to our knowledge, no study has used an automated image analysis method to evaluate the anti-plaque effects of cymenol.…”

Visualization of dental plaque with a 3D-intraoral-scanner—A tool for whole mouth planimetry

“…Planimetry has been used with many variations to analyse conventional or fluorescence images [6][7][8][9][10][11][12][13][14] but it is still not very well established. One of the main reasons for this could be that capturing intraoral photos is very time-consuming and technically demanding, which makes the technique more suitable for special questions, for the assessment of individual teeth or for smaller examination groups.…”