Performance of a neural network trained to make third-molar treatment-planning decisions

The authors developed and tested 12 neural networks of different architectures to make lower-third-molar treatment-planning decisions, using a software-based neural network (Neudesk 1.2, Neural Computer Sciences, Southampton, UK). Network training was undertaken using clinical histories from 119 patients (with 238 lower third molars) referred for treatment planning (79 females and 40 males, mean age 25 years) together with output data consisting of actual treatments planned by a senior oral surgeon. Both the input clinical data and the consultant decisions were treated on a tooth-wise basis and were coded to numerical values. Binary data (e.g., present/absent) were coded to 1 and 0, while quantitative data (e.g., age) were scaled to fall between 0 and 1. A network based on the optimal architecture was trained and then interrogated with test data derived from a further 174 patients (119 females and 55 males, mean age 26 years) with 348 lower third molars. Network decisions were dichotomized with a threshold of 0.8. With no knowledge of the network decisions, the senior oral surgeon indicated his preferred treatments. The teeth were then assigned to "gold-standard" categories of indications present or absent based on National Institutes of Health consensus criteria. Against this, the network achieved a sensitivity of 0.78, which was slightly inferior to that of the oral surgeon (0.88), although this difference was not significant, and a specificity of 0.98, compared with 0.99 for the oral surgeon (p = NS). Agreement between the oral surgeon and network decisions was very high (kappa = 0.850). This study demonstrates that it is possible to train a neural network to provide reliable decision support for lower-third-molar treatment planning.