issn 2193-4673 • Vol. 1 • Issue 1/2024 1/24 AI dentistry international magazine of artifi cial intelligence in dentistry preview opinion The transformative power of AI in dentistry interview AI’s primary function is to bolster human skills trends & applications The missing link

editorial | Dr Robert A. Gaudin Fellow of the BIH Charité Digital Clinician Scientist Program, Charité—Universitätsmedizin Berlin, Germany The rise of artificial intelligence in dentistry: A game changer in patient care In a twist that was once confined to the realm of science fiction, artificial intelligence (AI) has become the major topic in politics, business and the media. As a founder of two dental AI health companies—US-based VideaHealth and dentalXr.ai Europe- based—I am confident in saying that my initial vision and collaboration with entrepreneurs and re- searchers has helped shape the dental AI environment. I am privileged to have been part of the initial research in 2016 on apical lesion detection conducted at Charité— Universitätsmedizin Berlin in Germany, the Massachusetts Institute of Technology and the Harvard University in the US. The promising findings underscored a future where AI would redefine the very fabric of how dental prac titioners approach diagnostics.1 Since then, there has been a surge in AI-related publi- cations in dentistry, particularly in the last five years.2–7 Radiographic image analysis is a focal point, and re- searchers globally have developed AI models to support dentists in diagnosing various dental images. The addi- tional advantages of AI in dentistry include: – streamlined detection of anatomical structures and dental materials, providing dentists with comprehen- sive preliminary findings, saving time and improving documentation quality; – superior pathology detection, identifying conditions like early caries more accurately; – enhanced patient communication, providing patients with a better understanding of their conditions by visually highlighting pathologies; and – improved marketing potential, conveying the dental practice’s commitment to progress, innovation and a patient-centric approach. AI-driven software, has become a symbol of progress and sophistication for dental practices. The adoption of AI not only streamlines workflows and enhances diag- nostic capabilities but also positions dental practices as pioneers in embracing the future of healthcare. Beyond image analysis, dentists envision AI assisting in automating various processes in their practices, from gen- erating insurance claims to transforming 3D scanners into diagnostic tools. AI has become intertwined with 3D- printing technology, heralding an era where precision meets effi- ciency, a future where dental prostheses and implants are not only tailor-made for each patient but are also crafted with unparalleled accuracy, thanks to the guiding intelli- gence of AI algorithms. As dental practices increasingly embrace this revolutionary amalgamation, the realm of AI and 3D printing in dentistry emerges as a beacon of innovation, promising a future where smiles are crafted with unprecedented precision and care. Despite concerns about AI replacing human roles, regulatory restrictions ensure that AI can only assist, the ultimate decision resting in human hands. While current AI capabilities may not generally surpass those of den- tists, it is acknowledged that improvements will come with time and evolving algorithms. The future holds a vision where AI, combined with diverse image modal- ities and patient information, provides dentists with a comprehensive analysis of each patient and an individ- ualised and maximally optimised approach to patient treatment. As the dental community navigates the integration of AI into daily workflows, understanding how to harness its potential is crucial. The consensus is clear: AI is not a threat but a tool that, when utilised effectively, has the potential to revolutionise patient care in dentistry. The journey towards an AI-assisted future in dentistry has begun, and its impact promises to be transformative. Editorial note: A list of references is available from the publisher. AI dentistry 1 2024 03

Primeprint® Solution: expand your practice or lab with 3D printing Boost your productivity with our medical-grade 3D printing solution and simplify the entire printing process to help you grow your practice or lab – including a post-processing unit (PPU) with a high level of automation and safety. Make Primeprint Solution work hard for you by powering it with DS Core™, for seamless integration with existing digital workfl ows including connection with DS Core™ Create1 – our expert design service – and other digital solutions. Stay connected like never before with your partners and labs. Visit dentsplysirona.com/dscore to learn more. Let’s work together. #DSCore #WorkingWithYou 1 not in all countries available yet.

opinion | For instance, AI is the driving force behind automated speech recognition and closed captioning, enhancing accessibility for individuals with hearing impairments. In the realm of online customer service, AI-powered chat- bots efficiently assist users on e-commerce websites, making shopping experiences smoother and more ef- ficient. Moreover, AI excels in image categorisation and analysis, a capability we often encounter in apps like Apple Photos or during medical image assessments at healthcare facilities. The evolution of AI The recent surge in AI’s prominence can be attributed to several factors. One crucial factor is the exponential growth in computational power, computers continuously becom- ing more potent and capable of handling complex AI tasks. Another pivotal development is the unprecedented access to massive data sets, consisting of millions of documents and images. Additionally, the emergence of deep learning networks has revolutionised AI by allowing it to process vast amounts of information, often derived from extensive online data sources. Traditionally, software developers created specific algorithms tailored to solving well-defined problems. However, deep learning, a subset of machine learning, which is itself a subset of AI, introduced a dynamic approach. Deep learning models are adept at handling substantial data sets and can learn the unique characteristics of various document types, such as images, essays or strings of computer code. These models then generate new, original content that closely resembles the examples they have encountered, all with minimal human intervention. Dr Rune Fisker, senior vice president of product strategy at the dental scanning and software company 3Shape, has underscored the significance of deep learning in AI’s advancement. He noted that deep learning demands less development effort compared with traditional ap- proaches while delivering significantly higher performance. The societal and other implications of this are profound, as it will make computers considerably more intelligent. The implications for dentistry But what does this mean for the field of dentistry? The potential applications of AI in dentistry are vast and trans- formative. While AI is not a panacea, ignoring its potential would be a missed opportunity. AI is poised to become the next evolution in the dental profession, much like how digital technology revolutionised dentistry by surpassing the limitations of analogue methods. AI 2.0 (3Shape) edentulous scan. Dr Fisker envisions AI-powered (computer-aided) denture design as not only technically feasible but also inevitable. The impact of AI extends to various aspects of dental care, including imaging, diagnostics and eventually design. 3Shape’s current intra-oral scanning technology, called AI 2.0, uses AI to help identify edentulous soft tissue and delineate between soft tissue, teeth and other artefacts in the mouth. Conventional intra-oral scans naturally capture everything within range of the scanner’s beam, including unhelpful images of soft tissue irrelevant to the final diagnosis or design of the final prosthesis. Using AI and deep learning, modern 3Shape scanners can intelligently differentiate between soft tissue and other, more important, intra-oral information. 3Shape’s scanning software automatically and instantly deletes this soft-tissue information, producing a cleaner, more useful final digital record of a patient’s intra-oral situation. Before the company’s AI-powered technology was developed, technicians and clinicians needed to manually annotate the unwanted soft tissue and tongue on the initial scanning output. Over time, 3Shape accumulated a very large set of these accurately annotated scans, which it then used to train its deep learning algorithm, effectively teaching it to do the identification work human annotators had performed previously. AI in dental imaging and diagnostics In our everyday lives, AI enhances our efficiency, effective- ness and predictability. In North American oral health- care, these qualities translate into increased profit margins. One of the most promising applications of AI in dentistry is in dental imaging and diagnostics. Traditional dental radiographs AI dentistry 1 2024 07

opinion | AI can assist in the design of surgical guides for implant placement. acteristic points and the outer boundaries of dentures. With AI, these processes can be automated using deep learning and extensive data sets. While this intervention may not revolutionise dentistry, it will significantly reduce the time required in denture laboratories, making the design process more efficient. than completely automating our workflows, it is essential to leverage AI as a powerful tool while dedicating time to validating AI-generated recommendations. This approach not only saves time but also enhances the quality of patient care, ultimately improving the lives of both patients and dental professionals. Dr Fisker envisions a future in which patients can in- stantly view accurately generated digital simulations of their final dentures and laboratories can produce 3D-printed dentures within hours. In this future, AI will substantially reduce barriers to access, enhancing the patient experience. This outcome is not just theoretically feasible; it is highly likely to become a reality in the foreseeable future. The role of AI in denture design To delve deeper into the potential of AI in denture design, it is crucial to understand the underlying principles. Mathematical equations and discrete anatomical land- marks already exist to delineate essential denture design factors such as tooth position, tooth size, tooth shape and gingival contours. AI has the potential to automate a significant portion of the design process by relying on established philosophies, principles, physics, anatomy and physiology that have been instrumental in dentistry for decades. Conclusion In conclusion, AI in dentistry empowers us to be more predictable, effective and precise in our practice. Rather 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). AI dentistry 1 2024 09

has not yet been mastered, despite years of effort and oceans of investment. Narrow AIs, however, already easily match or surpass hu- man abilities, and they have become the tools of choice for performing many exacting tasks. Many of these involve computer vision, the analysis and recognition of objects or imagery. More than a decade ago, it was found that a trained AI could recognise and categorise nodules in radio- graphs of cancer patients’ lungs as accurately as a panel of oncologists could, and much faster. Computer vision and AI are now familiar parts of the oncological toolkit, and they are being applied to a widening array of medical fields. One of those is dentistry. Dentists are in an excellent position to take full advantage of AI. There exists, to start with, a virtually limitless supply of dental radiographs for training. The radiographic image is the coin of the realm in dentistry; patients are accustomed to having their pathologies explained to them with reference to the “spectral smudges on an X-ray” evoked by The Atlantic’s reporter. The range of pathologies to be detected is rela- tively narrow, and the AI program can not only identify them but also quantify them with greater than human precision. The dental radiograph is, therefore, an ideal application for the sharp focus of narrow AI. The second opinion—so to speak—provided by an AI program is directly valuable to the practitioner. The computer is hypersensitive to subtle greyscale gradations; it may detect something the human reader has overlooked. More impor- tantly, it is never tired, distracted or rushed and so is not prone to the types of mistakes and oversights that people routinely make simply because they are human. The AI program may in many cases simply duplicate the perceptions of the human, in which case nothing is gained but confirmation, but it may add information overlooked by the human or differ in its interpretation, leading to a re-examination and re-evaluation of the evidence. Even if these benefits may seem minor to an experienced practitioner confident in his or her abilities, there is another side of the AI experience to consider: the patient’s. The results of the AI program’s analysis are presented to the patient in vivid, intuitively understandable form. The radiograph no longer consists merely of spectral smudges, but has become graphically compelling, having highlighted areas, colour-coded outlines and explanatory labels. For a patient, the enhanced display conveys a heightened sense of pre- cision, clarity and objectivity. The diagnosis is no longer just the opinion of one person, whom a cynic might suspect of ulterior motives. It need not be taken on faith; it is supported by the unbiased authority of a digital computer. While the graphic presentation of a computed analysis may impress a patient as something more than human, the prac- titioner should be aware that the AI program is an assistant, not a supervisor. Even though the accuracy of AI’s radio- graphic analyses in various medical fields has been shown to be indistinguishable from that of human interpreters, the AI program actually knows much less about teeth (or lungs or livers) than the trained and experienced practitioner does. What it does know, and knows very well, is how a large number of specialists have interpreted a very large number of radiographs. Its findings are, in effect, those that hundreds or thousands of dentists would make if they were to vote on the content of a given radiograph. Where there is not unanimous agreement, majority opinion prevails, or findings are presented in terms of probabilities. The practitioner using the AI program remains entirely free to form a different opinion or to disregard the advice the program gives, but has the benefit of knowing what a large group of peers would have made of the radiograph in question. The most significant impact of dental AI, however, is not that it necessarily brings a superhuman level of certainty to the data upon which diagnoses are based—although in most cases it may—but that it provides, for the first time, an objective and uni- versally accessible standard of reference. Objective standards are precisely the thing that dentistry has lacked in the past, and their absence has given rise to suspicions about the candour and consistency of dental diagnoses. Look at the Reader’s Digest writer: guided only by a phone book, he collected a bewilderingly large variety of diagnoses. If he had visited only dental offices using an AI assistant, he would have been given a much smaller variety, and the differences would have been due to small variations among the radiographs made by dif- ferent practices rather than to the whims of individual dentists or the immediate financial needs besetting them. Consistency is not the only thing AI brings to dentistry. It also provides support for insurance claims and facilitates record-keeping, tracking of patients’ dental health and com- parison of performance among multiple practices in an orga- nisation. It trains dentists at the same time as dentists train it. In the future, it may reveal connections between dental health and general health that we do not now suspect. Those are some of the collateral benefits. Above all, however, AI will give patients the reassurance of knowing that the condition of their teeth is not merely a matter of opinion. Editorial note: This article was first published in digital— international magazine of digital dentistry, Vol. 4, Issue 1/2023. about Dr Kyle Stanley is a specialist in implantology and a passionate advocate for mental health in the dental profession. He is founder and chief clinical offi cer of Pearl, a company transforming patient care through artifi cial intelligence. Dr Stanley maintains a private practice in Beverly Hills in the US, where he focuses on implant surgery and prosthetics. opinion | m o c . k c o t s r e t t u h S / r a t s r e p u S © AI dentistry AI dentistry AI dentistry AI dentistry 11 1 2024 11

interview | A visual question answering example framework with the assistance of an image encoder, which generates a natural language representation from a radiograph. (Image: © 2023 Huang et al., licensed under CC BY 4.0) You provided an example of using NLR to help dentists lower the likelihood of potential adverse drug reactions in relation to dental procedures and other drugs. Could you describe what it might look like when a dentist chooses to use ChatGPT or other forms of AI to make their practice and treatments as effective as possible? It would be very effective. Of course, as I mentioned in the last question, strict and proper data sorting is extremely important before this application. After that, for dentists, LLMs will help provide a more careful approach to treatment and help decrease the incidence of 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. AI dentistry 1 2024 13

interview | a valuable tool. As a working group, we have observed that there are protocols of great clinical value that can be very useful both for general dentists and for those who specialise in a particular field, so it is essential to have a tool that directly provides accurate information to questions posed to it. For clinicians just learning about AI in dentistry, what would be some very basic principles for them to know to better understand the impact of research like yours? As I indicated before, it is important to be aware of the limitations that text generation systems such as ChatGPT currently have in the sense that not all the information provided is accurate. This is the key point that a clinician needs to be aware of today. Nowadays, there are tools to train AI systems ourselves so that the information provided is adequate for the purpose for which it is consulted, but this should not preclude the dental professional being up to date scientifically speaking, such as by attending congresses and courses to keep up to date and reading relevant scientific literature. Because large language models and really all AI programs rely on big data, what encouragement would you offer clinicians concerned about data usage? States and international organisations are taking action through specific legislation in this area. As a group based in the EU, we are closely monitoring this legislation. Particular attention must be paid to the use of patients’ personal data when training an AI, as this data is sensitive and we could potentially be in breach of data protection laws and face serious legal consequences. Patients should also be aware of these issues and take care to avoid exposing their data to apps or systems that have nothing to do with genuine medical assistance, especially those that aim to commercialise such data. Editorial note: The study, titled “Beyond the scalpel: Assessing ChatGPT’s potential as an auxiliary intelligent virtual assistant in oral surgery”, was published for the December 2024 issue (in progress) of Computational and Structural Biotechnology Journal. about Prof. Víctor Díaz-Flores García holds a PhD in dentistry, an MS in advanced endodontics and a bachelor’s degree in law. He is professor of dentistry at the European University of Madrid in Spain, where he is part of the research group Transformative Research in AI and New Enhancements for Dentistry. AI dentistry 1 2024 15 Were there any aspects of your findings that were unexpected? What do you feel are the key takeaways of your research as they apply to AI in dentistry going forward? The use of ChatGPT, or any other app that uses large language models, must currently be understood as a tool in its infancy. Not all the information given to us is correct, so it is necessary to train the system to give increasingly correct answers. In the studies we have carried out with ChatGPT, we have seen a promising consistency in the responses to clinical protocols, but this must always be checked by the health professional when using these tools as a basis for diagnosis or treatment. It is obvious that in the near future these tools will be present in our daily treatment, but today we must understand that they are untrained systems that must be taken into account in their proper measure when making clinical decisions. Your team’s publication indicated that AI could be- come an incredibly reliable assistant in oral surgery, particularly in areas of the world where dental spe- cialisations are not yet recognised. What inspired you as researchers to explore AI’s capabilities in this direction? Access to information is essential for decision-making. The availability of up-to-date protocols of clinical actions is a benefit for the patient and can avoid safety prob- lems in many aspects (use of medicines, application of cer- tain materials, etc). An AI program trained by profession- als specialised in a specific branch of dentistry would be

AI research | 2 3 Fig. 2: Researchers make use of generative AI to design personalised dental crowns. Fig. 3: Natural tooth (left) compared with tooth tailored by generative AI (right). The generative AI-designed crowns had the lowest 3D discrepancy, closest cusp angle and similar occlusal contacts compared with natural teeth. In lithium silicate, the AI-designed crowns were found to have an expected lifespan similar to that of natural teeth. According to the researchers, the other two methods of designing dental crowns produced crowns that were either too large or too thin and failed to reach the same lifespan as that of natural teeth. “This demonstrates that [the algorithm] could be utilised to design personalised dental crowns with high accuracy that can not only mimic both the morphology and bio- mechanics of natural teeth, but also operate without any additional human fine-tuning, thus saving additional costs in the production process,” added senior researcher Dr James Tsoi, an associate professor in dental materials science at the university. “Many AI approaches design a ‘lookalike’ product, but I believe this is the first project that functionalises data-driven AI into real dental application. We hope this smart manufacturing technology will be the stepping stone for driving Industry 4.0 in dentistry, which is vital to meet the challenges of an ageing society and lack of dental personnel in Hong Kong,” Dr Tsoi stated. Clinical trials for using the generative AI for dental crowns are underway. Additionally, the researchers are working to expand the applicability of the tool to other dental pros- theses, such as partial and complete dentures. Editorial note: The study, titled “Morphology and mechanical performance of dental crown designed by 3D-DCGAN”, was published online in the March 2023 issue of Dental Materials. Fig. 4: The HKU Dental Materials Science research team: (from left) co-investigator postdoctoral fellow Dr Hao Ding, principal investigator Dr James Kit Hon Tsoi, and PhD candidate Ms Yanning Chen. 4 17

AI research | CBCT images showing overlaid expert and deep learning system segmentations. Every image on each column is annotated by the same expert, shown in red, the deep learning system annotation is shown in green and overlap is shown in yellow. (Image: © 2022 Järnstedt et al., licensed under CC BY 4.0, no changes) dibular canal and performed better overall than the radiologists. In addition, it showed promising gen- eralisability with regard to new CBCT scanners and ethnic groups. “When a huge amount of data is fed to the neural network and the location of the mandibular canal is marked in it, it learns to optimise its own internal parameters. The neural network resulting from this learning quickly finds the mandibular canal from the individual 3D data input,” said co-author Vesa Varjonen, vice president of research and technology at dental equipment manufacturer Planmeca, which is based in Helsinki. “In clinical assessments, experts went through the results produced by the model and discovered that in 96% of the cases they were fully usable in clinical terms. We are highly confident that the model works well,” commented co-author Jaakko Sahlsten, a doctoral researcher at Aalto University. “The collaboration arose from the needs of experts practising clinical work and from seeking ways to help their everyday work. A lot of time can be saved by using artificial intelligence in patient treatment planning,” said Varjonen in a press release. “Tampere University Hospital provided us with extensive and versatile clinical materials produced with several 3D-imaging devices. The data was divided at random and part of it used for training the neural networks and part of it isolated for testing and validating the designed method,” said Sahlsten. Planmeca to integrate the model in its imaging portfolio For Planmeca, a Finnish family business and one of the world’s leading equipment manufacturers in health tech- nology, the collaboration with FCAI and Tampere University Hospital means significant new business potential. “Digitality and AI used in imaging equipment are import- ant for us. We will integrate the neural network model developed in this research into our imaging software. This will improve the usability and performance of our equipment,” said Varjonen. Model for orthognathic surgery In addition, the collaborative research project developed a neural network model for orthognathic surgery. “The model helps to identify landmarks in the skull area for correcting malocclusion and planning jaw alignment surgery,” said Varjonen. “I see artificial intelligence as a very powerful tool that physicians and other experts can use when making their first assessments or to get alternative opinions. The challenge with deep learning models is that we cannot give definite grounds as to why the model reaches a specific outcome. Further research is needed to increase the explainability and transparency of the models,” concluded Sahlsten. Editorial note: The study, titled “Comparison of deep learning segmentation and multigrader-annotated man- dibular canals of multicenter CBCT scans”, was published on 3 November 2022 in Scientific Reports. AI dentistry 1 2024 19

trends & applications | 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 © 21

trends & applications | 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 AI dentistry 1 2024 23

trends & applications | unaware of the dental world, to prescribe a test to determine whether the patient has cytokine-producing inflammation in the jaw. Until now, there has been no way other than verbal communication for doctors to know whether their patients have any oral pathologies. Any general medical practitioner can ask for a 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-profit organisation he co-founded. Recognised for pioneering clinical implementation of cutting-edge technologies, he serves as a consultant and key opinion leader for industry-leading companies and dental societies. He is the vice president of the Digital Dentistry Society, reflecting his dedication to advancing the field. Dr Stanley also holds an academic position at the prestigious University of Pennsylvania in the US and has delivered over 250 keynote presentations in more than 50 countries. Dr Stanley, a TEDx speaker and National Geographic documentary host, was recently listed among the “32 Most Influential People in Dentistry” by Incisal Edge magazine in the US. Actively driving innovation, he introduces novel concepts and therapies at White Clinic, delving into regenerative medicine, longevity, and the development of biological, integrative and functional dentistry and medicine. Recently, Dr Stanley co-created Missing Link, the world’s first artificial intelligence software that helps the medical community communicate better with dentists by means of scanning dental radiographs for hidden pathologies that could be disrupting systemic health. Explore his insights further through his podcast, Biting into Healthcare, and delve into his impactful work at miguelstanley.com. contact Dr Miguel Stanley R. Dr. António Loureiro Borges 5 1 Miraflores, 1495-131 Algés, Portugal Editorial note: This article was first published in digital— international magazine of digital dentistry, Vol. 4, Issue 4/2023. www.whiteclinic.pt www.missinglink.ai AI dentistry 1 2024 25

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. | meetings | 27 27

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 AI dentistry 1 2024 29

invis is the future of ortho- restorative care. Invisalign Smile Architect™ Transform the invasive procedures of the past into the minimally invasive treatments of tomorrow. Invisalign Smile Architect™ is a first-of-its-kind smile design solution that combines alignment and restorative planning in a single platform, promoting lasting oral health. © 2023 INVISALIGN, ITERO and CLINCHECK, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. M10765