issn 2193-4673 • Vol. 4 • Issue 4/2023 digital international magazine of digital dentistry 4/23 including supplement interview Big data in implant dentistry— “We are standing at the beginning” case report A fully guided digital workfl ow for predictable implant planning and placement AI supplement More predictable, more precise, more profi table: Artifi cial intelligence in dentistry

editorial | Magda Wojtkiewicz Managing Editor Artifi cial intelligence opens a new chapter in dental healthcare Artificial intelligence (AI) is already present in our everyday life, whether we are aware of it or not. AI is also revolutionising the field of dentistry, offering a wide range of applications that improve patient care, diagnostics and practice management. In this issue of digital, you will find our second AI supplement, a section dedicated to AI and its presence in dentistry. Before you dive into the details, here are some examples of AI being applied in dentistry. Diagnostic and imaging support One of the most significant applications of AI in dentistry is in diagnostic support. AI algorithms can analyse dental radio- graphs and photographs, aiding dentists in the detection of issues such as dental caries, periodontal disease and oral cancer. These algorithms can identify abnormalities and anomalies in radiographs and scans, supporting early disease detection and timely intervention. Treatment planning AI can assist dentists in creating treatment plans tailored to individual patients. By analysing patient data, including medical history, images and dental records, AI can suggest optimal treatment plans and prosthetic designs. This not only improves the pre- cision of treatments but also enhances treatment outcomes. Patient management AI streamlines various patient management tasks within dental practices. It can handle appointment scheduling, send auto- mated reminders to patients and assist with billing, making the dental office more efficient and patient-friendly. Natural language processing in electronic health records AI-driven natural language processing tools are increasingly being used to analyse textual information within electronic health records. By extracting and analysing relevant patient data, AI can enhance decision-making and improve patient care. Oral health monitoring AI-powered devices and apps are being developed to monitor patients’ oral hygiene habits. These tools can provide person- alised recommendations for better oral care, helping patients maintain their oral health between dental visits. Education and training In dental education, AI is playing a crucial role in providing realistic training experiences. Dental simulators and virtual reality tools, powered by AI algorithms, allow students and dentists to practice various dental procedures in a safe and controlled environment. Predictive analytics AI can predict oral health outcomes and treatment success based on historical patient data. Dentists can use these insights to develop treatment plans that are more personalised and provide better patient management. Quality assurance AI can ensure the quality of dental impressions and prostheses. By analysing these products, AI can verify that they meet specific standards and accuracy criteria, reducing errors and enhancing patient satisfaction. Virtual consultations and teledentistry The rise of virtual consultations and teledentistry has been accelerated by AI. Chatbots and virtual assistants powered by AI can provide patients with information, guidance and even initial assessments of dental issues. Teledentistry platforms utilise AI to facilitate remote consultations, enabling dentists to diagnose and treat patients from a distance. As AI technologies continue to evolve, the applications in dentistry are expected to expand even further. Dentists and dental practices that embrace AI can already benefit from improved diagnostic accuracy, personalised treatment planning, enhanced patient engagement and greater efficiency in practice management. However, it is essential to stay updated with the latest advance- ments in the field, as AI in dentistry continues to evolve rapidly. 03 4 2023

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industry news | CleanImplant “Trusted Quality” seal – Five-step approach STEP 1 Neutral sampling of five implants Batch-spanning random sampling: Three implants are ordered ex factory, and two implants of the same type are purchased via mystery shopping from practices. STEP 2 Unpacking and scanning under clean room conditions All five collected samples are carefully unboxed, mounted and scanned in a clean room environment according to Class 100 FED-STD-209E and Class 5 DIN EN ISO 14644-1. STEP 3 Externally audited process of analysis Scanning electron microscope (SEM) imaging and elemental analysis (energy-dispersive X-ray spectroscopy) are performed according to the DIN EN ISO/IEC 17025 accreditation process (competence of testing and calibration laboratories). The independent test laboratories are regularly monitored in external audits by the accreditation body. STEP 4 Full-size and high-resolution SEM images A special full-size, high-resolution SEM image—digitally composed of more than 360 single SEM images at 500× magnification—always shows the implant surface from shoulder to apex. STEP 5 Peer-review process Two members of the scientific advisory board independently review the comprehensive analysis report and sufficient clinical documentation or multi-annual Post-Market Clinical Follow-Up studies of the analysed implant system showing survival rates of > 95% for the device or device family. Fig. 1: Dr Dirk Duddeck placing an implant on the sample holder of the scanning electron microscope. Fig. 2: Implant sample on the sample holder of the scanning electron microscope. (All images: © CleanImplant Foundation) Table 1: CleanImplant five-step approach. “This award is an objectively transparent proof that col- leagues are using a residue-free implant system for their patients by manufacturers who have implemented the highest-quality standards,” explained Dr Dirk Duddeck, founder and head of research at CleanImplant. To obtain this valid, objective proof, a five-step approach was es- tablished in cooperation with the eight-member scientific advisory board (Table 1). Every award of the quality seal is valid only for two years and has to be renewed after this period. Currently, the following implant systems also carry the “Trusted Quality” seal: Kontact S (Biotech Dental), whiteSKY (bredent group), UnicCa (BTI Biotechnology Institute), (R)Evolution and Patent/BioWin! (Champions- Implants), In-Kone (Global D), ICX-PREMIUM (medentis medical), AnyRidge and BLUEDIAMOND IMPLANT (MegaGen), T6 (NucleOSS), Prama (Sweden & Martina), and SDS1.2 and SDS2.2 (Swiss Dental Solutions). Other testing and analysis results are pending. In addition, the contract manufacturers of ceramic implants, CeramTec Group and Komet Custom Made, received the CleanImplant Certified Production Quality Award. “This award is an objectively transparent proof that colleagues are using a residue-free implant system for their patients.” CleanImplant was also present at the 2023 joint con- gress of the European Association for Osseointegration and German Association of Oral Implantology in Berlin in Germany where 27 renowned implantology experts from 15 countries, met for the 3rd CleanImplant Ambassadors’ Summit. contact More and more dentists are supporting the CleanImplant Foundation. Certified by CleanImplant, they pass on the trust they have gained in the products to their patients and referring dentists. CleanImplant Foundation CIF Berlin, Germany www.cleanimplant.org 11 4 2023

m o c . k c o t s r e t t u h S / o n N E o c N © i i l interview | cannot be used for patient treatment, but it will bring implant dentistry further in the long run. Once the data entry process becomes routine for the dentist, the time requirement will become minimal. The use of modern technologies also raises concerns regarding data protection. How can this issue be addressed? And are there any other issues that need to be considered when handling personal medical data? All data can be collected in an anonymised way. We must ensure that insurance companies or organ- isations who could gain financially cannot access this data. For example, all patient data could be coded in the database using a code only known by the treating physician. Thereafter, all implant-specific data could be added to that database. An example of big data documentation is the case of the database used for patients with Sjögren’s syndrome, a rare auto- immune disease affecting, among other things, the eye (keratoconjunctivitis sicca) and the mouth (hypos- alivation, xerostomia). More than 15,000 well- classified Sjögren’s patients are anonymously registered in a very valuable database documenting their disease. Those responsible for using the data and writing arising research reports have no access to the patient files. When data is missing or incomplete, the treating clinician is asked to provide the missing data where possible. Financially, there is barely any support. “We should fi rst begin to better record implant procedures, restorations, procedures used in the upper and lower jaw.” What are the three main messages from your EAO lecture? Big data in implant dentistry is just getting started. There is no generally approved protocol as to what parameters to evaluate and how to score. First, the con- tent of the questions through which data will be gathered must be arranged, in addition to determining how those responses will be reported. Thus far, only very general trends have been reported with regard to implant dentistry. We have to agree on the creation of a standardised database in which all results related to implant treatment will be recorded. Editorial note: This interview was edited and was first published in today EAO Berlin 2023. 13 4 2023

case report | 3 4a 4b 4c Fig. 3: Initial CBCT scan. Coronal view of tooth #21 showing buccal bone loss. Figs. 4a–c: Digital impressions of the initial situation. 5 6 7 Fig. 5: Intra-oral radiograph after the extractions and ridge preservation. Fig. 6: Intra-oral image with the temporary prosthesis in place. Fig. 7: CBCT scan of the maxillary anterior region after the extractions. 8a 8b 9 Figs. 8a & b: Digital impressions after the extractions. Fig. 9: Implant planning for all four positions. 10 Fig. 10: Final planning for two implants with merged intra-oral scan and CBCT data. 15 4 2023

case report | As is routine protocol in my dental practice, we captured a digital impression of the maxillary and mandibular arches with the DEXIS IS 3800 intra-oral scanner (Figs. 4a–c), along with intra-oral photographs to document the initial oral condition. These digital models were used for the fabrication of the temporary removable prosthesis. Upon receiving approval from the insurance company for the proposed treatment plan, all four teeth were ex- tracted. After the extractions, the extraction sockets were meticulously debrided with EthOss degranulation burs and filled with EthOss grafting material to promote pri- mary closure and healing of the wound (Fig. 5). To preserve both the aesthetic and functional aspects for the patient during the time between extraction of the teeth and the new bridgework, a temporary removable prosthesis was fabricated (Fig. 6). The patient’s general dentist has also been working fully digitally for years, and the temporary prosthesis was made from a digital impres- sion and printed models. Two months after the extractions, we obtained a CBCT scan of the maxilla (Fig. 7) and captured digital impres- sions using our DEXIS IS 3800 intra-oral scanner (Fig. 8). These scans were essential for commencing the implant planning process and creating the surgical guide. During the implant planning phase, we created a prelim- inary plan using 3D imaging software with a prosthetically driven implant planning approach (Figs. 9 & 10), and the plan was exported into surgical guide planning software for final planning and construction of the surgical drilling guide (Figs. 11a–c). The implants were planned in all four positions with the object of identifying the two most op- timal and accessible sites for the placement of two im- plants and the corresponding bridge restoration. After completion of the planning and drilling reconstruc- tion, the surgical guide was 3D-printed with a Stratasys printer using MED610 resin (Stratasys). The two implants (4.1 ⫻ 12.0 mm Straumann Bone Level Tapered, Regular CrossFit, SLActive, Roxolid) were then placed utilising the Straumann guided surgery kit for precise guidance. The remaining piece of amalgam in the bone of tooth #21 was carefully removed—only a small piece in the gingiva re- mained (Fig. 12). The buccal bone was again thickened with EthOss, and the wound was closed with a semi- submerged technique, facilitating proper healing and in- tegration of the implants (Figs. 13a & b). After a ten-week osseointegration and healing period, the patient returned for a final assessment of the implant sta- bility using the implant stability quotient measurement. The subsequent step will involve the completion of the fi- nal prosthesis, which will be performed by the patient’s general dentist. To create the screw-retained monolithic 13a 13b Figs. 13a & b: Intra-oral view of the implants with healing abutments after placement. bridge, a digital impression will be obtained using an intra- oral scanner, and the dental technician will also work fully digitally—as far as possible—for the final prosthesis. Editorial note: This article was first published in implants—international magazine of oral implantology, Vol. 24, Issue 4/2023. about Dr Beat R. Kurt received his master’s degree in dental medicine in 1990 from the University of Bern in Switzerland and completed his postgraduate education in oral surgery at the central hospital of Lucerne in Switzerland. He has been in private practice for more than 25 years in Lucerne and specialises in implantology, including guided implant surgery, soft-tissue management and bone augmentation. He has over 17 years of experience working with various guided surgery systems and has been using a complete digital workflow for several years. Dr Kurt runs a referral practice. He can be contacted at office@oralchirurgie.ch. 17 4 2023

case report | 3 4 Fig. 3: 3D implant planning with the Galileos software. Fig. 4: Implant planning and parallelisation with YomiPlan. tionised the art and science dentists use to approach treatment of their patients. This article will demonstrate some of the innovative technology, materials and tech- niques and possibilities of full-arch zirconia implant treatments by way of a case report. Case report The patient presented with multiple periapical radiolu- cencies associated with failing endodontically treated teeth, a horizontal root fracture and a failing long-span bridge (Fig. 1). A poor long-term prognosis was given to all the remaining mandibular teeth except tooth #46 (Fig. 2), and the treatment options, limitations and risks were reviewed thoroughly with the patient. The patient “Digital scanning of implant positions can produce accurate 3D modelling, and advancements in materials and prosthesis fabrication methods [...].” did not want a removable restoration and did not want to go a day without teeth and wanted to have biologically friendly materials used for treatment. It was decided to 5 Fig. 5: Laboratory virtual mock-up of the temporary restoration. 19 4 2023

case report | “Preoperative planning was performed using CBCT and YomiPlan planning software to select and parallel all the implants.” Surgical phase Advanced platelet-rich fibrin (A-PRF+) and injectable platelet-rich fibrin (i-PRF) were produced using hor- izontal centrifugation (Bio-PRF). Atraumatic extrac- tions were performed, and the sockets decontami- nated using curettage, degranulation burs and ozone therapy. The Yomi link was attached on the mandibular left via bite registration, and a CBCT scan with fiducial arrays was taken (Fig. 6). The link placement allowed com- plete visual access of the surgical field from tooth #33 to tooth #46. Surgery was initiated under robotic assistance at sites #45, 43, 41 and 31. The osteotomies were incrementally increased according to manu- facturer’s recommendations, and drill orientation were confirmed intra-orally and via Yomi dynamic live CBCT navigation. Successful placement according to tight anatomical parameters and with parallelisation of implants was possible with high confidence via the haptic controls and locked drill path and depth using Yomi robot assistance. SDS1.2 implants were placed into the sites. The sockets were subsequently grafted with allograft (Cortical Mineralized/Demineralized Blend, particle size: 0.25–1.00 mm; Maxxeus CTS) hydrated with i-PRF, and an A-PRF+ membrane was placed over each site and sutured in place. The first phase of surgery was completed in approximately 90 minutes, and the Yomi link was removed and the guide arm detached. 13 14 15 Fig. 13: New temporary restoration in situ. Fig. 14: Digital impression using titanium dioxide powder. Fig. 15: Scanner interpreting the diffusion of light from the surface of objects. Shiny surfaces can interfere with the matching of the point of interest by the software owing to overexposure. Surgery continued on the mandibular left quadrant, and an attempt was made to re-link the patient with Yomi robot using the implants, but it was unsuccessful. Yomi’s conventional workflow allows approximately one quadrant at a time to be worked on. A new scan and four or more stable teeth are needed to anchor the link. This has now been overcome with the newer Yomi bone link, which would have been ideal in this particular case. However, freehand immediate placement and parallel- isation of implants were possible with the visualisation of the four previously placed implants. Digital impressions were taken with CEREC Primescan (Fig. 7) and sent to the laboratory for same-day fabrication of the temporary restoration (Flexcera Smile Ultra+, Desktop Health; Fig. 8). Suturing was completed, and the full-arch temporary restoration was adjusted and seated with temporary cement (Fig. 9). At five months of healing, the remaining failed denti- tion was removed and the soft tissue allowed to heal for seven weeks. Preparation of the implants for the final restoration consisted of removal of the temporary 21 4 2023

case report | 18a 18b Figs. 18a & b: Final restoration in function. graphs (Fig. 17) and cemented with PANAVIA SA Cement Universal (Kuraray Noritake Dental). The patient returned two weeks later for an occlusion check and adjustment along with an oral hygiene check. Pink firm gingiva around all the implants was noted such that it was even difficult to get a probe into the sulcus (Fig. 18). Conclusion This case study has showcased the transformative potential of modern dental technology in immediate full-arch zirconia implant therapy. The implementation of CBCT imaging, robotic assistance, digital scan- ning and advanced manufacturing with biocompati- ble materials has revolutionised the field of dentistry, offering patients enhanced precision, comfort and immediate results. As implementation of new technologies increases, learning some limitations of the technology is part of the evolution. In this case, it was noted that scan- ning powder for taking digital impressions of multi- ple prepared zirconia implants was necessary and that multiple one-piece zirconia implant abutments did not provide enough retention for a Yomi-linked surgery. These challenges were addressed and overcome with modifications of technique, learning the capabilities of the technology and leaning on the fundamentals of implant surgery and restorative dentistry. Overall, these new approaches to full-arch zirconia im- plant therapy represent a paradigm shift in dental care. They not only provide patients with a rapid and biologi- cally friendly solution, but also enable precision implant placement and prosthesis fabrication. With solid clin- ical fundamentals in dentistry, the clinician can utilise the constant evolution of dental technology to enhance the possibilities and services offered, elevating the standard of care for dental patients. “The implementation of CBCT imaging, robotic assistance, digital scanning and advanced manufacturing [...] has revolutionised the field of dentistry [...].” Editorial note: Please scan this QR code for the list of references. about Dr Daniel Madden received his DDS from the University of Minnesota in the US and pursued advanced studies in implantology and comprehensive dentistry abroad at Radboud university medical center in Nijmegen in the Netherlands. He has a passion for education and technology in dentistry and believes that this leads to a more comfortable, efficient and pleasurable patient experience. A certified integrative nutrition health coach, Dr Madden offers patients biological treatment solutions for optimum oral and whole-body health at Heights Family Dental in Hood River, Oregon in the US and his surgical services through his company Peak Potential Dental at multiple private practice locations in the states of Oregon and Washington. conact Dr Daniel Madden www.dentistdanielmadden.com 23 4 2023

case report | 4a 4b 5 6a 6b Figs. 4a & b: Guide post is inserted into the pilot hole made with the drill in the model (a & c). Guide Right guide post (b). Figs. 5a & b: Guide Right guide sleeve and post (a). Guide sleeve placed over the guide post with the retentive cleat positioned on the lingual aspect (b). Figs. 6a & b: Primopattern LC Gel placed over the cleat (a). Primosplint placed on the lingual aspect of the teeth on the cast (b). for diagnostic and surgical guides and affordability of an in-office preliminary guide that can be worn during the initial diagnostic CBCT scan. The components of the Guide Right system (DePlaque) for creating a diagnostic guide and surgical guide consist of: (1) straight and offset guide posts; (2) straight and angled guide sleeves; (3) a 3/32 in. (2.381 mm) pilot drill; and (4) addi- tional drills with depth stops that match the interior of the guide sleeves. The offset guide posts are designed as two pieces. The upper removable part is available in 0.0–3.5 mm offset in 0.5 mm increments. Regarding the 7a 7b Figs. 7a & b: Resin adapted to the lingual and occlusal aspects of the teeth (a). Diagnostic guide (b). 25 4 2023

case report | 12 13 Fig. 12: First angle correction made utilising the bending tool to bend the offset guide post 6° in the lingual direction. Fig. 13: Second angle correction of the modified offset guide post 4° to the distal aspect. recommendations, and a consent form was signed. Local anesthetic was administered, and the lower right lateral incisor (tooth #42) was atraumatically extracted. The patient was scheduled for the implant placement phase of treatment. The patient returned eight weeks after extraction of tooth #42 for evaluation of tooth #41 and of site healing and for initiation of the planning phase of implant treatment (Fig. 2). Keratinised soft tissue had covered the extraction socket, and no inflammation was noted. Tooth #41 was examined, and no mobility was noted, nor was there percussion sensitivity. The patient indicated an absence of hot or cold sensitivity in the area. The treatment plan was reviewed for placement of an implant in site #42 and a delayed loading protocol, allowing for osseointegration of the implant before restoration. An impression of the mandibular arch was taken to initiate the planning phase of treatment with fabrication of a diagnostic guide, and the patient was scheduled for the next appointment. The conventional impression was utilised to create a stone cast to be used to fabricate a diagnostic guide. The 3/32 in. (2.381 mm). Guide Right pilot drill was utilised to create a guide hole in the planned implant site on the cast that was parallel to the adjacent teeth and centred in the extraction site (Figs. 3a–c). A Guide Right one-piece guide post was inserted into the pilot hole on the cast (Figs. 4a & b). Next, a Guide Right guide sleeve was inserted over the guide post with the retentive cleat positioned to the lingual aspect (Fig. 5). A light-polymerising resin (primopattern LC Gel, primotec) was placed over the cleat and then a roll of light-polymerising resin (primosplint, primotec) was placed on the lingual aspect of the teeth on the cast (Figs. 6a & b). The resin was then pressed on to the lingual aspect of the teeth and the occlusal surfaces, light-polymerised and removed from the cast, creating the diagnostic guide (Figs. 7a & b). The CBCT scan with the diagnostic guide in place was imported into implant planning software (Carestream Dental) and analysed for implant placement at the planned implant site. A virtual implant (3.3 × 12.0 mm) was placed in the planning software with respect to the available anatomy in the mesiodistal and buccolingual dimensions. The virtual implant was viewed in cross section to access its orientation with respect to the guide sleeve on the diagnostic guide (Fig. 8). A line was drawn through the long axis of the virtual implant and of the guide sleeve to analyse what corrections would be necessary in the buccolingual dimension (Figs. 9a–c). A 6° angle correction between the virtual implant axis and guide sleeve axis would be required (Fig. 10). A shift of 2 mm from the position of the guide sleeve and virtual implant position would also be required. 14a 14b 14c At the next appointment, the diagnostic guide was tried in intra-orally and fit and stability confirmed on the arch. A CBCT scan was taken with the diagnostic guide in place. Figs. 14a–c: Guide post before correction (a), after the first angle correction of 6° to the lingual aspect (b) and after the second angle correction of 4° to the distal aspect (c), completing the two-bend guide post modification. 27 4 2023

case report | sleeve set on the drills. The drilling sequence through the surgical guide was completed with a Straumann 2.8 mm drill with the 15 mm guide depth. A 3.3 × 12.0 mm implant was then placed into the osteotomy and the Straumann explantation tool utilised to place the platform of the implant 1–2 mm subcrestally. A 2 mm high healing abutment was placed with its top flush with the gingival crest. A CBCT scan was taken to document the implant placement relative to the surrounding anatomy. Analysis of the scan demonstrated ideal placement in the narrow site, respecting the adjacent anatomy in the mesiodistal and buccolingual directions. The restorative phase of treatment was initiated after three months of osseointegration. Restoration was completed with a screw-retained crown. A periapical radiograph was taken to confirm seating of the implant restoration on the platform (Fig. 18). Radiographically, it was noted that the bone level on the mesial and distal aspects was at the top of the platform and that there was complete bone fill on the distal aspect of tooth #41. Clinically, the gingiva was healthy and keratinised and presented with no inflammation (Fig. 19). Discussion It is well established that surgical guides aid in ideal placement of implants, and the use of CBCT is becoming a routine part of the planning and fabrication of surgical guides. CBCT scans provide valuable information when planning implant placement, but prosthetic positioning is not possible with a typical scan. Information from a dental cast may be used to ideally position the implant prosthetically, which is especially critical in narrow sites. The information is then transferred to the CBCT scan by use of a diagnostic guide. Coordinating the cast and CBCT data allows prosthetic positioning to be utilised with the virtual planning.9, 10 A diagnostic guide fabricated on a cast of the pretreatment arch aids in guiding planning and analysis, providing data to the planning software to better aid in surgical guide design. The particular case featured in this article required ridge augmentation to create dimensions that would accom- modate implant placement. After healing of the grafted ridge, a new CBCT scan was taken with the diagnostic guide, and implant planning in the software was then performed with the new osseous anatomy. 18 19 Fig. 18: Periapical radiograph of the restored implant, demonstrating good implant placement with respect to the anatomy in the narrow site. Fig. 19: Implant restoration in situ. Conclusion Guided implant placement allows the practitioner to avoid misplacement with regard to the surrounding anatomy. This is particularly critical when placing an implant into a narrow site. When done freehand, this may result in contact with the root of the adjacent teeth or a lack of interproximal bone, which may lead to implant failure owing to insufficient bone between the implant and tooth. A CBCT scan provides analysis of the planned site in 3D, but as implant treatment is restoratively driven, there needs to be a way to incorporate the restorative position with the anatomy to best plan for ideal implant placement. Utilisation of a diagnostic guide allows that information to be part of the implant planning and fabrication of a corrected surgical guide for ideal implant placement in narrow sites and avoids potential problems with surgical placement as well as with restoration of the implant. Editorial note: Please scan this QR code for the list of references. about Dr Sean W. Meitner is a clinical professor at Eastman Institute for Oral Health at the University of Rochester in New York in the US. Dr William S. Woodworth is in private practice in Phelps in New York in the US. Dr Gregori M. Kurtzman is in private practice in Silver Spring in Maryland in the US. Design of the diagnostic guide uses straight guide posts on the pretreatment cast. The offset guide post is used when a correction to the osteotomy position is required, positioning the osteotomy to the facial or lingual aspect based on the CBCT analysis. This allows use of the guide hole in the initial cast to correct the position and angulation of the guided osteotomy when fabricating the corrected surgical guide. contact Dr Gregori M. Kurtzman 3801 International Dr Ste 102 Silver Spring, MD 20906, US drimplants@aol.com 29 4 2023

case report | 4 6 5 7 a history of persistent dental and oral malodour. The patient expressed a desire to regain her ability to eat like before and recover her quality of life and confidence. developed by the International Team for Implantology, assists in evaluating the level of challenge and potential complications linked to implant-related restoration (Fig. 3). The extra-oral examination showed a low smile line, and the intra-oral examination found a removable bridge from tooth #13 to tooth #23 that was poorly adapted and showed signs of deterioration. The maxillary teeth, with the exception of tooth #18, were mobile. Generalised gingival inflammation, bleeding on probing and dental caries were also present (Fig. 1). The radiographic examination exposed severe bone loss in the posterior of the maxillary left quadrant, as well as caries and apical lesions on maxillary teeth (Fig. 2). Treatment planning After an extensive conversation with the patient about the various treatment alternatives, a joint decision was reached that the chosen approach would involve a digital workflow, immediate implant placement and maxillary full-arch implant-supported restoration. The treatment workflow involved: After conducting both radiographic and clinical assess- ments, the patient was categorised as having a complex condition according to both the surgical and prostho- dontic SAC classifications. This classification system, 1. digital implant placement planning using coDiagnostiX (Dental Wings); 2. design and printing of the bone reduction guide, surgical guide and resin models; 8 9 31 4 2023

case report | 14 15 and cleaning the temporary prosthesis with a very soft toothbrush. The sutures were removed 12 days after the surgical procedure. Prosthetic procedure able as implant placement in healed sites. In patients with compromised periodontal health and hopeless teeth, this is an excellent alternative for rehabilitation, as long as adequate access for peri-implant hygiene is ensured. After 12 weeks, the delivery of the final screw-retained prosthesis was performed. During this time, the implant sites healed successfully, and osseointegration was accomplished. An open-tray impression was taken, leading to the acquisition of the final cast models. These models were then utilised to create the final prosthesis. A comprehensive assessment was conducted of the prosthesis to ensure a precise and passive fit during the clinical evaluation. Furthermore, functionality, phonetics, occlusion and aesthetics were meticulously verified (Fig. 13). The screw access holes were filled using Filtek Supreme resin (3M ESPE). Oral hygiene instruc- tions were given, and periodontal supportive therapy was scheduled for every three to four months. After two years, clinical and radiographic control of the rehabilitation was carried out (Figs. 14 & 15). The soft and hard tissue surrounding the implant exhibited fa- vourable conditions. Furthermore, the patient had gained a deeper understanding of her oral health and acquired knowledge on how to maintain proper oral care. Treatment outcomes The patient expressed great satisfaction with the outcomes achieved. She could now enjoy eating with- out any concerns. Similarly positive outcomes were achieved across the functional, biological and aesthetic aspects. Conclusion Editorial note: Please scan this QR code for the list of references. about Prof. Li Xiaofeng graduated from the School of Stomatology of Xi’an Medical University in China and later specialised in implantology. She is president of the Hangzhou Dental Hospital’s west branch and director of the dental basic teaching and research section at the Zhejiang University of Traditional Chinese Medicine in China. She is also a member of the Chinese Stomatological Association’s Oral Implantology Professional Committee and a fellow of the International Team for Implantology. Dr Li Shuguang is vice president of the Hangzhou Dental Hospital’s west branch and a visiting associate professor at the school of dentistry of the Zhejiang University of Traditional Chinese Medicine in China. He holds the DSD Mastership certification and is the executive director of the Chinese Esthetic Dental Society and a Immediate implant placement after tooth extraction has become a common surgical approach in clinical practice. The outcome of this procedure is as predict- director of the International Congress of Oral Implantologists. He is an executive director and special committee member of the Chinese Society of Digital Dental Industry and a member of the International Team for Implantology. 33 4 2023

case report | 7 9 11 8 10 12 Fig. 7: Surface texturing in the pre-sintered state (prior to the final sintering procedure). Fig. 8: Bridge after a 7-hour sintering cycle. Fig. 9: Appearance of the bridge after individualisation with CERABIEN ZR FC Paste Stain. Fig. 10: Appearance of the bridge after two glaze firings. Figs. 11 & 12: Clinical situation after restoring the teeth with a lithium disilicate onlay and a zirconia bridge. Fig. 13: Final radiograph used to check for excess cement around the bridge. avulsed central incisors, which had been replanted in the hospital, and periodontal therapy, occlusal elevation was planned on the left side. 13 The plan was to restore the teeth and elevate the occlusion with three onlays and a crown made of lithium disilicate (IPS e.max CAD, Ivoclar). During tooth preparation, however, a longitudinal root fracture of the first molar was detected. Therefore, only the first premolar was restored in this session. For this purpose, an onlay was produced chairside with the CEREC system (Dentsply Sirona) and adhesively luted with PANAVIA V5 (Kuraray Noritake Dental). The first molar was extracted. One week later, the extraction socket, which was still healing, was modelled for the ovoid pontic using an electrotome loop. The second premolar and molar were prepared as abutment teeth for a bridge. The bridge was then designed (Figs. 4–6) and milled from KATANA Zirconia Block for bridges in Shade A3.5 and individualised with CERABIEN ZR FC Paste Stain (both Kuraray Noritake Dental; Figs. 7–10). A further week later, the bridge was luted with the self-adhesive resin cement PANAVIA SA Cement Universal (Kuraray Noritake Dental) after sandblasting (Figs. 11–13). about Dr Florian Zwiener is a dental professional with expertise in endodontics, prosthodontics and CAD/CAM technology. Having developed a passion for dentistry, he pursued his education at the University of Cologne in Germany and obtained a degree in dentistry. He practises at Dr Frank Döring’s dental clinic in Hilden in Germany, where he continues to apply his specialised knowledge and skills, ensuring that his patients receive the highest quality of care. Follow Dr Zwiener on Instagram: @dr.florian_zwiener. 35 4 2023

supplement | supplement to shift around the release of OpenAI’s ChatGPT and sophisticated online image generators like DALL·E and Midjourney at the end of 2022. ChatGPT (Chat Generative Pre-trained Transformer) is a popular online chatbot that can respond to written commands with eerily human-like accuracy—ask any high school teacher you know about it! Over the past year or so, competing alternatives from technology giants like Google, Microsoft and IBM have entered the market. Dr Rune Fisker, senior vice president of product strategy for the dental scanning and software company 3Shape, attributes the recent leap in quality of AI-powered computing to an increase in computational power (i.e. computers have continued to become more powerful), internet-enabled access to historically large data sets (i.e. large collections of thousands if not millions of similar documents) and something called deep learning networks. Traditionally, software developers built specific algorithms— rigorous sets of computing instructions—to help com- puters solve specific, easily categorisable problems. Deep learning—a subset of machine learning, which is itself a subset of AI—models work more dynamically. They can tackle massive amounts of information (usually by em- ploying huge online data sets) and learn the distinctive characteristics of specific types of documents (e.g. images, essays or strings of computer code) to produce new, © Daniel Chetroni/Shutterstock.com ChatGPT (Chat Generative Pre-trained Transformer) is a popular online chatbot that can respond to written commands with eerily human-like accuracy. original work that is similar but not identical to the examples they have encountered. This process requires minimal human interference. “Because deep learning requires less development effort than previous approaches and delivers significantly higher performance, it will make computers significantly more m o c . k c o t s r e t t u h S / s n o i t a e r C t r A t i m m u S © Deep learning models can tackle massive amounts of information and learn the distinctive characteristics of specifi c types of documents to produce new, original work that is similar but not identical to the examples they have encountered. 37 4 2023

supplement | supplement m o c . k c o t s r e t t u h S / v o p o P _ y e r d n A © AI can be used to improve patient scheduling software. and instantly deletes this soft-tissue information, pro- ducing a cleaner, more useful final digital record of a patient’s intra-oral situation. Before the company’s AI-powered technology was de- veloped, 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.3 Pearl markets Second Opinion as “a second set of eyes” for dentists.4 I think that this is a helpful way to under- stand best practices for AI implementation in oral health- care. To this effect, Pearl makes a good, broadly appli- cable point about a fundamental advantage AI has over human technicians: “Machines are able to perform the same task over and over, without getting bored, tired, or distracted.” 4 Truly, Pearl’s technology enables clinicians to become informed of important considerations that they may have missed owing to fatigue or simple human error. It does not replace dental professionals, but it augments their existing aptitude. Importantly, 3Shape’s AI applications continue to im- prove themselves over time: each time a new scan is performed, the training data set grows by one scan. According to Fisker, one of AI’s most exciting potentialities is its theoretical ability to make computers smarter over time as they continuously iterate, absorb new infor- mation and improve.3 More than half a dozen companies are currently de- veloping AI tools to detect caries and other medical and dental conditions automatically by analysing den- tal radiographs. The American company Pearl was the first technology company cleared by the US Food and Drug Administration to do this work.3 It is AI-powered Second Opinion software detects signs of pathologies and several common conditions in dental radiographs automatically in real time, delivering superior radiological accuracy compared with a human dentist. According to the company, Second Opinion can even foreground issues that are difficult to identify, such as incipient caries or early signs of a periapical radiolucency.4 Further, AI can be used to improve patient scheduling in a clinical setting. Efficient scheduling is paramount in making effective use of chair time, reducing patient wait- ing times and optimising resource allocation. AI can de- termine optimal staffing levels based on expected patient load, reducing over- or understaffing issues. It can be used to analyse patient history for various services and schedule appointments accordingly, enhancing the likeli- hood that facilities are neither under-utilised nor over- booked. Algorithms can calculate appointment duration, consider preferences for appointment times and health- care providers, monitor real-time patient flow and adjust appointment schedules. Rescheduling can be done automatically without effecting other schedules. It can also send automated reminders, allowing patients to reschedule or cancel appointments online and thereby reducing the occurrence of no-shows. It can historically predict which patients are more likely to miss appoint- ments, allowing facilities to overbook or follow up with reminders to those patients. 39 4 2023

supplement | supplement m o c . k c o t s r e t t u h S / s e g a m I a v i t a e r C © AI enables us to be more predictable, more effective and more precise and to have a second opinion or a proposal at minimum. While dentures are significantly more complex than crowns, according to Fisker, AI will revolutionise digital dentures just like it is beginning to dentistry. AI tools will eventually automate aspects of complete and partial den- tures currently designed using existing CAD technology.5 Currently, CAD technicians must mark the characteristic points and the outer boundary of the denture manually. No great technological leap would be required to auto- mate these processes using deep learning and large data sets. While this AI intervention would not revolu tionise dentistry, it would save denture laboratories meaningful time. Fisker predicts a future in which patients can view instantly generated, accurate digital simulations of final dentures and laboratories can produce 3D-printed dentures within an hour or two. In this future, AI will have significantly reduced barriers to access, delivering better patient ex- periences. “This outcome is clearly technically feasible,” Fisker suggests, “and I do not doubt it will happen in the foreseeable future.” 3 Mathematical equations and discrete anatomical land- marks already exist that can delineate important denture design factors such as tooth position, tooth size, tooth shape and gingival contours. In the future, I expect AI to allow us to automate a vast majority of our design parameters by relying on philosophies, principles, physics, anatomy and physiology that have been instrumental and institutional for decades. How should I feel about it? Ultimately, AI enables us to be more predictable, more effective and more precise and to have a second opinion or a proposal at minimum. In a perfect world, we would resist the temptation to turn over our metaphorical car keys to our computers; rather than fully automating our work- flows using AI, we should employ the tools available to us and set aside time to do the important human work of confirming or invalidating AI-generated recommendations. The time saved will still be significant and the quality of care will improve immensely and so will the money earned and the lives changed. Please scan this QR code for the list of references. about 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 effi cacy 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 certifi ed 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 fi rst 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). 41 4 2023

supplement | supplement 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 com- plications. 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 fac- tors 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 cru- cial to view AI as an enhancer rather than a substitute. AI’s primary function is to bolster human skills, not to over- shadow 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 guide- books 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. 43 4 2023

supplement | supplement Leveraging the power of artifi cial intelligence in dentistry By Iveta Ramonaite, Dental Tribune International The power of artificial intelligence (AI) has great appli- cation not only in general healthcare but also in special- ised fields such as dentistry. Dr Michael Parchewsky, a dentist at Terra Dental Care in Calgary in Alberta in Canada, hosted a free webinar in which he discussed how AI can help support dentistry with regard to im- proving both the oral and systemic health of patients. He also discussed some of the principles of AI and talked about how it will continue to help dental professionals to improve efficiency, diagnostic accuracy, case pre- sentation and case acceptance. y k s w e h c r a P l e a h c M i r D © Dr Parchewsky, how did you start your journey from an analogue to a digital workflow? What motivated you to take the digital leap? As a CEREC workflow user for nearly 20 years, my original approach to the digital workflow involved single appointment crowns. My journey then turned to the implant workflow in order to be able to digitally plan implants for the fabrication of surgical guides. Digital technology provides me with better efficiency; however, my main motivation for the digital leap was the opportunity it gave me to offer better care for my patients. What does AI mean to you personally? How has it changed your day-to-day work as a dentist? AI provides dentists with quickly available and intuitive information that can be used to treat their patients. For me, it has allowed my team to make better choices of therapies for patients and has allowed us to scan and plan treatment faster. The AI-generated proposal for CEREC crowns is an example of the benefits of AI technology. What are some of the technologies you use that feature AI, and what could you tell us about some novel technologies that will soon be entering the dental market? “AI provides dentists with quickly available and intuitive information that can be used to treat their patients.” Dr Michael Parchewsky. In our current workflows, we use AI to help with our CEREC workflow, office management and the analysis of patients’ sleep apnoea. Coming to the market soon is software such as OraQ, Pearl and Denti.AI, which will help dentists to improve their treatment planning and case acceptance through analysis of complex data sets. What other important insights on the use of AI in dentistry did you provide in your webinar? I think it is important to know where the technology is going and to understand how the role of a dentist may change in the future. These are some of the topics I covered in my webinar. Editorial note: The webinar is available on demand and free of charge at www.campus.dentsplysirona.com. 45 4 2023

supplement | supplement 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 impos- sible. 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 con taminating the socket, which is in fact bone marrow, the core of our immune system? “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.” 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 osteo- myelitis, 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 commu- nity 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 to dentists and vice versa—which is immunology? What are the immunological effects of all of these treat- ments? 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. m o c . k c o t s r e t t u h S / i i l i o t a n A o z b a R © 47 4 2023

supplement | supplement m o c . k c o t s r e t t u h S / o d u t s v o k u J © i 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 else- where; 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 life- time, 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 full- mouth 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 com- munication 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 diag- nostics and also perhaps to the lack of training that 49 4 2023

supplement | supplement 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 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 cardio - logist 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 health- care. 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 auto- immune 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. “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-profi t 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, refl ecting his dedication to advancing the fi eld. 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 Infl uential 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 fi rst artifi cial 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 Mirafl ores, 1495-131 Algés, Portugal www.whiteclinic.pt www.missinglink.ai 51 4 2023

manufacturer news | Developed by clinicians, for clinicians Founded by dentists, ClearCorrect listens carefully to clinicians’ needs and continually invests in its products and services, highlighting the brand’s customer-centric philosophy. Since being acquired by Straumann Group in 2017, the company has significantly accelerated its software and product development activities, solidifying its position as a leader in clear aligner manufacturing and distribution. With a dedication to efficient product development including technological advancements and improvements to the user experience for clinicians and patients, ClearCorrect continues to put customers’ needs front and centre. All of the recently launched innovations have been developed in collaboration with clinicians, helping to elevate their practices to achieve their full potential. “ClearCorrect is thrilled to launch these new solutions and features globally. Our latest wave of innovations allows clinicians to treat more complex cases, and we will continue to work together in partnership with clinicians to bring healthier, more confident smiles to patients,” said Laura Sterling, head of global marketing and education orthodontics at Straumann. www.clearcorrect.com Fig. 4: ClearCorrect Doctor Portal. (All images: © ClearCorrect) * Patent pending. ** Not available in all markets. Contact your local ClearCorrect or Straumann Group representative to learn when it will be available in your country. D I G I T A 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 O F D E N T I S T R Y AD Register at www.dds.berlin 28 & 29 JUNE 2024 DIGITAL DENTISTRY SHOW Digital DentistHy Show In collaboration with Digital Dentistry Society U N V E I L I N G T H E F U T U R E O F D E N T I S T R Y • D I G I T A L D E N T I S T R Y S H O W

STRAUMANN® REVEX SCANBODY DO YOU WANT TO ACHIEVE THESE GOALS? → Reduce visits from 5 to 3 (up to 40 %) → Provide more comfort to your patients and increase efficiency¹,² Then Straumann® RevEX is your tool: it’s digital, comfortable and simple – and the key to a fully digital workflow for the final full-arch restoration. www.straumann.com/revex ” A REAL GAMECHANGER. Dr. Panos Papaspyridakos, USA ” 1 Panos Papaspyridakos, Armand Bedrossian, Yukio Kudara, Panagiotis Ntovas, Abdullah Bokhary, Konstantinos Chochlidakis. Reverse scan body: A complete digital workflow for prosthesis prototype fabrication. Journal of Prosthodontics, 2023 2 E. Armand Bedrossian DDS, MSD, FACP, Panos Papaspyridakos DDS, MS, PhD, Edmond Bedrossian DDS, FACOMS, FAO, FITI “The Reverse Scan Body protocol”: Completing the Digital Workflow, Compendium June 2023 (will be published in August 2023). 3 2 / 8 0 0 0 / A / n e / 6 5 0 0 A

manufacturer news | Groundbreaking dental technologies Kuraray Noritake Dental: Born in Japan Kuraray Noritake Dental is quintessentially Japanese and has a long-established history that has shaped its entire existence. Today, the company’s craftsmanship, underpinned by ground- breaking dental technologies and outstanding product quality, is recognised across the globe. Kuraray, which is the parent company of Kuraray Medical, was founded in 1926 in Kurashiki in Japan by Magosaburo Ohara, who was a true innovator. He later would state: “I can see ten years into the future.” Over the years, this forward-thinking outlook has proved to be at the very core of the company’s pioneering drive. Kuraray initially began to develop dental products in the 1970s and later introduced its first key adhesive technology—the MDP monomer—in 1981. Noritake, which is the parent company of Noritake Dental Supply, was founded in 1904 in Nagoya in Japan. Its ceramic tableware and industrial abrasion wheels are well known globally. Brands like CLEARFIL, PANAVIA, KATANA and CERABIEN stand for groundbreaking technologies integrated into products that make an enormous difference. They now sit at the forefront of the latest trends in minimally invasive dentistry, helping users to attain the ultimate goal of maintaining natural teeth across the entire lifetime of a patient. Kuraray, which is the parent company of Kuraray Noritake Dental, boasted net sales of ¥541.8 billion (€3.8 billion) in 2020 and had a workforce of over 11,000 employees in December 2020. Thanks to its pioneering advances in engineering resulting in an exciting, innovative and universally utilised dental portfolio, Kuraray Noritake Dental is considered the jewel in the crown of this organisation. For every single one of its employees, wherever they operate in the world, a healthy smile means more than anything else. www.kuraraynoritake.com 57 4 2023 In 1987, Noritake launched its first dental products and established an entirely new class of veneering ceramics. This was done under the inspiring leadership of Kiyoko Ban, a woman who, by the 1980s, was already at the forefront of enhanced dental aesthetics and who is regarded as a true innovator in the field of dental ceramics. In the years to come, both Kuraray Medical and Noritake Dental Supply focused on advancing their core competencies. Then, in 2012, they joined forces to form Kuraray Noritake Dental. This combination of long-standing expertise in polymer-based organic chemistry with ceramic-based inorganic chemistry has enabled Kuraray Noritake Dental to develop a whole range of groundbreaking dental products. These include gold-standard self-etching adhe- sives and innovative universal adhesives, an array of cutting-edge resin cements for streamlined workflows, easy-to-use composites for direct restorations, highly aesthetic zirconia blanks for indirect restorations, and pioneering liquids and porcelains for virtually every finishing and staining technique in use today.

meetings | m o c . k c o t s r e t t u h S / u L g n a G © i i m a M i Inspiration, confi dence and passion delivered With its commitment to advancing oral health and deliver- ing innovative solutions, Dentsply Sirona has put together an exceptional programme that features an array of keynote presentations, engaging panel discussions and interactive workshops. Attendees can look forward to exploring the latest trends, research and breakthroughs in the field of implant dentistry. The event will offer valuable insights into ways of improving dental practices and pro- vide networking opportunities with industry peers. “It is an honour to host the Implant Solutions World Summit again in 2024,” said Tony Susino, group vice president of global implant and prosthetic solutions at Dentsply Sirona. “This event reflects our commitment to advancing implant dentistry through education, innovation and collaboration. We are excited to bring together experts from around the world to share their expertise and inspire the future of implant and prosthetic innovations,” he continued. Discover the ever-evolving world of dental implant solutions The Implant Solutions World Summit programme is being developed together with the scientific chairs, Prof. Lyndon F. Cooper, dean of Virginia Commonwealth University School of Dentistry in the US, and Dr Malene Hallund, a prominent oral and maxillofacial surgeon in Denmark. With their extensive experience and contri- butions to the field, they will lend their expertise to en- sure that the scientific programme delivers unparalleled educational content and is an enriching experience for all attendees. “This event serves as a platform for professionals ded- icated to implant dentistry to connect, exchange ideas and lead with innovations,” said Prof. Cooper. “We are looking forward to a programme that will inspire and challenge attendees, pushing the boundaries of what is possible in this rapidly evolving field. I believe it will provide a transformative educational experience for all participants,” he added. Designed to empower dental professionals and fos- ter collaboration, the agenda will feature plenary and parallel sessions as well as master classes. Leading experts and renowned speakers from all over the world will share their knowledge, insights and real-world case studies, providing attendees with valuable prac- tical information that can be directly applied in their practices. The diverse range of parallel sessions and master classes will dig deeper into specific areas of interest to enable attendees to customise their con- ference experience to meet their unique professional development goals. Attendees of the 2024 Implant Solutions World Summit will also be able to visit an interactive exhibition to learn more about Dentsply Sirona’s products, solutions and including the EV Implants, OSSIX regenerative solutions, DS Signature Workflows and the cloud-based DS Core platform. treatment workflows, Early bird registration for the Implant Solutions World Summit is available until 31 January 2024. To find out more information about the event and to register, visit www.dentsplysirona.com/worldsummit. 59 4 2023

meetings | | The Escobar is an extension of the Badeschiff that includes a covered bar area. research evidence, the scientifi c 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 artifi cial intel- ligence, the digital workfl ow 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 scientifi c programme can be found online at the event’s offi cial 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. 61 4 2023

How to send us your work submission guidelines | m o c . k c o t s r e t t u h S / s l i e x p 2 3 © Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: · the complete article; · all the image (tables, charts, photo- · · graphs, etc.) captions; the complete list of sources consulted and the author or contact information (bi- ographical sketch, mailing address, e-mail address, etc.). In addition, images must not be embed- ded into the MS Word document. All im- ages must be submitted separately, and details about such submission follow be- low under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much in- formation. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to emphasise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use un- derlining. Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing pro- gramme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word process- ing programme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such formatting before layout, which is very time-consum- ing. Please consider this when formatting your document. Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our requirements but send us the largest files available. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) Also, please remember that images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail or share the files in our cloud storage (please contact us for the link). Please also send us a head shot of your- self that is in accordance with the re- quirements stated above so that it can be printed with your article. Image requirements Abstracts Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to ap- pear in this section and format it accord- ing to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary information (60 words or less). · We require images in TIF or JPEG for- mat. · These images must be no smaller than Questions? 6 x 6 cm in size at 300 DPI. · These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com 65 4 2023

O r t R e h o d o s t o r n t i c s a t i v e D e n S t l e e p u r e s I m p l a n t Simplify workflows and expand your practice NEW DEXIS IS 3800 Expand your treatment offerings DEXIS™ IOS Solutions seamlessly integrates into your dental workflow, helping you to simplify processes, increase productivity, and facilitate practice expansion. Say hello to more time for what really matters — your patients. Find out more at dexis.com © 2023 Dental Imaging Technologies Corporation. All rights reserved; DXIS00275 /RevA dexis.com