RGUHS Nat. J. Pub. Heal. Sci Vol No: 3 Issue No: 4 eISSN: pISSN:
The Practice of medicine is delicately balancing science and technology on one side and patient oriented service on the other. Dentistry is no exception with notable influences of technological innovations on clinical practice as witnessed in the last two decades. It has made a profound impact ona variety of aspects including diagnosis, clinical treatment procedures in terms of improving precision, cost and time-effectiveness as well as patient motivation. Patients are increasingly informed about technologies recently available to an extent that it even influences their decision on the choice of their ideal dental practitioner. It is imperative that we work and serve our patients by adapting to best serve their wants and needs. However, maximizing the benefits of today’s innovations requires clinicians to be aware, comprehend and be knowledgeable about, what’s available, what’s possible, and how best to apply it in clinical or laboratory practice.
This is a bird’s eye view of some of the emerging trends ushered in by technological innovations that are slowly revolutionising our approach to dental practice.
Right treatment always begins with the right diagnosis. Digital radiography from simple intraoral digital periapical X-rays to advanced imaging techniques like, cone beam computed tomography, magnetic resonance imaging and ultrasound have found its place in modern dentistry. These imaging modalities have been of great value not only in diagnosis but also in carrying out minimally invasive treatment protocols that are image-guided and more predictable. Changing from analogue to digital radiography has not only made the imaging process simpler and faster but also made image storage, manipulation (brightness/contrast/enhancement, image cropping, etc.) and retrieval easier. Further, electronic distribution and storage of digital images allow for better communication between practitioners in addition to the decreased radiation exposure.1
Of all the advances in digital radiography, the Cone beam CT is an exciting technology that has seen rapid growth in the recent past. The threedimensional imaging technique has made complex dental and cranio-facial structures more accessible for examination aiding in early and accurate diagnosis, better planning capabilities assisting in monitoring the progress of healing.2,3,4,5,6 Owing to the advantages offered, it is being quickly adopted by most specialties and is becoming the standard of care for many dental procedures. One of the major considerations is high cost of these systems which in due course is expected to come down paving way for transition even faster.
Computer-aided design/computer-aided manufacturing-aided restoration with virtual articulator software
Recent improvements in computer-aided design (CAD) and computer-aided manufacturing (CAM) for indirect restorations now provide for replication and digitization of the complex topography of the tooth structure. Over the last several years, CAD-CAM techniques have transitioned from the domain of the unreliable to mainstream practice. Compared with the traditional casting procedures, the technique is less laborious, has eliminated manual errors improving the fabrication accuracy of prosthesis along with their biocompatibility, better mechanical properties and longevity.7,8 Further, a software of digitalized virtual articulators representing jaw movement is being integrated with the CAD/CAM system during the fabrication of the prostheses. They comprise virtual condyle and incisor guide planes that can be precisely measured by the jaw movement analyser. Virtual articulators are kinematically able to design prostheses having the capability of simulating mandibular movement by moving digitalized occlusal surfaces against one another enabling correct digitalized occlusal surfaces to allow for collision-free movement.9
T-Scan, Jaw tracking devices & EMGs
Occlusal disease, musculoskeletal and temporomandibular disorders are commonly encountered by practitioners in their day to day practice. Diagnosing and treating them is a challenge owing to the complexity of the human musculoskeletal and occlusal systems. Systems such as TekScan (T-scan) permit for the accurate study of occlusal contacts and the forces created by examining even slightest occlusal interferences, analyse and display the timing and force of the patients’ bite in 2D and 3D graphics. This is of significant value in full-mouth rehabilitation and implant-protected occlusion.10
Study of mandibular kinematics permits detection and assessment of TMJ functional irregularities arising from internal obstacles such as a displaced articular disc. Jaw tracking devices are used to study jaw movements and consequent occlusion which may even be micro traumatic for TMJ disorders.
Elevated muscle activity associated with malocclusion-directed nociception (sensory nerve response to harmful stimuli) can be detected with surface electromyography (EMG) that can even record muscle activity for some hours and provide useful information in nocturnal bruxism.11 Use of the above advanced equipment in clinical practice will be on the raise in the near future.
Taking impressions is an indispensable part of day today dental practice. The use of digital impression technique produces more accurate impressions with reduced chair-side time while also omitting the use of traditionally used messy impression materials, pouring models and the need for disinfection etc.12,13 Digital impressions simplifies and hastens the fabrication process as it can be sent as digital images directly to the laboratory or for immediate in-office fabrication .
Laser technology holds great promise for both hard and soft tissue applications and is undergoing a lot of refinement. On account of the ease, efficiency, specificity and comfort it provides over the conventional modalities, lasers are indicated for a wide variety of procedures in dental practice
Hard lasers, such as, Carbon dioxide (CO2), Neodymium Yttrium Aluminium Garnet (Nd: YAG), and Er:YAG, which offer both hard tissue and soft tissue applications are not very popular in general practice owing to its high cost.
On the other hand, cold or soft lasers, based on the semiconductor diode are compact, low-cost devices used most commonly for many applications including periodontal and oral surgical procedures, treating tooth sensitivity, root canal disinfection, bleaching of teeth ,photo stimulation of herpetic lesion, aphthous ulcers etc.14
Looking at the future, it is certain that specific laser technologies will become essential components of dental operatory in contemporary dental practice over the next decade similar to LED curing lights and intraoral cameras. However, despite the high cost, currently many practitioners have integrated both hard and soft tissue lasers very effectively into their practices.
An invisible method of orthodontic tooth movement making use of sequential clear, removable plastic aligners is gaining a lot of popularity in the recent years. This is a major area with tremendous possibilities especially indicated for treatment requiring minor tooth movement and in cases of relapse. Introduction of this technology in orthodonticshas revolutionized cosmetic dentistry as patients get to benefit from easy cleaning, less food restrictions, and eliminating uncomfortable visits to the orthodontist for adjustments etc.15
As technology gets smarter, and marketing more pervasive, we have seen an increase of this trend in general practice. While improved technology can have a positive effect for patients and the profession, it is important to proceed with caution when the dentist’s expertise and supervision are no longer included in treatment. Practitioners have to keep their patients informed about the pros and cons of all their available treatment options, and keep themselves abreast of new developmental trends.
This is one of the most promising trends that has taken dental industry by storm. Advancements in 3D printing are drastically changing what can be done in terms of cost, speed and accuracy.
The 3D printing industry is successful in developing resins and are working on developing other materials like ceramic to print crowns, inlays, replacement teeth, veneers, denture bases and surgical guides. 3D printing can also easily enable the production of retainers and custom aligners. Advances have gone on even further, creating anti cariogenic recipes to 3-D printed teeth.16
Virtual Reality training in Dental education
Virtual reality training has the potential to revolutionise how dental professionals are educated, both at college and in continuing education courses. It provides a virtual laboratory for any dental professional to test out the latest technology and techniques.
Dental haptic-enhanced VR simulators: Simulations are not new to dentistry and recent developments in virtual-reality technology not only aims to replicate the clinical situation but also identify mistakes and guide the students while working on them. Dental haptic-enhanced VR simulators allow students to experience differences in tactile sensations of all the tissues handled such as drilling enamel and dentin while preparing tooth for restoration, feeling bone and soft tissues while performing periodontal and maxillofacial surgery. Indeed a very useful tool for learning , planning and preparing for implant.17
Simulation in dentistry is ever evolving with increasing opportunities for learning a variety of procedures not only limited to preclinical training but also closer to clinical proficiency.
Technology and Practice Management
As a dentist keen on offering the best in your patient’s interest, you must complement the best technology available with methods to improve patient relationships, finances, marketing, and other operational aspects of your practice.
Patient education and motivation : The onus is on the Dentist to create awareness and comprehension in their patients to help reduce their fear and gain trust by educating them using recent technology like intraoral camera, education software, videos, 2D and 3D imaging of different dental procedures.18
Virtual mock-up : It is one of the biggest positive consequences of digitization specially in cosmetic dentistry. With virtual mock-ups and digital photos, patients can actually envision themselves with their final restorations. Patients now get a chance to try different smiles and choose whatever looks most appealing to them not only boosting their trust but makes them committed to the outcome. An aware patient is likely to comply with and participate in his treatment strategy for overall satisfaction.
Patient record management : Computerized database technologies are used to solve problems such as limited storage space for patient records and their plaster casts by converting these items to 3D digitized virtual models.
Social media marketing : Dentists are now recognizing the power of social media to educate patients about the latest techniques available and their benefits. Patient education can go a long way toward encouraging people to visit their dentist more often. Furthermore, digital outreach can be used to empower people to take an active role in promoting oral health.
Further newer digitized communication techniques like webinars and other digital conferencing techniques have made dissemination of knowledge significantly easier and less expensive for practitioners willing to update but cannot afford the time and the expense involved.
Another technology that will have a huge impact on dental care is artificial intelligence (AI).Artificial intelligence (AI) is already a reality in many fields, and will likely impact dentistry in the coming years.With the advent of digital dentistry, dental institutions and clinics now collect a significant amount of data – from 3D images, to patient files, to intraoral scans and so on. While the data so generated will be helpful in day to day-practice of the clinician and the dental team, analytics will open a sea of opportunity with AI.19
AI will enable systems to learn and develop its own intelligence, scan, analyse and make sense of the massive amounts of data and help suggest treatment options, predict problems and issues before they happen, and ensure any planned medication or procedures won’t interfere with other health concerns.20
Limitations in adopting technology in dentistry
One of the common pitfalls in adopting new technology is reluctance to change or learn. While some clinicians procure new equipment they fail to even read the owner’s manual and are not confident to operate it efficiently. Misunderstanding of the new technology tends to foster slower adoption rates. This scenario can be easily avoided by attending advanced hands-on training courses in these areas of technology.
The challenge to our profession today is to improve the quality of oral health while satisfying the wants, needs and demands of the patients. Unstinted support of dental educators, researchers, and practitioners is crucial to bring about changes that will ensure high standards of care. Technological innovations spur advancement of the art and science of clinical dentistry. Technology enables simplification of oncecomplex procedures and provides superior and comfortable patient experiences while expanding the scope of available procedures. Judicious adoption and integration of technology will certainly help in attaining the highest professionalism and increased accessibility of dental services. To ensure continued viability of the profession, it is the duty of the dental educators (managements and faculty) to upgrade institutional infrastructure responsive to and supportive of scientific and technological advances .
Scientific and technological advancements that generate new knowledge will continue to occur at an unprecedented rate. In the coming years, innovations will transform the way dental care is provided to patients. The time is not far when there will be no impressions, no plaster models, no tracing papers, and no pliers in every dental clinic.
Future seems to be more interesting and exciting for dental profession since technological innovations will slowly, but surely, get infused into routine clinical practice making dentistry easier, faster, better and most importantly ‘Enjoyable’. Let’s embrace them in the best interest of our patients and together SMILE with satisfaction.
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