Dental News September 2023

Artificial Intelligence in Dentistry Posterior Tooth Replacement

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ARTICLES 8

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Posterior tooth replacement

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Posterior Tooth Replacement with Dental Implants in Sites Augmented with rhBMP-2 at Time of Extraction Abstract

Barry P. Levin, DMD; and Peter Tawil, DDS Barry P. Levin, DMD Clinical Associate Professor, University of Pennsylvania, Philadelphia, Pennsylvania Peter Tawil, DDS Former Resident in Periodontics, University of Pennsylvania, Philadelphia, Pennsylvania; Private Practice, Beirut, Lebanon tawilpeter@gmail.com

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This case series demonstrates seven molar-site implants placed in six consecutively treated patients. All sites were augmented with rhBMP-2 (1.50 mg/cc)/ACS (recombinant human Bone Morphogenetic Protein-2/Absorbable Collagen Sponge) at extraction to regenerate bone-facilitating implant placement.

In four patients, osteotomies were initiated with trephines to evaluate qualitatively for native bone and for the absence of residual ACS. All sites facilitated implant placement after augmentation. All seven implants achieved primary stabilization and were functionally loaded. No implants were lost or developed complications. It can be concluded that augmenting molar extraction sockets with rhBMP-2/ACS can allow standard implant placement in the posterior dentition that is capable of withstanding a functional load.

With the evolution of dental implant therapy, the treatment of extraction sockets has progressed from a simple matter of wound healing to what is often times a complex surgical procedure aimed at minimizing bone resorption. The consequences of physiologic wound healing from extractions often include both vertical and, more prominently, lateral reductions of the local alveolar process. The healing of extraction sockets is accompanied by marked ridge resorption within the first 3 to 4 months.1 Schropp demonstrated approximately 50% horizontal bone

loss 12 months after extractions.2 Nevins et al demonstrated that when extraction of teeth with prominent roots are augmented with grafts, when compared to ungrafted sites the grafted sites facilitated favorable implant placement. Significantly fewer of the grafted sites required additional grafting procedures at the time of implant placement.3 Although many “ridge augmentation” techniques exist, it is certainly more efficacious for both surgeons and patients to prevent bone modeling that results in physiologic resorption and necessitates more involved modalities.

The term “socket preservation” usually refers to the placement of various bone replacement grafts that are often covered with a barrier membrane.

The bone graft materials are used to maintain space and serve as an osteoconductive scaffold to support passive osteogenesis within the “pores” both between and within the graft particulate. Iasella et al demonstrated significantly greater 3-dimensional (3-D) ridge preservation for extraction sockets augmented with allograft bone and collagen membranes compared to ungrafted controls.4 Araújo et al demonstrated in the canine model that the pores of tricalcium phosphate particulate can be invaded by erythrocytes, and that later these pores would become the locus of new bone formation.

These same authors also noted that a degree of delayed healing Quarter IV

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Posterior Tooth Replacement with Dental Implants

and minimal bone formation occurred between the second and fourth weeks of recovery.

These authors speculated that the ß-TCP (betatricalcium phosphate) graft may have retarded bone formation.5 In a review article, Darby et al concluded that ridge preservation is an effective procedure in limiting both horizontal and vertical ridge alterations in post-extraction sites, and that there is no technique superior to another.6 The barrier membrane provides a soft-tissue exclusionary function, blocking the ingrowth of epithelial and fibroblastic cells and favoring the repopulation of osteoblast cells for bone replacement of the graft material. Investigators such as Carmagnola et al reported excellent clinical results when particulate xenograft coverage, without soft-tissue closure, was achieved when a collagen membrane was adapted over the bone graft and beneath the mucoperiosteal flap.7 The majority of these procedures provide 3-D bone volume, facilitating prosthetically driven implant placement. The caveat of these treatments is that osseointegration occurs to support long-term tooth replacement that may involve permanent inclusion of graft material. At the inception of dental implantology, the phenomenon of osseointegration was investigated through histologic animal studies. Titanium implants were inserted into healed alveolar ridges, composed of “native” bone. Most long-term (over 10 to 15 years) studies followed these types of clinical situations. It would seem logical that ideal clinical situations would support the possibility of implant placement into sites composed of native bone, excluding bone graft materials occupying spaces of potential bony trabeculae. The challenge that still exists today, when teeth require extraction and site preparation is chosen to facilitate future implant placement, is to regenerate de novo bone and maintain osseous morphology favorable for restoratively driven implant placement.

Recombinant technology has given surgeons the ability to stimulate wound healing and cellular differentiation, leading to tissue regeneration.

The stimulatory properties of these peptides require vehicles for sustained delivery. Some of these growth factors are commercially available in combined packaging, with bone grafting particulate as the delivery vehicle. These materials possess some degree of osteoconductivity and occupy a physical space, preventing maximum osseous fill of the desired space. Some of these growth factors are not specific for osteoblastic differentiation. One of the few commercially available recombinant growth factors proven to be selectively osteoinductive is recombinant

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human Bone Morphogenetic Protein-2 (rhBMP-2) (INFUSE® Bone Graft, Medtronic, Inc. [FDA PMA submission number for INFUSE OMF indication is P050053.]). rhBMP2 is a differentiation factor that changes the phenotype of precursor cells (mesenchymal stem cells) into osteoblasts and chondroblasts. The standard dose of the protein is 1.50 mg per 1 cc of the solution. The lyophilized rhBMP-2 is combined with sterile water chairside. Once the solution is mixed, it is uniformly dispensed onto an absorbable collagen sponge (ACS). Following a minimal saturation time of 15 minutes, this collagen sponge can be cut into various size strips to be delivered to the site of desired regeneration. The release of the growth factor is sustained over an approximately 2-week time period. Because the ACS is not treated by crosslinking to delay degradation, it is resorbed quickly, leaving no remnants of graft material at the placement site. This facilitates a maximum potential for bone-fill of the grafted defect. The stimulatory regenerative and vascular invasion effects of rhBMP-2 also accelerates bone formation. This is significant because it can shorten the overall treatment time for patients.

PURPOSE The purpose of this article is to present a case series of consecutively treated patients (Table 1) who at the time of molar tooth extractions received grafting of the alveolus with the rhBMP-2/ ACS material alone. This retrospective analysis fully complies with the Helsinki Accords and Ethical Guideline for Clinical Research. All patients included in this case series signed written consent forms that explained the nature of the procedure undertaken, stating that they agreed to undergo the prescribed therapy. These patients were also informed that the material used for augmentation was a recently FDA-approved material that was indicated for grafting of extraction sockets. All grafted sites received dental implants within a 3- to 6-month time period following extraction.

Surgical procedures were not altered in terms of underpreparation, bone condensing, or additional grafting at the time of implant placement, with the exception of the initiation of osteotomies with a small (2.7-mm outer and 2-mm inner diameter) trephine. The cores harvested were submitted for qualitative histologic evaluation to confirm the presence of vital bone. All implants subjectively achieved primary mechanical stability and were restored 3 to 8 months after placement.

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Posterior Tooth Replacement with Dental Implants

Continuing Education 2

CASE 1 The patient was a 71-year-old man with significant caries and subsequent bone loss associated with tooth No. 30. The septal bone was lost, with the exception of the coronal aspect, resulting in a “bridge of bone” connecting the buccal and lingual cortices of the site (Figure 1). After reflection of the full-thickness buccal and lingual flaps, extraction, and manual and ultrasonic debridement of the socket to remove all visible soft-tissue remnants, the defect was obturated with the rhBMP-2/ACS material (Figure 2). Fifteen weeks after the first procedure, the site was reopened to perform implant placement. Flap reflection revealed excellent and complete bone reformation (Figure 3). The implant osteotomy preparation was initialized with the harvest of an approximate 5-mm trephine core. The trephine had an internal diameter of 2 mm and an outer diameter of 2.7 mm. The completion of implant placement was performed according to the manufacturer’s guidelines, resulting in the delivery of a 5-mm x 11-mm implant with primary stability.

Because of excellent subjective stability, a transmucosal healing was chosen, with placement of a healing cap and a nonsubmerged closure (Figure 4). Qualitative histology demonstrated lamellar bone without evidence of the ACS carrier.

Restorative therapy commenced approximately 4 months after implant placement. Delivery of the definitive prosthesis, consisting of a gold custom abutment and cement-retained crown, occurred at 5 months following implant placement surgery and 8.5 months after extraction and augmentation (Figure 5).

CASE 2 The second patient was a 75-year-old woman who presented with a chronic infection associated with a fracture of the distobuccal root of tooth No. 3.

Following flap reflection, complete buccal bone loss was associated with the root fracture. Tooth No. 3 was extracted, with all remaining bony walls of the extraction socket being preserved (Figure 6). Debridement was followed by obturation of the defect with the rhBMP-2/ACS (Figure 7).

A subepithelial, connective tissue pedicle graft was rotated to provide partial coverage of the grafting material. The graft was then closed with a monofilament polytetrafluoroethylene (PTFE) suture. Approximately 18 weeks following extraction and grafting, full-thickness flaps were reflected, revealing complete osseous regeneration of the original defect (Figure 8). The

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106

CASE 1

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osteotomy was initiated with the same trephine bur to harvest a core of representative bone PURPOSEat the site of implant insertion. Implant present placement proceeded The purpose of this article is without to present aalteration case series offrom conthe manufacturer’s protocol by inserting 4.8secutively treated patients (Table 1) who at the time ofamolar mm 8-mm fixture with primary, toothxextractions received grafting of thetactile, alveolusstability, with the and transmucosal healing properties.

At about 8 rhBMP-2/ACS material alone. This retrospective analysis months postplacement, the implant was restored fully complies with the Helsinki Accords and Ethical Guidewith a custom abutment and cement-retained line for Clinical Research. All patients included in this case crown (Figure 9). series signed written consent forms that explained the nature of3the procedure undertaken, stating that they agreed CASE to undergo thewas prescribed therapy. These were also The patient a 66-year-old manpatients who required informed that the material used for augmentation was adue reremoval of the three mandibular right molars cently FDA-approved material that was indicated for grafting to rampant caries and attachment loss. Following of extraction sockets.and extractions, the sockets flap reflection All grafted siteswith received dental implants and withinmanual a 3- to were debrided both ultrasonic instrumentation (Figure 10).

The sockets the first 6-month time period following extraction.

Surgicalof procedures and molars were augmented with weresecond not altered in terms of underpreparation, bonerhBMP-2/ condensing, ACS. The site of the third molar wasplacement, obturated with or additional grafting at the time of implant with the aexception noncrosslinked, collagen plugwith fora small hemostatic of the initiation of osteotomies (2.7-mm purposes only.

The restorative treatment plan outer and 2-mm inner diameter) trephine. The cores harvested encompassed tooth replacement in the first and were submitted for qualitative histologic evaluation to confirm second molar positions only, negating the need the presence of vital bone. All implants subjectively achieved for the patient to incur the greater expense of primary mechanical stability and were restored 3 to 8 months augmenting the third molar site. Primary closure after placement.

was achieved with a monofilament PTFE suture.

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The patien subsequen bone was lo in a “bridge of the site ( and lingual ment of the defect was o Fifteen w to perform and comple my prepara 5-mm trep 2 mm and a plant place guidelines, with prima a transmuc cap and a no demonstrat Restorative implant pla sisting of a occurred at 8.5 months CASE 2

The second with a chro buccal root buccal bon No. 3 was e traction so followed b (Figure 7). rotated to p graft was th ylene (PTF Approxim full-thickn regeneratio was initiat representa Implant pla ufacturer’s primary, ta At about 8 with a custo

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Posterior Tooth Replacement with Dental Implants

CASE 3 Approximately 6 months after the extractions and augmentation procedure, thewho patient returned The patient was a 66-year-old man required removal offor the implant placement surgery.

Surgical reopening three mandibular right molars due to rampant caries and attachrevealed excellent visual regeneration and ridge ment loss. Following flap reflection and extractions, the sockets preservation (Figure 11). The site of the tooth No. were debrided with both ultrasonic and manual instrumenta31 osteotomy was chosen for biopsy harvesting, tion (Figure 10). The sockets of the first and second molars were because this is where the most severe bone loss augmented with rhBMP-2/ACS. The site of the was Fig 6.

Fig 7. existed at the time of extraction, and thisthird sitemolar would with a noncrosslinked, collagen for hemostatic beobturated most representative of new boneplug formation, as purposes only. opposed to possibly harvesting preexisting native The This restorative treatment planqualitatively encompassed tooth replacebone. trephine core revealed ment in the first and second molar positions only, negating the what was diagnosed by the histopathologist for the patient incur the greater expense of augmentasneed “normal bone”towithout any foreign body or inflammatory responses being (Figure ing the third molar site. Primary closureevident was achieved with a 12).

Serving as a historic control, Trombelli et the al monofilament PTFE suture. Approximately 6 months after reported on histomorphometric measurements of extractions and augmentation procedure, the patient returned Fig 8.

Fig 9. various tissues present at Surgical different time intervals. for implant placement surgery. reopening revealed exThese describeand great human cellentauthors visual regeneration ridgevariability preservationin(Figure 11).

Fig 6. 40. 0%+*ƫ/+ '!0ƫ+"ƫ0++0$ƫ +ċƫăƫ !)+*/0. 0%*#ƫ(+//ƫ+"ƫ %/0+ġ trephine cores taken from extraction sites.

In The site of the tooth No. 31 osteotomy was chosen for biopsy har 1 (ƫ +.0!4ċƫFig 7. 01. 0%+*ƫ+"ƫ!40. 0%+*ƫ/+ '!0ƫ3%0$ƫ.$ ġĂĥ relation to the present case series, Trombelli ċƫFig 8. !ġ!*0.5ƫ/$+3%*#ƫ +),(!0!ƫ +*!ƫ.!#!*!. 0%+*ċƫFig 9. vesting, because this is where the most severe bone loss existed at et al described the presence of a provisional %+#. ,$% ƫ ,,! . * !ƫ+"ƫ.!/0+.! ƫ%),( *0ċƫ the time of extraction, and this site would be most representative matrix and woven bone dominating what they of new bone formation, as opposed to possibly harvesting pre- implant surfaces either to the collar of the implants, described as late-phase healing taken at 12 to 24 existing native bone. This trephine core qualitatively revealed or to the rough–smooth titanium border, depending weeks after extractions.

Although tissue modeling whatdescribed was diagnosed the histopathologist as “normal was described as fast, the authors found individual the remodelthe implant type used in each was asby fast, the authors found bone” the onmodeling ing of the newly to be what they calledevent “seemingly without any foreign or inflammatory responses being evi- situation.

The formed most bone common adverse or remodeling of thebody newly formed bone to be what slow.” The trephine core presented in this particular case demdentcalled (Figure 12).

Serving as aslow.” historicThe control, Trombelli et al morbidity was mild to moderate postoperative they “seemingly trephine core reported on in histomorphometric measurements of various tis- edema onstrated thiswas type of healing,intraas described

by Trombelli etThis al.8 A that noted and extraorally. presented this particular case demonstrated reaction to oral grafting with rhBMP-2/ACS has suestype present different time Theseby Trombelli high degree of woven bone as well as a cell and this ofat healing, as intervals. described 9 These same

by Boyne et al.matrix etauthors al.8 Adescribe high degree of woven bone as well as also been reported great variability in human fiber-abundant provisional was present. investigators detected antibody production to a trephine cell andcores fiber-abundant provisional matrix was taken from extraction sites. In Two 4.8-mm x 10-mm implants were placed rhBMP-2 in a small percentage (12%) of patients present.

Two 4.8-mm x 10-mm implants were relation to the present case series, Trombelli using standard protocol. These implants treated with a achieved therapeutic ofand 1.50 mg/ RELATED CONTENT: placed using the standard These implants et al described presenceprotocol. of a provisional primarydosage stabilization facilitated +.ƫ)+.!ƫ%*"+.) 0%+*Čƫ.! ƫ +*! mL. This was a transient finding that did not affect achieved primary stabilization and facilitated transmucosal healing. At just under 20 weeks, matrix and woven bone dominating what they . "0%*#ĥ %//1!ƫ !#!*!. 0%+*ƫ 0!.% (/ƫ 0 or require further treatment. It transmucosal healing.healing At just under the treatment outcomes described as late-phase taken at 12 20 to weeks, the two implants were restored with two indentalaegis.com/go/cced58 two implants were restored with two individual is also worth mentioning that although the retrieved 24 weeks after extractions. Although tissue dividual cement-retained crowns (Figure 13). trephine cores revealed qualitative evidence of cement-retained crowns (Figure 13). healthy bone, without evidence of persisting graft material or adverse cellular reactions, FINDINGS TABLE All of the 1consecutively treated patients underwent histomorphometry was not performed. The extraction of molar teeth, simultaneous bone percentages of woven bone, lamellar bone, and augmentation rhBMP-2/ACS, andPatients implant soft tissue within the cores were not evaluated. The Case Series with of Consecutively Treated placement approximately 4 to 6 months after the purpose of the histologic component of this report is to demonstrate the presence of viable Extraction Placement Implant Implant Date native first Patient procedure. It isDate important to point out several Date Toothbone, # Diameter without undesired Length inflammatory Restored processes findings: First, all of the augmented sites facilitated or residual graft materials, in the locations of restoratively driven implant placement that was 0ċƫāƫĨ ĩƫ ĈĥĊĥāĀƫ āĀĥĂĊĥāĀƫ ņăĀƫ Ćƫ))ƫ āāƫ))ƫ ăĥăĥāāƫ not possible at the time of extraction because of implant insertions. Most importantly, from a clinical 0ċƫĂƫĨ ĩƫ ĈĥĂĉĥĀĊƫ āĂĥąĥĀĊƫ ņăƫ ąċĉƫ))ƫ ĉƫ))ƫ ĈĥāĂĥāĀƫ bony insufficiency. Second, all implants subjectively perspective, all consecutively placed implants in 0ċƫăƫĨ ĩƫ ĆĥĂĉĥāĀƫ āāĥāĥāĀƫ ņăĀČƫņăāƫ ąċĉƫ))ƫ āĀƫ))ƫ ăĥĂĆĥāā and achieved primary stability. No mobility or rotation this case series achieved osseointegration in a standard ĂĥĂąĥāĀƫ period of of the implants occurred of the 0ċƫąƫĨ ĩƫ ĈĥĂĉĥĀĊƫ upon tightening āāĥāĊĥāĀƫ ņăƫ were functionally ąċĉƫ))ƫ loaded ĉƫ))ƫ healing abutments. Third, no additional bone time (3 to 8 months). Delayed loading due to poor 0ċƫĆƫĨ ĩƫ ăĥĊĥāĀƫ ĊĥāăĥāĀƫ ņăĀƫ ąċĉƫ))ƫ āĀƫ))ƫ āĥĆĥāāƫ augmentation was necessary at the time of implant subjective bone quality or suboptimal implant 0ċƫćƫĨ ĩƫ āāĥĂĆĥāĀƫ ņāĊƫ stability was ąċĉƫ))ƫ āĀƫ))ƫ ăĥāĀĥāāƫ not found with any of the implants in placement in any ofćĥāĀĥāĀƫ these cases. Implant placement resulted in circumferential bony coverage of the this case series.

14

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event or morbidity was mild to moderate postoperative edema that was noted intra- and extraorally. This reaction to oral grafting with rhBMP-2/ACS has also been reported by Boyne et al.9 These Posterior Tooth Replacement with Dental Implants same investigators detected antibody production to rhBMP-2 in a small percentage (12%) of patients treated with a therapeutic dosage of 1.50 mg/mL. This was a transient finding that did not affect treatment outcomes or require further treatment.

It is also worth mentioning that although the retrieved trephine cores revealed qualitative evidence of healthy bone, without evidence of persisting graft material or adverse cellular reactions,

DISCUSSION Ridge preservation is a frequently investigated subject. Numerous combinations of bone replacement grafts, barrier membranes, and the addition of various growth factors have been evaluated. The primary goal of these procedures is to preserve and/or regenerate alveolar bone associated with extraction sockets and prevent the anticipated, physiologic bone resorption that follows tooth loss. Araújo et al found that when canine extraction sockets are augmented with BioOss Collagen® (Osteohealth, www.osteohealth. com), some of the expected dimensional alterations could be offset. The collagen portion of the graft was readily eliminated, whereas the xenograft portion of the graft persisted, although bone formation occurred on the surface of the graft particles.10 The presence of newly formed bone onto the nonresorbable graft surface demonstrates the passive process of osteoconduction. Graft particles are placed into the site and the repopulation of the boneforming cells occurs over time and is dependent on the individual defect’s and patient’s ability to heal and regenerate lost or damaged tissue. This 108 process lacks a stimulatory cellular component.

11 According to Lane et al, the tissue engineering model is composed of three elements. First, each site of regeneration requires that cells be capable of differentiating into the desired cell line needed to regenerate the desired lost tissue. Second, a signaling molecule is required to provide chemotactic, morphogenic, and differentiation messages to these cells. Third, the signaling molecule and migrating cells require a scaffold or matrix to provide the physical space necessary to carry the message to the site and facilitate cellular migration. The fate of implants placed under functional, occlusal load in sites augmented with any bone graft is a primary concern for clinicians and patients. The possibility of placing implants is the first step in a multistep process of tooth replacement. Initial stability, followed by secondary stability or osseointegration, is the specialty of the restorative dentist. Treatment is considered a failure if these implants do not function in a healthy state, under normal occlusal conditions. In an animal model, Jovanovic et al demonstrated that machined titanium implants can function for 12 months after placement in sites of experimental defects augmented with rhBMP-2/ACS 3 months prior to placement. Not only were these implants successfully loaded for

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Dental News

Fig 10.

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1COMPENDIUM year, but the authors also noted that the boneFebruary 2012 to-implant contact (BIC) for fixtures inserted into rhBMP-2 grafted sites was comparable to implants placed into native bone.12 In a pilot study conducted in humans, Cochran et al evaluated a subtherapeutic dose of rhBMP-2 (0.43 mg/cc) in extraction sockets or ridge augmentations. The 3-year results demonstrated safety and long-term efficacy of this growth factor for site development facilitating implant placement.13 In a randomized controlled study, Fiorellini et al evaluated rhBMP-2/ ACS delivered at 1.50 mg/ cc, 0.75 mg/cc, ACS alone, and ungrafted controls in the treatment of maxillary extraction sockets with buccal wall defects.14 Significant ridge height was preserved, and bone width was regenerated when the sites were augmented with rhBMP-2/ACS. Ungrafted and ACSonly grafted sites demonstrated little bone regeneration. The sites grafted with the commercially available dosage of 1.50 mg/cc of rhBMP-2 outperformed the sockets grafted with the subtherapeutic dose of 0.75 mg/cc in terms of dimensional bone maintenance and regeneration.

These investigators evaluated anterior sites for socket augmentation and preservation. The present case series follows consecutively treated molar sites. This may be of significance because most human studies evaluating rhBMP-2/ACS for Quarter IV

Ridge prese combination the addition primary goa alveolar bon anticipated Araújo et al mented wit com), some The collage the xenogra tion occurre of newly for onstrates th are placed in cells occurs and patient’ This proces Accordin posed of thre cells be capa to regenerat required to p messages to cells require sary to carry The fate sites augme cians and pa step in a mu followed by of the restor implants do sal conditio that machin

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Quarter III

Posterior Tooth Replacement with Dental Implants

bone regeneration have focused on maxillary sinus grafts14,15 or maxillary anterior extraction sites.

When comparing the findings of the present case series with ungrafted extraction sockets, it can be concluded that regeneration of native bone— not unlike normal bone remodeling—occurred.

Serving as another historic control, Evian et al studied histologic cores of ungrafted extraction sites at varying time intervals. These investigators noted two distinct regenerative phases. From 4 to 8 weeks, a “progressive osteogenic phase” was described. From 8 weeks on, the “osteogenesis slows down” and maturation of bony trabeculae increases in bone volume. Bone that was present in the 16-week study specimen was described as mature, with fewer cellular elements compared to earlier specimens. The bone found in this case series was qualitatively similar to the later specimens in the Evian study of ungrafted extraction sites.16 CONCLUSION It can be concluded that augmentation of molar extraction sockets with rhBMP-2/ACS results in the regeneration of de novo bone, capable of accepting timely implant placement, without altering manufacturer-specified osteotomy preparation, and functional loading in a standard time period. Because the implants were inserted and loaded prosthetically into native bone, without the presence of residual graft materials, these implants can be expected to achieve optimal long-term success, comparable to implants placed into unmanipulated, edentulous bone.

REFERENCES 1. Amler MH. The time sequence of tissue regeneration in human extraction wounds. Oral Surg Oral Med Oral Pathol. 1969;27(3):309-318.

2. Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313323.

3. Nevins M, Camelo M, De Paoli S, et al. A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots. Int J Periodontics Restorative Dent. 2006;26(1):19-29.

4. Iasella JM, Greenwell H, Miller RL, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical

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Dental News

and histologic study in humans. J Periodontol.

2003;74(7):990-999.

5. Araújo MG, Liljenberg B, Lindhe J. beta-Tricalcium phosphate in the early phase of socket healing: an experimental study in the dog. Clin Oral Implants Res. 2010;21(4):445-454.

6. Darby I, Chen ST, Buser D. Ridge preservation techniques for implant therapy. Int J Oral Maxillofac Implants. 2009;24(suppl):260-271.

7. Carmagnola D, Adriaens P, Berglundh T. Healing of human extraction sockets filled with Bio-Oss. Clin Oral Implants Res. 2003;14(2):137-143.

8. Trombelli L, Farina R, Marzola A, et al. Modeling and remodeling of human extraction sockets. J Clin Periodontol. 2008;35(7):630-639.

9. Boyne PJ, Lilly LC, Marx RE, et al. De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus floor augmentation. J Oral Maxillofac Surg.

2005;63(12):1693-1707.

10. Araújo M, Linder E, Wennström J, Lindhe J. The influence of Bio-Oss Collagen on healing of an extraction socket: an experimental study in the dog. Int J Periodontics Restorative Dent.

2008;28(2):123-135.

11. Lane JM, Yasko AW, Tomin E, et al. Bone marrow and recombinant human bone morphogenetic protein-2 in osseous repair. Clin Orthop Relat Res. 1999;361:216-227.

12. Jovanovic SA, Hunt DR, Bernard GW, et al.

Long-term functional loading of dental implants in rhBMP-2 induced bone. A histologic study in the canine ridge augmentation model. Clin Oral Implants Res. 2003;14(6):793-803.

13. Cochran DL, Jones AA, Lilly LC, et al. Evaluation of recombinant human bone morphogenetic protein-2 in oral applications including the use of endosseous implants: 3-year results of a pilot study in humans. J Periodontol. 2000;71(8):1241-1257.

14. Fiorellini JP, Howell TH, Cochran D, et al.

Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation. J Periodontol.

2005;76(4):605-613.

15. Triplett RG, Nevins M, Marx RE, et al. Pivotal, randomized, parallel evaluation of recombinant human bone morphogenetic protein-2/absorbable collagen sponge and autogenous bone graft for maxillary sinus floor augmentation. J Oral Maxillofac Surg. 2009;67(9):1947-1960.

16. Evian CI, Rosenberg ES, Coslet JG, Corn H. The osteogenic activity of bone removed from healing extraction sockets in humans. J Periodontol.

1982;53(2):81-85.

Quarter IV

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Admira Fusion 5 by VOCO – Simplified shade system through Cluster-Shades

The correct determination of the tooth shade is the key for an aesthetic result of the restoration. Finding the optimal shade is often not that easy. One of the most common methods to define the tooth shade is the use of shade guides. Compared to the variety of shades that a natural tooth has, a shade guide can only show a limited colour spectrum, which can lead to an incorrect shade selection. VOCO has therefore set itself the goal of offering dentists a state-of-the-art universal filling material that extremely simplifies daily practice. The solution: The further development of the innovative, purely ceramic-based ORMOCER® filling material Admira Fusion. With the new universal composite Admira Fusion 5, it is now possible to cover all VITA® classical shades with just five Cluster-Shades.

New and patented resin matrix

Admira Fusion 5 uses five different Cluster-Shades, each of which bundles several VITA® classical shades. The so-called Cluster-Shade-System is enabled by the new patented resin matrix, which has been adapted to the size and optical properties of the nano-hybrid particles, which results in optimised light scattering. The result: a targeted and enhanced chameleon effect within the respective Cluster-Shade, which allows the filling material to perfectly match the natural tooth shade. Thanks to this simplified shade system, dental practices are optimally positioned for all cases in their daily practice with only five shades and can thus significantly slim down their inventory. There is no need for multi-colour layering or the use of an additional blocker or opaquer. By optimising the resin matrix, it has also been possible to significantly reduce the light-curing time: For all five shades, a polymerisation of only 10 seconds is necessary. This saves valuable time.

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With Admira Fusion 5, dentists benefit from the advantages of the proven technology of the high-performance composite Admira Fusion. The innovative combination of nano-hybrid and ORMOCER® technology, in which both fillers and resin matrix are based on silicon oxide, enables a purely ceramic-based material. Due to the ORMOCER®s (Organically Modified Ceramics) used, Admira Fusion 5 is highly biocompatible, as it does not contain any classic monomers. In addition, the material has by far the lowest polymerisation shrinkage of 1.25 % by volume and an associated extremely low shrinkage stress compared to all conventional restorative composites.

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Smart Smile: Revolutionizing Dentistry With Artificial Intelligence

Ashwini Dhopte1 and Hiroj Bagde 2 1 Department of Oral Medicine and Radiology, Rama Dental College and Research Centre, Kanpur, IND 2 Department of P e r i o d o n t o l o g y, Rama Dental College and Research Centre, Kanpur, IND Corresponding a u t h o r. hirojbadge8@gmail.com

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Dental News

Abstract Artificial intelligence (AI) has emerged as a transformative technology in various industries, and its potential in dentistry is gaining significant attention. This abstract explores the future prospects of AI in dentistry, highlighting its potential to revolutionize clinical practice, improve patient outcomes, and enhance the overall efficiency of dental care. The application of AI in dentistry encompasses several key areas, including diagnosis, treatment planning, image analysis, patient management, and personalized care.

AI algorithms have shown promising results in the automated detection and diagnosis of dental conditions, such as caries, periodontal diseases, and oral cancers, aiding clinicians in early intervention and improving treatment outcomes.

Furthermore, AI-powered treatment planning systems leverage machine learning techniques to analyze vast amounts of patient data, considering factors like medical history, anatomical variations, and treatment success rates. These systems provide dentists with valuable insights and support in making evidence-based treatment decisions, ultimately leading to more predictable and tailored treatment approaches. While the potential of AI in dentistry is immense, it is essential to address certain challenges, including data privacy, algorithm bias, and regulatory considerations.

Collaborative efforts between dental professionals, AI experts,

and policymakers are crucial to developing robust frameworks that ensure the responsible and ethical implementation of AI in dentistry.

Moreover, AI-driven robotics has introduced innovative approaches to dental surgery, enabling precise and minimally invasive procedures, and ultimately reducing patient discomfort and recovery time. Virtual reality (VR) and augmented reality (AR) applications further enhance dental education and training, allowing dental professionals to refine their skills in a realistic and immersive environment.

AI holds tremendous promise in shaping the future of dentistry.

Through its ability to analyze vast amounts of data, provide accurate diagnoses, facilitate treatment planning, improve image analysis, streamline patient management, and enable personalized care, AI has the potential to enhance dental practice and significantly improve patient outcomes.

Embracing this technology and its future development will undoubtedly revolutionize the field of dentistry, fostering a more efficient, precise, and patient-centric approach to oral healthcare. Overall, AI represents a powerful tool that has the potential to revolutionize various aspects of society, from improving healthcare outcomes to optimizing business operations. Continued research, development, and responsible implementation of AI technologies will shape our future, unlocking new possibilities and transforming the Quarter IV

Revolutionizing Dentistry With Artificial Intelligence

way we live and work.

Keywords: patient care, treatment planning, diagnosis, dentistry, artificial intelligence Introduction and background Artificial intelligence (AI) is a rapidly advancing field that encompasses the development of computer systems capable of performing tasks that typically require human intelligence. It involves the creation of computer systems and algorithms that can learn, reason, and make decisions based on data and patterns [1]. AI encompasses various subfields, including machine learning, natural language processing, computer vision, and robotics. AI has found applications in numerous industries and sectors, including healthcare, finance, transportation, manufacturing, and entertainment. Key technologies driving AI advancements include deep learning neural networks, which are capable of processing and analyzing complex patterns in data, and natural language processing algorithms, which enable machines to understand and generate human language [1].

The term “artificial intelligence” was coined by John McCarthy, a computer scientist, in 1956 during the Dartmouth Conference, where he and other researchers discussed the potential of creating machines that could simulate human intelligence [2]. Early AI research focused on solving mathematical and logical problems.

Researchers developed algorithms and symbolic reasoning approaches to mimic human problemsolving abilities. In the late 1980s and 1990s, AI research shifted toward neural networks and machine learning. Researchers explored the use of interconnected artificial neurons to simulate human brain functions and enable learning from data. In the 2000s and early 2010s, the availability of vast amounts of data and advancements in computing power led to the emergence of deep learning. Deep learning architectures, particularly deep neural networks, revolutionized AI by enabling complex pattern recognition and learning from unstructured data. In recent years, AI has seen remarkable progress in several areas.

Reinforcement learning, a technique where agents learn through interactions with an environment, has gained attention for its successes in gameplaying AI, robotics, and optimization problems [3].

In dentistry, AI technology has emerged as a powerful tool, revolutionizing various aspects of oral healthcare. It involves the use of algorithms and machine learning techniques to analyze large volumes of data, identify patterns, and

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Dental News

make accurate predictions. By leveraging AI, dentists can enhance diagnosis, treatment planning, patient care, and practice management [1]. In the realm of diagnosis, AI algorithms can analyze radiographs, images, and patient data to detect and diagnose oral diseases. Through machine learning, AI algorithms continually refine their diagnostic accuracy by learning from vast datasets. This not only improves the accuracy of diagnoses but also enables early detection of conditions, leading to more timely interventions and better patient outcomes [1].

AI plays a pivotal role in creating personalized treatment plans for patients. By analyzing complex patient data and considering various parameters, AI algorithms can optimize treatment plans. For example, AI can assist in the precise placement of dental implants, considering factors such as bone density, occlusal balance, and esthetic considerations. AI also enables virtual simulations and 3D modeling, providing dentists and patients with visual representations of anticipated treatment outcomes. This enhances communication and facilitates informed decisionmaking [3,4].

AI technology has transformed patient care in dentistry by providing personalized support and enhancing the overall dental experience. AIpowered chatbots and virtual assistants offer patients 24/7 access to information, appointment scheduling, and guidance [5]. Patients can receive answers to frequently asked questions, oral hygiene tips, and immediate support during dental emergencies. By streamlining administrative tasks, such as appointment reminders and followups, AI frees up time for dental professionals to focus on patient interaction and quality care.

This leads to improved patient satisfaction and enhanced overall dental experiences [6,7].

Moreover, AI has the potential to significantly enhance practice efficiency. AI algorithms can analyze patient records, treatment histories, and clinical data to identify patterns and trends.

This data-driven approach helps dentists make evidence-based decisions, optimize workflows, and reduce errors. By automating routine tasks like appointment reminders and inventory management, AI technology improves productivity and reduces costs. Dentists can devote more time to complex procedures and critical decision-making, resulting in efficient practice management [7].

Review The integration of AI in dentistry is of paramount importance as it has the potential to revolutionize Quarter IV

SHINING3DDENTAL.COM Quarter III

Age-defining Principles of Smile Design DentalMini Carescrew in the Assisted Network Age Membrane Limited Orthodontic Tooth Movement: About R.T.R.+ 2 Cases Reports

Real-time data sharing and collaboration have Treatment Options revolutionized modern dental technology, making it

The patient was presented with to the following options to easier for dental professionals access patient data and address her chief complaint. engage with each other.

Option 1: Space Opening Collaboration is critical inright the dental industry, given the Extraction of the mandibular third molar, orthodontic uprighting and distalvarious movement of the mandibular second need to integrate technologies and imaging tools. molar to open a prosthetic ceramic In the past, space dentalfor practices andimplant DSOs with haveastruggled crown replacement of the extracted mandibular first molar. with the siloed nature of their data management systems.

This option would require shorter orthodontic treatment time, However, technology has integrated various limited followmodern up visits at the cost of the loss of an extra tooth( the third molar) into and ahigher dedicated for the technologies singlefees cohesive solution thatimplant can be Figure 1 procedure its surgical and on prosthetic stages.

Fig. 10 - (L-R): Veneers received from the lab. Lab credits: accessedinfrom the cloud any device.

Precision Dental Lab, Thane, Mumbai Option 2: Space Closure For instance, digital patient records can now be Non extraction treatment, with mesial root movement and Wet & dry trial was done to check the marginal accessed of from central dashboard, allowing protraction thea mandibular second and third dentists molars into As a pharmaceutical company specialized in Veneers were prepared for final bonding. order close history, the residual create a solidplans, contact viewtopatient x-rayspace, images, treatment and fit. dentistry, Septodont’s aim is to support every dentist between thereports mandibular molar at andany second Fig. 11: Chairside progress fromsecond anywhere, time.premolar to succeed in their daily procedures.

Our mission without the need for prosthetic dental implant or crown. This Armamentarium for Real-time data sharing offers a much faster process is to provide our customers with dental products option would require longer orthodontic treatment time with Bonding the Prosthesisthan traditional methods, such calling orallocated emailing and services that are unsurpassed extensive follow up visits, however noas extra cost is their 9%HFinbymeeting Angelus, Silane forimages surgicaland and waiting prosthetic 1 and 2)such expectations for quality and performance. forprocedures. feedback. (Figures With features coupling agent(Angelus),

R.T.R.+ Membrane: the new resorbable bilayer synthetic membrane

as integrated messaging tools, dental professionals can bond Univeral To pursue our mission, weSingle recently acquired bonding agent (3M), share patient data and collaborate seamlessly, improving Biomedical Tissue, a company at the forefront of tissue After thorough explanation of the pros and cons of each Relyx veneer light cured the the accuracy diagnoses proposing more engineering which designs and produces option patient of opted for optionand 2. membranes Figure 2 adhesive cement (3M)to productive treatment plans. for tissue regeneration. lute the veneers.

This improved accessibility and seamless integration Septodont is happy to introduce today R.T.R.+ of technologies and imaging tools has enhanced Membrane, the unique resorbable synthetic membrane Treatment Progress Rubber dam isolation was carried out. The collaboration between dental professionals, enabling designed to improve post-extraction procedures. veneers were cleaned thoroughly & stabilised February 2021: them to provide more expedited patient care.

After a tooth extraction, approximately 30% of the using a putty bed. This was followed by etching Bonding: Genius Passive self ligation ( MEM Corporation, Scaling Up for Success: How Dental alveolar ridge is lost because of resorption¹. Using a Sweden Taiwan) with 14 NiTi (Thermal ultra) engaged. First the intaglio surface of the veneer with 9%HF for Enterprise Platforms Revolutionize Dental membrane improves the amount, quality, and contour molar bondable tube with a built in long extended hook that 10-15 secs followed by rinsing & air drying. This reached the level of the furcation to apply the force close to of the desired bone.

Delivery the center of resistance of the second mandibular molar. was ●followed coat ofleading the silane Thanksby to applying years of aresearch to a One of the significant advantages of modern coupling agent. technology in the dental space is that it is designed to patented technology, R.T.R.+ Membrane is the first work seamlessly in the background to help scale the resorbable membrane composed of 100% vegetalbusiness. This means that once staff members have based polymer, making it effective and easy to handle. set up the technology correctly, they can rely on it to It is the perfect addition to the bone graft R.T.R.+ for a handle many routine administrative tasks automatically. successful, synthetic procedure. ● With a resorption time of 4 to 6 months As a result, staff and providers can spend less time on manual tasks and more time to devote to diagnosis, and a bilayer structure, R.T.R.+ Membrane is highly effective within an appropriate time frame for bone treatment planning, and patient education.

Fig. 12: (L-R):1. HF application, 2.Frosty appearance of the intaglio regeneration.

Cloud-based systems, for example, can handle surface, 3.Application of silane-coupling agent. ● R.T.R.+ Membrane has a great resistance to the additional workload and data that comes with the prosthesis now ready for thein exposure.

In case was of suture rupture, it bonding can be left increased patient volume. They are an efficient way As bonding wereproperly. carried out. place tosteps guidefor tissues to heal to store, process, and share patient data, helping to intraoral acid wasis applied to the R.T.R.+ Membrane compatible withtooth every ensure the dental practice is prepared for growth and 37%● phosphoric bone graft in 4 sizes. of and the available central incisors for 20 secs. equipped to deliver the best possible care at scale. surfaces 1 Hsi Kuei Lin, Yuthoroughly Hwa Pan, Eisner Yu With the power of modern technology, dental followed by rinsing & theSalamanca, surface was Te dried.

Lin 5 and Wei Jen Chang.

Int. J. Environ.

Res. Public practices can position themselves for success in air Universal bonding agent (Single bond Health 2019, 4616; Prevention of dried Bone Resorption today’s fast-paced healthcare landscape, staying universal 3M)16,was applied & air to a thin

by HA/β-TCP + Collagen Composite after Tooth ahead of the curve and providing higher-quality care uniform layer.

Extraction: A Case Series and, ultimately, better outcomes for all.

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Revolutionizing Dentistry With Artificial Intelligence

oral healthcare in several ways.

Applications of AI in diagnosis AI has made significant advancements in the field of diagnosis in dentistry, revolutionizing the way oral diseases are detected and diagnosed.

The following subsections delve into specific applications of AI in the diagnosis of oral diseases.

Dental Radiology AI algorithms can analyze dental radiographic images, such as panoramic radiographs and cone beam computed tomography (CBCT) scans, to aid in the detection and diagnosis of various dental conditions. AI-powered image analysis can help identify and quantify dental caries (tooth decay), periodontal diseases, bone loss, and anatomical abnormalities. Automated image analysis can also assist in the detection of oral tumors, cysts, and other pathological conditions [8].

Treatment planning and implant placement: AI can aid in treatment planning for dental implants by analyzing CBCT scans. AI algorithms can simulate implant placement and provide dentists with virtual treatment plans, optimizing the placement position and angulation for optimal outcomes. For example, AI algorithms can aid in the identification of dental anomalies such as impacted teeth, supernumerary teeth, or developmental abnormalities. By comparing patient data with established norms and patterns, AI algorithms can flag any deviations and alert dentists to potential issues. AI algorithms can also assist in the detection of abnormalities in the temporomandibular joint (TMJ) and the surrounding structures. By analyzing radiographs and clinical data, AI algorithms can identify signs of TMJ disorders, such as joint degeneration, osteoarthritis, or disc displacement. This enables early intervention and appropriate treatment planning [9,10].

Image enhancement and noise reduction: AI techniques, such as deep learning, can be employed to enhance the quality of dental radiographic images by reducing noise, enhancing contrast, and improving resolution. Improved image quality can lead to better visualization of dental structures, aiding in the interpretation and diagnosis of various dental conditions. By assisting dentists in identifying suspicious areas, AI technology has the potential to improve early diagnosis and ultimately save lives [11].

Orthodontics Cephalometric analysis and treatment planning: AI algorithms can analyze cephalometric radiographs to automatically identify and measure key anatomical landmarks used in

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Dental News

orthodontic diagnosis and treatment planning.

AI-powered software can assist orthodontists in generating cephalometric tracings, analyzing facial and dental measurements, and simulating treatment outcomes based on established treatment protocols.

Malocclusion diagnosis and classification: AI models can aid in the diagnosis and classification of malocclusions by analyzing various diagnostic data, such as dental models, facial photographs, and radiographic images. By training on large datasets, AI algorithms can learn to identify and categorize different types of malocclusions, helping orthodontists in treatment planning and determining appropriate treatment modalities.

AI-powered software can generate virtual 3D models of patients’ dentition and simulate the progression and outcome of orthodontic treatment. AI algorithms can automate the process of bracket placement by analyzing dental models and predicting optimal bracket positions based on individual tooth anatomy [12,13].

Periodontology AI algorithms can analyze various diagnostic data, such as clinical parameters, radiographs, and intraoral images, to aid in the diagnosis and classification of periodontal diseases. By learning from large datasets, AI models can identify patterns and indicators of periodontal disease severity, enabling early detection and personalized treatment planning. AI-based software can automate periodontal charting by analyzing clinical data, such as probing depths, attachment levels, and bleeding scores, extracted from patient records.

Automated charting can reduce the time and effort required for manual charting, enhance accuracy, and provide a comprehensive visual representation of periodontal health status. AIpowered software can assist in treatment planning for periodontal diseases and implant placement by analyzing patient-specific data and simulating treatment outcomes. AI algorithms can aid in the selection of appropriate treatment modalities, optimize the placement and angulation of implants, and provide virtual simulations for evaluating different treatment scenarios. AI can enhance implantology procedures by assisting in implant selection, placement, and prosthetic rehabilitation. AI algorithms can analyze patientspecific anatomical data, such as CBCT scans, to optimize implant positioning, determine the appropriate implant size and type, and consider factors such as bone density and proximity to vital structures [14].

Endodontics Quarter IV

Revolutionizing Dentistry With Artificial Intelligence

AI-powered software can assist in the detection and segmentation of root canals within radiographic images, helping endodontists accurately locate and analyze complex root canal systems. Automated canal detection can save time, enhance efficiency, and improve the precision of root canal treatment. AI techniques, including machine learning, can be utilized to develop predictive models that estimate the success or failure of endodontic treatments based on patient-specific data, such as clinical parameters, radiographic findings, and treatment protocols.

Instrumentation techniques: AI algorithms can analyze and optimize endodontic instrumentation techniques, such as rotary or reciprocating file systems, by considering factors such as canal morphology, anatomy, and mechanical properties.

AI can also aid in optimizing irrigation protocols by analyzing the distribution and efficacy of irrigants within the root canal system, helping to improve disinfection and treatment outcomes [15].

Root fracture detection: AI algorithms can analyze radiographic images and detect root fractures, which can be challenging to diagnose clinically. Automated fracture detection can aid in identifying root fractures early, allowing for timely treatment decisions and potentially preventing tooth extraction [16].

CariScreen AI: CariScreen AI is an AI system developed by dentists and engineers that assists in the detection and diagnosis of dental caries (tooth decay). The system uses advanced algorithms to analyze dental images and provide dentists with accurate and efficient assessments of tooth decay risk. By implementing CariScreen AI, dental clinics have reported a significant improvement in the early detection of caries, leading to timely interventions and better oral health outcomes for patients [17].

Prosthodontics AI can assist in treatment planning for prosthodontic cases by analyzing patient data, such as digital impressions, radiographs, and facial scans, to create virtual 3D models of the patient’s oral anatomy. AI algorithms can aid in the design and fabrication of prosthodontic restorations, such as crowns, bridges, and dentures, by optimizing the shape, fit, and aesthetics based on patient-specific parameters and preferences.

AI-powered software can analyze digital impressions and intraoral scans to detect and delineate the margins of tooth preparations accurately. Automated margin detection can improve the precision of prosthetic restorations, Quarter IV

facilitating optimal fit and reducing the need for manual adjustments.

Virtual articulation and occlusion analysis: AI algorithms can analyze digital models of dentition and simulate virtual articulation to assess occlusal relationships, identify interferences, and evaluate functional dynamics. Virtual articulation and occlusion analysis can aid in prosthetic treatment planning, ensuring proper occlusal alignment and harmony for optimal functional and aesthetic outcomes.

Prosthetic esthetics and shade matching: AI systems can analyze digital images of patients’ natural teeth and assist in prosthetic esthetics by providing shade-matching recommendations and predicting the appearance of prosthetic restorations in different lighting conditions.

Augmented reality (AR) and guided surgery: AIpowered AR platforms can assist prosthodontists in guided implant surgery, providing real-time navigation and visualization of the implant placement process [8].

Oral Surgery AI algorithms can analyze radiographic images, such as panoramic radiographs, CBCT scans, and MRI scans, to aid in the diagnosis of oral and maxillofacial conditions, including tumors, cysts, fractures, and impacted teeth. AI-powered software can assist in the detection, segmentation, and classification of anatomical structures and abnormalities, supporting accurate diagnosis and treatment planning. AI-based surgical planning tools can utilize patient-specific data to generate virtual surgical simulations. Surgeons can virtually plan complex procedures, such as orthognathic surgery or tumor resection, by simulating various scenarios and assessing the potential outcomes. AI algorithms can assist in surgical simulation, providing insights into the optimal surgical approach, implant positioning, and reconstruction techniques, leading to improved surgical precision and patient safety.

AI can be integrated into surgical navigation systems and robotic-assisted surgeries, enhancing the precision and accuracy of surgical interventions. AI algorithms can track anatomical landmarks, assist in real-time navigation during surgery, and provide feedback to the surgeon.

This technology can be particularly valuable in complex cases involving intricate anatomical structures or challenging access, improving surgical outcomes and reducing complications.

AR platforms can superimpose virtual models onto the surgical field, aiding in precise incision placement and tissue manipulation and reducing the risk of intraoperative complications [18,19].

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Revolutionizing Dentistry With Artificial Intelligence

Oral Pathology AI algorithms can analyze histopathological images of oral tissue samples to aid in the diagnosis of oral diseases, including oral cancer, precancerous lesions, and inflammatory conditions. AI-powered systems can assist pathologists in detecting and classifying different histopathological patterns, improving diagnostic accuracy and efficiency [11].

Image analysis and feature extraction: AI techniques, such as deep learning, can be employed to analyze digital histopathological images and extract relevant features, including cellular morphology, nuclear atypia, and tissue architecture. AI algorithms can quantify these features and provide objective measurements to assist in disease diagnosis, grading, and prognosis.

Improving patient care with AI AI has significantly improved patient care in dentistry by providing innovative solutions that enhance patient support, accessibility, and overall experience. This section delves into specific applications and benefits of AI in improving patient care.

AI-powered Chatbots and Virtual Assistants for Patient Support and Guidance AI-powered chatbots and virtual assistants have emerged as valuable tools for patient support and guidance. These AI systems are designed to interact with patients, answer their questions, and provide assistance throughout their dental journey. Chatbots utilize natural language processing algorithms to understand and respond to patient inquiries in real-time. Patients can obtain information about dental procedures, oral health tips, post-treatment care instructions, and more. Chatbots can also guide patients in emergency situations, providing immediate support until they can receive professional care [20,21].

Virtual assistants powered by AI provide patients with personalized support and guidance. They can assist patients with appointment scheduling, reminder notifications, and follow-up care. Virtual assistants are available 24/7, allowing patients to access information and support at their convenience.

24/7 Access to Information, Appointment Scheduling, and Oral Hygiene Tips AI technology provides patients with roundthe-clock access to information, appointment scheduling, and oral hygiene tips, enhancing convenience and accessibility. Patients can access dental websites or mobile applications integrated with AI technology to obtain information about

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various dental procedures, treatment options, and oral health tips. AI algorithms analyze patientspecific data, such as age, medical history, and treatment preferences, to provide personalized recommendations and guidance.

Moreover, AI-powered systems enable patients to schedule appointments online without the need for phone calls or manual coordination. By integrating with dental practice management software, AI algorithms can check dentists’ availability, suggest suitable time slots, and book appointments seamlessly. This eliminates wait times and simplifies the appointment scheduling process for both patients and dental practices. AI technology also offers patients personalized oral hygiene tips and reminders. Based on individual characteristics, such as age, dental conditions, and treatment history, AI algorithms provide tailored recommendations for maintaining good oral health. Patients receive reminders for routine dental check-ups, preventive care, and hygiene practices, leading to better oral health outcomes [22,23].

Enhanced Patient Experience and Satisfaction Through AI Technology AI technology has transformed the patient experience in dentistry, leading to increased satisfaction and improved overall care. The availability of AI-powered chatbots and virtual assistants offers patients immediate support and assistance, eliminating the need to wait for responses or appointments. Patients receive prompt and accurate information, reducing anxiety and increasing trust in the dental care process.

AI-powered systems also contribute to improved patient engagement and education. By providing interactive and personalized information, patients feel more involved in their oral health journey.

This empowers them to make informed decisions, comply with treatment plans, and actively participate in their dental care. The convenience and accessibility offered by AI technology enhance patient satisfaction. Patients can access information, schedule appointments, and receive support at their preferred time and location, increasing convenience and reducing barriers to care. Additionally, the proactive nature of AIdriven reminders and notifications ensures that patients stay on track with their oral health care, leading to better treatment outcomes [24,25].

Enhancing practice efficiency with AI In recent years, AI has made significant advancements in various industries, including healthcare. AI has the potential to revolutionize medical practices by improving efficiency, Quarter IV

Revolutionizing Dentistry With Artificial Intelligence

accuracy, and decision-making processes. Here are some ways AI can enhance practice efficiency: Data Analysis and Pattern Recognition for Evidence-Based Decision-Making One of the key advantages of AI in healthcare is its ability to analyze large amounts of data quickly and accurately. Medical practices generate massive amounts of data, including patient records, test results, medical images, and research papers. AI algorithms can process and analyze this data to identify patterns, correlations, and insights that may not be apparent to human healthcare providers.

By leveraging AI, medical practices can adopt evidence-based decision-making processes. AI can analyze patient data to identify risk factors, predict disease progression, and recommend appropriate treatment options based on historical patient outcomes. This data-driven approach enables physicians to make more informed decisions, leading to better patient outcomes and reduced medical errors [26].

Workflow Optimization and Error Reduction Through AI Algorithms AI algorithms can optimize and streamline medical workflows, reducing administrative burdens and improving overall efficiency. For example, AI-powered scheduling systems can analyze various factors such as physician availability, patient preferences, and appointment duration to automatically schedule appointments in an optimized manner. This reduces the chances of scheduling conflicts, ensures better resource utilization, and minimizes patient waiting times.

Moreover, AI can assist in error reduction by identifying potential mistakes or inconsistencies in medical documentation. Natural language processing algorithms can analyze clinical notes, medical charts, and other documentation to flag errors, inconsistencies, or missing information.

This helps healthcare providers identify and rectify errors before they have the potential to affect patient care [27].

Automation of Routine Tasks Like Appointment Reminders and Inventory Management AI can automate repetitive and time-consuming tasks, allowing healthcare providers to focus more on patient care. For instance, AI-powered chatbots or virtual assistants can handle appointment scheduling, answer patient queries, and provide basic medical information. This reduces the administrative burden on staff and enhances the patient experience by providing quick and accurate responses.

AI can also automate inventory management Quarter IV

processes, ensuring that medical supplies and equipment are available when needed. By analyzing historical usage patterns and realtime data, AI algorithms can predict inventory needs, generate purchase orders, and optimize stock levels. This eliminates the risk of stockouts, minimizes wastage, and ensures smooth operations within the practice [28].

Challenges and ethical considerations Data Privacy and Security Concerns in AI Implementation [29,30] Data privacy and security are significant challenges in the implementation of AI. AI systems rely on vast amounts of data, including personal and sensitive information, to train and make predictions. This creates concerns about how this data is collected, stored, and utilized. Some specific challenges and ethical considerations in this area include the following: Informed consent: Obtaining informed consent from individuals for collecting and using their data in AI systems is essential. However, ensuring meaningful consent can be challenging, as AI often operates on complex algorithms and the implications of data usage may not be fully understood by users.

Data breaches: AI systems can be vulnerable to data breaches, which can lead to unauthorized access, manipulation, or theft of sensitive information. This raises ethical concerns about the potential harm caused to individuals whose data is compromised.

Algorithmic bias: AI algorithms can inadvertently perpetuate bias and discrimination if the training data used is biased or if the algorithms themselves are flawed. Ensuring data privacy and security involves addressing these biases to prevent unfair or harmful outcomes.

Third-party data sharing: AI implementation often involves collaborations and data sharing with third parties. Ensuring that data privacy and security standards are maintained across all entities involved becomes crucial, as any mishandling or misuse of data can have severe consequences.

Data retention and de-identification: Determining the appropriate length of time to retain data and how to effectively de-identify it poses challenges.

Retaining data for too long or inadequately anonymizing it can lead to privacy breaches and compromise individual identities.

Addressing these challenges requires implementing robust data protection measures, such as encryption, access controls, and data anonymization techniques. Organizations must also adhere to relevant regulations and standards, Dental News

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Revolutionizing Dentistry With Artificial Intelligence

like the General Data Protection Regulation and data protection laws specific to their jurisdiction.

Ensuring Transparency and Ethical Standards in AI Algorithms [31,32] Transparency and ethical standards are critical for building trust in AI systems. AI algorithms often operate as black boxes, making it challenging to understand how decisions are made. Ensuring transparency and ethical standards involves the following challenges and considerations: Explainability: AI algorithms should be able to provide clear explanations for their decisions and predictions. This is particularly important in high-stakes applications like healthcare, finance, and criminal justice, where individuals need to understand how decisions affecting them are reached.

Bias and fairness: Addressing biases in AI algorithms is essential to prevent unfair or discriminatory outcomes. Algorithmic transparency can help identify and mitigate biases by enabling scrutiny of the training data, algorithmic design, and decision-making processes.

Accountability: Establishing accountability for AI systems is crucial. Organizations must ensure that those responsible for developing and deploying AI algorithms are accountable for their decisions and actions. This includes addressing issues like algorithmic accountability, responsibility for errors or biases, and liability in case of adverse outcomes.

Ethical guidelines and frameworks: Developing and adhering to ethical guidelines and frameworks is necessary to guide the design and implementation of AI systems. These guidelines should consider factors such as human values, privacy, fairness, and societal impact.

Public trust and engagement: Ensuring transparency and ethical standards in AI algorithms requires active engagement with the public. Involving diverse stakeholders, including domain experts, policymakers, and affected communities, helps build trust and ensure that AI systems align with societal expectations.

Need for Continuous Research and Development to Refine AI Technology [33] AI is an evolving field that requires continuous research and development to refine and improve technology. Several challenges and ethical considerations arise in this context.

Algorithmic Bias and Discrimination: As AI algorithms become more complex, addressing algorithmic bias and discrimination remains a persistent challenge. Ongoing research is necessary to develop techniques that reduce bias and ensure.

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Future directions in AI dentistry Potential Advancements in AI Algorithms and Applications [34] The field of AI dentistry is rapidly evolving, and there are several potential advancements on the horizon in terms of algorithms and applications.

These advancements aim to improve diagnosis, treatment planning, and overall patient care. Here are some key areas of development: Predictive analytics: AI algorithms can leverage large datasets to predict disease progression, treatment outcomes, and patient-specific risks.

By analyzing historical patient data, genetic information, lifestyle factors, and treatment records, AI can help dentists make more informed decisions and develop personalized treatment plans.

Natural language processing: AI systems can be trained to understand and process dentalspecific terminology, patient medical histories, and clinical notes. This would enable them to extract valuable insights from unstructured data and facilitate seamless integration with electronic health records systems.

Virtual assistants: AI-powered virtual assistants can assist dental professionals in various tasks, such as appointment scheduling, patient communication, and data management. These assistants can be designed to provide evidencebased recommendations, answer patient queries, and streamline administrative workflows, freeing up more time for dentists to focus on patient care.

Integration of AI With Other Emerging Technologies (e.g., Robotics) [35] The integration of AI with other emerging technologies holds immense potential in revolutionizing dentistry. Here are a few areas where AI can be combined with other technologies for improved outcomes: Robotics and automation: AI can be integrated with robotic systems to enable precise and automated dental procedures. Robots can perform tasks like tooth preparation, dental implant placement, and repetitive procedures with high precision, reducing human error and enhancing treatment outcomes.

AR and VR: AI algorithms can be utilized to enhance AR and VR experiences in dental training and patient education. By merging AIgenerated dental models with real-time patient data, dentists can visualize and plan treatments more accurately. Patients can also benefit from interactive simulations that help them understand procedures and visualize potential outcomes.

Internet of Things (IoT): AI can play a crucial role Quarter IV

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Revolutionizing Dentistry With Artificial Intelligence

in analyzing data collected from connected dental devices and sensors. By processing real-time data from toothbrushes, wearables, and intraoral cameras, AI algorithms can provide personalized oral health recommendations and early detection of dental problems [36].

To further advance AI in dentistry, future research should focus on addressing the limitations identified, expanding datasets, improving data quality, and developing interpretable AI models. Deep learning algorithms, which are commonly used in AI applications, often operate as “black boxes” where it can be challenging to understand how they arrive at specific decisions or predictions. This lack of interpretability can be a concern in healthcare settings, where it is crucial to have transparency and explainability for ethical and legal reasons. Long-term studies evaluating the clinical impact of AI algorithms are needed to assess their effectiveness, safety, and cost-effectiveness. Robust studies involving diverse patient populations and comparisons with existing standards of care are necessary before widespread adoption. Additionally, ethical considerations, such as transparency, accountability, and fairness, should be integrated into the development and deployment of AI systems in dentistry. With continued research, collaboration, and careful implementation, AI has the potential to revolutionize dental practice and improve oral healthcare outcomes for patients.

Limitations of AI in Different Specialties [22] Data availability and quality: One of the major limitations of the application of AI in dentistry is the availability and quality of data. AI algorithms require large and diverse datasets to train and validate models effectively. However, in certain dental specialties, such as rare oral diseases or specific procedures, obtaining a sufficient amount of high-quality data can be challenging. Limited data can restrict the accuracy and generalizability of AI models.

Bias and generalizability: AI algorithms are susceptible to biases present in the training data. If the training dataset is not diverse and representative of the population, the AI models may exhibit biases, leading to inaccurate predictions or recommendations. Ensuring the inclusion of diverse patient populations and data sources is crucial for reducing bias and improving the generalizability of AI models across different dental specialties.

Interpretability and explainability: AI models, particularly deep learning models, often operate as black boxes, making it difficult to interpret the reasoning behind their decisions. In dental

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specialties where clinical decisions have significant implications for patient care, such as oral surgery or orthodontics, it is important for clinicians to understand the factors influencing AI predictions.

Lack of interpretability and explainability can hinder the acceptance and trust in AI systems by dental professionals.

Ethical and legal considerations: The use of AI in dentistry raises ethical and legal concerns.

Patient privacy, confidentiality, and informed consent must be carefully addressed when collecting and utilizing patient data for AI applications. Additionally, legal frameworks and regulations regarding liability, accountability, and professional responsibility need to be established to ensure the safe and responsible use of AI in dental practice.

Clinical validation and integration: While AI algorithms show promise in various dental specialties, rigorous clinical validation studies are necessary to evaluate their effectiveness, reliability, and safety. Integration of AI systems into existing dental workflows and clinical practice may also pose challenges in terms of compatibility with existing dental software, infrastructure, and clinical protocols.

Continuous training and adaptation: AI models require regular updates and continuous training to keep up with advancements in dental knowledge and technology. Dental professionals need to stay updated with AI developments and undergo appropriate training to effectively use AI tools and interpret their outputs. Ensuring ongoing support and maintenance for AI systems is crucial for their successful implementation in different dental specialties.

Applications of Various AI Techniques in Dental Teaching [30] Virtual simulations and training: AI can be utilized to develop virtual simulations and training modules that provide dental students with a realistic and interactive learning environment.

These simulations can help students practice various dental procedures, improve their clinical skills, and enhance their decision-making abilities.

AI algorithms can provide real-time feedback and guidance, allowing students to learn at their own pace and receive a personalized education.

Intelligent tutoring systems: AI-based intelligent tutoring systems can analyze student performance, identify areas of weakness, and provide customized learning materials and recommendations. These systems can adapt to individual learning styles and provide personalized feedback, allowing students to receive targeted instruction and support. AI algorithms can also Quarter IV

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Revolutionizing Dentistry With Artificial Intelligence

assist in the assessment and grading of students’ work, streamlining the evaluation process.

Adaptive learning platforms: AI can power adaptive learning platforms that tailor educational content to the specific needs and abilities of each student. These platforms can analyze student performance data, identify knowledge gaps, and deliver personalized learning materials to enhance comprehension and retention. Adaptive learning systems can also track students’ progress over time, allowing educators to monitor their development and provide targeted interventions when needed.

Conclusions In conclusion, the future of AI in dentistry holds immense potential for advancements in algorithms and applications. Integrating AI with other emerging technologies like robotics, AR/VR, and IoT can further enhance dental care. However, addressing limitations, ensuring data privacy, and maintaining ethical considerations are crucial for the successful and responsible integration of AI in dentistry. Continued research and collaboration will be key to unlocking the full potential of AI in transforming oral healthcare. To further advance AI in dentistry, future research should focus on addressing the limitations identified, expanding datasets, improving data quality, and developing interpretable AI models. Long-term studies evaluating the clinical impact of AI algorithms are needed to assess their effectiveness, safety, and cost-effectiveness. Additionally, ethical considerations, such as transparency, accountability, and fairness, should be integrated into the development and deployment of AI systems in dentistry. With continued research, collaboration, and careful implementation, AI has the potential to revolutionize dental practice and improve oral healthcare outcomes for patients.

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Dentophobe Poeme The nightmare of the dentophobe: the ghostly coat, the tools that probe the sharp that pricks beleaguered souls the whining whirr of howling holes you cried but for the grace of God go I beneath the dentist’s prod but now you’re trapped, you curse the drill whose nimble use requires skill from years in school, bedeviled tests a harried soul that never rests to clean the rot and patch the hole a thankless but essential role

by Wael Almahdi | September 2023

for otherwise, the aches so great that teeth inflict, would ne’er abate you think you may partake of sweets and sticky, tooth-dissolving treats one thinks in one’s naïveté a dab of paste keeps germs away these famished fiends do fiercely dine on carbs that leave a sickly shine the surface was a mere hors d’oeuvre, for next they fall upon the nerve! despite your every ounce of might you moan and groan throughout the night the oral urgh extracts a toll come dawn you scoop your tattered soul and lumber to the green-decked chair the spot where mouths and checks come bare! this pain allay, oh Doc, you pray, for anguish made me madly bray Doc says your teeth were photogenic until your fare turned cariogenic a numbing here, a shining there a healing capped with dental flair no wonder then, that AI’s threat can never make a dentist sweat!

Quarter IV

Dr Wael Almahdi, BDS, MBA Dental News

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How to Scale a DSO (Without Increasing Front Desk Headcount)

Scaling a Dental Support Organization (DSO) involves managing various challenges. One significant challenge is to grow without increasing your front desk headcount. In this article, we’ll explore strategies to help your DSO thrive while optimizing staff resources.

Understanding the Role of the Front Desk The front desk team is the heart of the dental practice. These busy employees handle critical tasks like registering patients, scheduling appointments, addressing patient inquiries, dealing with insurance providers and collecting payments.

Some front desk teams also handle Human Resources functions for both clinical and non-clinical employees.

What are the Limitations of Increasing Front Desk Headcount?

While you might think that hiring more people for the front desk is necessary when scaling your Dental Support Organization, it’s not that simple. Consider that a DSO scales in three main ways: 1.

Acquiring established practices 2.

Opening new practices under the brand (called “de novo” in DSOspeak) 3.

Attracting more patients to existing practices Many DSOs use all three strategies.

The goal is to grow without a proportional increase in overhead.

However, expanding front desk teams at the same rate you expand the business limits the pace of growth.

This is due to multiple factors.

Consider the following issues:

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Not Enough Space If you want to hire more people for the front desk, you’ll need more room in your offices. This can be expensive, and it might not always be possible, especially if your offices are already small.

Training Every new person you hire for the front desk will need training. This takes time and can hamper how the current team does their work. Plus, you have to retrain as processes and policies change.

Costs Adding staff costs a lot of money.

You have to pay their salaries, benefits, buy more office equipment, and give them a place to work. You need to think about how this will affect your budget.

Management Complexities Managing a larger front desk team is not easy. It takes good leadership and planning.

For example, communication becomes more difficult as you add employees to the team.

Limited Hours Usually, front desk staff work during regular office hours. If your DSO wants to stay open longer – perhaps for emergency cases – hiring more front desk staff might not help if they’re not willing to work evenings and weekends.

Employee Turnover The dental field can have a lot of staff turnover. This means that the time and money you spent on training new staff are wasted if they leave.

Fewer Resources If you spend more money on front desk staff, you’ll have less for other Quarter IV

How to Scale a DSO (Without Increasing Front Desk Headcount)

important things, like patient care or better technology.

Clearly, hiring more front desk staff might not be the best way to make your DSO grow. Instead, you can use a smart mix of technology, process improvement, and staff development. Let’s discuss these strategies in more detail.

The Role of Technology in Scaling Your DSO Well-designed technology can streamline administrative tasks. Dental-specific applications contain various combinations of tools. Here are some of the most common platforms: ● Practice management software (PMS) ● Electronic health records software (EHR) ● AI-powered patient communication software ● Online scheduling platforms ● Patient self-service tools Successful DSOs use these technologies to automate manual tasks and enable patient selfservice.

AI-powered Patient Communication Software These platforms can handle a variety of tasks, including appointment scheduling and rescheduling and answering common patient inquiries. The platforms operate 24/7, reducing the need for additional front desk staff while improving patient service. And they are extremely cost-effective, some with a monthly cost less than a week’s wages for a receptionist.

The Power of Patient Self-Service Artificial Intelligence also enables patient selfservice which can reduce front desk workload significantly. Consider various self-service options and how they’ve successfully integrated into DSOs. For example, patients could learn which insurance providers you contract with on your website. They can check in for appointments and fill out paperwork digitally. As mentioned previously, an AI-powered chatbot can enable patients to manage appointments via SMS or with an online scheduling platform. They can also answer patient questions on your website or through texting.

AI-powered systems enable patients to schedule appointments online without the need for phone calls or manual coordination. By integrating with dental practice management software, AI algorithms can check dentists’ availability, suggest suitable time slots, and book appointments seamlessly. This eliminates wait times and simplifies the appointment scheduling process for both patients and dental practices.

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Dental News

(Dhopte A., Bagde H., June 2023) Optimize Appointment Scheduling Implement efficient scheduling practices to maximize patient volume without overburdening front desk staff. If you have an AI-powered patient communications platform, you can customize it for scheduling policies. For example, the AI chatbot can present first appointments, sometimes called “moving scheduling forward.”

This can help fill the schedule for maximum productivity.

Centralize Administrative Functions Centralize administrative functions at a DSO level whenever possible. This includes billing, insurance verification, and appointment scheduling. This lets your DSO benefit from economies of scale and reduces the need for front desk staff at individual practices.

Outsource Non-Core Functions Outsourcing non-core functions, such as billing and insurance verification, can reduce the workload on the front desk. And it is often cheaper in the long run.

Standardize Processes Successful businesses are built on good systems.

Create standardized processes that can be applied across all DSO locations. Standardization reduces the complexity of training and managing front desk staff at each practice. Moreover, it ensures consistent service quality.

Once you’ve created standardized workflows, it’s time to optimize them. First, map workflows. Then analyze the functions one at a time. Scrutinize them for weaknesses like duplicate work or manual tasks that could be automated. Set goals and create a timeline for completion. Improved efficiency leads to increased productivity using your existing staff.

Staff Training and Development Investing in staff training and development is crucial. Upskilling and cross-training existing staff can help them handle increased workloads effectively.

Final Thoughts In this article, we’ve explored strategies to help your DSO scale without adding front desk staff.

By optimizing processes, leveraging technology, and investing in staff development, you can achieve growth while maintaining quality patient care.

Dhopte A., Bagde H., June 2023 Quarter IV

Dürr Dental IDS highlights: sustainable “Quite a few periodontal surgical and AI-supported Interview

Interview

interventions could be avoided” “AI shouldn’t be a ‘fancy feature’ you don’t need!”

Over 20 years ofand the Vector method: 1999,trade this technique has were been used to treat Sustainability AI - these twosince central fair topics in focus at periodontal with the aidcompany of ultrasound – using a low-pain therapy on IDS by thediseases German dental Dürr Dental.

But how canthat AIfocuses really be the cause of the disease.

In our interview, Univ.-Prof.

Andreas Braun and Dr.how Johannesmeaningfully integrated into products for a Dr. dental practice?

And does Simon Wenzler act fromthat the Clinic of Restorative Dentistry, Periodontology and Preventive a company takes sustainability seriously?

We discussed these questions with the CEO Martin tell Dürrstein.

Dentistry at RWTH Aachen University us about their experiences and offer advice for application of the techniques in practice.

What innovations did you show at IDS? Martin Dürrstein: We presented a wide range of innovations. In the field of system hygiene we launched a new line of disinfectant wipes that are plastic-free. The challenge with disinfection wipes is that paper wipes cannot be stored in a wipe disinfection solution because they would decompose. This means that all disinfecting wipes on the market, both those of our competitors and our classic line, are made of 100% plastic, even if they don’t feel that way. Our new line is called “green”, which that Braun, the wipewhen material is plastic-free 1.indicates Professor did you first and therefore more environmentally friendly. become aware of the Vector method?

We are planning to expand this line.

Prof. Dr. Andreas Braun: To start with, it How does the more environmentally friendly was Prof. Nolden from the University of material composition in terms of price?

Bonn drewThe mygreen attention Martinwho Dürrstein: wipes to areit.5 That times was around 2000, after market launch. more efficient than just conventional wipes due to Prof.

Nolden told mebehavior in particular a better impregnation and a about higher how the Vector canofbe usedThis formeans low-pain absorption capacity liquids. that more surface treatment. area can be Because wetted. Although periodontal I had they now containonfewer wipes since the written my thesis the objectification of individual wipe has a higher material thickness. sensory perceptions, I was very aware of But topic if you go byquickly the wetted area, the wipes are the and became fascinated still less expensive, even if the individual wipe with this new technique. is somewhat more expensive in terms of price.

Surely you presented more than one new 2.

Dr. Wenzler, what brought you to innovation? We know Dürr Dental as an the Vector method? innovative company.

Dr. Johannes-Simon Wenzler: During Martin Dürrstein: We have revised our highmy time studying I had end suction line Tyscor in andMarburg, are now launching a new generation on the market.

The special learned about conventional scaling and

DentalNews News 46 Dental 40

DN YEARBOOK 2023.indd 56

radial technology, the speed of the units can

now be adapted the actual demand.into a options could betoreadily translated We say the unit breathes in speed. dental systematic treatment concept. For Thisthe matter practice, this results in high energy savings.

For is particularly important for patients who example, a practicetohas 5 treatment units, are moreifsensitive pain, as – based onit will need in a conventional installation, needs my experience – they are are notitreally well cared for either curettage an extraction systemwith thatmanual constantly serves or with machine regardlessis 5 rooms, regardlessinstruments, of whether treatment of whether we are talking acoustic being performed in all rooms.about The new Tyscor scalers, magnetorestrictive ultrasonic suction system, on the other hand, operates scalers, piezoelectric or with feedback, which ultrasonic indicates scalers how much jet powder devices. After consulting withis pressure is currently required.

The speed Prof.

Braun, I started adjusted according astreating needed.patients who are more sensitive to pain the Vector A second innovation that with distinguishes the system.

Coincidentally, this fitted in really Tyscor line is its network capability. It is well with my scientific endeavours at the fully IoT-capable. This makes it possible for time in the project area TransMIT, which technicians to solve problems remotely if there was all about in applications in dentistry is a malfunction, in the device. For example, by involving energy transfer. performing a reset remotely. With the cloudbased IoT solution, we immediately notice

3. How did you start using the Vector when devices have a problem. method, and how do you use the The dentist can, of course, opt out of having system today?

feature of the new Tyscor line ismyself the 75% which energy root planing, and I asked

their device monitored by us.

He has the choice.

Prof.

Dr. Andreas Braun: Well, I started out The third advantage: the Tyscor devices can pretty much as a pilot user, so I embarked grow with the user.

Until now a new suction on using the new system without any real system had to be purchased expanding prior knowledge.

I quickly when realised that I the practice and a higher vacuum volume was could use it very effectively, and that the required.

When a dental practice opts for the process of using the instrument in the Tyscor line from Dürr Dental, they can purchase periodontal pockets involved noticeably the pain samefor unit the event an the expansion. less theinpatient thanofwith other

saving. That is phenomenal! By switching to

The two units connect and cooperate, when Quarter IV December 2022

04/01/2023 6:54 PM

Dürr Dental IDS highlights: sustainable and AI-supported

demand is high, both work in parallel, when the demand is low, only one unit operates, so the side effect is redundancy - if one device should fail, the supply is ensured by the other device.

You said that the new Tyscor suction system consumes much less energy than previous models. In terms of sustainability, you are primarily focusing on energy consumption?

Martin Dürrstein: When we talk about green practice and about environmental responsibility, it is not about the process of creating a product, but in its use. We are talking about 95% to 5%. This is not only the case with our products, but, for example with a car. Around 90% of a product’s energy consumption is in its use and only a single-digit percentage of the footprint is in its production. If we succeed in making the product more environmentally friendly in its life cycle after manufacture, the effect is completely different - that’s the big lever - than if you only start in production.

Do you work with external partners on your sustainability efforts?

Martin Dürrstein: Yes, we also work with consultants: an energy consultant who deals with the classic area of production: How much energy do we consume in total - how much electricity, how much heating energy? This service provider calculates the figures for our company, which is where our data on energy consumption in production and use in the life cycle of a product, which I have just mentioned, comes from.

The second area in which we seek advice is the sustainability of our company buildings. We have 3 manufacturing sites in Germany. The production site for digital imaging is already CO2 neutral, not through the purchase of certificates, but - I would call it honestly CO2 neutral - through building refurbishment and the replacement of fossil fuels. For example, the roofs are completely covered with photovoltaics.

Sustainability in our field means, that products must be durable and repairable. This has always been true for Dürr Dental products. This means that we have entered the

for 20 years. Spare parts, such as compressor units for the compressor, can always be purchased and equipment is repaired on-site in the dental practice. However, after 20 years, we would recommend that the dentist consider purchasing a new unit.

In addition to sustainability, AI was the big topic at this trade show. You already presented AI-supported products in the past. Have you intensified AI development?

Martin Dürrstein: We have consistently used AI in our products. Our focus is clearly on the everyday work of the dentist. We say that AI should support the dentist. AI should not be a “fancy feature”, that you don’t need. We look at which procedures there are, and what occurs very regularly in the routine of dental practices because that’s where you can make sense. The AI in our readers detects, for example, whether the imaging plate has been inadvertently inserted the wrong way around and corrects this. Then there is the subject of the nerve canal -which is identified by the X-ray software by Dürr Dental, even if the exposure is suboptimal.

AI features are also integrated into the new VistaScan Mini View 2.0, the successor to the Mini. By the way, we are the only company that offers a spectrum in this area: Our flagship is the VistaScan Ultra View with 2 slots. All VistaScan devices have AI features: wear detection warns when the imaging plate is defective, scratched, or cracked. The dentist is alerted so that he does not wrongly assume that the tooth is defective. The Smart Reader facilitates the assignment of the X-ray image to the patient file. These readers are intended for the various treatment rooms and by reading in the film, it is directly assigned to the patient, so that there is no longer any risk of confusion.

Do you work with dental practices that evaluate your developments?

Martin Dürrstein: We don’t just go into the closet and shut the door (laughs). We are in constant dialog with practices.

Because it makes no sense to develop something for a target audience that is not involved in the development.

You put a lot of energy into the further development of your imaging software VistaSoft, Is it an open system?

sustainability discussion at a very high level, and it is precisely these qualities that distinguish us. The products must live for a long time, they must support the dentist completely stress-

48

free, which is guaranteed, by our on-site service.

What is the service life of Dürr Dental equipment?

Martin Dürrstein: We develop devices for a service life of 10,000 hours, which means that under normal circumstances they have a life expectancy of well over 10 years. However, depending on how much a device is used, there are large differences in the survival time.

You said that your devices are also characterized by repairability. ability. But can they still be repaired after more than 10 years?

Martin Dürrstein: Absolutely! Sometimes we get requests for equipment that has been in use in the dental practice Dental News

Martin Dürrstein: Yes. We are in dialog with all suppliers and offer an ideal connection to the systems of 3Shape, Dentsply Sirona, Sicat and Exocad. I believe that when someone chooses Dürr Dental, they choose the provider that gives them the greatest freedom to buy the intraoral scanner they really want for their practice. He can also integrate AI functions from third-party suppliers. And we believe we can claim to offer good interfaces in our software solution. An interface must be such that it simply flows.

Mr. Dürrstein, you already had several exhibitions this year (e.g. AEEDC, IDS). Are you satisfied with them in general?

Martin Dürrstein: We are super satisfied! We had enough traffic at our booth. I would say that they were a great success for us.

Quarter IV

EDSIC 6-8 September 2023 Intercontinental Citystars - Cairo - Egypt

Reunion of the ARAb union of DentAl AssociAtions unDeR the hospices of the egyptiAn synDicAte

DR. ehAb heikAl pResiDent of the egyptiAn DentAl synDicAte

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Dental News

The Egyptian Dental Syndicate International Congress EDSIC 2023 took place at the luxurious Intercontinental Cairo City Stars in Cairo, Egypt from the 6th to the 8th of September 2023. The program included lectures and 25 workshops in Oral Rehabilitation, Artificial Intelligence in dentistry, Dental Photography, Orthodontics and clear aligner technologies, Endodontics and broken file management, Dental Esthetics including Restorative composites, Indirect and Direct Ceramic Restorations, Periodontics, Oral Surgery suturing techniques and Implant dentistry, Intraoral Scanners and Radiology, and medical communications techniques. The lectures and workshops were given by 30 international speakers and 140 local speakers.

The sessions were at full capacity of attendance as well as the workshops, they were fully booked.

The president of the Egyptian Syndicate, Dr. Ehab Heikal highlighted during the opening speech the achievements of the syndicate mainly by facilitating the communications and the logistics through an advanced computer application where the anesthesia was equally and easily distributed at the official price via a simple process. Many other services were also made possible using this electronic medium.

Quarter IV

DR. ehAb hAssAnien, DR. ehAD heikAl, DR. tony Dib

DR. AmR AskeR lectuRing on oRthoDontic mAnAgement of supeRnumeRARy teeth

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pRof. pAul tipton lectuRe on tReAtment

Dental News of the WoRn Dentition

DR. heshAm AmeR tAlking About pitfAlls in Designing AligneRs

DR. mohAmAD RAyyAn lectuRing on smARt RestoRAtions folloWing enDoDontics

pRof. hAsAn selim sheDDing light on unDeRstAnDing Quarter IV Rct

DR. hAny ezz Receiving the ceRtificAte foR DiRect 3D pRinteD AligneRs fRom DR. mohAmeD Ali

DR. RehAb beshiR explAineD 3D pRinteD memoRy AligneRs, Receiving heR ceRtificAte fRom DR. mAhmouD fAthy

l.

R. DRsNews nAshWA gAmAl, ehAb RAsheD, meRnA fARAg 52to Dental

pRof gihAm Abulniel lectuRe on pulp theRApy in vitAl immAtuRe teeth

DR. esRA celik AnD DR. boRA koRkut fRom tuRkey

DR. heshAm AmeR WoRkshop Quarter IV

nsk booth

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Dental News

Photos From The Exibition

cAvex booth

sDi booth

DR. AhmeD tARek fARouk At the shofu booth

vitA booth

mAni booth

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osstem booth

Photos From The Exibition

gc booth

kulzeR booth

RitteR implAnt booth

DR. tony Dib, DR. mohAmeD AbDAllA, DR. ehAb heikAl

RAmy elzoghby on shofu booth

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Dental News

Quarter IV

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Meeting is Held at the Jacob K. Javits Convention Center

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Acteon AnD shining 3D booth

pictuRe fRom the busy exhibition flooR

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pictuRe fRom the busy exhibition flooR

toothpick booth

Quarter IV

DR. Abou bAkR RAWi

TROPHY DISTRIBUTION

DR. ADnAne mARWAn fRom lybiA

DR. zAkARiA bAshA fRom syRiA

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tRophy to DR. iyAD mAguit fRom kuWAit Dental News

pRof. hAssAn selim Quarter IV

British University in Egypt

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Prof.Tarek Abbas Dean of Faculty of Dentistry Dear Students Greetings and welcome to The British University in Egypt Faculty of Dentistry. I am extremely pleased to have this opportunity to introduce you to the Faculty of Dentistry and I am glad you’ve joined us.

The British University in Egypt Faculty of Dentistry prepares students to practice dentistry in the 21st century with knowledge and understanding of dental specialties and varied practice settings.

This occurs in an ethical and professional environment. The Faculty presents a dynamic curriculum, which provides excellent training, integrates the health sciences with clinical experience and utilizes modern technology. Our success is based on maintaining a strong and distinguished faculty and staff, supported in their commitment to teaching and administration, professional development, scholarship, research, student service and community service. We encourage imaginative inquiry and the free exchange of ideas, and promote personal development, professionalism and high ethical standards.

We are committed to excellence in all that we strive to achieve.

The Faculty of Dentistry is committed to graduate dentists who are fully aware of their place and duties in society and are characterized by theoretical knowledge and clinical skills.

The Bachelor’s Degree in Oral and Dental Medicine and Surgery offered by the faculty is aimed primarily at educating and training graduates for efficient dental practice in the new century. It is a five-year program that provides the dental graduate with professional knowledge of different dental fields of specialization, contemporary applications, and the latest developments in dentistry as well as the dental skills necessary to deliver this knowledge to patients in terms of proper diagnosis, treatment planning, and execution. All this takes place within a framework of ethics while keeping the welfare of their patients at the forefront of their thoughts.

The faculty also provides a postgraduate master’s degree that is approved by the Ministry of Higher Education in six clinical specialties of dental science.

Continuous education programs include an implantology fellowship of a one-year program starting March 2023 in collaboration between The British University In Egypt and the Sheffield Implantology Team is inaugurated.

Prof. Tarek abbas addressing dr. azem Qaddoumi during The visiT To The clinics aT bue

PicTure during The visiT of The oPeraTing room

Dental News

Quarter IV

Prof. Tarek abbas surronded by his GuesTs durinG The Tour of The bue

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dr. aboubakr rawi from iraq

dr. ahmed rizk from sudan

dr. azem qaddoumi from Jordan

dr. bassam alnoubani from PalesTine

Dental News

Quarter IV

dr. bassam maaTTar from Tunisia

dr. eid khalil from lebanon

TROPHY DISTRIBUTION

By Prof. Tarek Abbas

dr. fadia dib from syria

dr. hasan alnaTour from PalesTine

dr. mohamed aTiwa from lybia

dr. mohamed benhafiz from yemen

Quarter IV

Dental News

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dr. nadim abou Jaoudeh from lebanon

dr. Tony dib from lebanon

dr. zakaria elbasha from syria

dr. ziad ellahem from ksa

Dental News

Quarter IV

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