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    Computer Technologies in Dentistry

    December 21 2022

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    Reading time 10 minutes

    Contents

    Technologies improve dental care quality. Artificial intelligence helps a doctor to tackle difficult tasks in diagnosis. A specialist gets new opportunities for treatment while focusing on special features of a patient’s oral cavity.

    What Is Digital Dentistry?

    Digital dentistry is an area where information technologies are used for diagnosis and treatment of oral cavity diseases. Is aimed at improving the cosmetic effect and comfort for a patient1.

    There are widespread oral cavity diseases such as tooth decay or periodontitis. Their treatment is costly for both patients and the health care system. Information technologies provide for a more cost-effective approach2.

    Each patient needs to provide a lot of data: medical history (both general medical history and dental care history), clinical information, diagnostic images (X-ray and CT images). AI systematizes and processes them2.

    What Does Digital Dentistry Deal with?

    It is applied for diagnosis and treatment of oral cavity diseases3:

    • It identifies signs of diseases. AI analyzes diagnostic images to determine the probability of a disease such as tooth decay, a cyst or tumor.

    • It creates 3D models. Information technologies make it easier to install prostheses and reconstruct an patient’s teeth. A risk of error is reduced because a doctor creates and considers a computer model in advance.

    • It helps plan treatment. The neural network combines various pieces of clinical information to predict changes in teeth. It is applied in orthodontics and surgery. For instance, doctors examine movement of teeth after surgery or bone tissue development.

    Digital medical record containing various pieces of dental data is another area of digital dentistry application. There are three ways of processing it4:

    1. Full integration. Patient data is transferred via secured communication channels through a common interface. For instance, a dental X-ray image from one dentist’s office can be quickly examined at another dentist’s office. Requests from different computers are sent through a central server.

    2. Partial integration. Some programs are incompatible. For instance, one can request age and sex of a patient, while it is impossible to request information about treatment.

    3. No integration. The platform is completely autonomous: a doctor does not exchange information with another clinic and enters it manually.

    It is easier for private dentist’s offices to organize data processing because the number of staff and patients is relatively small. Large organizations need more complex and highly integrated infrastructure4.

    Digital Dentistry in Surgery

    Augmented and virtual reality technologies (AR/VR) combine various types of data and a surgeon’s skills. AR/VR advantages are implemented in the form of a special navigation system. It consists of surgical instruments, an optical sensor and a computer5. A dentist prepares for using this system as follows6:

    1. Preparing a patient’s oral cavity images. The image is obtained using an intraoral scanner or CT.

    2. Creating a virtual model for a future implant. Jaw structure can be taken into account by setting necessary parameters.

    3. Uploading a digital model to the navigation system.

    4. Calibrating instruments to meet the parameters provided by software.

    The static navigation system directs a surgical instrument to a predetermined point3.

    The dynamic navigation system gives more freedom to a doctor: it is possible to change the position or angle of the instrument7. The information system monitors the process using a sensor. The surgeon is advised in real time. A monitor shows a patient’s jaw layout, and the area for the future implant is colored6.

    CAD/CAM Technology in Dentistry

    CAD and CAM are computer-aided design and computer-aided manufacture systems. In dentistry they are used for preparing onlays, crowns, bridges, etc. for teeth reconstruction8.

    What Does the Technology Deal with?

    CAD/CAM application has three stages8, 9:

    1. Oral cavity scanning. A doctor makes a dental impression which is used for preparing a dental cast. Then it is placed into a device which scans it and sends data to a computer. this stage is often missed: the oral cavity image is obtained immediately using the intraoral scanner.

    2. Creating a virtual model. The CAD/CAM program creates the computer model. The dentist adjusts it by moving its edges with a cursor and selects the necessary shape and size for reconstruction. The doctor considers how the new element will fit considering other teeth, gums and soft tissues.

    3. Producing a dental product. A block is put into a dental milling machine. Materials can be different, for instance, zirconium or ceramics. The machine shapes the dental mill blank, and the digital model becomes real.

    All stages are not necessarily completed at one dentist’s office. The process may be organized in the following way10:

    1. "On-site" production. A doctor makes an image and produces a dental prosthesis without engaging a laboratory.

    2. Laboratory production. The dental cast prepared by the dentist is sent to the laboratory where the model is completed.

    3. Centralized production. The laboratory creates a digital model based on the dental impression. The data is sent to another laboratory where a physical copy is prepared. The dentist obtains the final version.

    Advantages and Disadvantages of the System

    CAD/CAM technology advantages8, 9, 11:

    • The cost of production is reduced. The main equipment (the intraoral scanner, the computer and the dental milling machine) can be placed in the clinic. Digital methods replace some stages implemented in a laboratory.

    • A patient spends less time in the dentist’s office. The whole process takes up to two hours, while preparation requires only one visit to the dentist’s.

    • The process is controlled. The computer measures oral cavity dimensions and creates the dental prosthesis. The specialist adjust the model if necessary. The result is predictable.

    However, the technology has disadvantages10, 12:

    • High cost. Purchasing CAD/CAM systems is costly for a clinic. "On-site" production saves time, but it increases the cost for the patient.

    • Need for training. Special training is needed to do everything correctly. The dentist or the dental technician have to learn how to use equipment and software.

    Types of Prostheses

    1. Complete denture. Application: when teeth are completely absent. Although a traditional method is used more frequently, there is information about better durability and biocompatibility of CAD/CAM prostheses13.

    2. Partial denture. This is a plastic base colored like gums with removable teeth14. The specialist creates the prosthesis using the computer. Elements are placed on the digital model of the jaw one by one. Then the prosthesis is produced using the 3D printer15.

    3. Crowns and bridges. These types of prostheses are used to replace damaged or missing teeth15. If they are produced using CAD/CAM technology, in many cases they are made of zirconium. There are also metallic and ceramic options10.

    4. Inlays, onlays and veneers. These are plates which are placed on tooth surface to correct a defect or color17. Research on models produced using CAD/CAM technology showed that 90.4% of them had been usable for more than ten years 18.

    Teledentistry

    Teledentistry is the area where information technologies are used for exchanging clinical information remotely. It allows videoconferencing, transferring photos, X-ray images and results of laboratory tests19.

    Teledentistry applications19:

    • A doctor remotely advises a patient in the course of treatment.

    • A specialist obtains the second opinion in complicated cases.

    • The technology is used for teaching students.

    However, sometimes patients are not ready to use remotely provided services. Reasons for this include information security concerns. There are also infrastructure issues: high-speed Internet connection, compatible software and technical support are not available in some dentist’s offices20.

    The technology is implemented gradually, making geographical distance shorter. It allows saving time spent on travel and queues. A patient can ask a doctor’s advice and make plans for new teeth using a smartphone.

    Sources

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    2. Schwendicke F. Digital Dentistry: Advances and Challenges. J Clin Med. 2020 Dec 11; 9(12):4005. doi: 10.3390/jcm9124005. PMID: 33322245; PMCID: PMC7763256.

    3. Alauddin MS, Baharuddin AS, Mohd Ghazali MI. The Modern and Digital Transformation of Oral Health Care: A Mini Review. Healthcare (Basel). 2021 Jan 25; 9(2):118. doi: 10.3390/healthcare9020118. PMID: 33503807; PMCID: PMC7912705.

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    6. Kuo PJ, Lin CY, Hung TF, Chiu HC, Kuo HY. A novel application of dynamic guided navigation system in immediate implant placement. J Dent Sci. 2022 Jan; 17(1):354-360. doi: 10.1016/j.jds.2021.09.030. Epub 2021 Oct 6. PMID: 35028058; PMCID: PMC8740148.

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    11. Samra, Adriana & Morais, Eduardo & Mazur, Rui & Vieira, Sergio & Rached, Rodrigo. (2016). CAD/CAM in dentistry – a critical review. Revista Odonto Ciência. 31. 140. 10.15448/1980-6523.2016.3.21002. URL: https://www.researchgate.net/publication/316818725_CADCAM_in_dentistry_-_a_critical_review.

    12. Nassani MZ, Ibraheem S, Shamsy E, Darwish M, Faden A, Kujan O. A Survey of Dentists’ Perception of Chair-Side CAD/CAM Technology. Healthcare (Basel). 2021 Jan 13; 9(1):68. doi: 10.3390/healthcare9010068. PMID: 33451003; PMCID: PMC7828474.

    13. Srinivasan M, Kamnoedboon P, McKenna G, Angst L, Schimmel M, Özcan M, Müller F. CAD-CAM removable complete dentures: A systematic review and meta-analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time-cost analysis, clinical and patient-reported outcomes. J Dent. 2021 Oct; 113:103777. doi: 10.1016/j.jdent.2021.103777. Epub 2021 Aug 13. PMID: 34400250.

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