The Emerging Face of Digital Dentistry

A visit to the dentist has never ranked high on anyone’s highlight reel. Invasive drilling, messy impressions, and long waits for appliances have prompted many people to grit their teeth in frustration. However, like nearly every other field, dentistry is undergoing a quiet transformation. It’s rapidly going digital.

Technologies such as intraoral image scanning, 3D printing, AI-aided diagnostics, augmented reality (AR), and robotics are rapidly transforming dentistry. These tools aid in analysis and treatment, speed procedures, improve precision, and make it possible for underserved populations to receive care. They also dial up the comfort level for patients, including young children and the elderly.

“Digital technologies are not just a shift but a transformation in dentistry, fundamentally changing how practitioners approach care and how patients experience treatment,” observed Mohsen Khobyari, a practicing dentist and president of the American Academy of Digital Dentistry.

The evolution to digital dentistry presents some challenges and concerns, however. Not all dentists are eager to invest the time, money, and training required to overhaul their practices. This could lead to unequal access to care. In addition, there are worries about data privacy, and dentists becoming overly reliant on technology.

Filling the Gaps

Digital dentistry’s roots extend back to the mid-1980s. That’s when CAD/CAM technology began to reshape the way dentists design and produce restorations. What followed was an ongoing series of innovations: digital X-ray systems provided faster and better views of teeth. Intraoral scanners allowed dentists to obtain detailed images of the mouth. Labs with 3D printers began producing custom crowns, bridges, and other oral appliances.

These tools deliver both quantitative and qualitative gains. They alleviate staffing challenges, automate processes, aid in diagnostics, and typically improve the patient experience. “For practitioners, tools like 3D printing and CAD/CAM systems streamline workflows, making same-day restorations possible. This reduces patient chair-time and enhances satisfaction,” Khobyari said.

The precision that CAD/CAM systems and 3D scanners offer is unparalleled, Khobyari added. “Digital impressions have an accuracy of 10 to 15 microns, compared to traditional impressions that often carry a margin of error around 50 microns. This kind of precision ensures better-fitting restorations, which reduces the need for adjustments and remakes.”

“The big difference is patient comfort and speed,” said German Gallucci, chair of the Department of Restorative Dentistry and Biomaterials Sciences at Harvard School of Dental Medicine. Scanning technology aids in detecting discoloration, small chips and scratches, inflammation, cavities, and receding gum lines. Augmented reality can show patients what’s wrong, along with a preview of how their teeth or smile will appear after implants or dentures.

3D printers also are making their mark. Traditionally, dentists have relied on milling techniques—typically using a drill bit—to subtract material from a crown or other appliance so that it fits correctly. Newer additive methods—which collect data from an intraoral scan—fabricate appliances that require little or no adjustment.

“Additive manufacturing processes produce a significantly better fit for patients. In the future, it’s likely that all restorations and prostheses will be printed,” noted Mark Ludlow, Section Head of Implant Dentistry, Digital Dentistry, and Removable Prosthodontics at the University of Utah.

Today, most 3D printing used in dentistry takes place in a lab, but the technology is filtering into dental offices. One barrier to widespread adoption is the price of 3D printers, which can set a dental office back $10,000 or more. “It’s a significant issue, particularly for smaller practices,” Khobyari said. Another challenge revolves around the materials that office 3D printers use. At present, they don’t match the aesthetic quality of conventional materials like porcelain.

However, “Companies are rapidly making progress with additive materials. It’s only a matter of time before 3D printing becomes the industry standard,” said Michelle Aguilos Thompson, Director of Digital Dentistry and Associate Professor in the Department of General Practice and Dental Public Health at the University of Texas School of Dentistry at Houston (UTHealth Houston School of Dentistry).

Bites Meet Bytes

Artificial intelligence and robotics represent another frontier of digital dentistry. For example, AI is already delivering more nuanced and accurate diagnostics and designing crowns, mouthguards, and dentures.

Robotic devices already aid with certain types of dental surgery. Within a few years, dentists will likely use these devices for drilling, filling cavities, handling root canals, installing appliances, and numerous other tasks. “Robotics, although still in its infancy in dentistry, holds promise, especially for surgical procedures like implant placement, where precision is critical,” Khobyari said.

At present, Yomi, a robot produced by a company called Neocis, is the only FDA-cleared robotic system for dental surgery. It has performed more than 20,000 robot-assisted implants, according to the company. The robot guides surgeons through the procedure with real-time feedback and assists in positioning the drill precisely. This reduces the risk of human error and leads to more predictable, consistent outcomes.

Boston-based Perceptive is developing an advanced robot that combines 3D imaging, artificial intelligence, and a robotic arm. Pending FDA approval, it will perform dental procedures like crown placements with unparalleled speed and precision. The system dramatically reduces the time required to complete tasks, said CEO Chris Ciriello. For example, it can fit a crown in approximately 15 minutes, compared to traditional methods that require a few hours over multiple visits.

“The dentist remains in control of the robotic system. There’s a human in the loop at all times,” Ciriello said. The robot relies on custom algorithms and optics to push beyond current scanning methods. Using an optical coherence tomography (OCT) process that relies on photons to generate 3D volumetric data, a dentist can see inside a tooth in real time. The robot can then use this data to guide a dentist through a procedure faster and improve efficiency, safety, and consistency. The robot has already been used successfully on an experimental basis.

The result? “The robot cuts to an accuracy level of about 30 microns, which is one-third the thickness of a human hair,” noted Perceptive chief technology officer Phillip Getto. “It’s a level of accuracy that’s nearly impossible to achieve by hand.” In practical terms, the robot can precisely remove tooth decay. “You have a better image of the cavity than X-rays can provide, and the robot can remove only the minimum amount of tooth required,” Getto added.

Crowning Achievements

At first thought, the idea of a robot drilling and scraping teeth may seem somewhat, well, unnerving. But experts say that patients are highly receptive to the idea of automated systems that work alongside their human counterparts. This includes tasks such as administering anesthesia, cleaning, drilling, and installing appliances. “These systems can make various types of dental, periodontal, and orthodontic processes simpler and more comfortable for patients,” Thompson said.

For the foreseeable future, dentists will remain in charge. “Humans still need to confirm things, and they need to be in the loop because machines can glitch and make mistakes, too. There’s also a need for a kill switch,” Thompson observed. At Perceptive, “The focus is on semi-automating processes rather than replacing humans,” Getto said. “Dentists will be able to stop the machine at any instant.”

Digital technologies also unlock opportunities for telemedicine, home diagnostics, and mobile clinics. Gallucci is particularly enthusiastic about emerging consumer technologies. For example, he noted that digital toothbrushes that contain internal scanners will soon appear on store shelves. These devices will spot areas that a person missed with a toothbrush; monitor the pH level of the mouth; spot calculus (tartar), plaque, and cavities, and possibly even detect cancer and other diseases.

More advanced 3D facial scans, intraoral scans, and an imaging technology called cone beam computed tomography (CBCT) can capture images of teeth, soft tissue, bone structure, and jaw movements (chewing and grinding, for example). AI can analyze the data to understand why certain teeth incur damage, and then design an appropriate appliance or remedy. Dentists can capture precise information about the oral cavity and jaw and share the information with patients, in ways that include animations.

AI is impacting dentistry in other ways. For example, a company called Pearl offers an FDA-approved tool that uses AI to detect numerous conditions in dental x-rays. This makes it possible to detect issues earlier and spot hard-to-diagnose conditions. Another company, Dandy, has built a digital lab that practices can use to rapidly design and fabricate crowns, bridges, implants, dentures, mouthguards, and more.

An Instrument for Progress

The widespread adoption of digital dental technologies could wring out many of the inefficiencies in the current system, experts say. For example, accurate home diagnostics might eliminate the need for regularly scheduled visits to the dentist. Instead, a smartphone app connected to a smart toothbrush would indicate when a patient needs a cleaning, filling, or other procedure.

The technology could also have a profound impact on the availability of dental services, including for those that live in rural areas, developing nations, and other underserved regions. “Today, one of the biggest problems in dentistry is the lack of access to oral health,” Gallucci said. “Not only are current treatments expensive; they are unavailable in many regions of the world.”

Mobile clinics could help address the problem. Vans equipped with intraoral scanners, 3D printers, AI diagnostics, and robots could expand the availability of services in many parts of the world. “In some cases, it may not be possible to get 20 dentists to an underserved area, but it’s possible to for one or two dentists with several robots to treat patients,” Gallucci said.

Further out, Khobyari believes AI and 3D printing could lead to regenerative bio-printed tissue that could be used to replace teeth and gums. These restorations could be better customized to patients, accelerate treatment time, and boost biocompatibility. This, in turn, could speed the healing process and drive down costs.

Drilling into a Digital Future

Naturally, any vision for the future intersects with practical realities. At the moment, some of these technologies—particularly robots—aren’t ready for mainstream use, and getting dentists to invest and adapt will take time. Ludlow noted that a significant shift in skill shifts and training is necessary: “The techniques and workflows that accompany digital dentistry can be very different than traditional methods.”

There’s also the issue of data privacy. Laws such as HIPAA may regulate how medical practitioners collect use and share health data, but they can’t prevent data breaches and data leakage. “The risks extend far beyond the dentist’s chair,” noted Douglas Schuler, president of the Public Sphere Project, an organization that analyzes public interactions and digital technologies. An increased focus on security and privacy is warranted, many observers say, because small offices often don’t deploy adequate security measures.

Finally, the Food and Drug Administration (FDA) in the U.S. and other regulatory agencies across the world must adapt. “One of the current challenges is the length of time it takes to secure regulatory approval, particularly for AI-driven diagnostic tools or 3D-printed materials,” Khobyari said. “Regulators will need to ensure that AI complements the dentist’s expertise without overstepping their bounds.”

Indeed, the question isn’t whether digital dentistry will take root, but how it will impact both dentists and patients. Concluded Thompson: “We are seeing a new generation of hygienists and dentists graduate from schools, begin working in practices that aren’t digital—and within a year or two, the practices adopt digital tools. The value proposition for many of these practices is too big to ignore.”

Further Reading