With the current predicament caused by the coronavirus disease 2019 (COVID-19) outbreak and the resulting dental industry market contraction, every dentist is wondering, “What does the future hold for us?” While we cannot predict the future, we can be certain that 10 years from now, amazing improvements in the dentistry business will fundamentally overhaul dental healthcare facilities globally. Going to the dentist is one of the most frequent childhood phobias. Who can’t relate? Sitting in a gigantic chair illuminated by blinding light, enduring long seated sessions with someone looking and poking inside your mouth with edgy and frightening gadgets, and generating noises like tortured souls from hell’s screams. Finally, after your pain is over, that same someone encourages you not to eat your favorite sweets and to brush your teeth regularly. No one likes going to the dentist, even though everyone understands how important dental health is and how strongly it is linked to our general health. However, an armada of new technologies ranging from virtual reality to artificial intelligence (AI) to CRISPR (clustered regularly interspaced short palindromic repeats) will revolutionize dentistry and our entire approach to oral health in the future. 

Digital transformation is a term that is commonly used in various business sectors, including the field of medicine, including dentistry. We have been able to get around constraints and challenges that were prevalent in clinical and technological workflows just a few years ago because of ongoing developments in information technology (IT). The trend toward digitalization has been accelerated by changes in social and cultural behaviors in developed countries, such as urbanization, centralization, and mobility, as well as by easy access to smartphones, tablets, and the Internet, as well as by the need for efficiency in markets that prioritize convenience. The use of digital tools and applications offers fresh approaches to today’s most urgent health care issues, including the aging population’s increased prevalence of chronic diseases and the rising expenses of treatment over the course of a person’s lifetime. In the rapidly developing fields of dentistry, especially computer-aided design/computer-aided manufacturing (CAD/CAM) and rapid prototyping (RP), several digital processes for production handling are already integrated into treatment planning. The advent of AI and machine learning (ML) has opened up new possibilities for automated processing in radiological imaging. Additionally, augmented virtual reality (AR/VR)technology overlays different image files to create a virtual dental patient, providing the basis for performing non-invasive simulations comparing different outcomes prior to clinical intervention. These promising technologies have been made possible by increased IT power, and their full potential is yet to be determined in the future. Through the Internet of things (IoT), dental equipment can collect and exchange data using software, sensors, embedded electronics, and networking connectivity. This technology is evolving into the industrial IoT, where machines can communicate with each other in real-time for the precise treatment process, resulting in high-quality treatment and surgery with minimal time waste. 

Healthcare workers can quickly review the procedure and tests performed to better treat patients. Dentistry devices, with the help of the Internet, function as a Cyber-Physical System where the information contained within the devices via sensors is more valuable than the devices themselves. The use of smart devices with sensors to collect patients’ information aids in early disease detection or prevention, while also reducing overall financial costs for the care model. This article focuses on such digital or newer technologies in the dental field.

The Modernized Dental Industry

Rapid Prototyping

RP is the practice of quickly and autonomously producing three-dimensional (3D) models of finished goods or individual parts of larger assemblies using 3D printers. With the use of a variety of materials and this additive manufacturing technology, complex 3D geometries can be produced at a low cost with the least amount of material waste. For the manufacturing sector, health care professionals, and patients alike, the uncertainty surrounding the usage of these materials poses a challenge. Material selection is one of the most difficult aspects of dental care, as materials are commercially available. Although RP materials are intended for permanent tooth reconstruction, they are currently only approved for short- to medium-term oral retention, and their application is limited to temporary restorations. Although these applications do not require long intraoral retention, RP still has great potential in dental technology, not only for the mass production of dental models but also for creating drilling templates for implant placement. The ability to create huge numbers in a reproducible and standardized manner has major economic advantages. However, while the future of RP and its products appears promising from a technical and scientific perspective, the regulations surrounding itsuse remain unclear.

Another important application is the use of cone-beam computed tomography (CBCT) or CT-based 3D-printed models in dental teaching. However, a pilot study has shown that 3D-printed dental models may experience variations in dimensional accuracy over times of 4 weeks or longer, which highlights the need for additional research comparing various 3D printers and material combinations in order to shed more light on this issue. Many research teams are striving to create printable materials for dental reconstruction, such as zirconium dioxide (ZrO2). It is anticipated that the current material-related hurdles and restrictions will be removed in the near future. It is possible to create entirely new geometries with hollow bodies using this creative method of creating ZrO2 structures, which could be used in implant

dentistry for the time-dependent low-dose release of anti-inflammatory drugs. Instead of depending on a prefabricated dental tooth database, the synthesis of biomaterials using RP technology to artificially reconstruct missing tooth structures will be a completely new building block. At the end of growth, a patient-specific digital tooth record can be created and used for subsequent tooth reconstruction.

Artificial Intelligence and Machine Learning

AI encompasses various techniques for enabling machines to perform tasks with human-like intelligence by combining large amounts of data with sophisticated algorithms. Its utilization enhances outdated systems and speeds up innovation in the health care sector. AI plays a crucial role in addressing the COVID-19 pandemic, aiding in medical research and development, diagnosis, testing of possible treatments, evaluating public health impacts, and other related areas

ML, which is a component of AI, is already present in our daily lives, albeit in more covert ways, including through virtual assistants like “Siri” or “Alexa.” AI technology is built on computers’ expanding ability to think like humans and carry out jobs now carried out by humans more quickly, precisely, and with less resource consumption. It is therefore appropriate for occupations requiring the analysis and evaluation of massive amounts of data. In contrast to AI-based solutions, humans might become bored and fatigued of repetitive jobs, which raises the chance of errors. The artificial learning process also continually enhances performance as workload grows, unlike humans. Additionally, computers do not have the same prejudices that people do, which might lead to rash and inconsistent judgments. In dentistry, the application of AI and ML to diagnostic imaging in maxillofacial radiology is particularly appropriate. The current focus of AI research and applications in dental radiology is on automating the localization of cephalometric landmarks, detecting periodontitis/ periapical illness, classifying/segmenting maxillofacial cysts and/or tumors, and diagnosing osteoporosis. Computer software must be educated on enormous data sets (sometimes known as “big data”) in order to recognize meaningful patterns in radiographs.

A desirable AI system should be able to complete tasks more quickly than a person could. However, up until recently, there was a paucity of large-scale AI applications that were technically feasible and economically viable. The potential of AI in everyday dentistry applications has not yet been completely realized, despite the exponential advancement of technology. However, it is anticipated that a sizable number of AI models will be created in the near future for automated 3D imaging diagnostics, pathology diagnosis, risk prediction, recommending new therapy alternatives, and prognosis evaluation.

Telehealth Care (Tele Dentistry)

The fields of medicine and dentistry have made significant scientific advancements since the introduction of telehealth technology decades ago. Teledentistry, which is the integration of telecommunications and dentistry, involves the remote transmission of clinical data and photographs for dental consultation and treatment planning. The term “tele dentistry” was first defined by Cook in 1997 as “the practice of using video conferencing technologies to diagnose and provide treatment guidance over a distance.” Teledentistry has the potential to be particularly useful for individuals experiencing dental emergencies, and it can take two forms: real-time consultation or store-and-forward. Real-time consultations involve the use of video conferencing technology to allow dental experts and patients in different locations to see, hear, and speak with each other using modern telecommunications equipment and high-speed Internet connections. In store-and-forward, clinical information and static images obtained and stored in communication equipment are exchanged. The dentist obtains all clinical and radiological information from the patient.

Teledentistry, which involves transmitting clinical data and photographs for dental consultation and treatment planning, has been a significant scientific advancement in dentistry since the introduction of telehealth technology decades ago. Cook coined the term “teledentistry” in 1997, defining it as “the practice of using video conferencing technologies to diagnose and provide treatment guidance over a distance.”

Teledentistry can take two forms: (1) real-time consultation or (2) store-and-forward. In real-time consultations, dental experts and patients in different locations can communicate with each other using video conferencing equipment and high-speed Internet connections.26 Store-and-forward involves exchanging clinical information and static images that have been acquired and stored in communications equipment, which is then forwarded to professionals for consultation and treatment planning.

Teledentistry has the potential to improve oral health care access and delivery while reducing costs, thereby reducing inequities between rural and urban areas. It is particularly beneficial for patients with limited mobility, nursing home residents, and those living in rural areas. Teledentistry provides patients with a convenient way to increase self-care and potentially reduce visits and travel time. Telephone counselors can also effectively communicate measures to be taken in the event of dental trauma, and they are frequently used after hours. Teledental care is still in its infancy, and early research has focused primarily on certain rare diseases that may require surgical intervention. However, there is evidence to suggest that teleradiology systems can aid in the differential diagnosis of common lesions in general dental practice, leading to cost savings. Clear regulations and guidelines are needed to ensure clinical quality standards as well as technical requirements and security standards for sensitive patient information. Teledentistry is a useful tool, but it does not replace a physical dentist.

Augmented Reality and Virtual Reality

With the aid of virtual content, AR technology combines computer-generated perceptual data with real-world surroundings. It entails adding extra digital information on top of real-time photos or videos, as opposed to VR, which solely employs manufactured, computer-generated worlds that are detached from reality. Using these technologies, different experiences, including visual, aural, and haptic ones, can be employed singly or in any combination Both patients and health care professionals are very interested in the multiple AR/VR possibilities in dental medicine. Users of AR/VR software can overlay virtual visualizations on recordings of the patient moving naturally. This improves communication between patients and dental practitioners and increases the predictability and effectiveness of treatment. These digital simulations can mimic a range of potential outcomes without requiring intrusive work procedures. Utilizing intraoral scanners, projection, and display of the optically detected area, AR glasses are being utilized to enhance virtual implant design directly into the oral cavity. This streamlines dentistry procedures. Dental education is another fascinating application for AR/VR, as it offers interactive instruction with 24/7 access and unbiased evaluation.

In order to prepare teeth, for example, dentistry students can utilize AR/VR-based motor skill training, which stimulates more senses and helps students learn more effectively. Meanwhile, professionals can use AR/VR simulations to train in a totally virtual environment without endangering real patients. This is especially helpful for difficult and intricate clinical processes. AR/VR has the potential to completely change dental education in the next few years. Therefore, personalized medicine that integrates oral and general health while simultaneously placing a strong emphasis on patient-centered outcomes should be the main focus of dental research in the future. Dental research must be viewed as having an impact on society that alters clinical protocols rather than only producing scholarly papers. Research in the digital era is increasingly assessed in terms of its impact, and digitization with AI/ML and AR/VR is currently the most promising tool for new research. The dental team will continue to play a crucial role in the patient’s journey to receive the best care possible, so it is crucial to manage expectations and ensure transparency for all stakeholders.

3D Printing in Dentistry

The integration of 3D printing technology in dentistry has granted dentists access to capabilities that were once exclusive to dental laboratories. This technology has become increasingly available to practitioners in recent years, enabling them to offer more precise, cost-effective, and time efficient treatments to patients. The three most commonly utilized 3D printing methods in dentistry include

stereolithography, digital light processing, and material jetting. In fields such as traumatology, cardiology, neurology, plastic surgery, and craniomaxillofacial surgery, 3D printing is commonly used for digital imaging in surgical planning, personalized surgical instruments, and patient-physician communication. Its applications in dentistry include prosthodontics, oral and maxillofacial surgery, and oral implantology, as well as orthodontics, endodontics, and periodontology. Based on their operating principles, 3D printing technologies are classified into three types: fused deposition modeling, powder bed fusion, and light curing.

Laser Dentistry

The term LASER stands for “light amplification by the stimulated emission of radiation.” Since its first use in dentistry by Miaman in 1960, the laser has found numerous applications in both hard and soft tissue procedures. In recent years, there has been a surge in research studies investigating laser application in dentistry. Hard tissue applications of lasers include caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation, and diagnostics. Soft tissue applications include wound healing, removal of hyperplastic tissue to uncover impacted or partially erupted teeth, photodynamic therapy (PDT) for malignancies, and photo-stimulation of herpetic lesions. The use of lasers has resulted in increased efficiency, specificity, ease of use, cost-effectiveness, and patient comfort. Lasers used in dental practice can be classified based on the lasing medium used (such as gas or solid lasers), tissue applicability (hard or soft tissue lasers), wavelength range, and risk associated with the laser application.

Smart Toothbrush

Smart toothbrushes with inertial sensors are emerging as advanced oral health products in personalized health care. These toothbrushes require a significant amount of computational power for real-time signal processing of nine-axis inertial sensing and toothbrush posture recognition. To recognize toothbrush posture and brushing position, a recurrent probabilistic neural network model is trained, which then checks the correctness and completeness of the Bass brushing technique. Tooth brushing involves a series of movements that require manipulating the toothbrush. The toothbrush and the user’s movements are interdependent, and the sensor’s data must be used to accurately identify the user. Even after learning the Bass brushing technique, different users may have variations in their brushing movements during toothbrush operation. The toothbrush’s range can be restricted in the small space of the mouth, and brushing requires many areas, making it challenging to accurately classify small-scale actions. Therefore, developing accurate models and effective monitoring is a complex task. A smart toothbrush is intended to assist people in adhering to the recommendations of their dentists. It collects and displays valuable information about the user’s brushing habits, unlike manual dentist toothbrushes. It can do the following:

• Keep track of brushing time
• Keep track of how long a user brushes different areas
• Track the amount of pressure applied, identify the angle at which the user holds the brush, and beep when it is time to brush the next area of the mouth

Robotics in Dentistry: The Next Generation Technology

The use of robots, which are machines programmed by computers to perform manual tasks, has become increasingly prevalent with advancements in robotics and AI. These technologies have made it possible to automate many tasks, especially those that are hard and repetitive. In dentistry, there are several options for robotic automation and assistive technologies that can improve the quality of dental treatments. By taking on these tasks, robots can free up human resources for more critical duties, such as engaging with patients or performing other complex functions. In a study among dentistry students, a humanoid (i.e., a complete-body subject simulation robotic system [SIMROID]) was evaluated to determine if a robotic subject (patient) was more realistic than the commonly used mannequins for dental students to become accustomed to real patients.Another robotic system used in dental education is ROBOTUTOR, which serves as an alternative to a dentist for demonstrating proper toothbrushing techniques to people.

Here are some of the applications of robots in the field of dentistry:

• Endo Microrobot
• Endo microrobot provides precise endodontic treatment with no error, reducing stress for dentists.
• Dental Nanorobots

Nanorobots are built of nanomaterials that are measured in nanometers. These robots use nanotechnology for cavity preparation, restoration, dentin hypersensitivity, local anesthetic, single-visit orthodontic realignment, nanorobotic dentifrice (dentifrobots), local medication administration, tooth healing, and other applications. The nanoscopic dental robots provide quick and accurate treatment.

Surgical Robots

Application of robotics in oral and maxillofacial surgery in which the surgeon interactively programs the robot during surgery, after which the robot performs the preprogrammed task in the operating room such as milling and drilling of bones, osteotomy cuts, plate selection and positioning, surgical planning, and so on. Dental Implantology The most recent computer-assisted surgical method for guided implant placement obtains a 3D-built model that mimics the patient’s jaw using CBCT imaging data. The robot is then used to drill a jaw splint at the location chosen by a software planning system that generates a surgical guide.

Robotic Dental Drill

Tactile technology has made recent advances in which extremely fine needles puncture the gum to establish the position of the alveolar bone in an immobilized patient’s jaw, which is then wirelessly transferred to a computer and amalgamated with CT scan data to create a set of drill guides.

Robotic Tooth Arrangement

A single manipulator robotic system is commonly utilized in the area of prosthetic dentistry for the creation of a full denture prosthesis utilizing a six degrees of freedom Common Robotic System (CRS) robot produced in Canada. The entire technique is carried out using a 3D virtual teeth arrangement programming software.

Orthodontic Archwire Bending

Robotic technology is utilized to bend orthodontic archwires to a certain form automatically. SureSmile archwire bending robot, which includes grasping tools and a resistive heating system, is used in the production of orthodontic appliances using CAD/CAM, 3D imaging, and computers.

Future Scope of Technology in the Field of Dentistry

While AI has the potential to transform dentistry, it is important to note that its successful integration will require collaboration between dental professionals, AI experts, researchers, and regulatory bodies. As the technology develops and becomes more sophisticated, AI-driven tools and applications could contribute to more efficient, accurate, and patient-centered dental care. SmartTek and Kapanu have developed AR apps that use their phone or tablet’s camera to overlay virtual depictions of the improved set of teeth prior to the procedure. This allows patients and dentists to configure features of their teeth such as height and spacing to their liking before they even enter the surgery room. Future developments in CAD/CAM will bring dentistry closer to the total predictability of outcomes considering all auxiliary variables that CAD/CAM is used for in the majority of other sectors. Automatic restoration design based on all patient factors, such as skeletal and arch classifications, wear, age, tooth conditions, excursive movements, temporomandibular joint condition, precise input of condylar movements in relation to tooth positions, and design based on aesthetics and desired look, would be included in this.

Conclusion

To prioritize personalized medicine and patient-centered outcomes, dental research needs to move toward connecting oral and overall health. The goal of dental research should not be limited to producing scientific publications, but to deliver outcomes that benefit society. Future tools for cutting-edge research that are most promising are digitization with AI/ML and AR/VR. Research impact must be examined and evaluated in the digital age as a deliverable good, nevertheless. For digital dentistry, transparency and realistic expectations are crucial for patients, healthcare providers, universities, MedTech companies, insurance providers, the media, and policymakers. It is important to note that digital technologies cannot replace dental experts’ skills and empathy with patients. Therefore, the dental team’s role in providing individualized treatment and emotional support remains central, and controlling the digital toolbox’s power is critical.

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