Artificial Intelligence for Digital Implant Planning

Regarding dentistry, the use of AI is not a new phenomenon either. I remember in 2003 when Dentsply Sirona first introduced the CEREC 3D software that gave dentists restorative proposals for dental crowns, inlays, and onlays that were based on large datasets. Since then, the dental industry has implemented AI technology into various software applications for orthodontics, radiology, robotics, and most recently, treatment planning.

When discussing how this technology is being used in treatment planning, such as for dental implants, and determining whether you should consider adopting it in your practice, it is important to distinguish between true AI and augmented intelligence (AuI). AI refers to machine intelligence that is completely differentiated from the natural intelligence displayed by humans. Alternatively, AuI refers to machine intelligence that requires the input of human intelligence at points in its decision-making process. In a December 2022 white paper, Dentistry-Overview of Artificial and Augmented Intelligence Uses in Dentistry, the American Dental Association's Standards Committee on Dental Informatics emphasizes that AuI's design enhances human intelligence rather than replacing it. In most situations in which AI and AuI are being used in dentistry, whether that is for diagnosis, a review, or treatment planning, the final decisions are being made by dentists, and although AI has reduced the dependance on human variables, it has not obviated our involvement in the process.

"Pure AI is great If you are doing a process that is 100% repeatable every single time," observes Matt Vrhovac of Absolute Dental Services, an industry expert in the use of AI/AuI for the digital treatment planning of dental implants. "The robots that are used to put cars together on auto assembly lines are a good example of this. However, in dentistry, no two patients are the same, so clinicians are necessary to keep things in check."

Over the last several years, with the widespread adoption of cone-beam computed tomography (CBCT) technology and 3D digital impression scanners, the use of digital planning for dental implant treatment has become accepted as the norm. Many dentists have used these technologies to treatment plan dental implants, but until more recently, they have had to do much more of the work. As AI and AuI modules have been introduced into dental implant planning, they have begun to simplify the process.

AI and AuI are currently being applied in a variety of forms within dental planning software applications, including coDiagnostiX^®, Diagnocat, Exocad, 3-Shape, BlueSkyBio, RealGUIDE^™, and R2GATE^® to name a few. These software applications have various AI and AuI features that can help to identify anatomical structures, map nerves, align surface and radiological datasets for model matching, design restorations, and generate 3D models. Among other advantages, using AI and AuI can improve accuracy and efficiency when compared with manual human dental implant planning methods while being less dependent on the experience of the clinician or technician. For example, the CBCT segmentation performed during the development of implant guides, which previously took anywhere from 30 to 60 minutes, can now be completed in as little as 5 to 8 minutes.

Many dentists are now faced with the question of how they should they implement this new technology into their dental practices. Should you evaluate and purchase specific software platforms for in-office use or utilize planning services from a dental laboratory to assist you? According to Vrhovac, you need to ask yourself whether you want to be a clinician or a technician. As dentists and businesspeople, we must remember that how we use our time has a significant effect on our profitability. Only dentists can provide clinical dentistry and approve diagnoses and designs, but many of these other processes can be delegated to team members or digital planners, so doing so may make the most sense if your goal is to be as profitable and efficient as possible. The cost of implementing dental implant planning that incorporates AI and AuI technology can be substantial, so that should also be taken into consideration. This can be especially true when you are purchasing multiple software platforms and possibly hardware as well. When considering software options, evaluate all of the functions of each application and how you and your team can use them.

During the last year, I have been beta testing the Diagnocat platform, which claims to be an "all-in-one" AI software application. It has multiple AI/AuI capabilities, including the ability to analyze 2D and 3D radiographs, cloud storage, a collaboration tool for multiple providers, a superimposition tool, and CBCT segmentation. Most recently, Diagnocat's engineers have added a component that I believe will be an absolute game changer-a module that automatically designs and generates the actual surgical implant guide and restoration for you. Although this tool is currently only available to doctors who are beta testing Diagnocat, the workflow and the results that I have seen thus far are amazing. Simply uploading a CBCT scan and digital impression scan enables the program to produce a surgical guide to place the implant as well as the restoration that it will support. If you plan on investing in AI/Aui for your dental practice, having one software application that can complete multiple treatment planning tasks can be advantageous.

Whether you decide to adopt AI/AuI for implant planning in your practice or outsource its use to a laboratory, the decision should be considered carefully and based on your specific goals. The use of AI/AuI does not replace our clinical decision-making or alleviate the need for our presence, but it also does not compensate for inexperience or a lack of understanding of the fundamentals of dental implant planning. However, when appropriately used in implant treatment planning, AI and AuI can enhance our diagnostic abilities and workflows as well as improve our efficiency and profitability. With all of the advantages associated with incorporating AI/AuI into dental implant planning, I believe that it is here to stay and will only continue to become more robust and accurate over time.

Christian Yaste, DDS
Owner
Ballantyne Dentistry
Charlotte, North Carolina