Cosmin SINESCU

Abstract

Complex Approaches on Modern Dentistry: Human, Artificial Intelligence or Both?

Cosmin Sinescu1,2, Tareq Hajaj1,2, Andreea Codruța Novac1,2, Daria Negruț1,

Ioana Moldovan1, Daniela Maria Pop1,2, Alina Tănase1,2,3, Cristian Zaharia1,2,

Emanuela Lidia Crăciunescu1,2, Mihai Romînu1,2, Virgil Florin Duma2, 

Ladislau Kabai2, Meda-Lavinia Negruțiu1,2

1“Victor Babeș” University of Medicine and Pharmacy, 2 Piaţa Eftimie Murgu, Timișoara 300041, Romania

2Research Center in Dental Medicine Using Conventional and Alternative Technologies, Department of Prostheses Technology and Dental Materials, Faculty of Dental Medicine, “Victor Babeş” University of Medicine and Pharmacy, 9 Revoluţiei 1989 Ave., 300070 Timişoara, Romania

3Department of Professional Legislation in Dental Medicine, Faculty of Dental Medicine, "Victor Babeș" University of Medicine and Pharmacy, 2 Piaţa Eftimie Murgu, Timișoara 300041, Romania

Introduction: The estimated success rate for implant treatments after ten years is approximately 84%, although 59% of patients anticipate their implants will last a lifetime. The typical treatment duration is about four months, with only 12% of patients willing to accept a higher risk of implant failure for quicker results. A significant majority, 61%, are open to using autologous bone grafts, especially in the retromolar area, while only 23% agree to harvesting bone from the hip. To avoid complications from donor sites, 43% prefer bone substitute materials. Furthermore, 67% are willing to pay extra for advanced imaging and guided implant placement to eliminate the need for bone graft surgery. 

Seeking second opinions is common, particularly among younger males, with rates ranging from 46% to 62%. Patients dissatisfied with dentures may endure treatment-related discomfort, but most prefer minimally invasive solutions. Clinicians express concerns regarding shock absorption, especially in how chewing forces are transmitted through crowns to dental implants. Clinical evidence indicates that all-ceramic dental prostheses are susceptible to fractures from repetitive occlusal stress. To alleviate stress on the jawbone, softer crown materials are recommended, particularly for patients with weakened bones or low calcium levels. Zirconia abutments can concentrate stress and are more likely to encounter mechanical issues compared to titanium.

Notable variations in abrasive resistance among occlusal surfaces can create challenges for the masticatory system, potentially leading to temporomandibular or masticatory dysfunction. Studies reveal that nocturnal bite forces during bruxism can surpass those exerted during the day. Electromyography indicates differences in muscle activity between balanced occlusion and canine-guided occlusion, with the latter requiring less muscle effort during chewing. However, findings on the impact of occlusion on masseter muscle activity in complete denture wearers remain inconsistent. Sleep bruxism may serve as a stress reliever, helping maintain the homeostasis of the masticatory system. Research highlights the need for evidence-based approaches to manage bruxism in patients with implants.

Artificial intelligence (AI) is a branch of computer science focused on developing machines or systems that can perform tasks typically requiring human intelligence. AI spans various fields, including machine learning, natural language processing, robotics, computer vision, and expert systems. It has emerged as a transformative force in healthcare, with dentistry being no exception. Advances in machine learning and data analysis position AI to revolutionize how dental professionals diagnose, treat, and manage oral health.

We are on the cusp of what many view as a new era in dentistry, in which AI has the potential to draft notes, communicate with patients, and provide diagnoses. While the possibilities are exciting, they also pose complex questions: What role will dentists play in this new landscape? If computers can generate diagnoses for oral conditions, how will this affect dental practice, particularly regarding patient care?

Despite the potential of innovative technologies to improve oral health outcomes, dentists have been relatively hesitant to adopt them. This reluctance partly arises from the need for rigorous testing before any technology can be trusted. Additionally, there exists a romanticized perception of the dental surgeon, whose expertise transcends textbook knowledge. Still, the concept of a computer-based diagnostician has long been appealing.

For decades, medical professionals have aimed to create machines capable of "thinking" like doctors and diagnosing patients. However, early models proved cumbersome and not particularly effective. Their utility improved significantly with advancements in natural language processing, which enabled the development of generative and explainable AI—allowing computers to create content that mimics human-style reasoning. This capability goes beyond simply searching for symptoms online; these advanced programs can synthesize data and "think" in ways akin to an expert.

Materials and Methods: Given the prevalence of fractures and the variety of materials available, the authors aimed to assess which design of a fixed screw-retained implant superstructure exhibits optimal mechanical performance in terms of chipping and fracture resistance. This study utilized two investigative approaches: a theoretical method involving numerical simulation for a comprehensive overview, and an experimental method comprising a mechanical analysis. Testing was conducted using the Zwick/Roell Z005 universal testing machine, which features a single-axial load force cell classified for precision in accordance with ISO 7500-1. The machine is equipped with TestXpert data processing software and an incremental extensometer, known for its minimal differential error. Additionally, Spectral Domain and Time Domain Optical Coherence Tomography were utilized to assess the integrity of the overdentures.

However, the questions are related to the possibilities in which the AI will be able to replace the dentist, preparing a tooth or making a crown. Beginning with restorative dentistry, the company's dental robotics system combines AI-driven 3D imaging software with a robotic arm designed for performing dental procedures. This innovative system aims to streamline tasks like crown placements, reducing the time required to just 15 minutes, compared to the traditional approach, which typically necessitates two office visits of at least one hour each.

Perceptive’s AI robotics system also leverages 3D volumetric data for diagnostics and treatment planning, facilitating early and highly accurate diagnoses. The process starts with an optical coherence tomography (OCT) scan of the patient's tooth and mouth, conducted using Perceptive’s handheld intraoral scanner. This state-of-the-art scanner captures 3D images beneath the gum line, through fluids, and under the tooth surface, providing exceptional imaging capabilities. Patients can easily visualize their dental conditions through these detailed images, enhancing their understanding of the care they need. The system features a handheld 3D volumetric scanner that constructs a detailed three-dimensional model of the oral cavity. Utilizing optical coherence tomography (OCT), the scanner captures images of teeth, gums, and even nerves beneath the tooth surface, all while avoiding harmful X-rays by employing light beams for highly accurate modelling.

The initial application of the robotic dentist focuses on preparing a tooth for a crown—a procedure that typically takes about two hours and requires two visits to the dentist. In contrast, the automated Perceptive system completes this task in approximately 15 minutes, significantly reducing the time patients spend in the dental chair. Developers assert that the machine operates safely even when patients are in motion, with all tests conducted on moving individuals yielding successful results. This demonstrates a high level of reliability and safety for the system.

​Results and Discussions: The system incorporates a handheld 3D volumetric scanner that creates a comprehensive three-dimensional model of the oral cavity. By utilizing optical coherence tomography (OCT), it captures images of teeth, gums, and even nerves beneath the tooth surface, all while avoiding harmful X-rays and employing light beams for precise modeling. The robotic dentist's initial focus is on preparing a tooth for a crown—a procedure that traditionally takes about two hours and necessitates two visits to the dentist. In contrast, the automated Perceptive system accomplishes this task in approximately 15 minutes, significantly decreasing the time patients spend in the dental chair. Developers assert that the machine operates safely even when patients are in motion, with successful tests on moving individuals indicating high reliability and safety. Within the broader dental industry, two primary types of AI-assisted technologies are gaining traction: platforms that utilize AI to interpret and analyse imaging for patients, providers, and payers, and software that automates patient engagement, scheduling, and other time-consuming administrative tasks for dental practices.

AI tools for dental practices include products that enable dentists to remotely analyseoral photos submitted by patients via smartphone. Imaging tools guide patients in capturing these images and can detect signs of declining oral health, alerting the dental care team. AI-guided 3D simulations assist orthodontists in accelerating fittings and transitions between braces, aligners, and retainers. Some tools even allow patients to visualize AI-powered, lifelike simulations of their teeth, mouth, and face post-treatment. Several FDA-cleared AI products utilize visual dashboards to pinpoint areas of decay in a patient’s mouth, motivating them to seek care sooner. However, experts at the intersection of AI and dentistry emphasize the need for caution alongside progress. Giannobile echoed the necessity for ongoing collaboration among researchers, practitioners, and industry professionals as AI continues to transform dental medicine.

​Conclusions: AI is supposed to augmenting, not replacing, human knowledge. AI products on the market today are not decision-makers, they are helpers.