Technology shaping the future of dentistry

Abstract

The art of dentistry and technological advancement in the fourth industrial revolution are interacting at a rapid pace, shaping the future of dentistry. The dental profession has integrated well with advancing technologies such as artificial intelligence (AI), augmented reality (AR), virtual reality (VR), three-dimensional (3D) printing, nanotechnology, and molecular biology resulting in oral healthcare services that are more accurate and predictable. It has enhanced the reach of dental services, made it sustainable, and energy efficient, reducing the carbon foot prints. This communication focuses on recent technological advancements and their influence on oral healthcare services.

Health is defined as the state of complete physical, mental, and social wellbeing and not merely absence of disease. Oral health affects all three components of wellbeing, hence becoming an important part of overall health. Oral healthcare burden on economy and healthcare infrastructure is huge, and as estimated by the World Dental Federation, 4 billion people are affected by oral diseases globally. Half of the world's population has experienced dental decay or suffered effects of dental caries.¹ Dental caries is regarded as the most common disease amongst the 291 conditions described in the global burden of disease study. Providing oral health care for all within the existing infrastructure and resources has become a challenge and demands a lot of planning in oral healthcare delivery.

Dentistry has progressed leaps and bounds as a science, and this development is keeping pace with the current technological advancements. It has integrated well with revolutioniszed technologies such as artificial intelligence (AI), augmented reality (AR), virtual reality (VR), digitalization, communication advancements, molecular biology, nanotechnology, material sciences, and three-dimensional (3D) printing. This integration is shaping the future of dentistry and has improved the efficacy, efficiency, and reach of oral healthcare services to provide sustainable health care.

Over the period of a decade, rendering dental education has become more complex because of mushrooming of dental colleges with lack of infrastructure and clinical material. The education system has metamorphosed into a systematic process in the recent years, and a lot of impetus has been on self-learning. The science of health education is tremendously benefited by emerging technologies such as AR, VR, AI, and ChatGPT. The fusion of AI, AR, and VR works like a match made in heaven for both the learners and the teachers in dentistry. For the teachers, it allows to create simulation and training material and analyze the students’ performance, identifying their strengths and weakness, and modify training accordingly. Algorithms can be set into virtual patients to give real-time response during simulated surgery, errors in procedures can be highlighted, and correct procedures can be suggested with remedial actions. The generic and physical models can be taken over by virtual patients with different medical histories, distinct personalities, and emotional responses. With the help of simulated situations using AR glasses with haptic created by VR, the students can perform virtual procedures in a preclinical setting under step-by-step guidance, experiencing consequences of their mistakes and knowing methods to correct them using real-time feedback. Learning may not remain classroom-bound but can be acquired through various digital sources throughout the world through AI-driven case libraries and collaborative learning environment.

Patient education is also improving by leaps and bounds. Various oral conditions and their causes and treatment simulations are available in open-source media. With AI and AR, patients can be informed about various dental problems and their process of development with the causative factors. Simulated models of various oral conditions can help the patients to identify the occurrence of the disease and guide them to report to clinicians for management. Algorithms can be set for preventive programs in schools considering the prevalent conditions in the population, and individualized guidance can be provided using AI. The oral hygiene maintenance practices for general population and especially children can be improved with the use of smart tooth brushes and application-based monitoring on mobiles. Similarly, children can be made to enjoy brushing with the use of simulations and AR, using their favorite characters in cartoons and movies.

In health sciences, diagnosis is considered as an art and is mostly a personalized skill depending on clinical acumen and experience. With judicious use, the newer technologies can be leveraged to hone up the skills of diagnosis. Using AI-set algorithms in various application-based programs, the patients’ symptoms and clinical examination can help the clinicians to reach a correct diagnosis that is relatively consistent. Similarly, radiographs can be read by AI-based algorithms using pre-set data inputs for diagnosis of particular clinical problem using the signs and symptoms. Use of AI in diagnostics has enabled very early diagnosis of oral diseases and malignancies, much before the human eye can identify, enabling early treatment. Current 3D reconstruction of images has made it possible for the clinician to examine the in vivo body structure in 3 dimensions for visualizing the extent of lesions and nature of problems.

The saliva is considered as the mirror of human body and can be used as a biosensor for chair-side diagnosis of various dental and general health conditions.² Various biomarkers can be identified from the saliva, using micro-assay and recombinant gene technology, and assessment can be made for caries risk, periodontitis, and oral cancers, and preventive measures can be taken at an early stage. It also helps to diagnose various systemic conditions such as diabetes, auto-immune diseases, viral infections, psychological conditions such as stress and depression, malignancies, and metabolic disorders. The development of chair-side salivary diagnosis being a non-invasive procedure will help in early diagnosis of conditions improving the prognosis tremendously.

Another important technological advancement that has brought the world closer is digitalization.³ The synergism of data management and digitalization has made the concept of telemedicine to be a reality. Opinions can be sought from any part of the world, which has improved the delivery of health care tremendously. Dental treatment data of patient can be maintained in the form of soft copies, and treatment can continue at any part of the globe. Digitalization has worked wonders in imaging sciences. It has obviated the need for old non–environment friendly concept of developer and fixer and reduced the radiograph dose tremendously, improving the quality of image acquisition and details. The ability of 3D reconstruction and prediction of treatment results on acquired images help to predict the visualized treatment objectives that can be used for patient education and improving patient compliance.

In dentistry, the negative likeness of oral tissues is recorded with a plastic material, and plaster casts are made as representative of the patient in his absence for diagnosis, treatment planning, and fabrication of prosthesis and appliances. The need for this impression making can be obviated with advent of intraoral scanners and cameras that can scan and record the oral tissues in place of the impression. This is a non-invasive procedure, well received by the patient, and obviates the need for making plaster casts, which has the issue of asepsis, space occupation, and waste management. The recorded impressions can be digitized, forwarded to labs for fabrication of accurate and bio-similar prosthesis or appliances using computer-aided designing and computer-aided manufacturing (CAD-CAM) technology, with or without 3D printing the impression. This has improved the accuracy of the end product and reduced the time required for delivery of prosthesis and appliances. The use of intraoral cameras and scanners has changed the face of many dental specialties, especially orthodontics, where adult orthodontics and invisible orthodontics in the form of aligners has emerged with rapid pace. Clinical data algorithms are developed in the form of computer programs using AI for management of malocclusion, and aligners are fabricated for the complete treatment that are not fixed on teeth, are invisible, and are preferred by young and adult patients.

Another technological advancement that has come as a boon for dentistry is 3D printing and machine milling.⁴ After acquisition of digital data in the form of radiograph and photographs, the exact models of craniofacial structures can be replicated using AI and 3D printing. In this way, the defects in craniofacial structures can be easily identified, and model surgeries can be performed that improve surgical outcomes. It also helps to accurately fabricate the surgical splints that are the most important tool for transferring pre-planned treatment goals into reality in orthognathic surgical procedures. This 3D printing technology is also effectively used for fabrication of patient-specific implants for restoration of lost parts of craniofacial region.

Nanotechnology has enabled the clinicians and researchers to express their control over the smallest of particles at the molecular level in a clinical setting. This has made possible to convert the ‘passive’ dental materials into controlled and targeted ‘active smart biomaterials.’ This ability of nanomaterials to change the properties according to change in conditions and respond to physiologic changes can be used in preventive dentistry, endodontics, orthodontics, regenerative therapy, gene therapy, and for caries control. The improved understanding of molecular biology at cellular level synergistically coupled with nanotechnology is opening avenues for a new era of biomodulation in dentistry. In orthodontics, the nanoparticles can be effectively used to modulate the response of cells to applied force for bio-modulating bone-turnover rate, reducing the duration of treatment by enhancing tooth movement. Nanotechnology has paved way for development of targeted and personalized treatment protocols with predictability and accuracy.⁵

Regeneration of lost-tooth structure or tissue in the craniofacial region has always been an aim of researchers and clinicians over a period of many decades. Effective use of principles of molecular biology, tissue engineering, and nanotechnology has rendered some success in regenerative dentistry.⁶ ‘Once a tooth structure is lost, it cannot be regenerated,’ the regenerative dentistry challenges this preconceived notion with efforts toward development of restorative materials that can create self-healing tooth and wall off progressive damage to tooth structure due to chemical and biological insults. Restorative materials that can regenerate dentine will soon be a reality.

Clustered Regularly Interspaced Palindromic Repeats (CRISPR) is a path-breaking genome-editing method that is undertaken by nature for genetic modification, and researchers have discovered its immense potential only recently.⁷ This technology can be an ultimate weapon against cancer and various craniofacial deformities. Improved understanding in fields of genetics and genomics has paved way for gene therapy for management of various destructive periodontal conditions and is a boon for management of craniofacial defects using tissue engineering. Genetic identification, intrauterine imaging, and developments in genetic sciences help to diagnose various craniofacial deformities in the utero and uterine surgery and are also developing as a science. The practical application of this technique still needs lot of omic research and collaborative efforts.

The technological advances have not only improved the quality, efficiency, and delivery of dental healthcare but also made it environment friendly and sustainable. The digital technologies are helping to reduce carbon foot prints by developing paperless dental offices that do not make plaster casts and use bio hazardous developers and fixers for developing radiographs. The newer dental materials are more bio friendly and have replaced the older amalgam restoration, which is considered as an environmental hazard. The newer dental clinics are going to be more energy efficient and green, reducing the generation of massive dental waste.

Dentistry is developing at a rapid pace, and the demand of oral healthcare facilities will increase exponentially after inclusion of dental procedures in health insurance schemes in India. The important question that needs to be answered at the end is whether dentists will perform as robots and dentistry will become a mechanical and machine-driven science losing the humane touch? Whatever advancements occur, the human-to-human interaction, soft skills, and good clinical practices will remain as the spirit of dentistry. God willing, this symbiotic interaction between art of dentistry and technology will make the dental sciences more reachable, cost-effective, accurate, biologically viable, environment friendly, and sustainable. Shaping the future of dentistry will pave the way for providing oral health care for all, without the limitations of region, religion, economics, and beliefs.

Disclosure of competing interest

The authors have none to declare.