Is there still a scientific literature? An editorial by Dr Mauro Labanca, Italy news Many years ago, Prof. Pierluigi Sapelli, having to organise a meeting on evidence-based dentistry, “forced” me to give a talk on the subject. This led me to study in a frenzied way in order to better understand what goes behind a scientific publication and to familia- rise myself with words that at the time were almost unknown to those who were not “super experts”. Thereafter, I better understood the difference be- tween personal opinions, published here and there, and serious research, multicentre studies, reviews, and meta- analyses. Those were the days of in-depth research, the days when the same implant remained on the market for years without significant changes and the follow-up lasted for several years. Then, as now, I used to try to explain to those who attended my con- ferences how to read the documenta- tion that accompanied new products put on the market. I am now forced to notice that the situation is taking a 5 Dr Mauro Labanca. worrying, and perhaps dramatic, turn. This is certainly true for all sectors and in all countries, but our profession, dentistry, a profession where most are freelancers, is paying the price in an amplified manner for this increasingly emerging phenomenon. Understanding the dramatic vicious circle is quite simple: research about a product or procedure, well-conducted and with intellectual honesty on the part of researchers, requires a great deal of time and energy and, ulti- mately, a financial investment. When there is a potential risk of the results being unfavourable to what has been studied, who then wants to spend money on verifying the scientific va- lidity of a protocol or a material that will perhaps be modified owing to mar- ket requirements within a short time? Moreover, it is very often enough to comply with CE regulations, which certify that a product has met EU health, safety and environmental re- quirements, in order to market a new product. This says nothing about its efficacy or real intended use, and, there- fore, supposedly therapeutic products can be proposed to us without any kind of scientific support or research behind them. There can sometimes be laughable documentation which refers to general concepts and not to the product in question. Unfortunately, all this sometimes occurs with the guilty silence of a plethora of scientific societies that all too often talk about the highest sys- tems instead of making themselves, as would be good and desirable, guaran- tors of the scientific nature of products and protocols. Mala tempora currunt, and it only remains for us to hope that an individual capacity for criticism will be able to guide young colleagues towards conscious choices to prevent experimentation on unsuspecting pa- tients who honour us with their trust—a trust which should never be betrayed. Editorial note: This article was published in the Italian edition of implants—international magazine of oral implantology, vol. 2, issue 2/2022. Artificial intelligence and augmented reality in implant planning An editorial by Dr Francesco Mangano, Italy Technology is now pervasive in dentistry, and implantology is no ex- ception. Intra-oral and face scanners, CBCT and digital condylographs allow us to acquire 3D images and videos of our patients, useful not only for diag- nosis but also for treatment planning. The patient becomes virtual. 5 Dr Francesco Mangano. Until recently, however, this in- formation was difficult to segment and assemble, and this limited the patient virtualisation process. Obtaining the virtual patient was difficult and costly, needing time and effort, since segmen- tation and alignment were essentially manual, and operator-dependent. Today, thanks to artificial intelli- gence (AI), it is possible to use cloud- based software capable of returning to the clinician, in a few minutes and at very low cost, the entire set of 3D files of the patient (derived from intra-oral, face and CBCT scanning). These files, in STL format, are per- fectly aligned and segmented, elimi- nating any possible error by the oper- ator. Each tooth, for example, is the result of the perfect fusion, segmenta- tion and alignment of CBCT (root) and intra-oral (crown) scans. The segmen- tation and alignment are automated, being the result of a learning process (machine learning) which represents the basis of AI. It is a real revolution that has opened the door to changes in all fields of dentistry: from the possibility, for example, of planning a 3D orthodontic set-up that is truly safe for the bone to the planning of prosthetic complex cases. In implantology, AI-assisted soft- ware such as Virtual Patient Creator (Relu) allows us to enhance our diag- nostic and planning skills. In particular, the use of 3D files in STL format processed by Virtual Patient Creator (Figs. 1 & 2), combined with modern virtual reality and aug- mented reality (AR) systems, creates new possibilities. In fact, it is pos- sible to upload all files derived from AI-assisted software directly into apps specifically designed for AR, such as HoloDentist (FifthIngenium). Thanks to these apps, wearing an AR device such as HoloLens 2 (Microsoft), the dentist can view the holographic 3D models of the patient and use them to make a correct diagnosis and for communication with the dental labo- ratory, colleagues or patients in order to illustrate to them the selected treat- ment plan. such an extent that they have the same dimensions as the operator, and the same applies for the holo- gram of the implant. Finally, by navigating inside these models, the surgeon can tilt, rotate and otherwise move the implant within the bone hologram. This process is also guided by other masks and holo- grams, which can be on or off during 3D planning, for example that of the teeth and soft tissue or that of the prosthetic wax-up. This is authentic 3D planning, without the need for any guided implant surgery software or conventional 2D radiographic sections. This allows planning in a fast, intuitive and fun way, drastically reducing costs. The spatial position of the implant thus designed is saved and exported, to- gether with the other files, for the design of the sur- gical guide, in open-source software. The next future development will be the import of this planning into a dynamic implant naviga- tion system. 1 2 5 Fig. 1: Automatic segmentation from CBCT in Relu’s artificial intelligence-assisted, cloud-based software. Fig. 2: Fusion and automatic alignment and superimposition of 3D files from the intra-oral scan over the CBCT data. The use of AI and AR technologies transforms the manner of not only diagnosis and communication but also of implant planning. On the basis of the set of files segmented and aligned via AI, the surgeon wearing AR glasses such as HoloLens 2 or Magic Leap 2 (Magic Leap) can plan the positioning of one or more implants in the correct 3D position, inclination and depth, using holograms.* Basically, it is no longer necessary to use software dedi- cated to guided implant surgery: the surgeon drags and drops the desired fixture from a 3D library pro- vided by the HoloDentist app and positions it within the holographic model of the bone. The surgeon can also enlarge the holographic models to Editorial note: As part of a session on innovations in implant diagnostics and planning on Friday, 30 September, from 9:00 to 10:30, Dr Mangano will be presenting a lecture, titled “Artificial intelligence and augmented reality in implant planning”, on this interesting topic. * Scan QR code to watch a video on 3D implant planning with holograms using HoloDentist and HoloLens 2. 6 29 th EAO Annual Scientific Meeting · Geneva © Dr Mauro Labanca© TetianaD/Shutterstock.com