The Role of Artificial Intelligence in Dentistry

In Conversation with Dr. Lukas Berr

Over the past decade, artificial intelligence has been making greater inroads across all industries, including healthcare and dentistry. Artificial intelligence, i.e., the computing processes that simulate human cognition and analyze large amounts of data, is shaping how advanced dental clinics handle organizational tasks, diagnostics, and communications. But how far is artificial intelligence likely to go? Does it pose an existential threat to dentists and other medical professionals?

Dr. Lukas Berr is an oral surgeon at the Donaustadt Clinic, Vienna, with a keen understanding of artificial intelligence. Our team at Zircon Medical recently hosted Dr. Lukas Berr on our podcast series to discuss the role of artificial intelligence in dentistry and its disruptive potential.

Introducing Dr. Lukas Berr, the oral surgeon at the Donaustadt Clinic, Vienna

Dr. Lukas Berr is currently the oral surgeon at Donaustadt Clinic, Vienna. He recalls he always knew he wanted to get into medicine because he was especially good with his hands, and he wanted to improve the quality of life of his patients. Since he was particularly skilled at working in small spaces, he knew he could get into vascular surgery, nerve surgery and reconstruction, or other such fields necessitating immense precision. However, vascular surgeries required long training periods, but Dr. Berr wanted to enter a field wherein he could specialize relatively early and become independent quickly — dentistry seemed like the perfect fit.

Dr. Berr emphasizes the need to continue advancing and improving. Even though his formal education hadn’t primed him for artificial intelligence capabilities (public universities often struggle to keep pace with advancements in technology), he taught himself about artificial intelligence in dentistry. He continued his education and research in AI and naturally followed his passion to various unchartered territories.

The leading advantages of artificial intelligence in dentistry

Dr. Berr mentioned three primary advantages of artificial intelligence in dentistry — the division of labor and the reduction of workload, digital app shaping, and organizational benefits.

• Division of Labor
  

AI helps with the division of labor and the subsequent reduction of workload for the dentist and the staff. Different tools, such as speech recognition and organization software, can reduce the workloads for individuals, improving the clinic’s overall productivity.

• Digital App Shaping
  

AI can digitize the patients’ mouths and show them a three-dimensional view of their teeth, zooming in on all the details. This doesn’t just help with diagnostics but also helps patients understand why they need treatment. The digitized visuals can be used with radiological techniques to track the implant positions and outline the complete treatment plan.

• Organizational Software
  

AI capabilities can boost the dental clinic’s organizational capacities. For example, diction software automatically records or transcribes everything the dentists say, taking the burden off dentists and assistants to take notes. This significantly reduces the documentation workload.

The current role of artificial intelligence in dentistry

While artificial intelligence poses some brilliant theoretical capabilities in specific niches, it’s yet to go mainstream because the cost of AI integration is a major roadblock to most dental practices. Dr. Berr regularly works with diagnostic software from radiological images, i.e., the identification of caries, bone inflammations, and dental pathologies. He also works with speech recognition, implant planning, and scanning software.

When it comes to the diagnosis of caries, artificial intelligence learns from certain patterns stored according to X-ray images. Generally speaking, AI identifies certain patterns in x-ray shadings, with the darker areas representing regions where the radiation passes deeper and the brighter areas representing the areas the radiation bounces off, such as the amalgam fillings. The appropriate shades are fed into the AI software with various images, training the software to identify caries.

This process reduces the workload because the AI analyzes countless x-ray images simultaneously. As such, the dentist only has to analyze the x-rays revealing certain anomalies or concerning signs, which might be one in ten x-rays. That significantly reduces the dentist’s overall workload. It’s important to note that AI provides brilliant assistance, but the interpretation of results must come down to the dentist. As such, artificial intelligence can support dentists but not necessarily replace them.

Dr. Berr mentions that telecommunication is yet another technological breakthrough sweeping across the dental industry. Even though telecommunication isn’t exactly artificial intelligence, it’s primed to have a disruptive force, replacing the need for physical consultations and training with virtual consultations and training. Online training is likely to make advanced dental training more accessible because budding dentists won’t have to fly over to different cities or countries anymore. However, the real challenge would be providing high-quality online training without physical presence.

AI’s future potentialities and disruptive force

In recent years, there have been reports that a “robot dentist” in China has successfully performed a dental implant on a human without any harm or complications. While the medical industry has marveled at this development, it has raised valid questions about AI’s future potentialities and disruptive force. It raises the existential question facing most industries — can robots effectively replace dentists?

Dr. Lukas Berr is a little cynical about such claims. He believes artificial intelligence will merely serve as a heightened assistant, aiding the surgeon or dentist in the procedure. For example, AI will automate the scheduling, implanting, planning, and certain other tasks, but the implant will still have to be placed by dentists. Over time, as the relevant AI software becomes cheaper and more accessible, Dr. Berr believes most dentists will be able to perform implants even without significant experience.

He also believes dentists are irreplaceable because robots can’t be used for hands-on treatments. The mouth is a small space wherein even the tenth of a millimeter makes a massive difference, and the mouth is constantly in motion. As such, you need human dentists who can compensate for those movements haptically, making it virtually impossible for robots to completely replace dentists. The patient is sedated, relaxed, and intubated to reduce motion. However, this remains an invasive procedure for placing single tooth implants. Nevertheless, in edentulous jaws where multiple implants must be placed at once, this may present a potential treatment option in the future.

There have also been claims that dentists will soon have to adopt AI capabilities or face possible extinction. Dr. Berr is also skeptical of those claims because nothing is more important than a strong patient experience and human touch. While dentists will have to integrate AI to a certain extent, it won’t necessarily be a requisite for survival.

“Do you really become unemployed if you no longer work digitally?” Dr. Berr asks before stating, “I don't know, because, at the end of the day, it's the patient who decides whether to come to you or not.” Based on his professional experience, the foremost factor for most patients is their inter-personal chemistry with the dentist. Patients consider whether they like the dentist, organization and if they’re well-cared for. While all patients have different preferences, their need for strong inter-personal chemistry with the dentist is a constant. 

Tips for new dentists eager to adopt new techniques and technologies

When asked about his goals for the future, Dr. Berr stated that he wants to use digitization to enhance his capabilities, making dentistry more convenient and practical for more people. He believes prosthetic procedures can truly benefit from digitization because they involve numerous intermediary steps that can be chiseled down. He also wants to digitally engage network colleagues globally for a more efficient exchange of knowledge and information.

Dr. Berr can be found on Facebook and Linkedin, or you can schedule a consultation with him at the Donaustadt Clinic in Vienna. You can also listen to Dr. Berr in our Zircon Medical podcast or continue reading for a detailed article on the growing role of artificial intelligence in dentistry. 

Over the past couple of years, artificial intelligence (AI) has become an integrated part of our daily conversations. One might liken excitement around AI to the internet boom of the 90s, a period when everyone knew they were on the precipice of a sea-change, but few could figure out exactly how that change would shape our lives. Similarly, artificial intelligence is primed to change every aspect of our lives and human behavior in ways we can predict but can’t know for certain. 

AI integration in dentistry is a topic of concern for dentists across the globe. At this point, most dentists are aware of the “Chinese robot dentist” that’s successfully placed implants into a patient’s mouth without human intervention (though dentists were in attendance). The idea of being replaced by robots is so frightening that it has spawned numerous film series and books. However, instead of focusing on the distant possibility of robot dentists taking over, it’s worth focusing on how you can use AI capabilities to your advantage.

In fact, most of us already use AI to varying degrees without our active awareness. That’s because AI comes in various forms — even Alexa and Siri are examples of AI — and their distinction from regular non-AI technology is often a little blurry. If you consider all the tools and software your dental clinic uses, you might find that you’re already benefiting from AI tools, such as voice recognition software, smart technology for diagnostics and analytics, etc.

Below, we discuss how artificial intelligence is already shaping the dental industry and its future potentialities.

Diagnostics

One of AI’s greatest benefits lies in enhanced diagnostic capabilities. AI-driven software and tools allow dentists to analyze numerous dental x-rays in record time and provide incredibly precise diagnostics for underlying problems, such as caries, inflammation, and other problems. Artificial intelligence can also be used to detect fillings, implants, etc., to get a complete overview of the patient’s mouth with the utmost accuracy. 

Denti.AI is a great example of an AI-driven software enabling automated diagnostics of x-ray images in dentistry. This program identifies and detects dental anomalies, such as caries, by analyzing hundreds or thousands of x-rays and images. Furthermore, the program is constantly learning about new pathologies and problems to solve complex problems. You can run multiple x-rays through the program and sit back as the system provides an inventory of potential problems across the entire selection.

Using Denti.AI is also fairly simple. You have to upload dental images, such as panoramic radiographs and bitewing, to the software. It analyzes the images within a few seconds and provides a chart with probable pathologies, marking its findings on the image. You can go through the results and audit the findings. The program also produces an assessment report with the patient’s dental history, potential diagnosis, and other details. Denti.AI can detect pathologies, previous treatments, crowns, implants, bridges, extractions, and more.

Dx Vision by Dentem is yet another example of AI integration in diagnostics. Like Denti.AI, this program also identifies possible anomalies and problems with dental x-rays. Dx Vision has a 99% success rate in detecting objects, such as implants, fillings, bridges, etc. The program tags the x-ray with its findings, and dental professionals worldwide can provide feedback on the diagnostic results to further train the program. Over time, with continued training, the program becomes smarter and more adept at handling complexities.

DiagnoCat is another AI-based software with impressive results in dental radiology and diagnostics. This software’s artificial intelligence analyzes the acquired CBCT images and recommends possible pathological processes. It goes beyond simple diagnostics and actively helps with individualized therapeutic planning, such as implant planning and endodontics. Once the dataset is uploaded, DiagnoCat aids in CBCT-based implant planning and generates images of the projected anatomic region for the procedure. It enables the recording of diagnostic protocols in a few seconds.

AI-based diagnostic tools, like Denti.AI, Dx Vision, and DiagnoCat, save dentists countless hours in diagnosis, improve the identification of anomalies, and build more trust with patients.

Orthodontics

Artificial intelligence and machine learning have found significant use in orthodontic treatment planning. In fact, numerous aligner companies, including Invisalign, use AI algorithms to plan orthodontic treatments. AI technologies allow orthodontists to find the optimal treatment plan to move the patients’ teeth from point A to point B. This is especially beneficial for orthodontists or dentists who don’t have the necessary levels of training to plan the treatment themselves.

Invisalign is currently using virtual reality, facial recognition, and machine learning technologies for its popular “SmileView” feature. Invisalign, and other similar aligners, provide patients a preview of their smiles after the orthodontic procedure. Some of them also provide a week-by-week overview of the position of the patient’s teeth during the entire treatment plan. Orthodontists leverage this technology to show patients why they need orthodontic treatment and take them through the entire treatment plan.

Dental Monitoring™ (DM) is another example of a company using deep learning technologies for its advanced treatment management system in orthodontics. Deep learning is a subset of artificial intelligence that doesn’t need to be “trained” — it learns automatically through an analysis of large data sets. DM has numerous possibilities — it detects unseated aligners and sends a customized message to the patient, the dentist can follow the patient’s progress without in-person visits, and the program notifies the dentist if the patient’s archwire has become passive, and more.

While AI is playing a massive role in orthodontics, studies have shown that it still has some limitations. The existing orthodontic AI programs often ignore oral diseases and previous health problems affecting the orthodontic correction. They chart an orthodontic treatment plan without warning the dentist about existing pathologies, such as periodontitis, that may be the underlying cause of teeth migration. As such, dentists must continue holding the reigns to diagnose the patient’s oral health before using AI-based orthodontic tools.

Organization

Beyond diagnostic and orthodontic capabilities, artificial intelligence helps with organizational tasks to improve the dental clinic’s overall functionality.

AI-driven dental analytics, for example, help dentists manage their overall business operations and patient care. AI technologies can also link the patient’s dental history with their overall medical history and send alerts whenever they have an increased risk of dental diseases due to underlying medical conditions. As mentioned previously, some of the existing AI tools can monitor the patient’s progress and inform dentists if something is amiss — the patient has to simply upload pictures of their smile regularly.

Voice recognition is currently one of AI’s most widely implemented functionalities — Google Home, Alexa, and Siri are examples of AI-based voice recognition. Speech or voice recognition software can take accurate notes while the dentist narrates, present the dentist with the necessary information a lot faster than their human counterparts, and automate tasks around the dental practice. VoiceboxMD is an example of an AI-based voice recognition software that takes precise notes, transcribes accurately, and recognizes complex prescription names and medical terms.

Surgery

One of the most contentious applications of artificial intelligence is in oral and maxillofacial surgery, i.e., robot surgery. The primary challenge here is simulating human body motion and human intelligence to ensure utmost precision — working within the human mouth involves millimeters of precision while adjusting for constant tongue and mouth motion. While AI implementation in oral surgery hasn’t completely reached mainstream accessibility and fruition, the future potentialities seem intriguing. When the patient is sedated and intubated, then motion is significantly reduced, which may improve the conditions for robot surgery.

In oral implantology, AI algorithms are already widely in use to plan proper implant position (in relation to accessible bone and the prosthetic restoration attached to the implant later on) prior to placement in a virtual software 3D jaw model. Using this data, a surgical implant splint may be printed or milled containing information for the best implant position. By positioning this splint on the remaining teeth or provisionally attaching it to the bone using small screws, the optimal drilling procedures may be carried out through a hole in the splint. After removing the splint, the implant may be then be easily and gently screwed into the drilled hole. This procedure may also be named as backward planning.