Developments in Artificial Intelligence Dentistry That Dentists Need to Know

By Rebecca Pozzie

Will artificial intelligence (AI) remake the dental profession or become just another fad with no lasting impact? Smart money is betting on the former.

Artificial intelligence (AI) is beginning to change how dentists practice their discipline, from diagnosing your patient's dental problems to promoting and managing your practice.

The application of artificial intelligence to dentistry is potentially far-ranging. Current use cases involve screening radiographs for caries, bone loss and other problems; evaluating photographs and other data sources to help with diagnoses and treatments; monitoring phone calls to help with patient communications; and making the processing of dental claims faster and more accurate. But artificial intelligence can revolutionize nearly every practice area that depends on large bodies of data and on precise clinical interventions to make precise clinical judgments.

Although artificial intelligence first took hold in orthodontics, it's quickly establishing credibility in other dental specialties. That's because it refines and strengthens clinical techniques, especially regarding imagery. For this reason, many dental experts are optimistic about AI's ability to make the delivery of dental care more objective and standardized than ever before. This will improve the quality of care provided and allow dental practices to raise their productivity and billings to new heights.

What Is Dental Artificial Intelligence?

Artificial intelligence is a broad term that can be applied in several ways, depending on the industry it's being applied to. In general, AI refers to a computer system's ability to either learn or decipher complex data and large data sets. In dentistry, AI depends on the application of both artificial neural networks (ANNs) and convolutional neural networks (CNNs). The former helps computers find patterns within dental data and then show machines how to recognize them. CNN's are deployed in the analysis of visual images for diagnostic purposes.

Although "AI" is used to describe the broad field, the delivery of AI technology rests on five sub-fields, including:

• Machine learning: Machines using neural networks, physics and statistics to generate data insights without being programmed.
• Deep learning: Using image and speech recognition to detect patterns in large volumes of data.
• Cognitive computing: Simulating human communications by interpreting images and speech and answering appropriately.
• Computer vision: Analyzing photos and videos to uncover their underlying meaning.
• Natural language processing: Analyzing and generating human speech.

The use of these five disciplines will ultimately give dentists insights into the practice of dentistry beyond their own capabilities and across large data sets. This will result in more diagnostic and treatment precision while reducing human bias.

AI Trends and Development in Dentistry

Artificial intelligence has shown great promise in helping dentists practice their specialties. Here are several of the major clinical domains in which AI has achieved gains recently.

Radiology: Building on CNN's strengths at detecting and identifying anatomical structures, applications now exist that detect and diagnose dental caries. It has been shown that a computer can identify caries with a sensitivity rate of 74.5% to 93.3%. This compares with the sensitivity rate for human dentists of between 19% and 94%.

Orthodontics: ANNs have proven themselves useful in helping orthodontists determine whether teeth should be extracted as part of an orthodontic treatment plan. This can help prevent the unnecessary removal of teeth while still achieving the patient's desired outcome. To this end, four ANNs, using several clinical indices, attained 80% to 90% accuracy in determining whether extractions were required to treat patients' malocclusions.

Periodontics: It's always been challenging to determine whether a patient has aggressive or chronic periodontitis. The problem is that there's no single empirical marker that identifies patients with aggressive vs. chronic periodontitis. Enter an AI ANN, which distinguished between the two groups using immunologic factors and was correct 90% to 98% of the time. In another periodontic area, a CNN algorithm was used to diagnose and predict the course of periodontally compromised teeth (PCT). Using this system, diagnostic accuracy ranged from 76.7% to 81.0%, while the ability to predict the need to extract teeth ranged from 73.4% to 82.8%.

Oral pathologies: Oral pathologies have the potential to become precancerous or cancerous. That's why the application of AI processing to this problem is significant. Fortunately, a CNN has been proven 80% effective at diagnosing head and neck cancer lesions in terms of specificity and accuracy. This is slightly below the performance of human dentists. Another fruitful AI application regarding oral pathologies is being able to differentiate between tumor types. For example, a CNN algorithm accurately identified ameloblastomas vs. keratocystic odontogenic tumors at a comparable rate to human dentists. But human specialists took an average of 23 minutes to make their diagnoses vs. the CNN algorithm, which took just 38 seconds.

Almost Unlimited Use Cases

If you pull the camera back, it's easy to envision a future where AI touches virtually every dental discipline. According to Colgate Oral Health>, here are the specialties most likely to be affected by AI technology in the years to come.

Orthodontics:

1. Decision-making around the need for tooth extraction.
2. Prediction of size of unerupted teeth.
3. Management of impacted canine teeth.
4. Cephalometric diagnoses.
5. Production of skeletal malocclusion in connection with mandibular morphology.

Restorative dentistry and prosthodontics:

1. Prediction of restoration longevity.
2. Color matching for esthetic restorations.
3. Design of removable partial dentures.
4. Envisioning the outcome of tooth-whitening procedures.

Periodontology and oral medicine:

1. Diagnosis and classification of periodontal disease.
2. Use of immunologic parameters to diagnosis aggressive periodontitis.
3. Classification of halitosis using identification of periodontal pathogens in saliva.
4. Prediction of aphthous ulcer recurrence.

Temporomandibular joint disorders (TMD):

1. Use of magnetic resonance imaging to determine TMD prognosis.
2. Use of screening questions to help with TMD treatment.
3. Identification of subgroups of internal derangement of the temporomandibular joint.

Endodontics:

1. Location of accessory canals.
2. Detection of periapical radiolucencies.

Oral and Maxillofacial Surgery:

1. Detection of root fractures.
2. Clinical decision support for dental implant treatments.

Oral Cancer:

1. Prognosis of oral cancer based on lesion histology and genetic analysis.
2. Assessment of hyper-nasal speech following oral/oropharyngeal cancer treatment.
3. Oral cancer risk assessment.

From Research to Marketplace

It's one thing to create an AI system in the research lab. It's quite another to build a successful company around it—i.e., a commercial venture that can bring AI innovations to the dental marketplace at scale. Such progress is happening today with many dental AI start-ups.

For example, KAVO, creator of DEXvoice™, is leveraging AI to speed dental workflow using voice commands. DEXvoice allows dentists in the operatory to capture, show, compare or acquire images using their voices alone. Integratable with Amazon's Alexa technology, DEXvoice saves dentists extra steps and improves and simplifies infection control./p>

MMG Fusion's Chairfill™ is an example of a marketing-driven AI application. How does it work? It retrieves a practice's patient and scheduling data to determine available chair time and then fills that time with patients who have unmet treatment needs or who require additional care. Once it identifies vacancies and needs, it communicates directly with patients to book appointments without human involvement.

In a related AI field called augmented reality (AR), a company called Kapanu has created proprietary software to visualize a patient's smile. Its application, IvoSmile™, gives patients an image of their post-treatment smile in just a couple of minutes. This makes it easier to explain the benefits of treatment and to achieve patient buy-in with fewer objections and delays.

Finally, Overjet's Dental Assist™ shows that AI will likely have a powerful impact on the core of dentistry—the ability to make diagnoses quickly, consistently and with high quality. Dental Assist™ enhances patient care by automating elements of the clinical review process using AI. So useful is this ability that more than a dozen major dental insurers have integrated Overjet's dental AI into their claims processing.

There are many similar examples; all focused on making dental care more standardized, of higher quality and easier to market to prospective patients. The point is, AI is bringing the practice of dentistry into the 21^st century, using advanced computing to solve problems that heretofore only had manual human solutions.

The Access Issue

Providing access to dental care is a big challenge in U.S. healthcare. The good news is that AI technology is helping to break through geographic and economic access barriers. A case in point is the mobile app called Smilo.ai. It's a smartphone app that gives patients the ability to quickly assess their dental health and then share the findings with a dental provider who can provide treatment. How does it work? It prompts patients to take a photo of their teeth and gums. The app then imports the images, using them to rate people's oral health. This encourages early detection of dental problems and less invasive treatments. It also gives dentists an educational platform for engaging with patients around dental-health issues, which will likely lead to office appointments for developing treatment plans.

However, Smilo.ai doesn't just jumpstart dental diagnoses. It also serves as a 360-degree, end-to-end platform that virtually connects dentists to patients, assuring a high-quality patient experience for years to come.

The takeaway from Smilo.ai—and from other AI dental systems available now and under development—is fundamental. Artificial intelligence has the potential to solve the profession's thorny access problem by effectively harnessing a device nearly every American adult has in their pocket or purse—a smartphone. If the ultimate result is better dental—and public—health, that will be a remarkable achievement, indeed.

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