Tele-orthodontics: A Pilot Study on the reliability of virtually acquired records for orthodontic decision-making

Background The aim of this pilot study was to assess the reproducibility of treatment planning when using different diagnostic information formats: patient-provided (virtual) versus in-office (clinical) records. Methods Nine orthodontic cases with various malocclusion complexities were selected from individuals seeking orthodontic treatment at one institution. The cases were distributed to three groups of raters: third-year orthodontic residents, orthodontists < 10 years of experience, and orthodontists ≥10 years of experience. First, the raters assessed the virtual records provided by the patient and determined the most appropriate treatment plan, modality, and plan with modality. One month later, the raters were provided the clinical records to re-determine the best treatment strategy. Cohen’s kappa statistics were calculated to measure intra-observer reliability. Results Orthodontists ≥10 years of experience demonstrated a statistically significant reliability for treatment plan (kappa and 95% Confidence Interval, k=0.25, 95% CI 0.07, 0.40), modality (k=0.43, 95% CI 0.32, 0.62) and combined decision (k=0.25, 95% CI 0.14, 0.42). The Cohen's kappa coefficients however indicated only fair to moderate agreement. No other group showed a statistically significant finding. Conclusions This study demonstrated fair to moderate agreement between treatment decisions when comparing virtually obtained initial records with in-office obtained clinical records. The overall agreement between the two formats was 53.1% for treatment plan, 65.4% for treatment modality, and 37% when considering both plan and modality combined. Virtual records can serve as a helpful screening tool but should not replace a clinical examination when making orthodontic decisions.