doi: 10.56294/hl2024.454
ORIGINAL
Application of Artificial Intelligence in Dentistry
Aplicación de la Inteligencia Artificial en Odontología
Nazila Ragimova1, Vugar Abdullayev1 
*, Ayan Mirzoyeva2, Elnare Mirzoyeva3
1Azerbaijan State Oil and Industry University, Computer engineering. Baku, Azerbaijan.
2Suleyman Demiral University, Faculty of Dentistry. Turkey.
3Azerbaijan State Academy of Physical Education and Sport. Baku, Azerbaijan.
Cite as: Ragimova N, Abdullayev V, Mirzoyeva A, Mirzoyeva E. Application of Artificial Intelligence in Dentistry. Health Leadership and Quality of Life. 2024; 3:.454. https://doi.org/10.56294/hl2024.454
Submitted: 04-03-2024 Revised: 31-07-2024 Accepted: 16-11-2024 Published: 17-11-2024
Editor:
PhD.
Prof. Neela Satheesh
Corresponding Author: Vugar Abdullayev *
ABSTRACT
Dentistry is one of the youngest medical applications of artificial intelligence. Here, artificial intelligence and its various components (machine learning, deep learning, neural networks) are applied at a number of stages, such as diagnosis, decision-making, treatment planning, and prediction.
Dental radiology, maxillofacial surgery, orthopedic dentistry is some of the application areas of artificial intelligence in dentistry. Despite some advantages, there are a number of problems (security, legal and ethical problems during decision-making, etc.). Their solution is also related to the development of artificial intelligence application. This updates and improves its future application directions.
In the article, the application, management, advantages, application problems, and future directions of artificial intelligence in dentistry are mentioned.
Keywords: Dentistry; Artificial Intelligence; Machine Learning; Advantages; Challenges.
RESUMEN
La odontología es una de las aplicaciones médicas más jóvenes de la inteligencia artificial. Aquí, la inteligencia artificial y sus diversos componentes (aprendizaje automático, aprendizaje profundo, redes neuronales) se aplican en varias etapas, como el diagnóstico, la toma de decisiones, la planificación del tratamiento y la predicción.
La radiología dental, la cirugía maxilofacial y la odontología ortopédica son algunas de las áreas de aplicación de la inteligencia artificial en odontología. A pesar de algunas ventajas, existen una serie de problemas (seguridad, problemas legales y éticos durante la toma de decisiones, etc.). Su solución también está relacionada con el desarrollo de la aplicación de la inteligencia artificial. Esto actualiza y mejora sus futuras direcciones de aplicación.
En el artículo, se mencionan la aplicación, la gestión, las ventajas, los problemas de aplicación y las futuras direcciones de la inteligencia artificial en odontología.
Palabras clave: Odontología; Inteligencia Artificial; Aprendizaje Automático; Ventajas; Desafíos.
INTRODUCTION
The field of application of artificial intelligence is quite wide. With the introduction of physical use in the manufacturing sector, the introduction of intelligent robots has confirmed the idea that artificial intelligence is one of the main aids to the human workforce. On the other hand, artificial intelligence, which is not limited to the cyber environment, has also begun to be applied to human-centered fields. One of them and the most important is the field of medicine.
The medical sector is a human-centered field and encompasses many sub-fields. One of them is dentistry, and the impact of artificial intelligence has not escaped this sector.
It is normal for an experienced dentist to be skeptical about the prospect of robot doctors in the future. Artificial intelligence essentially uses computer technology to mimic human critical thinking, decision-making, and intelligent behavior.
Artificial intelligence (AI) is the technology that enables robots to perform tasks that were considered the prerogative of humans just a few decades ago. Automation has become so firmly embedded in our lives that sometimes we don't even realize how we interact with machines. Planning a route on Yandex maps, allocating time for exercise on the website of a fitness club, finding out the comfortable size of your financial cushion in a banking application - these are just a few examples of how robotic algorithms work at the everyday level. However, the possibilities of AI are much broader. Artificial intelligence, when applied to the field of dentistry, helps to achieve more accurate diagnosis of diseases and improve the treatment of patients. To understand the integration of Artificial Intelligence and dentistry, we can first outline some concepts that a dentist should know about artificial intelligence and machine learning.
Artificial Intelligence components and application in dentistry
The main component of artificial intelligence technology is a neural network. His device mimics the cognitive abilities of the human brain, acting as an information processing system. In the early stages of artificial intelligence, it was necessary to manually configure the software to solve each specific problem. Today, medicine and other fields use a branch of artificial intelligence called machine learning.
Machine learning involves learning to perform tasks with artificial intelligence without prior knowledge or rules. Instead, the system identifies patterns in patterns from large datasets, adjusting configurable parameters to produce the correct response. As a result, the algorithm identifies patterns that can later be applied to new tasks.
We can summarize the general description of the application of Artificial Intelligence in dentistry as shown below (figure 1).
Figure 1. Artificial Intelligence and dentistry
Basically, artificial intelligence systems can be used for the timely treatment of a widespread disease such as dental caries. As a rule, the latter is diagnosed during a visual or X-ray examination. However, if the carious process develops not on the chewing surfaces, but between the teeth (called contact caries), it is much more difficult to detect. Image interpretation in dental radiology is currently one of the most visible applications of AI in clinical dentistry. The most common pathologies such as caries or apical lesions, periodontal bone loss, cysts or bone fractures are detected by AI in 2D and increasingly 3D images. Similarly, landmark identification in cephalometric radiographs is a typical task where AI can assist dentists.(1,2,3) Current AI-assisted interpretation of radiographs is as accurate, or in some cases more accurate, than practitioner interpretation. In addition, it saves time for evaluation and facilitates the creation of comprehensive and systematic reports.(1) Often, patients consult a doctor too late when tooth cracks appear. This significantly complicates the treatment - instead of a filling, you have to put a crown or completely remove the diseased tooth by replacing it with an implant. Meanwhile, research shows that artificial intelligence is not only able to detect contact caries at an early stage - it can do it much faster than a human.
Treatment planning, as the term suggests, is the planning of the management of a patient's dental and oral problems in a systematic and orderly manner that involves full knowledge of the patient's needs, the exact nature of the problems, and the prognosis of possible management options. is considered. In the case of simple dental problems, the dentist can effectively identify the problem, characterize it along with the patient's needs, and quickly choose the right management option. In the case of complex dental problems, it can be rare for both patient and dentist to develop a complete picture of the problems and consequences of restorative options before the first consultation. The dentist must assess the problems correctly and also gauge the patient's attitude, motivation and compliance. The assessment phase (building a more complete picture of the problem(s) and patient compliance) therefore often overlaps with the decision-making, treatment planning, and delivery phases.(4)
In the decision-making process, Artificial Intelligence can mainly help doctors in building decision support systems in choosing which treatment method is intended for a patient based on the results obtained from the available analysis. On the other hand, there are some problems here.
The ethical and legal issues surrounding AI in dentistry are significant and multifaceted. Determining who is responsible for errors or adverse outcomes related to AI-generated decisions is a major concern. Legal frameworks should address responsibility and accountability in the use of AI tools. Ensuring transparency in AI algorithms is critical to building trust between dentists and patients. Black-box AI models, whose decision-making processes cannot be easily interpreted, pose challenges for clinical acceptance and regulatory approval. AI systems must be designed and tested to avoid biases that may lead to inequities in dental care.(5)
Second, artificial intelligence technologies can be used to modernize medical equipment. One of the latest innovations in this direction is the voice-controlled dental chair. This model runs on an Arduino processor and converts voice commands into software code and drives the chair to move. Bluetooth technology is used for data transmission. Some developers argue that dentists won't need assistants anytime soon; After all, a chair equipped with "arms" and sensors that monitor the main vital signs is able to replace several assistants.(6,7,8)
Finally, one of the most "creative" applications of AI is in the field of bioprinting. This is a technology for creating three-dimensional 3D models based on cells. Thanks to it, it is possible to reproduce living tissues or even whole organs in successive thin layers of cells. In dentistry, bioprinting is used to regenerate oral tissue.
Artificial Intelligence-based management in dentistry
The field of artificial intelligence-based learning systems has evolved significantly since its inception in the 1980s. Today, artificial intelligence is often used to “play out” scenarios that simulate clinical work and minimize the dangers associated with training on real patients. Various studies have shown that with the help of automated systems, students learn the material faster, because the interactive process creates a high-quality learning environment.(9,10,11,12)
Patient management based on artificial intelligence
Virtual assistants for a dental clinic based on artificial intelligence can perform several tasks simultaneously with greater accuracy and fewer errors. For example:
· Patient registration.
· Sending reminders about the patient's right to choose a doctor or doctor's appointment.
· Choosing a specialized clinic.
· Medical examination, doctor's advice.
· Patient feedback.
The patient goes to the dental clinic for the first time or makes an online contact and is given a medical card containing the following information about the patient:
· Last name, first name, middle name (full).
· Gender.
· Date of birth (day, month, year).
· Identity document (passport series, passport number, fin code, address).
· Citizenship.
· Compulsory medical insurance (number, name of the insurance company).
Categories of citizens who have the right to receive medical assistance (citizens from this category have the right to receive priority medical assistance in the form of an examination based on a consultation with a doctor-specialist and a document confirming the category of citizen):
· War veterans.
· Family members of martyrs and veterans.
· Other preferential categories of citizens.
The medical card must be kept in the clinic, it is not issued, it is transferred to the offices by the receptionists.(13,14,15)
The time allocated to the patient in the clinic is determined according to the existing standards.
Dental administrators call patients the day before their appointment to remind them of the appointment date and time. If you signed up for a doctor's appointment in advance, and for some reason the administrator could not contact you, did not tell whether the appointment will take place (doctor's illness, vacation, etc.), then inform the administrator.
In dental conditions, the payment of diagnostic and therapeutic measures for a specific patient is determined by the doctor after the examination.
If you have any problems, questions or suggestions regarding the registration form, please contact the dental administration.
Any effective dental treatment begins with a consultation with a dentist, during which the preparation of the oral cavity for certain medical procedures is determined.
It is advisable to carry out this process in a specialized clinic, so that doctors of different specialties can clearly communicate with each other, carry out step by step, and constantly coordinate treatment with each other.(16,17,18)
After the initial consultation, the first thing patients receive is a treatment plan. This complex plan includes the following blocks:
· A description of the patient's condition and all abnormalities detected during the examination.
· Possible solutions to problems.
· Stages and timing of treatment.
· Treatment methods, materials and costs.
It should be remembered that the treatment plan is different in each clinic. This is due to several factors:
· Presence Of Appropriate Specialists in The Clinic (For Example, Dentists, Orthopedists, Surgeons, Implantologists, Orthodontists).
· Experience And Knowledge of Clinic Doctors.
· Technical Equipment of The Clinic.
· The Level of Interaction Between doctors, their high-quality transmission of information about the progress of the patient's treatment.
Regardless of which clinic you go to, the initial advice is to clarify the diagnosis using X-ray or computed tomography (CT). It is impossible to make a prognosis based only on the words of the patient.
For initial diagnosis, at least, it is necessary to undergo a CT scan, which is especially important for those interested in implants and prostheses. A 3D dental photograph provides a complete picture of the condition of the patient's jaw, as the doctor has the opportunity to examine it in three dimensions. The image is complete enough to accurately assess the condition of the jaw and teeth and diagnose the patient.(19,20,21,22)
If an implant or a particularly complex tooth extraction is necessary, CT will help identify factors complicating the operation.
If a sinus lifts or bone grafting is planned, a high-quality 3D image is also necessary. Bone tissue can also be seen on an X-ray, but the condition of soft tissues, mucous membranes, canals and blood vessels can only be seen in a clear three-dimensional image.(23,24,25,26)
Therefore, in dentistry, diagnostic images are always prescribed, without them it is impossible to estimate the extent of treatment.
After receiving the treatment plan, the doctor and the patient jointly agree on the option that they will accept as the basis and follow for the entire duration of the treatment.
Here the patient can express his opinion about the service of the clinic. All written applications of citizens must be submitted in the following form:
· Last name, first name of the person applying to the clinic.
· E-mail address.
· Contact number.
· Suggestions.
· Complaints.
Advantages of Artificial Intelligence in dentistry
In the diagnosis, treatment and prognosis of diseases
Artificial intelligence can be used in the diagnosis of oral diseases and the detection of changes in the mucous membrane, including new derivatives. Typically, dentists diagnose such diseases by observing the morphology of stained specimens on glass slides under a microscope. But this is given as a result of biopsies. For this reason, automated systems are increasingly used for long-term forecasting.(27,28,29)
In dental radiology
Artificial intelligence has shown its superiority in detecting various anatomical structures. For example, selection of teeth using periapical radiography.
In maxillofacial surgery
Robotic assistants that copy the movements of the human body are the most used form of artificial intelligence in maxillofacial surgery. Implant placement, tumor removal, biopsy and temporomandibular joint (TMJ) surgery are just a few examples of surgeries successfully performed by robots. A comparative analysis of the results of artificial intelligence and humans shows significantly higher accuracy compared to procedures performed manually by surgeons. Studies report shorter operative times and safer manipulations around delicate tissue structures.(30,31,32)
In orthopedic dentistry
The use of artificial intelligence in orthopedics is currently limited to creating the design of restored teeth. There is a special CAD/CAM program for 3D modeling of the dental system. Its mission is to recreate physical objects by digitizing design work into commercial products such as CEREC or Sirona. The software can also be used to select a shade or predict the failure of composite resin crowns.(33)
In orthodontics
Orthodontic treatment planning usually depends on the dentists experience. However, many variables must be considered for diagnosis and cephalometric analysis, so determining a treatment plan, much less predicting its outcome, can be difficult. Artificial intelligence is an ideal tool for solving such problems. Thanks to artificial intelligence algorithms, the effects of skeletal models and anatomical landmarks can be clearly seen in lateral cephalograms.
In addition, analysis of images taken by radiography and intraoral scanners can be used for a more accurate diagnosis. Artificial intelligence algorithms will help print the aligners and determine at what pressure and how to move the teeth.
For example, a 70-year-old male patient applied to the clinic because of a tooth fracture of the upper jaw prosthesis. The patient appears to have a fully mobile prosthesis in the upper jaw and a lingual bar in the lower jaw. A panoramic radiograph was taken to assess the total condition and measure the bone levels.
Figure 2. Panoramic radiograph
CAD is a method of shaping the automatic creation of a three-dimensional model using special software, while CAM is the manufacture of an orthopedic product based on a pre-built 3D template.
Modeling and production of prostheses is organized with the participation of three components:
Scanner: creates a virtual model of the jaw and individual elements in a three-dimensional format. The scanner takes a digital picture of the patient's mouth or can digitize a pre-made plaster model.
Computer with software: provides simulation of a virtual structure and its restoration. The technician determines the shape, size, relief and other parameters of the prosthesis.
Milling machine: the equipment independently grinds the product according to the model developed in the program. The crown material is placed inside the veneer (ceramic, metal, zirconium dioxide).
Our patient has bilateral diametric fulcrum. Since the distance between the gingival margin and the high floor of the mouth is less than 8 mm and provides stabilization of periodontally weak teeth, sublingual plaque is recommended.
Figure 3. 70 year old male patient
Application Problems of Artificial Intelligence in Dentistry
The implementation of artificial intelligence and machine learning solutions for dental clinics is associated with certain difficulties. The main reason is that automated systems based on artificial intelligence are expensive. Not all medical institutions can afford such costs.
In addition, the accuracy and reliability of AI systems is a concern. Although automated systems are becoming increasingly sophisticated, they are still prone to errors and biases. The quality of the predictions made by AI largely depends on the labeling of the data used to "train" the program. Poorly labeled data can lead to bad results.
Finally, AI systems take time to get right. Despite the promising results of artificial intelligence models, the reliability of data from newly registered patients from other dental facilities should be verified. It is also necessary to ensure confidentiality and compliance with technical security protocols that guarantee the security of personal data to customers.
Although there have been recent suggestions of how AI will change dentistry, it is unlikely that it will ever replace doctors. Dentistry performed by machines without human intervention does not constitute full clinical care. Machines lack the so-called "clinical intuition" or empathy that determines the degree of trust in a doctor. The most interesting aspect of human communication is extremely difficult to translate into computer language.
The future of Artificial Intelligence in dentistry
The directions of application of Artificial Intelligence in the future are diverse. Some of these are:
Figure 4. Artificial Intelligence in the future
Advanced imaging analysis – this defines the reflection of existing analyzes in an even more advanced form. Thus, Artificial Intelligence will be able to provide faster diagnosis of diseases such as cancer. This mainly includes the initial stage.
Personalized treatment - is another future-oriented process that artificial intelligence promises in medicine. This also applies to dental care. Treatment personalization describes the process of creating a treatment tailored to the patient by analyzing the patient's past records as well as information about the patient's current condition. On the other hand, this process is especially related to big data technology.
Robotic assistants – although this is an existing approach, the focus in the future is on robotic assistants treating each patient individually.
Big Data integration – as mentioned above, especially in the implementation of individualized treatment, it involves planning individualized treatment by analyzing data obtained from various sources (even including the patient's social network activity).
RPA (Robotic Process Automation) – in other words, the automation of processes such as the automation of relatively trivial processes (for example, patient registration, etc.). Also, automation of the processes performed by medical assistants, such as robotic assistants approaching patients and following them in time, accompanying them, etc., by artificial intelligence-based robots, is characterized.
Virtual assistants – also known as bots – these small cyber assistants are part of RPA, helping to perform processes such as contacting patients, tracking them, providing information, scheduling appointments and more.
CONCLUSIONS
Dentistry, one of the fields of application of Artificial Intelligence, is a relatively young field of application. So here, artificial intelligence can be applied at many stages of the life cycle intended for an entire business process. These include diagnosis, treatment planning, decision making, management, etc.
The application of Artificial Intelligence in this field has many advantages, which are listed separately in the article. However, despite its many advantages, there are also a number of implementation problems, which cover many stages, from legal and ethical behavior to decision-making processes. Overcoming these problems will also change the future direction of artificial intelligence application. Of these, the development of teledentistry is one of the main examples. It is possible to implement this process by eliminating a number of ethical and legal as well as security problems.
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FINANCING
The authors did not receive financing for the development of this research.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
AUTHORSHIP CONTRIBUTION
Conceptualization: Nazila Ragimova, Vugar Abdullayev, Ayan Mirzoyeva, Elnare Mirzoyeva.
Data curation: Nazila Ragimova, Vugar Abdullayev, Ayan Mirzoyeva, Elnare Mirzoyeva.
Formal analysis: Nazila Ragimova, Vugar Abdullayev, Ayan Mirzoyeva, Elnare Mirzoyeva.
Drafting - original draft: Nazila Ragimova, Vugar Abdullayev, Ayan Mirzoyeva, Elnare Mirzoyeva.
Writing - proofreading and editing: Nazila Ragimova, Vugar Abdullayev, Ayan Mirzoyeva, Elnare Mirzoyeva.