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.

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中文翻译：

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DenTiUS Plaque，基于Web的细菌菌斑定量应用程序：开发和可用性研究。

背景：在牙科领域，牙菌斑的分析至关重要，因为它是两种最常见的口腔疾病（龋齿和牙周炎）的主要病因。在牙科文献中发表的大多数论文中，使用传统的，非自动化且耗时的指标对牙菌斑进行定量。因此，开发自动化的噬菌斑定量工具对临床医生和研究人员将具有巨大的价值。目的：本研究旨在开发一种基于网络的工具DenTiUS和各种临床指标，以使用图像分析技术评估牙菌斑水平。方法：该工具作为基于Web的应用程序执行，以方便研究人员使用。专家用户可以自由定义实验，包括在特定时刻或一段时间内来自单个患者（观察单个斑块生长模式）或多个患者（执行组表征）的图像。已经开发了检测可见斑块的新颖方法以及称为不可见斑块的新概念。这个新术语意味着根据不久的将来牙菌斑累积的风险，将剩余的牙齿区域分为3个子区域。还创建了新的指标来描述可见和不可见的菌斑水平。结果：系统生成定量分析的结果表，其中包含在每个图像中获得的绝对平均值（有关可见斑块的指标）和与参考矩相关的相对测量值（有关可见和不可见斑块的指标）。可以计算的临床指标如下：每强度区域的菌斑指数（API指数，0到100之间的值），面积增长指数（单位时间的菌斑生长率（小时）；面积/小时百分比） ，以及面积时间指数（以同一天的初始面积达到100％的菌斑面积所需的时间，以天为单位）。除了显示所有处理数据的完整报告之外，还可以从患者那里获得图像和图形。牙科专家通过可用性测试评估了DenTiUS Plaque软件，其中得分最高的问题涉及工作流程效率，在线帮助的价值，用户界面的吸引力以及总体满意度。结论：DenTiUS Plaque软件可实现对牙菌斑水平的自动，可靠和可重复的定量，提供有关面积，强度和生长方式的信息。牙科专家认识到该软件适用于牙菌斑水平的定量。因此，其在分析与不同口腔状况相关的斑块演变模式以及评估各种口腔卫生措施的有效性中的应用可以代表临床研究环境和研究方法学质量的提高。

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