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REVIEW ARTICLE

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THE SCOPE OF ARTIFICIAL INTELLIGENCE IN

DENTISTRY - A REVIEW

Dr.Vandana. S

Department of Oral Pathology and Microbiology,

Sri Ramachandra Dental College

Sri Ramachandra Institute of Higher Education & Research, Chennai , Tamilnadu , India.

To access & cite this article

ABSTRACT

Website: jidam.idamadras.com

Artificial intelligence

(AI) has found a number of

applications in the field of medicine and dentistry with

the need for collection, documentation and computation

of vast patient data, in treatment planning and diagnosis

as well as in dental education. Though the technological

advancements including introduction of robotic surgeries

for increased precision , neural networking for diagnosis,

virtual assistants to help dentists with better treatment has

paved way for newer avenues , AI is still in the infancy

stage and cannot replace human intelligence and skill.

However , the scope of AI in various fields of dentistry

is enormous and its future aspects appears extremely

promising .

Address for correspondence:

KEYWORDS : Artificial intelligence , virtual assistants ,

dentistry , dental education

Dr.Vandana. S,

Department of Oral Pathology and

Microbiology,

Sri Ramachandra Dental College ,

Sri Ramachandra Institute of Higher

Education &Research

Chennai , Tamilnadu , India.

E-mail: vandana@sriramachandra.edu.in.

Received

: 26.7.2019

Accepted

: 12.9.2019

Published

: 27.12.2019

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Vandana : Artificial intelligence in Dentistry

INTRODUCTION :

available in the market,²which can perform a number

of simple tasks in the dental clinic with greater

The human brain is the most complex organ of

precision, less manpower and fewer errors than

the body which controls our body’s internal functions

human counterparts.

and also integrates sensory impulses and information

to form perceptions, thoughts and memories . Inspite

AI IN PATIENT MANAGEMENT :

of the enormous advancements in technology over

time, till date , an effective model mimicking the

THE AI SOFTWARE PERFORMS THE

human brain remains an enigma to researchers all

FOLLOWING PATIENT MANAGEMENT

over the world. Constant search for this model has

TASKS :

led to the development of artificial intelligence

(AI) , a term coined by John McCarthy in 1956

•

Fixing and coordinating appointments according

to the convenience of the patient and practitioner.

and is defined as a field of science and engineering

concerned with the computational understanding of

•

Alerting the dental healthcare provider about any

what is commonly called intelligent behavior and

relevant medical history that the patient may have

with creation of artifacts that exhibit such behavior¹.

before every appointment (eg: History of allergy

The various techniques of AI which are being applied

or use of prophylactic antibiotics in those patients

in dentistry include artificial neural networks (ANN),

who have had cardiovascular surgeries)

genetic algorithms (GA), and fuzzy logic ². A large

•

Notifying the patients and dentists about checkups

amount of modern computer and technologies were

whenever any genetic or lifestyle information

inspired by Aristotle’s early attempts to formulate the

indicates increased susceptibility to dental

logical thinking through his syllogisms (a three part

diseases. (eg: periodontal screening for patients

deductive reasoning). Aland Turing, a young British

with diabetes and oral cancer screening for those

polymath explored the mathematical possibility of

who use any form of tobacco)

artificial intelligence and devised the Turing test to

suggest that machines can use available information

•

Managing documentation work and insurance

and reason to solve problems like humans³. Following

•

Assisting in the clinical diagnosis and treatment

its inception in 1959 when the first computational

planning

trainable neural networks were developed, the field

of medicine and dentistry has witnessed innumerable

•

Setting up regular reminders for patients who are

research using AI⁴. These computer systems monitor

on tobacco or smoking cessation programs. etc.

the admission and treatment of patients supported

•

Providing emergency tele-assistance in cases of

by health care professionals, from the moment of

dental emergencies when the dental health care

setting the time and date of examination, via opening

professional cannot be contacted.

a digital patient record, patient history taking,

support in clinical diagnosis of a disease, analysis

•

AI software enables us to create a complete

of radiographs and laboratory procedures, assistance

virtual database for every patient, which can be

in determination and administration of appropriate

extremely detailed and accessible at the same time

^5,6. The AI software can document all necessary

treatment. Advancements in technology has always

data and present it to the dentist much faster

benefitted healthcare, improved quality of patient

and more efficiently than a human counterpart.

services and served as a great tool available to

(eg: collecting all necessary dental records, extra

medical experts.

oral photographs and radiographs necessary for

diagnosing any dental condition). Adding to this,

THE ROLE OF ARTIFICIAL

the voice recognition and interactive interphases

INTELLIGENCE IN VARIOUS

enable the software to help the dentist perform

FIELDS OF DENTISTRY :

different tasks effortlessly².

AI IN DIAGNOSIS:

The use of AI in clinical medical and dental

practice is at an early stage of development and

Correct diagnosis is the key to a successful

still in the investigation phase. Currently, artificial

clinical practice. Adequately trained neural networks

intelligence based virtual dental assistants are

can be a boon to diagnosticians, in conditions having

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Vandana : Artificial intelligence in Dentistry

multifactorial etiology⁷ such as recurrent aphthous

In head-and-neck imaging modalities, AI provides

ulceration, where clinical diagnosis is made only on

additional leverage owing to its unique ability to

the basis of recurrence and by the exclusion of other

learn. It can be integrated with imaging systems

factors. In a study by Dar- Odeh et al in 2006⁸, data

such as magnetic resonance imaging and cone-beam

from 86 participants were used to construct and train

computed tomography to identify minute deviations

a neural network to predict the factors appearing to

from normalcy that could have gone unnoticed by the

be related to the occurrence of recurrent aphthous

human eye. Examples include the accurate location

ulcers. When this was further tested using untrained

of landmarks on radiographs, which can assist in

data of

10 participants the results revealed most

cephalometric diagnosis². ANN is found to act as a

accurate predictions such as gender, hemoglobin,

second opinion to locate the minor apical foramen,

serum Vitamin B12, serum ferritin, red cell folate,

thereby enhancing the accuracy of working length

salivary candidal colony count, frequency of tooth

determination by radiographs¹⁶and in diagnosing

brushing, and the number of fruits or vegetables

proximal dental caries¹⁷. Due to the sufficient

consumed to be related to recurrent aphthous

sensitivity, specificity, and accuracy it possesses , it

ulceration and appropriate for use as input data to

is believed to act as a model for vertical root fracture

construct ANNs. Hence, when trained ANNs were

detection in digital radiography¹⁸.

tested and compared with the diagnosis of a surgeon,

the results revealed high sensitivity and specificity

AI IN ORAL PATHOLOGY :

of ANN, thereby insisting on the importance of AI

in achieving correct interpretations and reducing

Artificial intelligence can be used as a useful

human errors³.

modality in diagnosis and treatment of lesions of

oral cavity due to its ability to screen and classify

AI IN TREATMENT PLANNING:

suspicious altered mucosa undergoing premalignant

The neural networks when optimally trained

and malignant changes as even minute changes at

with respect to lower third molars are found to have

single pixel level are detected. In the field of pathology,

high specificity and sensitivity equivalent to specialist

AI can be used to scan large number of tissue sections

consultation in categorizing tooth to “gold standard”

following histochemical and histological processing

based on National Institutes of Health

(NIH)

to locate minor details which aids in diagnosis and

consensus development program which describes

clinical decision making. Artificial intelligence can

a well defined criteria for the removal of third

accurately predict genetic predisposition to oral

molars⁹. ANN can also be employed to determine

cancer in a large population¹⁹.

if extractions are necessary before orthodontic

treatment¹⁰. Additionally it can be used in classifying

The AI within the Secretary-Mimicking

patients into aggressive periodontitis and chronic

Artificial Intelligence (SMILE) system is designed

periodontitis group based on their immune response

to aid pathologists to listen to voice commands

profile¹¹.

and perform numerous supplementary tasks in the

analysis of pathological sections and in creating

AI IN ORAL MEDICINE AND RADIOLOGY :

semiautomatically pathological reports²⁰. In

computerized drug prescription systems, AI improves

The neural network may help in the

system efficiency and reduces the risk of wrong drug

identification of individuals with a high risk of

choice by a physician²¹.

oral cancer or precancer for further investigation

or health education¹². This could solve the need to

AI IN ORAL AND MAXILLOFACIAL

devise a method for early detection of oral cancer

SURGERY :

which accounts for 30% of all the cancers in India¹³.

GAs and ANN are a promising tool for interpreting

The greatest application of artificial

the sizes of unerupted canines and premolars with

intelligence is the advent of robotic surgery where

greater accuracy in the mixed dentition period¹⁴ and

human body motion and human intelligence is

for predicting tooth surface loss, a universal problem

simulated²². Successful clinical application in image

that involves an irreversible, multifactorial, non-

guided surgery in cranial area include oral implant

carious, physiologic, pathologic, or functional loss

surgery, removal of tumor and foreign bodies, biopsy

of dental hard tissues¹⁵.

and temperomandibular joint surgery²³. Comparative

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Vandana : Artificial intelligence in Dentistry

studies in oral implant surgery indicate significantly

as chemical stability, wear resistance, and flexural

more accuracy compared to manual freehand

strength⁷.

procedure even if performed by experienced surgeons.

In the field of implantology and surgery, AI software

In addition no significant difference between

has helped plan surgeries to the smallest detail prior

experienced surgeon and trainees were found. Also,

to the actual surgery.

the image guidance allows more thorough surgical

resection potentially decreasing need for revision

AI IN ORTHODONTICS :

procedures¹⁹. Overall

, the advantages reported

include shorter operation time, safer manipulation

In Orthodontics, diagnosis forms the crux

around delicate structures and higher intra-operative

of the treatment. When a proposed model was

accuracy.

trained to assess the craniofacial skeletal and

dental abnormalities in cephalometry followed by

Another innovative application of AI includes

comparison with an expert opinion, the agreement

“bioprinting” where living tissue and organs can be

between them was found to be equivalent. Moreover,

constructed in consecutive thin layers of cells which

the model pointed out contradictions presented in

in the future may be used for reconstruction of oral

the data that were not noticed by the Orthodontists,

hard and soft tissues lost due to pathological or

thereby emphasising the contribution of AI in

accidental reasons and robotic surgery, where robotic

Orthodontic decision support²⁶.

surgeons perform semi-automated surgical tasks with

increasing efficiency under the guidance of an expert

In the field of Orthodontics, the software

surgeon².

can perform a number of analysis on radiographs

and photographs that aid in diagnosis and

AI IN PROSTHETIC DENTISTRY:

treatment planning^27,28. With the advent of intra-

oral scanners and cameras, the ordeal of making

In order to provide ideal esthetic prosthesis

a dental impression is also disappearing . These

for the patient , various factors like anthropological

digital impressions are not only quicker and more

calculations

, facial measurements, ethnicity and

accurate but also eliminate all the laboratory steps

patient preferences have been integrated by a design

thus drastically reducing the number of errors. With

assistant, RaPid for use in prosthodontics. RaPiD

the help of Artificial Intelligence, the computer can

integrates computer aided design, knowledge based

actually guide the dentist during the entire procedure

systems and databases , and employs a logic based

of making a digital impression and aid in making

representation as a unifying medium¹⁹. CAD/

an ideal impression²⁹. It can also be used to provide

CAM (Computer aided design/Computer aided

orthodontic consultations to general practitioners for

manufacturing) application in dentistry is the process

the alignment of crowded lower teeth⁷.

by which finished dental restoration is attained

through fine milling process of ready ceramic blocks.

The CAD/CAM technologies can be used to

It is used in manufacturing of inlays, onlays, crowns

fabricate accurate orthodontic plates and appliances³⁰.

as well as bridges. CAD/CAM technique essentially

Based on the information that is fed into the system

creates a two or three dimensional model and their

including the set algorithms and statistical analysis,

materialization by numerically controlled mechanics.

the AI software helps to predict tooth movement and

It has replaced the time consuming and laborious

final outcome of treatment too.

process of conventional casting and reducing the

human error component in final prosthesis²⁴.

CONCLUSION :

When we consider the possibility of

Apart from its role in patient care and

implementing ANN in clinical practice, it has

management in various fields of dentistry , AI can also

exhibited sufficient precision for designing and

be used in dental health education. Incorporation of

chair-side manufacturing of dental prostheses, based

AI in teaching and learning process can dramatically

on digital image acquisition following tooth cusps

improvise the way students perceive knowledge.

assessment²⁵. It can also have a great potential in

By preparing the next generation of highly skilled

investigating the properties of dental materials such

dental experts, it will benefit educators , students as

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Vandana : Artificial intelligence in Dentistry

well as patients on the long run. AI can contribute to

Adv Appl Bioinform Chem 2010;3:7-13.1.

designing an error free evaluation pattern , free of

9. Brickley MR, Shepherd JP, Armstrong RA. Neural

human bias compared to the differentiated curriculum

networks: A new technique for development of

followed now³¹. AI-based dental education can

decision support systems in dentistry. J Dent

significantly reduce the cost of education and

1998;26:305-9.

burden on educators. Despite the legal and ethical

10. Xie X, Wang L, Wang A. Artificial neural

issues involved , the future of AI in various fields

network modeling for deciding if extractions are

of medicine and dentistry can be infinite and the

necessary prior to orthodontictreatment. Angle

unpredictable changes it is believed to bring about

Orthod 2010;80:262-6.

can change the dynamics of human lives forever.

11. Papantonopoulos G, Takahashi K, Bountis T, Loos

B. Artificial neural networks for the diagnosis of

FINANCIAL SUPPORT AND

aggressive periodontitistrained by immunologic

SPONSORSHIP:

parameters. PLoS One 2014;9:e89757.

12. Speight PM, Elliott AE, Jullien JA, Downer MC,

Nil

Zakzrewska JM. The use of artificial intelligence

to identify people at risk of oral cancer and

CONFLICTS OF INTEREST:

precancer. Br Dent J 1995;179:382-7.

13. Varshitha A. Prevalence of oral cancer in India. J

There are no conflicts of interest.

Pharm Sci Res 2015;7:845-8.

14. Moghimi S, Talebi M, Parisay I. Design and

REFERENCES :

implementation of a hybrid genetic algorithm and

artificial neural network system for predicting the

Shapiro SC(1992).Encyclopedia of Artificial

sizes of unerupted canines and premolars. Eur J

Orthod 2011;34:480-6.

Intelligence. .2^nd Edn.Vol 1 and 2,New York,Wiley.

15. Al Haidan A, Abu-Hammad O, Dar-Odeh

Dr Sunali S Khanna , Prita A Dhaimade . Artificial

N. Predicting toothsurface loss using genetic

Intelligence: Transforming Dentistry Today .

algorithms-optimized artificial neural networks.

Indian Journal of Basic and Applied Medical

Comput Math Methods Med 2014;2014:1-7.

Research; June 2017: Vol.-6, Issue- 3, P. 161-167

16. Saghiri MA,Asgar K, Boukani KK, Lotfi M,Aghili

Bas B, Ozgonenel O, Ozden B, Bekcioglu

H, Delvarani A,et al. A new approach for locating

B, Bulut E, Kurt M. Use of artificial neural

the minor apical foramen usingan artificial neural

network in differentiation of subgroups of

network. Int Endontic J 2012;45:257-65.

temporomandibular internal derangements:

A preliminary study. J Oral Maxillofac Surg

17. Devito KL, de Souza Barbosa F, Filho WN. An

2012;70:51-9.

artificial multilayer perceptron neural network

for diagnosis of proximal dental caries. Oral

Turimg MA(1950).Computing machinery and

Surg Oral Med Oral Pathol Oral RadiolEndod

Intelligence. Mind ;49:433-460.

2008;106:879-84.

Lavrac, N.. Selected techniques for data mining

18. Kositbowornchai S, Plermkamon S, Tangkosol

in medicine. Artificial intelligence in medicine,

T. Performanceof an artificial neural network for

1999,16(1), 3-23.

vertical root fracture detection:An ex vivo study.

Kannan P. V., Artificial Intelligence, Applications

Dent Traumatol 2013;29:151-5.

in healthcare, Asian hospital and healthcare

19. Bijo Alexanderand Sunil John . Artificial

management.

intelligence in dentistry: current concepts and a

Anupama Kalappanavar, S. Sneha, Rajeshwari

peep into the future. Int. J. Adv. Res. 6(12), 1105-

G. Annigeri . Artificial intelligence: A dentist’s

1108

perspective . Journal of Medicine, Radiology,

20. Ye JJ. Artificial Intelligence for Pathologists Is

Pathology & Surgery (2018), 5, 2-4

Not Near- It Is Here: Description of a Prototype

Dar-Odeh NS, Alsmadi OM, Bakri F, Abu-

That Can Transform How We Practice Pathology

Hammour Z, Shehabi AA, Al-Omiri MK, et al.

Tomorrow. Arch Pathol Lab Med 2015; 139(7):

Predicting recurrent aphthous ulceration using

929−35.

genetic algorithms-optimized neural networks.

21. Syed-Abdul S, Nguyen A, Huang F, Jian W,

135

JIDAM/Volume:6/Issue:4/Pages 131 - 136/October - December 2019

Vandana : Artificial intelligence in Dentistry

Iqbal U, Yang V, et al. A smart medication

recommendation model for the elec- tronic

prescription. Comput Methods Programs Biomed

2014; 117(2): 218−24.

22. Ruppin J,Popovio A,Strauss

M,Spuntrup

E,Sterner A,Stoll C(2008).Evaluation of the

accuracy of three different computer aided

surgery systems in dental implantology: Optical

tracking versus Stereolithographic splint systems.

Clinical Oral Implant Research,19(7):709-716.

23. Widman G. Image guide surgery and medical

robotics in cranial area.Biomedical Imaging and

Intervention Journal 2007. ,3(1):e11:1-9.

24. Susic I, Travar M, Susic M.The application

of CAD/CAM technology in Dentistry.IOP

Conf Series: Materials Science and 200(2017

Engineering)012020.----------------

25. Raith S, Vogel EP, Anees N, Keul C, Guth JF,

Edelhoff D, et al. Artificial neural networks as

a powerful numerical tool to classify specific

features of a tooth based on 3D scan data.Comput

Biol Med 2017;80:65-76.

26. Mario MC, Abe JM, Ortega NR.

Paraconsistent artificial neural network as

auxiliary in cephalometric diagnosis. Artif

Organs2010;34:E215-21.

27. Xie X; Wang L; Wang A. Artificial Neural

Network Modeling for Deciding if Extractions

Are Necessary Prior toOrthodontic Treatment

Angle Orthod.; 2010, 80:262-266.

28. Mackin N., Sims-Williams J H., Stephens C

D. Artificial intelligence in dental surgery:

an orthodontic expert system, adental tool of

tomorrow. 1991, Dental Update 18: 341-343.

29. Kattadiyil MT, Mursic Z, AlRumaih H, Goodacre

CJ. Intraoral scanning of hard and soft tissues for

partial removabledental prosthesis fabrication. J

Prosthet Dent; 2014;112: 444-8.

30. Vecsei B, et al., Comparison of the accuracy of

direct and indirect three-dimensional digitizing

processes for CAD/CAM systems - An in vitro

study. J Prosthodont Res, 2016, JPOR-354 .

31. Divya Bharadwaj . Artificial Intelligence: Patient

Care and Health Professional’s Education .

Journal of Clinical and Diagnostic Research.

2019 Jan, Vol-13(1): ZE01-ZE02

136

JIDAM/Volume:6/Issue:4/Pages 131 - 136/October - December 2019