New Technologies in the Future of Dentistry

NEW TECHNOLOGIES
IN THE FUTURE
OF DENTISTRY
Adam Bilski

Introduction
How did dentistry change:
- Since 1884 cocaine was used as a local anaesthetic,
however due to its awesome but addictive
properties in 1905 it was replaced by procaine
(novocaine), formulated by Alfred Einhorn
- It wasn’t until 1960s, when dentists started
working with assistants
- High rotation motors (Airotor) were invented in
1950s (until then rotations were slow, and
mashines were extremely heavy)
- The use of diamond bits and carbide burrs were
introduced in around 1925
- Brushing teeth every day became a thing just after
WW2
NEW TECHNOLOGIES IN THE FUTURE OF DENTISTRY

HOW WILL IT LOOK IN THE NEXT 50 YEARS?

ARTIFICIAL
INTELLIGENCE IN
DENTISTRY

Artificial Inteligence
It is the simulation of human intelligence processes by machines,
especially computer systems. In general, AI systems work by ingesting
large amounts of labeled training data, analyzing the data for
correlations and patterns, and using these patterns to make predictions
about future states.
It focuses on 3 cognitive states:
- Learning
- Reasoning
- Self-correcting

In medicine we mostly use 2 branches of A.I.:
- Machine learning (system identifies patterns from large database and
learns to recognize them in the future)
* child sees multiple photos of cats  child recognizes cat *
- Deep learning (hierarchy of composable patterns building each other)
* child sees a couple of photos of cats  recognizes simple shapes like ears and eyes  starts
recognizing image of cat *
Mostly used algorithms in medicine - Convolutional Ceural Network
(CNN) and Artificial Neural Network (ANN)

Use of it in dentistry
Radiology:
- periapical radiographs – CNNs demonstrated 95.8–99.45% rate in
detecting and identifying teeth (clinical experts – 99.98%)
- periapical radiographs of posterior teeth - carious lesions detected
with an accuracy of 75.5–93.3% (clinical experts 19 – 94%)
Orthodontics:
- ANNs (Artificial Neural Networks) showed 80 – 93% accuracy in
determining the need for extraction in malocclusive patients

Quick revision
No single clinical, microbiological,
histopathological or genetic test can
discriminate AgP from CP patients.
Serum IgG significantly higher in chronic
periodontitis patients compared to healthy
controls, while serum IgG, IgG2, IgG3, and
IgG4 significantly higher in aggressive
periodontitis patients compared to healthy
controls.
Stathopoulou, P.G., Buduneli, N. & Kinane, D.F. Systemic Biomarkers for Periodontitis. Curr Oral Health Rep 2, 218–226 (2015).
https://doi.org/10.1007/s40496-015-0072-9

Periodontology:
Georgios Papantonopoulos and
his colleagues used an ANN to
distinguish betweenAgP and CP in
patients by using immunologic
parameters, such as leukocytes,
interleukins and IgG antibody
titers. The algorithm was 90–
98% accurate in classifying
patients as AgP or CP.

The best overall prediction was made by an ANN that included
monocyte, eosinophil, neutrophil counts and CD4+/CD8+T-cell ratio as
inputs.The study concluded that ANNs can be employed for accurate
diagnosis of AgP or CP using relatively simple and conveniently
obtained parameters, such as leukocyte counts in peripheral blood.
Papantonopoulos G, Takahashi K, Bountis T, Loos BG. Artificial neural networks for the
diagnosis of aggressive periodontitis trained by immunologic parameters. PLoS One. 2014
Mar 6;9(3):e89757. doi: 10.1371/journal.pone.0089757. PMID: 24603408; PMCID:
PMC3945718.

Jae-Hong Lee and his coworkers evaluated the potential utility and
accuracy of deep CNN algorithms for diagnosing and predicting
periodontally compromised teeth. Using the CNN algorithm, the accuracy
of PCT diagnosis proved to be 76.7–81.0%, while the accuracy of
predicting the need for extraction was 73.4–82.8%.

The noted difference in accuracy seemed to occur between different
types of teeth, with premolars more accurately diagnosed as PCTs than
molars (accuracies were 82.8% and 73.4%, respectively) (probably
because of the simpler anatomy of premolars)
Lee JH, Kim DH, Jeong SN, Choi SH. Diagnosis and prediction of periodontally compromised teeth using a deep
learning-based convolutional neural network algorithm. J Periodontal Implant Sci. 2018 Apr 30;48(2):114-123. doi:
10.5051/jpis.2018.48.2.114. PMID: 29770240; PMCID: PMC5944222.
.

Endodontics:
AI has been introduced to classify the given data using a CNN to
determine whether the distal root of the first mandibular molar
has 1 or more extra canals. Radiographs of 760 mandibular first
molars taken with dental CBCT were analysed. Image patches of
the roots obtained from corresponding panoramic radiographs
were processed by a deep-learning algorithm to classify
morphology.
Zhang X, Xiong S, Ma Y, et al. A Cone-Beam Computed Tomographic Study on Mandibular First Molars in a
Chinese Subpopulation. PLoS One. 2015;10(8):e0134919. Published 2015 Aug 4.
doi:10.1371/journal.pone.0134919

Analysis of angles of the teeth

Although the CNN had a relatively high accuracy of 86.9% several
limitations exist regarding its clinical integration. The images must be
segmented manually, which consumes a considerable amount of time.
Furthermore, the obtained images must be of adequate size and should
focus on a small region to allow the system to concentrate on the
object being studied, while covering enough area to include pertinent
information.
Zhang X, Xiong S, Ma Y, et al. A Cone-Beam Computed Tomographic Study on Mandibular First Molars in a
Chinese Subpopulation. PLoS One. 2015;10(8):e0134919. Published 2015 Aug 4.
doi:10.1371/journal.pone.0134919

Oral pathologies:
CNN has been shown to be a promising aid throughout the process of
diagnosis of head and neck cancer lesions. With specificity and
accuracy at 78–81.8% and 80–83.3%, respectively (compared with
those of specialists, which were 83.2% and 82.9% respectively), CNN
shows great potential for detecting tumoral tissues in tissue samples or
on radiographs.
Halicek M, Lu G, Little JV,Wang X, Patel M, Griffith CC, et al. Deep convolutional neural networks for
classifying head and neck cancer using hyperspectral imaging. J Biomed Opt. 2017;22(6):60503.
PoedjiastoetiW, Suebnukarn S.Application of convolutional neural network in the diagnosis of jaw
tumors. Healthc Inform Res. 2018;24(3):236-41.

One study used a CNN algorithm to distinguish between 2 important
maxillary tumours with similar radiologic appearance but different
clinical properties: ameloblastomas and keratocystic odontogenic
tumours.The specificity and the accuracy of diagnosis by the algorithm
were 81.8% and 83.3%, respectively, comparable with those of clinical
specialists at 81.1% and 83.2%. However, a more significant difference
was observed in terms of diagnostic time: specialists took an average of
23.1 minutes to reach a diagnosis, while the CNN achieved similar
results in 38 s.
Halicek M, Lu G, Little JV,Wang X, Patel M, Griffith CC, et al. Deep convolutional neural networks for
classifying head and neck cancer using hyperspectral imaging. J Biomed Opt. 2017;22(6):60503.
PoedjiastoetiW, Suebnukarn S.Application of convolutional neural network in the diagnosis of jaw
tumors. Healthc Inform Res. 2018;24(3):236-41.

Ameloblastoma Odontogenic keratocyst

Challenges:
- Secure data sharing
- Who will be held responsible for a patient who faces unintentional
consequences resulting from an error or adverse event caused by the
AI technology?
- Ethics?
- Clinic-labeled datasets may be of inconsistent quality, thus limiting
the efficacy of the resultant AI systems.

Conclusion
Although multiple studies have shown potential applications of AI in
dentistry, these systems are far from being able to replace dental
professionals. Rather, the use of AI should be viewed as a
complementary asset, to assist dentists and specialists. It is crucial to
ensure that AI is integrated in a safe and controlled manner to assure
that humans retain the ability to direct treatment and make informed
decisions in dentistry.

Smart toothbrushes
Smart technology present in patients houses
The goal is to reinvent oral care with data and
technology eradicating preventable diseases such
as cavities and periodontitis.

Considered to be the pioneer in the technology.
2014 - Introduction the world first connected electric toothbrush at CES
(Consumer Technology Association)
2015 – first smart toothbrush released for the market
2016 – launch of Rabbids Smart Brush (by Ubisoft)
Further on it introduced AR supporting devices, and first manual
toothbrush with A.I.

2020 – launch of Plaqless toothbrush, capable of detecting the biofilm
inside the cavity.
Dental plaque biofilm contains organic compounds (porphyrins) that
shine fluorescent red when exposed to blue spectrum light (around
400nm). By simply shining a blue light (near-UV) onto the teeth and then
analyzing how the light reacts to the presence of porphyrin in the bacteria
the toothbrush can guide you to the infected areas that need cleaning the
most. The toothbrush relays feedback to you in real-time by means of an
indicator light on the handle of the toothbrush or by the Bluetooth-
connected app.

Clinical study done on
detection of plaque on teeth
using near-UV light (first
column), dental plaque
distribution (middle column),
computer interpretation of
localization of plaque.
(Zhao Liu, Juliana Gomez, Soniya Khan, Deborah Peru, Roger Ellwood, "Red
fluorescence imaging for dental plaque detection and quantification: pilot study," J.
Biomed. Opt. 22(9) 096008 (18 September
2017) https://doi.org/10.1117/1.JBO.22.9.096008)

Sense IQ technology:
- adapting pressure
- sensing motion
- learning your patterns

Controversies
Martha McComas, a clinical assistant professor of dentistry at the
University of Michigan, has determined a research showing that people
generally favour brushing the dominant hand side of the mouth, as
well as they usually don’t pay enough attention for the canines (they
go straight from anterior to posterior).
The problem is the technique people brush with, that was proven not
to increase when using electric toothbrushes (important to instruct the
patient!) as well as patients treating the toothbrushes as a short
termed trend, and not following usage of them after a couple
months.

Additionally, by buying smart toothbrushes from companies like
Procter & Gamble and Philips Oral Healthcare you agree to their privacy
policies that enable them to share your data with third parties.

Already, medical information is among the most valuable items on the
black market. It allows counterfeiters to file false insurance claims and
even to buy medical equipment illegally. This valuable commodity is
leading to an increased incidence of compromised healthcare records.
That amounted to over 25 million potential breaches in patient
records in the first half of 2019 alone.
Healthcare data may be valued at up to $250 per record on the black
market (2nd is credit card data – $5,40).
(Acc. to the 2019 Trustwave
Global Security Report)

VIRTUAL REALITY (VR)

Virtual reality
It is a simulated experience that can be similar to
or completely different from the real world.
Currently, standard virtual reality systems use
either virtual reality headsets or multi-projected
environments to generate realistic images,
sounds and other sensations that simulate a
user's physical presence in a virtual environment.
A person using virtual reality equipment is able to
look around the artificial world, move around in
it, and interact with virtual features or items.

VR in medicine and dentistry
14th April 2016 - Dr Shafi Ahmed does the first operation to be
streamed live in 360-degree video.

In 2015 at International Dental Show in Cologne, Germany, presented
at Nobel Biocare stand there was a presentation of Dr Tristan Staas,
that showed an implant surgery from eyes of the dentist.
Dr Staas wearing 6 GoPro’s
and 6 microphones.

There are a couple of possible uses for VR in
dentistry:
- Revolutionary Relaxation & Pain Management
- Better Training
- Perform Virtual Robotic Dentistry
- Simulate Your Ideal Office Design
- Demystify Dental Procedures for Patients
- Have Equipment Repairs Diagnosed Remotely
- Increase Your Empathy for Patients (?)

Revolutionary Relaxation & Pain Management
Up to 15% of Americans avoid seeing the dentist because of plain fear.
Extensive research has shown that VR is indeed a highly effective
method for treating anxiety disorders and related problems.
Physicians from the University of Louisville use computerized virtual
reality environments to create highly realistic simulations which safely
and gradually expose patients to fear-inducing situations.

A VR distraction intervention can not only impact the experience of a
simulated aversive event, it can also reduce the vividness of memories
of such an event a week later. A study suggests that VR distractions can
be considered as a relevant intervention for cycles of care in which
people’s previous experiences affect their behaviour for future events.
If a dental patient for example has a more positive experience of a
treatment due to the VR distraction intervention, that patient might
have less vivid memories and as a consequence might be less likely to
postpone a future dental visit.

Dr Mark Olson using Oculus VR
Headset with patients in his
dental office in Newport Beach

Better training
A company named MOOG has created cutting-edge dental training
units which feature Haptic technology and deliver an incredibly realistic
virtual reality simulation of dental procedures. These units are already
being used at dental schools throughout Europe and Asia, and in 2014,
the University of Pennsylvania’s School of Dental Medicine became the
first dental school in North America to integrate this technology into its
curriculum.

Of course, virtual reality procedures don’t just provide a benefit
to dental students – practicing dental professionals can also use
similar technology to try out new procedures in the “virtual
world” before ever operating on a patient in the “real world.”

Virtual robotic dentistry
As teledentistry continues to grow in both
scope and success, it’s a definite
possibility that we could see widespread
adoption of virtual robotic dentistry in
the coming years. This type of treatment
could prove especially beneficial for
patients in rural areas, patients in nursing
homes, and others without access to
more traditional care.

Augmented Reality

Augmented reality (AR)
It’s an interactive experience of a real-world environment where the
objects that reside in the real world are enhanced by computer-
generated perceptual information, sometimes across multiple sensory
modalities, including visual, auditory, haptic, somatosensory and
olfactory.
Can be used both for education as well as for dentists already in
practice

Educational
DentSim simulator is a machine that
lets dental students and professionals
work on AR-supported phantoms.
Both the tooth and movement of the
handpiece is real-time monitored.
This device is already used by more
than 8500 students worldwide.

Professional
Ivoclar Digital has developed an app called IvoSmile, that lets patients
see their possibility of treatment effect before it happens.
It works both with prosthodontic treatment possibilities, as well as
orthodontic.

Pellegrino, G., Mangano, C., Mangano, R. et al. Augmented reality for dental
implantology: a pilot clinical report of two cases. BMC Oral Health 19, 158 (2019).
https://doi.org/10.1186/s12903-019-0853-y
Two patients, both needing implant rehabilitation in the upper premolar
area, were treated with flapless surgery. Prior to the procedure itself,
the position of the implant was virtually planned and placed for each of
the patients using their previous scans. This placement preparation
contributed to a dynamic navigation system that was displayed on AR
glasses. This, in turn, allowed for the use of a computer-aided/image-
guided procedure to occur. Dedicated software for surface
superimposition was then used to match the planned position of the
implant and the real one obtained from the postoperative scan.

https://doi.org/10.1186/s12903-019-0853-y
Accuracies, using this procedure were evaluated by way of measuring
the deviation between real and planned positions of the implants. For
both surgeries it was possible to proceed using the AR technology as
planned. The deviations for the first implant were 0.53 mm at the entry
point and 0.50 mm at the apical point and for the second implant were
0.46 mm at the entry point and 0.48 mm at the apical point. The
angular deviations were respectively 3.05° and 2.19°.

https://doi.org/10.1186/s12903-019-0853-y
From the results of this pilot study, it seems that AR can be useful in
dental implantology for displaying dynamic navigation systems. While
this technology did not seem to noticeably affect the accuracy of the
procedure, specific software applications should further optimize the
results.

Teledentistry

Teledentistry
Invented with the thought of children, patients with special needs and
elderly in nursing homes. Also people living in rural areas rarely get
access to a dentist, and almost never have the possibility of choice. This
can change significantly with the spread of teledentistry.
For instance, MouthWatch’s TeleDent service offers an all-in-one
teledentistry platform allowing patients to capture images, send
relevant information to a dentist remotely and do a live consult.

In 2020 The American Dental Association issued a policy on
teledentistry that offers guidance on the modalities that such services
can follow. This sets the pace in making teledentistry a general practice.

Telemedicine controversies
Before COVID-19
- A study with researchers posing as patients found that remote
doctors across 16 different telemedicine apps misdiagnosed
serious skin conditions.
- Ethics?
After COVID-19
- Guidelines expanding on use of telemedicine expanded by the
ADA and other medical associations around the world

Intraoral Cameras

Intraoral cameras
A remedy for problem with space in patient’s
cavity, as well as a great way to instruct and
inform patients.
These first dental IOCs were cumbersome and
required too much space and at a high cost of
about $40,000 per unit. Today, IOC systems are
about the size of the previous handpiece and
cost less than $5,000.

VistaCam iX HD Smart
Caries and plaque filters
display caries activity in
the Imaging Software
from DÜRR DENTAL
with the aid of a colour
scale and a numerical
value. The Proxi
interchangeable head
enables detection of
proximal caries – without
radiation exposure. It is
also possible to record
video clips.

Recently, an LED camera fitted with light-induced fluorescence
evaluator (VistaCam, Soprolife, and Soprocare) was developed and
clinically validated.
These IOCs have a unique feature called “Cario” mode that provides
different colors for healthy, infected, affected active, and arrested
dentine.
Pretty cool and useful article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712211/

HOWEVER
A recent systematic review on LIF (Light-Induced Fluorescence) with
Soprolife IOC has concluded that there was no clear evidence on the
detection of occlusal caries lesions and recommended future studies.
It is expected that the Intraoral Camera market will see a significant rise
in the next 7 years.

Regenerative dentistry
The treatment, developed by scientists from the University of
Nottingham and Harvard University, earned a prize from the Royal
Society of Chemistry after judges described it as a "new paradigm for
dental treatments“.
The tooth filling works by stimulating stem cells to encourage the
growth of dentin, allowing patients to effectively regrow teeth that
are damaged through dental disease.

Stem cells are primitive cells found in all multi-cellular organisms that are
characterized by self-renewal and the capacity to differentiate into any
mature cell type. These stem cells have the awesome potential for
regeneration and may be used to replace or repair damaged cells, and
have the potential to drastically change the treatment of conditions like
cancer, Alzheimer's and Parkinson's disease and even paralysis.

They are able to continuously produce daughter cells having the same
characteristics as themselves (self-renewal); they can generate
daughter cells that have different, more restricted properties, and
finally, they can re-populate a host in vivo (differentiation).

Using a single-cell RNA sequencing method and genetic tracing,
researchers at Karolinska Institutet, the Medical University of
Vienna in Austria and Harvard University in the USA have now
identified and characterized all cell populations in mouse teeth
and in the young growing and adult human teeth.
“We hope and believe that our work can form the basis of new
approaches to tomorrow’s dentistry. Specifically, it can expedite
the fast expanding field of regenerative dentistry, a biological
therapy for replacing damaged or lost tissue.”
“Dental cell type atlas reveals stem and differentiated cell types in mouse and human teeth” by Jan Krivanek, Ruslan Soldatov, Maria Kastriti, Tatiana Chontorotzea, Anna
Herdina, Julian Petersen, Bara Szarowska, Marie Sulcova, Veronika Kovar Matejova, Lydie Izakovicova Holla, Ulrike Kuchler, Ivana Vidovic Zdrilic, Anushree
Vijaykumar, Anamaria Balic, Pauline Marangoni, Ophir Klein, Vitor C.M. Neves, Val Yianni, Paul Sharpe, Tibor Harkany, Brian D. Metscher, Marc Bajenoff, Mina Mina,
Kaj Fried, Peter Kharchenko and Igor Adameyko, 23 September 2020 Nature Communications.
DOI: 10.1038/s41467-020-18512-7

THANK YOU
A DA M B I L S K I

Sources:
https://jcda.ca/l7
https://searchenterpriseai.techtarget.com/definition/AI-Artificial-Intelligence
https://medicalfuturist.com/the-amazing-future-of-dentistry-and-oral-health/
https://medicalfuturist.com/covid-19-was-needed-for-telemedicine-to-finally-go-mainstream/
https://www.theteledentists.com/
https://www.mouthwatch.com/
https://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-teledentistry
https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0091276
https://www.theguardian.com/technology/2016/apr/14/cutting-edge-theatre-worlds-first-virtual-reality-
operation-goes-live
https://vrscout.com/news/dental-surgery-virtual-reality/
https://www.nytimes.com/wirecutter/blog/smart-toothbrushes-dont-recommend/
https://medicalfuturist.com/your-privacy-in-the-digital-health-era-the-medical-futurists-guide/#
https://www.youtube.com/watch?v=xUaBrgsHkPs&ab_channel=TheMedicalFuturist
https://image-navigation.com/home-page/dentsim/
https://smartteksas.com/portfolio/augmented-reality-smile-application/
https://kapanu.com/

https://www.kolibree.com/en
https://www.ces.tech/Innovation-Awards/Honorees/2020/Best-Of/C/Colgate-
Plaqless%E2%84%A2-Pro.aspx
https://www.usa.philips.com/c-e/pe/electric-toothbrushes/sonicare/prestige-9900
https://oralb.com/en-us/products/electric-toothbrushes/io-series-9-electric-toothbrush/
https://www.newsweek.com/dental-fillings-heal-teeth-stem-cells-harvard-cavities-477415
https://medicalfuturist.com/crispr/
https://pubmed.ncbi.nlm.nih.gov/30329221/
https://www.mouthwatch.com/intraoral-cameras/
https://www.duerrdental.com/en/GB/products/imaging/intraoral-diagnostics/vistacam/
https://www.carestreamdental.com/en-us
https://aerospace-journal.com/coronavirus/300281/intraoral-camera-system-market-to-remain-
lucrative-during-2020-2024/
https://www.rdhmag.com/career-profession/article/14185563/artificial-intelligence-ai-in-
dentistry
https://en.wikipedia.org/wiki/Virtual_reality#1970%E2%80%931990

https://www.offthecusp.com/8-virtual-reality-trends-in-dentistry/
https://www.moog.com/markets/medical-dental-simulation/haptic-technology-in-the-moog-
simodont-dental-trainer.html
https://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-
teledentistry
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712211/
https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-019-0853-y
https://www.moog.com/
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134919
https://pubmed.ncbi.nlm.nih.gov/26427567/

New Technologies in the Future of Dentistry

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to New Technologies in the Future of Dentistry

Similar to New Technologies in the Future of Dentistry (20)

More from AdamBilski2

More from AdamBilski2 (8)

Recently uploaded

Recently uploaded (20)

New Technologies in the Future of Dentistry