With the pandemic entirely reshaping the healthcare landscape and highlighting such subsectors as telehealth and infection control, it feels like technology in the field of dentistry is progressing at a lightning pace. So what can we expect to see emerging from the labs and into the field, in the months and years ahead?
Dr Felix Sim
Mapping things out
Dr Felix Sim (BDS(Hons), MBBS, MFDS(Eng), FRACDS (OMS), is a specialist oral and maxillofacial surgeon, with a sub-specialty in oral cancer and reconstructive surgery of the jaws using microvascular free-tissue transfer. Utilising virtual surgery mapping technology into his practice has had significant advantages for both patients and the profession, he argues.
Dr Sim cites the case of his last training surgery in 2014 in Melbourne, where a patient with a benign tumour had to have almost the whole jaw resected and then reconstructed with the fibula bone. "The process from having the jaw rebuilt to [the patient] having teeth back was over 18 months, with multiple surgeries," says Dr Sim.
Today, by using virtual surgery and 3D printing technology, together with a team of surgeons and a prosthodontist, he is able to complete the above process in a single day. "The pinnacle of what we've done is that we've been able to do all that: take the tumour out, rebuild the jaw, and actually put in implants and teeth – on the same day – so that when the patients come out of the operating room, after having their jaw tumour removed, they've had a jaw rebuilt with teeth," says Dr Sim.
"It's not just quality of life for the patient. It's also a much better use of resources, much more economical in the sense that we haven't had to utilise hospital time as much," he says.
Dr Sim understands that, with new technology, there will be early and late adopters.
"Some people are still not using all digital technology because they feel like what they do works well, and that's completely reasonable," says Dr Sim.
"But the big part of it for people who are coming into the field is this technology of being able to plan virtually on the computer, and then taking that to the operating room does lessen the current learning curve so that it's not as hard to pick up these skills of how to make a new jaw from a straight bone."
However, Dr Sim firmly believes technology does not trump training.
"It's not there to replace your basic knowledge and skills, but it's there to complement it. And just like with any kind of new technology that we tend to adopt, we can't be too reliant on it without knowing what the basics are," says Dr Sim.
"Digital technology is also not foolproof. And you've still got to understand the traditional concepts of it, so when things don't go as planned – which happens – you're able to get yourself out of the situation."
In the future, the development that he thinks will most influence the industry will be the production of materials that are more biocompatible, that may negate the need of taking the bone from another place in the body.
"For example, you can actually get bone and tissue culture, and then have a material that will have a bone grow into it. And that way people don't have to have a leg wound because that's where the bone was taken out from."
He's also keen to see biomaterials like plates and titanium that are more compatible with radiation. "Often cancer patients need to have radiation and the plates can sometimes affect the concentration of radiation. But if you have plates and metals that are more inert, that then may actually have a better effect on the patients."
At a base level however, Dr Sim thinks technology should be more accessible. "It just improves efficiency, and probably to a certain degree in that particular case safety, if it means that more invasive procedures can be avoided," he says.
Professor Heiko Spallek
Data and informatics
Professor Heiko Spallek, Head of School and Dean at the University of Sydney School of Dentistry, in the Faculty of Medicine and Health, believes the COVID-19 pandemic made adopting new technologies a priority for the industry.
"No doubt one of the consequences of COVID has been that all sectors of the economy, including dentistry, have been compelled to be more open to advancements offered by technological progress," says Prof. Spallek.
"Generally speaking, the slower pace of the last 12 months seemed to have given the opportunity for clinicians to turn their attention to digital workflows as a real possibility of improving their dental practice."
According to Prof. Spallek, one of the biggest ways the pandemic has changed the medical industry is the growing need for quality health-related data.
"My own area of dental informatics, as well as my own research in how electronic health records in dentistry can improve patient outcomes, have seen the need for high-quality data emerging as critical to the way of how we managed COVID-19, how we keep track of the health
of all Australians, and of how we deliver care remotely.
"Many of the existing barriers to data sharing and interoperability that had hampered progress in digital health, dissolved through necessity, and the tenacity of informatics professionals across the health system."
Prof. Spallek has seen a number of advancements emerge in technology and research, including the use of biometric sensors to potentially improve early detection of disease, which could potentially offer new preventative strategies.
"The oral cavity seems to offer a good environment for these sensors, so that could be another significant advancement," he says.
Over the last 12 months, academics from Sydney University, in collaboration with Sydney Dental Hospital, introduced fully remote monitoring into their patients' treatments.
Their pilot study involves using aligners and a dental monitoring system to assess patients remotely, diagnose and treatment plan and scan patient's dentition to organise sequential aligners. After starting their treatment using aligners, patients scan their bite using smart phones. The images are checked by an artificial intelligence (AI) system and, if necessary, by the orthodontists at the Sydney Dental Hospital.
"If our clinical researchers can prove that this AI system works, then this approach has the potential to be used nationwide benefiting thousands of patients, especially the ones who live in rural areas. Potentially, it will reduce the public waiting list for orthodontic treatment to a minimum," he says.
However, Prof. Spallek believes the use of AI in dentistry needs more exploration. "While AI has been part of the healthcare system since the 1990s, it has not transformed dentistry in the same way that it has for driving cars or using our faces to unlock our phones," he says.
"One of the reasons why dental informatics has lagged behind applications of informatics in medicine and other industries is that Australia has been slower than other high-income countries in adopting the open standards needed to share data about patients. Without making
the data available and the system fully interoperable, we can't train the models to improve decision-making or automate tasks."
With the University of Sydney School of Dentistry embarking on a major curriculum reform beginning 2023, how can students keep up with technology?
"Sydney dental students are already trained to integrate new technologies into their practice, including new generation dental materials, rotary endodontics, cone beam computed tomography (CBCT), 3D printing, and electronic dental records," says Professor Spallek, who notes many of his current students will practise beyond the year 2070.
"As more technologies make their way into dental practice and the lives of dental patients, we will need to not only continually update our curricula to provide hands-on experience with these new technologies, but we also need to give students foundational skills in informatics and human factors so they can adapt to new technologies that appear in the future."
Artificial intelligence in dentistry - our policy
The ADA works hard to keep abreast of latest technology advances, not least because it is important to develop Policy Statements (PSs) to set industry standards in their application. One of the ADA's most recent PS is, indeed, Policy Statement 6.34, regarding the inclusion of artificial intelligence in dentistry practice. Our position states that "applications of artificial intelligence in dentistry should prioritise patient safety, quality of care, continuity of care, and data privacy and security."
Along with our Policy Statements on so many other technologies and important industry-related topics, you can find this policy in full on the ADA website at ada.org.au/Dental-Professionals/Policies
