AI dentistry—international magazine of artificial intelligence in dentistry No. 1, 2024 Preview

AI dentistry—international magazine of artificial intelligence in dentistry No. 1, 2024 Preview

Cover / Editorial / Content / The transformative power of AI in dentistry / Artificial intelligence: A gift to dentists / “AI’s primary function is to bolster human skills, not to overshadow them” An interview with Dr Hanyao Huang / Potential of AI as an assistant in oral surgery considering accuracy and legal aspects - An interview with Prof. Víctor Díaz-Flores García / Researchers use generative artificial intelligence to design realistic dental crowns / AI may assist in dental implant surgery, localising mandibular canals / The missing link / Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024 / International events / Submission guidelines / International imprint

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issn 2193-4673 • Vol. 1 • Issue 1/2024

1/24

AI dentistry
international magazine of artificial intelligence in dentistry

preview

opinion

The transformative power of AI in dentistry

interview

AI’s primary function is to bolster human skills

trends & applications
The missing link

[2] =>

Register at

www.dds.berlin

Digital
Dentistry
Show

In collaboration with
Digital
Dentistry
Society

OF DENTISTRY

OF DENTISTRY
D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E

DIGITAL
DENTISTRY
SHOW

D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E

28 & 29 JUNE 2024

[3] =>

editorial

|

Dr Robert A. Gaudin
Fellow of the BIH Charité Digital Clinician Scientist Program,
Charité—Universitätsmedizin Berlin, Germany

The rise of artificial intelligence in dentistry:

A game changer in patient care
In a twist that was once confined to the realm of science
fiction, artificial intelligence (AI) has become the major topic
in politics, business and the media. As a founder of two dental
AI health companies—US-based VideaHealth and dentalXr.ai
Europe-based—I am confident in saying that my initial
vision and collaboration with entrepreneurs and researchers has helped shape the dental AI environment. I
am privileged to have been part of the initial research in
2016 on apical lesion detection conducted at Charité—
Universitätsmedizin Berlin in Germany, the Massachusetts
Institute of Technology and the Harvard University in
the US. The promising findings underscored a future
where AI would redefine the very fabric of how dental
practitioners approach diagnostics.1
Since then, there has been a surge in AI-related publications in dentistry, particularly in the last five years.2–7
Radiographic image analysis is a focal point, and re
searchers globally have developed AI models to support
dentists in diagnosing various dental images. The additional advantages of AI in dentistry include:
– streamlined detection of anatomical structures and
dental materials, providing dentists with comprehensive preliminary findings, saving time and improving
documentation quality;
– superior pathology detection, identifying conditions
like early caries more accurately;
– enhanced patient communication, providing patients
with a better understanding of their conditions by
visually highlighting pathologies; and
– improved marketing potential, conveying the dental
practice’s commitment to progress, innovation and a
patient-centric approach.
AI-driven software, has become a symbol of progress
and sophistication for dental practices. The adoption of
AI not only streamlines workflows and enhances diag-

nostic capabilities but also positions dental practices as
pioneers in embracing the future of healthcare.
Beyond image analysis, dentists envision AI assisting in
automating various processes in their practices, from generating insurance claims to transforming 3D scanners into
diagnostic tools. AI has become intertwined with 3D-printing
technology, heralding an era where precision meets efficiency, a future where dental prostheses and implants are
not only tailor-made for each patient but are also crafted
with unparalleled accuracy, thanks to the guiding intelligence of AI algorithms. As dental practices increasingly
embrace this revolutionary amalgamation, the realm of
AI and 3D printing in dentistry emerges as a beacon of
innovation, promising a future where smiles are crafted
with unprecedented precision and care.
Despite concerns about AI replacing human roles,
regulatory restrictions ensure that AI can only assist, the
ultimate decision resting in human hands. While current
AI capabilities may not generally surpass those of dentists, it is acknowledged that improvements will come
with time and evolving algorithms. The future holds a
vision where AI, combined with diverse image modalities and patient information, provides dentists with a
comprehensive analysis of each patient and an individualised and maximally optimised approach to patient
treatment.
As the dental community navigates the integration of
AI into daily workflows, understanding how to harness
its potential is crucial. The consensus is clear: AI is not
a threat but a tool that, when utilised effectively, has
the potential to revolutionise patient care in dentistry.
The journey towards an AI-assisted future in dentistry has
begun, and its impact promises to be transformative.
Editorial note: A list of references is available from the publisher.

AI dentistry
1 2024

03

[4] =>

| content
editorial
The rise of artificial intelligence in dentistry: 					
A game changer in patient care
03
Dr Robert A. Gaudin

opinion
The transformative power of AI in dentistry
page 06

06

Eric Kukucka

Artificial intelligence: A gift to dentists

10

Dr Kyle Stanley

interview
page 16

“AI’s primary function is to bolster human skills, 			
not to overshadow them”
12
An interview with Dr Hanyao Huang

Potential of AI as an assistant in oral surgery 				
considering accuracy and legal aspects

14

An interview with Prof. Víctor Díaz-Flores García

AI research
Researchers use generative artificial intelligence 				
to design realistic dental crowns
16
Iveta Ramonaite
page 20

AI may assist in dental implant surgery, localising mandibular canals

18

Franziska Beier

trends & applications
The missing link 		

20

Dr Miguel Stanley

meetings
Long-awaited Digital Dentistry Show 						
to premiere in Berlin in June 2024
26
International events
Cover image courtesy of
pinkeyes/Shutterstock.com
issn 2193-4673 • Vol. 1 • Issue 1/2024

1/24

AI dentistry
international magazine of artificial intelligence in dentistry

preview

opinion

The transformative power of AI in dentistry

interview

AI’s primary function is to bolster human skills

trends & applications
The missing link

04 AI dentistry
1 2024

28

about the publisher
submission guidelines

29

international imprint

30

[5] =>

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not in all countries available yet.

[6] =>

| opinion

Deep learning models can tackle massive amounts of information and learn the distinctive characteristics of specific types of documents to produce new,
original work that is similar but not identical to the examples they have encountered.

The transformative
power of AI in dentistry
By Eric Kukucka, Canada

Introduction
When we think of artificial intelligence (AI), our minds often conjure up images of sentient humanoid robots from
iconic science fiction films like 2001: A Space Odyssey
and Blade Runner. More recently, films like Her have
explored the concept of AI agents possessing consciousness.
However, today’s discussion delves into the use of AI
in dentistry, where practical applications are changing
the landscape of oral healthcare.

Defining AI in dentistry
Before we dive deeper into the profound impacts of AI
in dentistry, let us establish a working definition. In practical terms, AI is a field of computing in which advanced

06 AI dentistry
1 2024

algorithms access extensive data sets to solve problems
in ways reminiscent of human cognition. IBM aptly characterises AI as the utilisation of computers and machines
to emulate human problem-solving and decision-making
capabilities.

AI in everyday life
Many people are unaware that they interact with AI
on a daily basis. If you have ever used voice-activated
virtual assistants such as Apple’s Siri, Amazon’s Alexa
or Google Assistant or received personalised recommendations on platforms like Netflix, YouTube or Spotify,
you have already experienced the influence of AI.
Beyond these personal interactions, AI plays a pivotal role
in various aspects of our professional lives.

[7] =>

opinion

For instance, AI is the driving force behind automated
speech recognition and closed captioning, enhancing
accessibility for individuals with hearing impairments. In
the realm of online customer service, AI-powered chatbots efficiently assist users on e-commerce websites,
making shopping experiences smoother and more efficient. Moreover, AI excels in image categorisation and
analysis, a capability we often encounter in apps like
Apple Photos or during medical image assessments at
healthcare facilities.

The evolution of AI
The recent surge in AI’s prominence can be attributed to
several factors. One crucial factor is the exponential growth
in computational power, computers continuously becoming more potent and capable of handling complex AI tasks.
Another pivotal development is the unprecedented access
to massive data sets, consisting of millions of documents
and images. Additionally, the emergence of deep learning
networks has revolutionised AI by allowing it to process vast
amounts of information, often derived from extensive online
data sources.
Traditionally, software developers created specific algorithms
tailored to solving well-defined problems. However, deep
learning, a subset of machine learning, which is itself a
subset of AI, introduced a dynamic approach. Deep learning
models are adept at handling substantial data sets and
can learn the unique characteristics of various document
types, such as images, essays or strings of computer code.
These models then generate new, original content that
closely resembles the examples they have encountered,
all with minimal human intervention.
Dr Rune Fisker, senior vice president of product strategy
at the dental scanning and software company 3Shape,
has underscored the significance of deep learning in
AI’s advancement. He noted that deep learning demands
less development effort compared with traditional approaches while delivering significantly higher performance.
The societal and other implications of this are profound, as
it will make computers considerably more intelligent.

The implications for dentistry
But what does this mean for the field of dentistry? The
potential applications of AI in dentistry are vast and transformative. While AI is not a panacea, ignoring its potential
would be a missed opportunity. AI is poised to become
the next evolution in the dental profession, much like how
digital technology revolutionised dentistry by surpassing
the limitations of analogue methods.
In our everyday lives, AI enhances our efficiency, effectiveness and predictability. In North American oral healthcare, these qualities translate into increased profit margins.

AI 2.0 (3Shape) edentulous scan.

Dr Fisker envisions AI-powered (computer-aided) denture
design as not only technically feasible but also inevitable.
The impact of AI extends to various aspects of dental care,
including imaging, diagnostics and eventually design.
3Shape’s current intra-oral scanning technology, called AI 2.0,
uses AI to help identify edentulous soft tissue and delineate
between soft tissue, teeth and other artefacts in the mouth.
Conventional intra-oral scans naturally capture everything
within range of the scanner’s beam, including unhelpful images
of soft tissue irrelevant to the final diagnosis or design of the
final prosthesis. Using AI and deep learning, modern 3Shape
scanners can intelligently differentiate between soft tissue
and other, more important, intra-oral information. 3Shape’s
scanning software automatically and instantly deletes this
soft-tissue information, producing a cleaner, more useful final
digital record of a patient’s intra-oral situation.
Before the company’s AI-powered technology was developed,
technicians and clinicians needed to manually annotate
the unwanted soft tissue and tongue on the initial scanning
output. Over time, 3Shape accumulated a very large set of
these accurately annotated scans, which it then used to
train its deep learning algorithm, effectively teaching it to
do the identification work human annotators had performed
previously.

AI in dental imaging and diagnostics
One of the most promising applications of AI in dentistry is in
dental imaging and diagnostics. Traditional dental radiographs

AI dentistry
1 2024

[8] =>

| opinion
Enhancing patient care and efficiency

AI-powered Second Opinion software (Pearl; hellopearl.com).

have long been indispensable tools for diagnosis and treatment planning. However, AI is poised to take this essential
aspect of dental care to new heights.
Several companies are currently developing AI tools capable of
automatically detecting dental conditions by analysing dental
radiographs. Pearl, an American company, gained clearance
from the US Food and Drug Administration for its groundbreaking
software in this area. Pearl’s AI-powered Second Opinion
software has surpassed human accuracy in detecting signs
of pathologies and common dental conditions in radiographs.
It even excels at identifying issues that may be challenging
for human dentists, such as incipient caries or early signs of
periapical radiolucency. Pearl’s approach is akin to providing dentists with a second set of eyes. This paradigm shift in
dental diagnostics augments the capabilities of dental professionals, offering them invaluable insights that may have been
overlooked owing to human fatigue or error.

AI can be used to improve patient scheduling software.

08 AI dentistry
1 2024

AI’s influence extends beyond diagnostics; it has the
potential to optimise patient care and streamline dental
practices. Efficient patient scheduling is vital for maximising chair time utilisation, reducing patient waiting
times and optimising resource allocation. AI can determine
optimal staffing levels based on expected patient loads,
minimising over- or understaffing issues. It can analyse
patient histories to schedule appointments effectively,
ensuring that facilities are neither under-utilised nor overbooked. Algorithms can calculate appointment duration, accommodate patient preferences for appointment
times and healthcare providers, monitor real-time patient
flow and adjust appointment schedules accordingly.
Moreover, AI can send automated reminders to patients,
enabling them to reschedule or cancel appointments
online, thereby reducing no-shows. By historically predicting which patients are more likely to miss appointments,
facilities can proactively overbook or send reminders to
improve attendance rates.

The future of AI in dentistry
The future of AI in dentistry holds immense promise.
AI will be seamlessly integrated into practice management
software, providing second opinions and aiding in treatment
planning. Advancements in CBCT technology will offer
unparalleled insights into anatomical structures, improving
surgical interventions and implant placement.
Furthermore, AI will revolutionise the design of digital
dentures, automating processes that were once performed
manually. Currently, CAD technicians manually mark char-

[9] =>

opinion

AI can assist in the design of surgical guides for implant placement.

acteristic points and the outer boundaries of dentures.
With AI, these processes can be automated using deep
learning and extensive data sets. While this intervention
may not revolutionise dentistry, it will significantly reduce
the time required in denture laboratories, making the
design process more efficient.

than completely automating our workflows, it is essential
to leverage AI as a powerful tool while dedicating time to
validating AI-generated recommendations. This approach
not only saves time but also enhances the quality of
patient care, ultimately improving the lives of both patients
and dental professionals.

Dr Fisker envisions a future in which patients can instantly view accurately generated digital simulations
of their final dentures and laboratories can produce
3D-printed dentures within hours. In this future, AI will
substantially reduce barriers to access, enhancing the
patient experience. This outcome is not just theoretically
feasible; it is highly likely to become a reality in the
foreseeable future.

about

The role of AI in denture design
To delve deeper into the potential of AI in denture design,
it is crucial to understand the underlying principles.
Mathematical equations and discrete anatomical landmarks already exist to delineate essential denture design
factors such as tooth position, tooth size, tooth shape
and gingival contours. AI has the potential to automate
a significant portion of the design process by relying on
established philosophies, principles, physics, anatomy
and physiology that have been instrumental in dentistry
for decades.

Conclusion
In conclusion, AI in dentistry empowers us to be more
predictable, effective and precise in our practice. Rather

Eric Kukucka graduated with a
diploma of denturism from George
Brown College in Toronto in Canada.
He is vice president of clinical removable
prosthetics and design technologies
at dental service organisation Aspen
Dental Management, where he is
responsible for the efficacy involved in
the delivery of care concerning removable
prosthodontics. He is an active researcher, educator, author and
key opinion leader who has helped develop protocols, processes
and materials used by practising clinicians around the world.
In 2019, Kukucka became the 32nd person in the world to be
certified as a global instructor of Dr Jiro Abe’s Suction Effective
Mandibular Complete Dentures methodology. He collaborated on
the development of monolithic milled digital denture technology
with Ivoclar and of intra-oral scanning strategies for digitising
dentures. He co-developed the reference denture scanning
strategy with 3Shape and in 2021 became the first denturist
appointed to its global corporate advisory board. He is also a
member of SprintRay’s clinical advisory board and a faculty
member of the Digital Dentistry Institute. Kukucka co-authored
The Digital Removable Metamorphosis (Quintessence Publishing, 2024).

AI dentistry
1 2024

[10] =>

| opinion

Artificial intelligence: A gift to dentists
Dr Kyle Stanley, USA
The May 2019 edition of
The Atlantic magazine contained
an article titled “The truth about
dentistry”. In it, the author visualised dentists—not a particular
dentist but dentists in the
abstract—as sinister authority
figures looming over the helpless patient’s recumbent form,
drill in hand. Mistrust permeated
the scene like swamp fog.
“When he points at spectral
smudges on an X-ray,” the
author pleads, “how are we to
know what’s true?”
Then there was the Dustin Hoffman
film Marathon Man with its
Nazi dentist-cum-torturer, and
the famous—or, if you’re a dentist, notorious—1997 Reader’s
Digest article by a writer who
visited 50 dentists in 28 states,
picking them at random out
Dr Kyle Stanley
of the Yellow Pages, and was
given treatment plans ranging
in cost from under US$500 to nearly US$30,000. That one
really hit a nerve, so to speak.
Dentists have had their share of bad rap, but still, the
experience of the Reader’s Digest writer was probably
not terribly far from the truth. It was borne out, with eerie
accuracy, by a 2021 Dental AI Council study intended to
quantify the suspected inconsistencies in dental diagnosis and treatment. The same set of full-mouth radiographs
was presented to 136 dentists, and they were asked to
provide tooth-by-tooth diagnoses and a treatment plan.
A person with confidence in the scientific basis of dentistry
might naturally expect a limited amount of diversity among
the responses and would assume that the commonalities
would far outweigh the differences. Not so. Not once did
more than half of the participants agree about the diagnosis for a given tooth. The variety of estimated costs
was almost comical, ranging from US$300 to US$36,000—
figures strikingly similar to those cited by the Reader’s Digest
author. Worse, the range of cost estimates did not present as a bell curve, the majority of responses clustered
together and only a few outliers at the extremes. Instead,
the distribution was more or less flat; the frequency of a
cost estimate of US$1,000 was about the same as that of
a cost estimate of US$10,000.

10 AI dentistry
1 2024

Other studies have found
that dentists’ interpretation of
radiographs—the very foundation of diagnosis—was far
from reliable. Estimates of
cavity depth and recognition
of radiolucencies were wrong
as often as they were right. In
another study, three dentists
examined several thousand
radiographs; their interpretations were in full agreement
only 4% of the time.

Houston,
we have a problem
How should we account for this
lack of precision in a medical
field? Is it due to dishonesty?
To greed? To variations in skill?
To honest differences of opinion?
Whatever the reason, it gives
dentistry a bad name. But there
is a remedy. It comes in the form
of a powerful new technology
that is already transforming many aspects of our lives:
artificial intelligence, or AI for short.
AI is an umbrella term covering a wide range of computing
techniques. They range from “general AI”—intelligence
indistinguishable from that of a human being, in all circumstances—to “narrow AI”, specialised programs whose
expertise is limited to a par ticular class of problem. Most
make use of a programming technique called a “neural
network” by loose analogy to the structure of the human
brain, and all have in common the property of trainability.
They learn by taking in vast amounts of data of a certain
type—say, photographs of faces or samples of text—and
extracting commonalities. Once trained, an AI program can
pick out a particular face in a crowd or write an essay or a
love poem as well as or better than you can.
General AI is the darling of science fiction writers, but
is very far from realisation. No AI system has anything
like the broad knowledge of all aspects of the world
that a human being has, and so, for the time being at
least, we do not have to worry about being taken over by
independent-minded and malevolent robots like the notorious
HAL of 2001: A Space Odyssey. Even the comparatively
limited task of safely operating a car in an urban environment

[11] =>

opinion

Narrow AIs, however, already easily match or surpass human abilities, and they have become the tools of choice
for performing many exacting tasks. Many of these involve
computer vision, the analysis and recognition of objects
or imagery. More than a decade ago, it was found that a
trained AI could recognise and categorise nodules in radiographs of cancer patients’ lungs as accurately as a panel
of oncologists could, and much faster. Computer vision
and AI are now familiar parts of the oncological toolkit, and
they are being applied to a widening array of medical fields.
One of those is dentistry.
Dentists are in an excellent position to take full advantage
of AI. There exists, to start with, a virtually limitless supply
of dental radiographs for training. The radiographic image is
the coin of the realm in dentistry; patients are accustomed
to having their pathologies explained to them with reference to
the “spectral smudges on an X-ray” evoked by The Atlantic’s
reporter. The range of pathologies to be detected is relatively narrow, and the AI program can not only identify them
but also quantify them with greater than human precision.
The dental radiograph is, therefore, an ideal application
for the sharp focus of narrow AI.
The second opinion—so to speak—provided by an AI program
is directly valuable to the practitioner. The computer is
hypersensitive to subtle greyscale gradations; it may detect
something the human reader has overlooked. More importantly, it is never tired, distracted or rushed and so is not
prone to the types of mistakes and oversights that people
routinely make simply because they are human. The AI program
may in many cases simply duplicate the perceptions of the
human, in which case nothing is gained but confirmation,
but it may add information overlooked by the human or
differ in its interpretation, leading to a re-examination and
re-evaluation of the evidence.
Even if these benefits may seem minor to an experienced
practitioner confident in his or her abilities, there is another
side of the AI experience to consider: the patient’s. The
results of the AI program’s analysis are presented to the
patient in vivid, intuitively understandable form. The radiograph
no longer consists merely of spectral smudges, but has
become graphically compelling, having highlighted areas,
colour-coded outlines and explanatory labels. For a patient,
the enhanced display conveys a heightened sense of precision, clarity and objectivity. The diagnosis is no longer just
the opinion of one person, whom a cynic might suspect of
ulterior motives. It need not be taken on faith; it is supported
by the unbiased authority of a digital computer.
While the graphic presentation of a computed analysis may
impress a patient as something more than human, the practitioner should be aware that the AI program is an assistant,

not a supervisor. Even though the accuracy of AI’s radiographic analyses in various medical fields has been shown
to be indistinguishable from that of human interpreters, the
AI program actually knows much less about teeth (or lungs
or livers) than the trained and experienced practitioner does.
What it does know, and knows very well, is how a large
number of specialists have interpreted a very large number
of radiographs. Its findings are, in effect, those that hundreds
or thousands of dentists would make if they were to vote
on the content of a given radiograph. Where there is not
unanimous agreement, majority opinion prevails, or findings
are presented in terms of probabilities. The practitioner using
the AI program remains entirely free to form a different opinion
or to disregard the advice the program gives, but has the
benefit of knowing what a large group of peers would have
made of the radiograph in question.
The most significant impact of dental AI, however, is not that it
necessarily brings a superhuman level of certainty to the data
upon which diagnoses are based—although in most cases it
may—but that it provides, for the first time, an objective and universally accessible standard of reference. Objective standards
are precisely the thing that dentistry has lacked in the past, and
their absence has given rise to suspicions about the candour
and consistency of dental diagnoses. Look at the Reader’s
Digest writer: guided only by a phone book, he collected a
bewilderingly large variety of diagnoses. If he had visited only
dental offices using an AI assistant, he would have been given
a much smaller variety, and the differences would have been
due to small variations among the radiographs made by different practices rather than to the whims of individual dentists
or the immediate financial needs besetting them.
Consistency is not the only thing AI brings to dentistry.
It also provides support for insurance claims and facilitates
record-keeping, tracking of patients’ dental health and comparison of performance among multiple practices in an organisation. It trains dentists at the same time as dentists train it.
In the future, it may reveal connections between dental health
and general health that we do not now suspect.
Those are some of the collateral benefits. Above all, however,
AI will give patients the reassurance of knowing that the
condition of their teeth is not merely a matter of opinion.

Editorial note: This article was first published in digital—
international magazine of digital dentistry, Vol. 4, Issue 1/2023.

about

has not yet been mastered, despite years of effort and
oceans of investment.

Dr Kyle Stanley is a specialist in implantology and a
passionate advocate for mental health in the dental profession.
He is founder and chief clinical officer of Pearl, a company
transforming patient care through artificial intelligence.
Dr Stanley maintains a private practice in Beverly Hills in the
US, where he focuses on implant surgery and prosthetics.

AI dentistry
1 2024

[12] =>

| interview

“AI’s primary function is to bolster
human skills, not to overshadow them”
An interview with Dr Hanyao Huang
By Anisha Hall Hoppe, Dental Tribune International

The journey of AI in dentistry has been progressive.
Traditional AI applications, like computer vision, have
been instrumental in enhancing diagnostic precision.
These systems primarily revolved around data extraction,
and the decision-making was largely reliant on human
expertise. However, the advent of large language models
(LLMs) like ChatGPT has ushered in a paradigm shift.
Instead of just processing and presenting data, LLMs
facilitate dynamic conversations, tapping into vast reservoirs of human knowledge across multiple sources.
This not only aids in information dissemination, but
also fosters a more interactive and holistic approach to
problem-solving, bridging the gap between raw data and
human-centred decision-making in the dental domain.
Now, many studies that were previously deemed
infeasible can actually be carried out.

Dr Hanyao Huang.

Artificial intelligence (AI) presents dental clinicians with
a multitude of helpful aids, and researchers are continually
expanding the capabilities that AI can offer a busy clinic.
Dental Tribune International spoke with Dr Hanyao Huang,
a researcher in the Department of Oral and Maxillofacial
Surgery at West China Hospital of Stomatology at
Sichuan University in Chengdu in China, regarding his
research into the application of AI in dentistry.
Dr Huang, could you kindly share with our readers your
motivations for researching ChatGPT’s application
in dentistry and explain why you feel they should be
excited about using AI in their practice and in the
field of dentistry?

12 AI dentistry
1 2024

Your study elaborated on how AI and LLMs are
becoming more valuable in medical and dental
diagnostics. In the study, you also provided a
really clear example of how to use ChatGPT in
a manner that effectively creates a consultation
on treatment options. What tips would you offer
to a dentist who wants to try out natural language
reasoning (NLR)?
Computer vision techniques in dentistry primarily focus
on analysing images from CBCT and radiographs to
detect dental issues and assist in surgery, offering quantitative insights from radiographs and real-time imaging.
We utilise it in order to decide what to do next. In contrast,
LLMs like ChatGPT, while not processing images directly,
excel in understanding and generating text, which aids in
patient interactions, research and education. Integrating
both can provide a holistic approach, in which after
image analysis, LLMs can generate detailed reports or
explanations, combining the strengths of both visual data
extraction and textual understanding. Inexperienced
dentists may be unaware of certain information, and they
can be assisted by LLMs and NLR. However, as this
technique is still under development, dentists cannot rely
on it fully at present. LLMs can gather abundant data,
but the sources are not all reliable. Further studies should
be undertaken that focus on sorting and evaluating the
authority of the available data.

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interview

A visual question answering example framework with the assistance of an image encoder, which generates a natural language representation from a radiograph.
(Image: © 2023 Huang et al., licensed under CC BY 4.0)

You provided an example of using NLR to help dentists
lower the likelihood of potential adverse drug reactions
in relation to dental procedures and other drugs.
Could you describe what it might look like when a
dentist chooses to use ChatGPT or other forms of
AI to make their practice and treatments as effective
as possible?
It would be very effective. Of course, as I mentioned
in the last question, strict and proper data sorting is
extremely important before this application. After that, for
dentists, LLMs will help provide a more careful approach
to treatment and help decrease the incidence of complications. For example, after the patient has described
the chief complaint, medical history, history of allergies,
medication history and diet history should be assessed,
and this could be done with LLMs like ChatGPT. Then the
programs can identify the more critical points or risk factors and better prepare the treatment plan. This would be
especially helpful for young and inexperienced dentists.
One of the major roles of AI in a clinic is visual data
generation and analysis, but the idea of a program
being a better diagnostician than a human makes
some clinicians wary that they could be out of a job.
What reassurances would you offer someone who
has heard rumours about AI in the medical setting?
The incorporation of AI in medical settings, particularly
in clinics, marks a significant shift. However, it is crucial to view AI as an enhancer rather than a substitute.
AI’s primary function is to bolster human skills, not to overshadow them. AI excels at swiftly processing vast amounts
of data and pinpointing patterns that might elude human

observation, yet clinicians should have the final say. Even
though AI can sift through data and propose diagnoses,
many medical choices demand a comprehensive grasp
of the patient’s background and other relevant details.
AI supplies data, but intricate decisions typically hinge on
human discernment. The introduction of AI in clinics paves
the way for ongoing education. Medical professionals
can harness AI to keep abreast of current studies, unique
cases and emerging methodologies. In the same way that
technology has reshaped various professions, the role of
medical practitioners may also adapt with AI’s inclusion.
This evolution does not signify job elimination but rather
a realignment of duties, fostering enhanced patient care.
To sum up, AI holds immense promise in refining diagnostic
precision and speed, but it does not supplant human
medical professionals. When utilised aptly, it can amplify
human potential and improve healthcare results.
Could you please tell our readers something more
about your study or about other ongoing projects
you are excited about?
We are embarking on an ambitious project to fine-tune
an offline LLM with knowledge curated from guidebooks across all specialties. Our goal is to create a more
accurate and context-aware chatbot tool that can assist
in various domains. We encourage all researchers and
clinicians to join this work.
Editorial note: The study, titled “ChatGPT for shaping
the future of dentistry: The potential of multi-modal large
language model”, was published online on 28 July 2023
in the International Journal of Oral Science.

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| interview

Although artificial intelligence has immeasurable potential for changing medicine, it is still a tool in training according to expert research.

Potential of AI as an assistant
in oral surgery considering
accuracy and legal aspects
An interview with Prof. Víctor Díaz-Flores García
By Anisha Hall Hoppe, Dental Tribune International

In many areas of the world, the population growth has
outpaced the availability of clinicians, prolonging waiting
times and placing greater demands on already full
clinical schedules. Dental Tribune International spoke with
Prof. Víctor Díaz-Flores García, an endodontist who also
holds a law degree, about his research which indicates that
artificial intelligence (AI) may be heralded as a technological
hero to the rescue.
Prof. Díaz-Flores García, what is the focus of your
research group at the European University of Madrid?

14 AI dentistry
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I, along with my co-workers Yolanda Freire Ana Suarez and
Margarita Gómez Sánchez, am a part of the Transformative
Research in AI and New Enhancements for Dentistry, or
TRAINED, group. We are exploring the possibilities of AI in
the field of dentistry, focusing particularly on patient safety.
The emergence of AI in the field of medicine as a whole is overwhelming, and it is necessary to study and understand how it can
be useful not only for clinicians but more importantly for patients
and the general population. Our group has published other papers
on this topic, and our aim is to continue working in this area.

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interview

a valuable tool. As a working group, we have observed
that there are protocols of great clinical value that can
be very useful both for general dentists and for those
who specialise in a particular field, so it is essential to
have a tool that directly provides accurate information
to questions posed to it.
For clinicians just learning about AI in dentistry,
what would be some very basic principles for them
to know to better understand the impact of research
like yours?
As I indicated before, it is important to be aware of the
limitations that text generation systems such as ChatGPT
currently have in the sense that not all the information
provided is accurate. This is the key point that a clinician
needs to be aware of today. Nowadays, there are tools to
train AI systems ourselves so that the information provided
is adequate for the purpose for which it is consulted,
but this should not preclude the dental professional
being up to date scientifically speaking, such as by attending
congresses and courses to keep up to date and reading
relevant scientific literature.

Were there any aspects of your findings that were
unexpected? What do you feel are the key takeaways
of your research as they apply to AI in dentistry going
forward?
The use of ChatGPT, or any other app that uses large
language models, must currently be understood as a tool
in its infancy. Not all the information given to us is correct,
so it is necessary to train the system to give increasingly
correct answers. In the studies we have carried out with
ChatGPT, we have seen a promising consistency in the
responses to clinical protocols, but this must always be
checked by the health professional when using these
tools as a basis for diagnosis or treatment. It is obvious
that in the near future these tools will be present in our
daily treatment, but today we must understand that they
are untrained systems that must be taken into account in
their proper measure when making clinical decisions.
Your team’s publication indicated that AI could become an incredibly reliable assistant in oral surgery,
particularly in areas of the world where dental specialisations are not yet recognised. What inspired
you as researchers to explore AI’s capabilities in this
direction?
Access to information is essential for decision-making.
The availability of up-to-date protocols of clinical actions
is a benefit for the patient and can avoid safety problems in many aspects (use of medicines, application of certain materials, etc). An AI program trained by professionals specialised in a specific branch of dentistry would be

Because large language models and really all AI programs
rely on big data, what encouragement would you offer
clinicians concerned about data usage?
States and international organisations are taking action
through specific legislation in this area. As a group based
in the EU, we are closely monitoring this legislation.
Particular attention must be paid to the use of patients’
personal data when training an AI, as this data is sensitive
and we could potentially be in breach of data protection
laws and face serious legal consequences. Patients
should also be aware of these issues and take care to
avoid exposing their data to apps or systems that have
nothing to do with genuine medical assistance, especially
those that aim to commercialise such data.

Editorial note: The study, titled “Beyond the scalpel:
Assessing ChatGPT’s potential as an auxiliary intelligent
virtual assistant in oral surgery”, was published for the
December 2024 issue (in progress) of Computational
and Structural Biotechnology Journal.

about
Prof. Víctor Díaz-Flores García
holds a PhD in dentistry, an MS in
advanced endodontics and a bachelor’s
degree in law. He is professor of dentistry
at the European University of Madrid in
Spain, where he is part of the research
group Transformative Research in
AI and New Enhancements for Dentistry.

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| AI research

Researchers use generative
artificial intelligence to design
realistic dental crowns
By Iveta Ramonaite, Dental Tribune International

CAD/CAM technology has greatly improved the productivity of dental prostheses but still has its drawbacks
when it comes to the design of crowns. Using an artificial intelligence (AI) learning method, researchers from
the Faculty of Dentistry at the University of Hong Kong
have created an algorithm for personalised dental crown
design of high accuracy to produce crowns that resemble
the morphology and biomechanics of natural teeth.
According to the researchers, the CAD/CAM workflow
has significantly improved dentistry, but is still labourintensive and time-consuming, particularly because
of the need for customisation for each patient, despite
CAD software using a tooth library to assist in generating prosthetic designs, and it generates health and environmental hazards during the 3D-printing and milling processes.
CAD/CAM remakes are often necessary because of marginal misfits, and design can affect the biomechanical
performance and thus the fatigue lifetime of the crown.
For this reason, a means of crown design that addresses
these issues is needed.

In the study, the researchers trained the algorithm
on 600 sets of digital casts of mandibular second
premolars and their adjacent and antagonist teeth and
tested it on an additional 12 sets of data to generate
12 crowns. They then compared the natural second
premolars with the designs created by their algorithm,
using CEREC software and by a technician using a
CAD program. They looked at morphological parameters of 3D similarity, cusp angle, and number and
area of occlusal contact points. They also subjected
the designs realised on computer in lithium disilicate to
biomechanical fatigue simulations based on physiological
occlusal force.
“During the training process, natural teeth morphological
features were learned by the algorithm, so that it can
design dental crowns comparable to a natural tooth—
both morphologically and functionally,” lead author
Dr Hao Ding, a postdoctoral fellow in applied oral
sciences and community dental care at the university,
said in a press release.

Fig. 1: Project co-investigator Dr Hao Ding and the design of a tooth crown using generative AI.
1

[17] =>

AI research

2
3
Fig. 2: Researchers make use of generative AI to design personalised dental crowns. Fig. 3: Natural tooth (left) compared with tooth tailored by generative AI (right).

The generative AI-designed crowns had the lowest
3D discrepancy, closest cusp angle and similar occlusal
contacts compared with natural teeth. In lithium silicate,
the AI-designed crowns were found to have an expected
lifespan similar to that of natural teeth. According to the
researchers, the other two methods of designing dental
crowns produced crowns that were either too large or
too thin and failed to reach the same lifespan as that of
natural teeth.
“This demonstrates that [the algorithm] could be utilised
to design personalised dental crowns with high accuracy
that can not only mimic both the morphology and biomechanics of natural teeth, but also operate without any
additional human fine-tuning, thus saving additional costs
in the production process,” added senior researcher
Dr James Tsoi, an associate professor in dental materials
science at the university.

“Many AI approaches design a ‘lookalike’ product,
but I believe this is the first project that functionalises
data-driven AI into real dental application. We hope this
smart manufacturing technology will be the stepping
stone for driving Industry 4.0 in dentistry, which is vital to
meet the challenges of an ageing society and lack of
dental personnel in Hong Kong,” Dr Tsoi stated.
Clinical trials for using the generative AI for dental crowns
are underway. Additionally, the researchers are working
to expand the applicability of the tool to other dental prostheses, such as partial and complete dentures.

Editorial note: The study, titled “Morphology and
mechanical performance of dental crown designed by
3D-DCGAN”, was published online in the March 2023
issue of Dental Materials.

Fig. 4: The HKU Dental Materials Science research team: (from left) co-investigator postdoctoral fellow Dr Hao Ding, principal investigator Dr James Kit Hon Tsoi,
and PhD candidate Ms Yanning Chen.
4

[18] =>

| AI research

AI may assist in dental
implant surgery,
localising mandibular canals
Franziska Beier, Dental Tribune International

Studies have shown that artificial intelligence (AI) can
recognise structural patterns in medical imaging data.
However, in dental and maxillofacial radiology, only a
few studies have used AI to locate mandibular canals.
Knowing their exact location is a prerequisite for dental
implant planning. Until now, dental professionals have
had to examine radiographs to locate the mandibular
canal, a potentially complex and time-intensive process. A recent study from Finland has now tested the
use of an AI-based model for this purpose and found
that it locates canals in 3D radiographs quickly and
precisely.
Localisation of the canal in CBCT images is complicated
by anatomical variations in the course and shape of the
canal according to individual and ethnicity. To avoid compression or other surgical complications, a safety margin
of 2 mm above the mandibular canal is recommended

in implantology. Precise knowledge of canal position is
also important for various other oral and maxillofacial
surgical procedures, such as jaw surgery or removal of
third molars.
Researchers from Aalto University in Espoo, Planmeca
and the Finnish Center for Artificial Intelligence (FCAI)
developed a deep learning system and trained it
with 3D images rendered with CBCT. The database
consisted of images from five different CBCT scanners
from four vendors and patient cohorts of two ethnicities;
869 Finnish patients (79%) and 234 Thai patients
(21%).
The performance of the deep learning system was
clinically evaluated by comparing its results with those
of four experienced dental and maxillofacial radiologists. The model accurately segmented the man-

Researchers in Finland have created an artificial intelligence-based model that locates the mandibular canals quickly and precisely. (Image © Alex Mit/Shutterstock.com)

18 AI dentistry
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[19] =>

AI research

CBCT images showing overlaid expert and deep learning system segmentations. Every image on each column is annotated by the same expert, shown in red,
the deep learning system annotation is shown in green and overlap is shown in yellow. (Image: © 2022 Järnstedt et al., licensed under CC BY 4.0, no changes)

dibular canal and performed better overall than the
radiologists. In addition, it showed promising generalisability with regard to new CBCT scanners and
ethnic groups.
“When a huge amount of data is fed to the neural network
and the location of the mandibular canal is marked in it,
it learns to optimise its own internal parameters. The neural
network resulting from this learning quickly finds the
mandibular canal from the individual 3D data input,” said
co-author Vesa Varjonen, vice president of research and
technology at dental equipment manufacturer Planmeca,
which is based in Helsinki.

Planmeca to integrate the model
in its imaging portfolio
For Planmeca, a Finnish family business and one of the
world’s leading equipment manufacturers in health technology, the collaboration with FCAI and Tampere University
Hospital means significant new business potential.
“Digitality and AI used in imaging equipment are important for us. We will integrate the neural network model
developed in this research into our imaging software.
This will improve the usability and performance of our
equipment,” said Varjonen.

“In clinical assessments, experts went through the results
produced by the model and discovered that in 96%
of the cases they were fully usable in clinical terms.
We are highly confident that the model works well,”
commented co-author Jaakko Sahlsten, a doctoral
researcher at Aalto University.

Model for orthognathic surgery

“The collaboration arose from the needs of experts
practising clinical work and from seeking ways to help
their everyday work. A lot of time can be saved by using
artificial intelligence in patient treatment planning,” said
Varjonen in a press release.

“I see artificial intelligence as a very powerful tool that
physicians and other experts can use when making their first
assessments or to get alternative opinions. The challenge
with deep learning models is that we cannot give definite
grounds as to why the model reaches a specific outcome.
Further research is needed to increase the explainability and
transparency of the models,” concluded Sahlsten.

“Tampere University Hospital provided us with extensive
and versatile clinical materials produced with several
3D-imaging devices. The data was divided at random
and part of it used for training the neural networks and
part of it isolated for testing and validating the designed
method,” said Sahlsten.

In addition, the collaborative research project developed a
neural network model for orthognathic surgery. “The model helps
to identify landmarks in the skull area for correcting malocclusion
and planning jaw alignment surgery,” said Varjonen.

Editorial note: The study, titled “Comparison of deep
learning segmentation and multigrader-annotated mandibular canals of multicenter CBCT scans”, was published
on 3 November 2022 in Scientific Reports.

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© H_Ko/Shutterstock.com

| trends & applications

The missing link
Dr Miguel Stanley, Portugal

I am very passionate about surgery, and my days
are typically taken up with treating complex cases, including those involving 3D bone and soft-tissue reconstruction around dental implants and comprehensive
oral rehabilitation, with my long-time team at the
White Clinic in Lisbon in Portugal, and I am very passionate about connecting systemic health to dental
health. In the past, when people said things like
“Oh you’re not a doctor, you’re just a dentist” to me,
it would made me recoil and actually feel bad about
myself and our beloved profession, and I was not really
sure of how to respond. In recent years, I have come
to understand that there is something more nefarious
in the statement, an us versus them dichotomy that
separates the medical community from the dental
community, and this assumed separateness does not
seem to be questioned or challenged. Have you ever
wondered why there are no dentists in most hospitals
around the world? It is as if there is an invisible barrier
separating the mouth from the rest of the body.

20 AI dentistry
1 2024

The term “dentist” leads to the perception that all we
do is fix teeth, and for example, when we perform a
tooth extraction, the only thing involved in this process
is a tooth going into the rubbish bin, but in reality that
is not the whole truth. At a biological level, every tooth
extraction is bone surgery, and once the tooth has
been extracted, the jawbone, which contains bone
marrow, is instantly exposed to the oral cavity, which
contains saliva with a well-documented microbiome,
and if the patient has undergone numerous dental
treatments, there is a high risk of pathogenic bacteria and fungus in the mouth that will come into contact with healthy bone marrow. No other bone surgeon
in the world would accept such contamination of the
surgical site. Why do we?
If we all know that a dental dam is essential to protect dentine against saliva or, even more importantly,
a root canal against contamination from the pathogens in the saliva, then why do we not use a dental

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trends & applications

What are the long-term consequences of dry socket
at an immune level? Americans spend an estimated
US$3 billion a year on the extraction of ten million
third molars, according to the American Public Health
Association. Dry socket, or post-extraction osteomyelitis, is one of the most common post-surgical
complications in the world, and tooth extraction is
probably the most prevalent surgery in humans, and
it is done by dentists, not doctors. That means that
one of the most common surgeries in the world is
done in a non-sterile environment and is associated
with one of the most common complications. When
you consider it in these terms, the significance of this
becomes obvious.
This is just one of many questions that I have been
asking myself and my peers in the dental community over the past years. Considering the number of
tooth extractions performed, root canal treatment as
a foundational therapy in our armamentarium to save
teeth, implants and all the other incredible tools that
we have to restore function and aesthetics, have we
been overlooking the one thing that connects doctors

“Have you ever wondered why
there are no dentists in most
hospitals around the world?
It is as if there is an invisible
barrier separating the mouth
from the rest of the body.”
to dentists and vice versa—which is immunology?
What are the immunological effects of all of these treatments? And more importantly, how does this affect
our systemic health when they are poorly executed
or contaminated? We all see in our daily practices
many areas of old or outdated treatments that we know
need to be redone, but patients choose not to or even
believe that we are just trying to make more money by
suggesting this. How can we explain to them that this
could be affecting their systemic health, especially in
patients with autoimmune disease or cancer, for which
it is imperative to ensure the lowest amount of systemic
inflammation possible and to have nothing burdening
the immune system.
There are many articles on the relationship between
oral disease and systemic disease, and we have known
for decades that periodontal disease can wreak havoc
on our overall well-being. There is more than enough
robust evidence to show that bacteria in gingivitis and
periodontal disease can enter the bloodstream and
cause a litany of systemic health issues.

dam when we do a tooth extraction? I ask this because
I think that it is far more critical to protect bone marrow
than dentine in terms of our immune system. Well, the
answer is very simple. We cannot! It is simply impossible. However, just because we cannot set up an
appropriate surgical field in order to create a level of a
safety against contamination for tooth extraction, does
that mean we should not delve into the consequences
at an immunological level of saliva contaminating the
socket, which is in fact bone marrow, the core of our
immune system?

[22] =>

| trends & applications
If it is true for gingivitis and periodontal disease, which
are naturally occurring and mostly due to negligence
on the patient’s behalf or a genetic predisposition,
then what does that say for old extraction sites with
residual infected roots or a tooth that underwent root
canal treatment 30 years ago without a dental dam that
now has an associated cyst? I believe we need to ask
more questions, and perhaps this is an opportunity for
the dental community to finally sit at the same table as
doctors with their heads held high because the truth
of the matter is that we know from the literature that
pathogens in periodontal disease cause a broader inflammatory response by means of cytokines entering
the bloodstream and there is mounting evidence that
cytokines pass through the blood–brain barrier, and
this is also true for infected third molars, dental cysts
associated with old or poorly performed root canal
treatments, peri-implant pathologies and even metal
hypersensitivities.

As such, we need to understand how we can improve
our diagnostics and screening to make sure that our
patients are receiving not only a dental check-up but
also an inspection of cytokine-producing low-grade
chronic infections or inflammation in the jawbone that
can be naturally occurring or the result of old, outdated
or poorly executed dental therapies. This is most important for people suffering from autoimmune disease
or cancer, for whom any necessary lifestyle changes
must be made immediately upon diagnosis in order to
dramatically reduce anything that may cause inflammation in the body, such as adopting a low-sugar diet,
quitting smoking and alcohol, implementing means
to avoid or ameliorate stress, and having good sleep.
But what if we could contribute a little bit more to these
patients desperately seeking solutions to improve their
systemic health? How can dentists help these patients?

I believe that we have a unique opportunity in the dental
arena to provide assistance to these patients, but we
need to update our diagnostic tools—many of us are
still only using 2D radiographs as our primary or only
diagnostic tool. Why are we accepting the use of only
radiographs when the rest of the medical industry uses
new technologies, such as MRI, endoscopy, CT scans
and blood panels, when needed? What other tools do
we have to assist and enhance our diagnostic capacities? Why is it that when we do oral surgery we still
only take radiographs and rarely CBCT scans? Why
not perform blood tests as well? The lack of congruence here is huge. A surgery is a surgery, whether performed by a dentist or a doctor. The immune system
sees it the same way; it does not differentiate between
the kneecap and the jawbone. We need to change the
paradigm.
I also think that it is important to start always measuring
vitamin D levels chairside too. We all are well aware
of the robust scientific evidence that shows the importance of optimal vitamin D and K2 levels for bone
remodelling. Bone remodelling is central to periodontal
disease, tooth extraction and implant surgery. Thankfully, there are new affordable chairside tests on the
market that can help instantly measure this, and patient
acceptance is high.
I am sure that many of you reading this article will
have patients who have had cancer or are undergoing
chemotherapy and who have no idea of the clear evidence of jawbone pathologies in and around areas of
old dental treatments. Patients commonly think that
if nothing hurts they are fine. However, at an immunological level, patients who have cancer must really
endeavour to remove all sources of low-grade chronic
inflammation and infection from their bodies to help

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trends & applications

their immune system to fight better. It will enhance all
of the other therapies they are undergoing.
I understand how difficult it is for dentists in the very
first appointment to give a comprehensive diagnosis,
especially if it concerns issues that were not part of the
patient’s primary reason for visiting. Patients too can
be resistant if they perceive that we are selling to them.
Also, some of the issues identified may be the result
of our own work or that of a friend, colleague or peer
in our community, making it incredibly challenging
and even embarrassing to explain this to a patient.
Most of our patients will have had work done elsewhere; this is the norm in dentistry.
In addition, patients often expect all dental treatments,
no matter how long ago they were done, to last a lifetime, and if it does not hurt, then everything is fine, as
if somehow pain is the only or first symptom to appear if
something is wrong. We know that that is not the case.
We also know that lifelong treatments are impossible to
guarantee—the literature and evidence on this are very
solid—and that most treatments have a ten- to 15-year
lifespan, even when we do a good job.
Another factor contributing to the problem is that in
many clinics around the world the time afforded to
dentists in the first visit is not sufficient. I learned this
as the founder of the Slow Dentistry Global Network,
through which we clearly see that most clinics around
the world simply do not have enough time in their daily

workflow for in-depth diagnostics, and to compound
this, often the only technology used is a periapical
radiograph of the tooth being treated and not fullmouth radiographs. This means that the clinician does
not have insight into the teeth overall. I believe that
there is a huge grey area in dentistry today that is due
to a combination of factors, leading to a complete lack
of standardisation or benchmarking in dental and oral
diagnostics.
When a patient goes to the cardiologist for a check-up,
typically, there is a standard protocol and report that
the primary care physician can understand. The same
goes for other specialties. Why is this not standardised
in dentistry? Why do some dentists only look at one
tooth? Some look at just teeth and aesthetics and
others look at everything. How do we improve on this?
Are we not in fact our own worst enemy by not having
a standardised approach to full-mouth diagnostics
to employ for the first-time patient? Perhaps this is
what we need to achieve in order to have a place at the
table of the medical industry, something doctors can
prescribe to their patients that dentists acknowledge
and can fulfil that would provide clear and direct communication between both sides, truly bridging the
divide and benefitting the patient. That is the mandate
of every doctor and dentist.
A few other challenges that dentists have are also
related to the time it takes to explain full-mouth diagnostics and also perhaps to the lack of training that

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[24] =>

| trends & applications

many dentists have in understanding this, because many of
us are focused mostly on teeth and not on immunology—
it is already difficult enough to talk about one tooth, let alone
the whole mouth! Usually, this is the domain of periodontists
as well as oral surgeons, but I think that the entire dental
community and mostly general practitioners have a huge
role to play in changing this paradigm.
With that said, I have recently been developing
artificial intelligence (AI) software called Missing Link
(www.Missinglink.ai) that aims to help bridge the
divide between dentists and doctors. This program
has been using machine learning, based on thousands of panoramic radiographs taken over a long
period and assessed by a team of highly trained dentists. Our AI engineers are some of the best in the
world and have developed a proprietary technology
around this platform. It is quite unique, as it does not
really look at the teeth but at the bone around the
teeth for any evidence of bone loss in the bone marrow that may have been caused by inflammation or
infection, such as a periapical cyst. This is something
easy for any dentist to understand, as it seeks to find
a reduction in the Hounsfield units caused by radiolucency owing to a lack of bone where there should
be bone. This is always present where there is elevated osteoclastic activity, but should not be present
in healthy bone.
So what does the Missing Link AI program search for?
It looks for cysts, impacted teeth, bone loss around
implants and issues in the apical area of treated and
untreated teeth and for artefacts indicating something
that may have been left in the bone after surgery.
Missing Link is not a diagnostic tool or a medical

24 AI dentistry
1 2024

device at this point, but it is a very effective screening
tool that can very quickly and accurately analyse
a panoramic radiograph and give a detailed and
easy-to-understand report highlighting where there
are evident issues in the bone (reduced Hounsfield
units) in the regions described. The report is so easy
to read that even the patient will understand, and
it can also help the patient, via a geolocation service,
to connect with nearby dentists, radiologists, hospitals
or clinics to obtain a CBCT scan. It is important to
understand that only a clinician can actually deliver
the final diagnosis after CBCT evidence and clinical
observation and, if the diagnosis is positive, provide
the necessary treatment to eliminate all sources of bone
infection and inflammation.
This will have immediate effects on the patient’s systemic health by reducing the cytokines produced by
infection and inflammation, improving the patient’s systemic well-being. The clinical evidence on this is strong.
There are so many studies coming out about the direct
correlation between non-communicable diseases and
oral inflammation or infection, so addressing the latter
will have a direct impact on the problem.
Missing Link has been developed to be deployed by
doctors, physicians, cancer experts, hospitals and
insurance companies. With patients’ consent, they can
scan their panoramic radiographs and help patients
to obtain the dental treatment they need in order to
reduce systemic inflammation. Unlike other AI programs
in the dental arena, Missing Link does not look at teeth,
and it does not look for tooth decay or any of the other
problems that most AI technologies do. This is a very
targeted program. Uniquely, it enables a doctor, usually

[25] =>

trends & applications

unaware of the dental world, to prescribe a test to
determine whether the patient has cytokine-producing
inflammation in the jaw. Until now, there has been no
way other than verbal communication for doctors to
know whether their patients have any oral pathologies.
Any general medical practitioner can ask for a cardiologist to check a patient’s heart and can expect an
electrocardiogram at a minimum and the resulting
medical report, and the same goes for investigating
any other organ in the body: some form of image will be
generated and a report from the specialist will be sent
to the general practitioner to provide some answers.
But how does a doctor ask a dentist for a report if dentists
are only looking at teeth and not at these specific
issues and if they lack the right tools or education?
We believe that there is a major blind spot here in healthcare. That is why Missing Link aims to connect doctors
to dentists and offers a tool for the medical community
to understand a little better what we are doing.
Naturally, dentists can also use this software, and it is
very easy to use. It employs advanced anonymising
technology, so if the panoramic radiograph has any
information on it, it will automatically offer to anonymise
it for data protection. Another plus is that it does not
ask for any information other than an e-mail address to
ensure that it knows where to send the report to. There
is no mining of any data whatsoever, which is something
that I understand is a concern to many people.
The engineers on the team are currently developing
the capacity to perform screening and diagnostics on
CBCT scans and are also developing the capacity to
screen full-mouth radiographs, which is the preferred
diagnostic method in the US.
Cancer is on the rise: around 18 million cases of
cancer were diagnosed globally in 2020, according to
World Cancer Research Fund International. Roughly
4% of the world population has some type of autoimmune disease, the National Stem Cell Foundation
has reported—that is 320 million people! We all know
somebody with an autoimmune disease and sadly
many with cancer. It is a battle for these people, and
we owe it to them to provide more answers. I believe
that bridging the divide between doctors and dentists
through technology is the only way to do this, and it
has to be simple, easy and highly focused and that is
exactly what this AI program is. If you know anybody
suffering from an autoimmune disease or cancer, ask them
for a panoramic radiograph, upload it to the platform
and see how the report generated could initiate a very
good discussion and perhaps the beginning of a journey
back to total body health.
Editorial note: This article was first published in digital—
international magazine of digital dentistry, Vol. 4, Issue 4/2023.

“Missing Link has been
developed to be deployed
by doctors, physicians,
cancer experts, hospitals
and insurance companies.”
about
Dr Miguel Stanley is the visionary
founder and clinical director of the well-known
White Clinic in Lisbon in Portugal, where
he transforms and improves the lives of
his patients with his team. His expertise
covers advanced implantology, prosthodontics,
oral surgery, aesthetics, practice management,
new technologies and ethics, encapsulated
in his No Half Smiles treatment philosophy.
He further champions the enhancement of the patient
experience and safety through the Slow Dentistry Global Network,
the Swiss non-profit organisation he co-founded.
Recognised for pioneering clinical implementation of cutting-edge
technologies, he serves as a consultant and key opinion leader for
industry-leading companies and dental societies. He is the vice
president of the Digital Dentistry Society, reflecting his dedication
to advancing the field. Dr Stanley also holds an academic position
at the prestigious University of Pennsylvania in the US and has
delivered over 250 keynote presentations in more than 50 countries.
Dr Stanley, a TEDx speaker and National Geographic documentary
host, was recently listed among the “32 Most Influential People
in Dentistry” by Incisal Edge magazine in the US. Actively
driving innovation, he introduces novel concepts and therapies
at White Clinic, delving into regenerative medicine, longevity,
and the development of biological, integrative and functional
dentistry and medicine. Recently, Dr Stanley co-created Missing
Link, the world’s first artificial intelligence software that helps
the medical community communicate better with dentists by
means of scanning dental radiographs for hidden pathologies
that could be disrupting systemic health.
Explore his insights further through his podcast, Biting into Healthcare,
and delve into his impactful work at miguelstanley.com.

contact
Dr Miguel Stanley
R. Dr. António Loureiro Borges 5 1
Miraflores, 1495-131 Algés, Portugal
www.whiteclinic.pt
www.missinglink.ai

AI dentistry
1 2024

[26] =>

| meetings

Long-awaited Digital Dentistry Show
to premiere in Berlin in June 2024
By Dental Tribune International
Now is an exciting time for dentistry. Technological
innovations lie at the heart of the profession and are
significantly advancing personalised dental care. To provide
a platform to celebrate digital innovations in the field and
educate the dental team, DDS.Berlin is bringing a highly
immersive experience to the capital of Germany—the
Digital Dentistry Show.
Scheduled for 28 and 29 June 2024 at the Arena
Berlin, the event promises to deliver engaging educational and social opportunities with a special
focus on digital products and the digital workflow in
dentistry.
Through live product presentations, workshops, discussion sessions and an exhibition, the 2024 Digital Dentistry
Show seeks to provide attendees with first-hand knowledge of digital dental products and services and to offer
space for personalised advice and face-to-face interactions with industry leaders. With the focus on robust

The 2024 Digital Dentistry Show will offer cutting-edge knowledge and
skills that will help dental professionals better navigate technological advancements in the field. Located in Berlin’s Alt-Treptow inner-city district,
the 6,500 m2 Arena Halle offers high-quality professional infrastructure.
(All images: © Markus Nass)

The Badeschiff is a picturesque floating public swimming pool area overlooking the Spree river.

26

[27] =>

meetings

The Escobar is an extension of the Badeschiff that includes a covered bar area.

research evidence, the scientific programme will feature
presentations by prominent opinion leaders, including
Drs Henriette Lerner, Alessandro Cucchi, Mirela Feraru,
Howard Gluckman, Fabrizia Luongo and Setareh Lavasani,
and cover a wide range of topics, such as artificial intelligence, the digital workflow in maxillofacial surgery and
full-arch rehabilitation, and digital bone surgery. Attendees
will have the opportunity to earn valuable continuing
education credits.
Besides a strong educational aspect, the 2024 Digital
Dentistry Show will serve as a social hub for dental
experts, professional organisations, manufacturers
and publishers who are looking to form or expand
their network of like-minded, future-oriented individuals.

To be hosted at one of Berlin’s industrial pearls, the
unique event location offers a rich history and a distinctive
modern feel.
The adjacent Escobar and the Badeschiff spaces will
enhance the relaxed and jovial atmosphere, underlining
the informal and engaging nature of the show.
The 2024 Digital Dentistry Show is expected to attract over
2,000 eminent dental professionals from around the world.
You are invited to be one of them!
More information on registration and the scientific
programme can be found online at the event’s official
website at dds.berlin.

Attendees will also have access to the Sonnendeck of the Escobar, where they will be able to enjoy delicious food and drinks.

[28] =>

| meetings

CIOSP 2024

ITI World Symposium 2024

24–27 January 2024
São Paulo, Brazil
www.ciosp.com.br/en

9–11 May 2024
Singapore
www.worldsymposium.iti.org

AEEDC 2024

ROOTS SUMMIT

6–8 February 2024
Dubai, UAE
www.aeedc.com

9–12 May 2024
Athens, Greece
www.roots-summit.com/en

159th Chicago Dental Society
Midwinter Meeting

Implant Solutions
World Summit 2024

22–24 February 2024
Chicago, USA
www.cds.org/
midwinter-meeting

13–15 June 2024
Miami, USA
www.dentsplysirona.com/
worldsummit

5th EAS Congress

DDS.Berlin

29 February–2 March 2024
Valencia, Spain
www.eas-aligners.com

28–29 June 2024
Berlin, Germany
www.dds.berlin

exocad Insights 2024

6th MIS Global Conference

9–10 May 2024
Palma de Mallorca, Spain
www.exocad.com/insights2024

12–15 September 2024
Palma de Mallorca, Spain
www.mis-implants.com

28 AI dentistry
1 2024

© 06photo/Shutterstock.com

International events

[29] =>

|
© 32 pixels/Shutterstock.com

submission guidelines

How to send us your work
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Please number images consecutively
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Please place image references in your
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In addition, please note:
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Questions?
Magda Wojtkiewicz
(Managing Editor)
m.wojtkiewicz@dental-tribune.com

AI dentistry
1 2024

29

[30] =>

| international imprint

AI dentistry
international magazine of

artificial intelligence in dentistry

Imprint
Publisher and Chief Executive Officer
Torsten R. Oemus
t.oemus@dental-tribune.com
Editor-in-Chief
Dr Robert A. Gaudin
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Designer
Franziska Schmid
Copy Editors
Sabrina Raaff
Ann-Katrin Paulick

International Administration

International Headquarters

Chief Financial Officer
Dan Wunderlich

Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
Phone: +49 341 48474-302
Fax: +49 341 48474-173

Chief Content Officer
Claudia Duschek
Clinical Editors
Nathalie Schüller
Magda Wojtkiewicz
Editors
Franziska Beier
Jeremy Booth
Anisha Hall Hoppe
Iveta Ramonaite

General requests: info@dental-tribune.com
Sales requests: mediasales@dental-tribune.com
www.dental-tribune.com
Printed by
Silber Druck GmbH & Co. KG
Otto-Hahn-Straße 25
34253 Lohfelden, Germany

Executive Producer
Gernot Meyer
Contributors
Prof. Víctor Díaz-Flores García
Dr Hanyao Huang
Eric Kukucka
Dr Kyle Stanley
Dr Miguel Stanley

Advertising Disposition
Marius Mezger
Art Director
Alexander Jahn

Copyright Regulations
All rights reserved. © 2024 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH is
expressly prohibited.
Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical
errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune
International GmbH.

30 AI dentistry
1 2024

[31] =>

invis is
the future
of orthorestorative
care.

Invisalign Smile Architect ™
Transform the invasive procedures of the past into the minimally invasive
treatments of tomorrow.
Invisalign Smile Architect™ is a first-of-its-kind smile design solution that combines alignment
and restorative planning in a single platform, promoting lasting oral health.

© 2023 INVISALIGN, ITERO and CLINCHECK, among others, are trademarks and/or service marks of Align Technology,
Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. M10765

[32] =>

DYNAMIC DENTISTRY
ANYTIME ANYWHERE FOR ALL

UNIQUE DYNAMIC DIGITAL TWIN

EU-01-24

ACCESS
IOS Scans + 4D Jaw Motion
Movements, reference plans,
dynamic contacts & more

ADVANCED
+ CBCT data
Axiography,
articulator parameters

Read carefully the product leaflet instructions before use.
Professional use only.
Twin In Motion™ is a class IIa medical device and Tech In Motion™ Hardware a class I medical device accessory.
© All rights reserved, 2024

AESTHETIC
+ Facescan data
Picture, face proportions,
OVD shift™

) [page_count] => 32 [pdf_ping_data] => Array ( [page_count] => 32 [format] => PDF [width] => 648 [height] => 895 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => AI dentistry—international magazine of artificial intelligence in dentistry No. 1, 2024 Preview

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Table of contents

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