Fuzzy modelling for selecting headgear types

The purpose of this study was to develop a computer-assisted inference model for selecting appropriate types of headgear appliance for orthodontic patients and to investigate its clinical versatility as a decision-making aid for inexperienced clinicians. Fuzzy rule bases were created for degrees of overjet, overbite, and mandibular plane angle variables, respectively, according to subjective criteria based on the clinical experience and knowledge of the authors. The rules were then transformed into membership functions and the geometric mean aggregation was performed to develop the inference model. The resultant fuzzy logic was then tested on 85 cases in which the patients had been diagnosed as requiring headgear appliances. Eight experienced orthodontists judged each of the cases, and decided if they 'agreed', 'accepted', or 'disagreed' with the recommendations of the computer system. Intra-examiner agreements were investigated using repeated judgements of a set of 30 orthodontic cases and the kappa statistic. All of the examiners exceeded a kappa score of 0.7, allowing them to participate in the test run of the validity of the proposed inference model. The examiners' agreement with the system's recommendations was evaluated statistically. The average satisfaction rate of the examiners was 95.6 per cent and, for 83 out of the 85 cases, 97.6 per cent. The majority of the examiners (i.e. six or more out of the eight) were satisfied with the recommendations of the system. Thus, the usefulness of the proposed inference logic was confirmed.