Application of Artificial Intelligence in Prosthodontics in the 21st century

Introduction

The advancement of Artificial Intelligence (AI) within the 21st century has caused drastic upheavals in variety of industries, with healthcare standing out as a key beneficiary. Artificial Intelligence (AI) is rising into health technology, revolutionising medical administrations through predictive, preventative, individualized, and participatory approaches. AI envelops distinctive computational concepts such as machine learning, deep learning procedures, and neural systems.¹ By mirroring human insights, AI frameworks offer plenty of benefits to people in their everyday lives. From dispensing with spam emails to cutting-edge smartwatches separating between schedule and high-impact exercises through accelerometer sensors and personalized item suggestions by online retailers, AI consistently coordinates social orders worldwide.

Machine learning helps in the department of healthcare to provide ideal learning sources for healthcare professionals. This technology offers assistance, help in simplifying complexities of clinical difficulties, and increase symptomatic precision. The improvement of information preparation, and the accessibility of enormous sums of information have driven the expanding selection of AI in medicine and dentistry. The department of radiology, say, for example, has benefited from the use of a specific computation that aids in diagnosing and recommending suitable treatment options. AI has the potential to be used in a few branches of dentistry, including the department of prosthodontics, the department of orthodontics, the department of oral and maxillofacial surgery, and the department of periodontics for screening and treatment planning.

AI has an enormous power to rule the field of prosthodontics. Machine learning can analyse patient information and conclude the finest treatment for each person based on their unique needs and problems. For illustration, AI can plan and create customized dental prostheses such as crowns, bridges, and dentures that flawlessly fit into the patient's oral cavity and work very naturally for the patient. AI is often helpful in situations where patients have one-of-a-kind or complicated dental structures that needs very customised approach. AI can help in implantology by perfectly arranging the orientation and also the placement of dental implants depending on factors such as bone thickness and close proximity of arteries, veins and nerves. AI may offer assistance to decrease the hazard of complications and progress the by and significant victory rate of the strategy. Artificial intelligence will improve the accuracy, proficiency, and viability of prostheses, eventually progressing quality of care for patients. The current literature review study can be an important asset for dentists and dental analysts who need to investigate the potential advancement of AI in the field of prosthetic dentistry and oral implantology. As age advances, patients expect more qualitative and conservative treatment; hence, the implementation of artificial intelligence, will benefit to the quality of treatment.

Historical Background

American computer researcher John McCarthy, also recognised as the founder of AI, created the phrase Artificial Intelligence. Warren McCulloch and Walter Pits made the most punctual work of Artificial intelligence in 1943. They proposed a demonstration for manufactured neurons. In 2006, Artificial intelligence (AI) joined the entrepreneurial segment. Numerous climbing commercial organizations, including Facebook, Twitter, and Netflix, have started to utilise AI.²

Prosthodontics was the primary application of counterfeit insights in dentistry. Prosthodontics is a branch of dentistry that replaces lost teeth and jaw structures with artificial versions. Computer Aided Machining (CAM) were created in the 1990s by researchers who used them to manufacture artificial teeth for human beings. AI frameworks help with the creation of occlusal surface plans for crowns that account for intraoral wear aspects, programmed total dentures, set-up creators, devices for figuring out the rise profile in implantology, and tools for naturally making systems for removable partial dentures, to title some of the novel alternatives that may be created by melding AI innovations with prosthodontics.

Lee J et al., created inserts that combined convolutional neural systems (CNNs) and fake insights (AI) with all-encompassing and apical radiography. The study's discoveries show that the AI-CNN calculation is about as successful in categorizing embed methods. Improper situation, destitute cementation, impediment, and interproximal repair are all factors that might lead to issues.

Lerner et al., proposed a model with Artificial Intelligence to decrease such blunders. This AI model is used in fabrication of implant prostheses with solid zirconia crowns. It will also assist in distinguishing subgingival borders of the projection. AI model makes a huge difference for dental practitioners in teeth arrangement and sustain interproximal and occlusal contacts. They selected records from 2016 to 2019 for the study, which used zirconia prothesis in posterior teeth. The study revealed a ratio of 7:11 male to female in 90 subjects. The trial included 106 implants. The information utilized to prepare AI models included intraoral photographs, radiographs, images, and CAD scans. The use of an AI demonstration in the generation of zirconia crowns for posterior teeth yielded greater outcomes, with a 91% survival rate and a 93% victory rate. The AI model shows a tall survival and victory rate, demonstrating the capacity to coordinate into dentistry.

Customarily, dental masters would prepare the tooth margins amid the generation of changeless dental prostheses employing a handpiece and various burs. The proper expansion and form of the finish line surrounding the teeth made a difference in fit of the prosthesis, giving a sound environment and protection for the gums and periodontal tissues. These strategies required more progressed mechanical mastery and time. The objective was to kill the tedious manual work and blunders. Zhang et al., conducted a profound learning show examination to extricate minimal lines precisely. The study involved 380 dental preparation models. The information is extricated utilizing a CNN show known as scanty octree (S-Octree). The preparation of dental arrangements brought in a scanty point cloud with names. The ponder utilized an eighth-depth octree structure. The information is isolated into preparing, verification, and test sets. CNN models are trained by naming the names of dental arrangements. The average accuracy was up to 97.43%. The study illustrated the capacity of artificial intelligence to combat human errors, with reasonable elective for appropriation.

Takahashi et al., conducted an investigation to make an AI engineering that could classify curves and utilize CNN to help with denture generation. The instructive information is organized with computer-based, unsupervised learning strategies. AI-enhanced reality made strides to understand delight with reduced stress. Counterfeit insights will optimize arrangement planning, play music and amusement that the quiet like, and indeed offer assistance to them rest.

Machine learning

With machine learning, computers can induce rules by utilizing progressed calculations. Machine learning is used in e-commerce, car, web look, sensor, mechanical technology, discourse acknowledgment, picture acknowledgment etc.

Neural Network

As the name suggests, neural network employs artificial neurons to set the calculation. It works nearly comparable to the human brain.

Deep learning

It is a type of machine learning that utilizes the distinctive computational layers for analysis of the input information. Deep learning is additionally known as a Conventional Neural Network (CNN).

AI in diagnosis and treatment planning in prosthodontics

Naseer et al., publishes a review on assessing the quality and outcomes of AI approaches in dentistry, concluding that AI aids in patient diagnosis and clinical decision making. AI can also forecast dental failures.³ According to Shajahan et al., AI aids decision support systems by combining patient data such as vital signs, medical history, health status, and drug use for accurate and exact diagnosis and treatment planning.⁴ According to Pradhan et al., AI provides patients with knowledge on suitable drugs and the easiest method of treatment, as well as the proper time of medication and information about its side effects if not taken on time. This intelligence allows the dentist to arrange an appointment without human intervention, track the progression of the disease, and do routine chore of scheduling an appointment on time. This technique uses the fastest speed to complete the routine tasks in dentistry. This method automatically calculates tooth loss using computer software. It identifies the cause of any dental illness and recommends the best treatment. Easily monitors high-risk patients and makes judgments in a matter of seconds. It is helpful for monitoring and making decisions while a robot performs surgery. Artificial intelligence aids in the objective measurement of masticatory effectiveness. AI facilitates the rapid and precise segmentation of three-dimensional teeth on CBCT. Artificial intelligence is also used to diagnose discomfort and dental cavities.

AI and implant prosthodontics

In the branch of prosthodontics, both the patient and the dentist require the highest grade of prosthesis. A perfect outcome necessitates cextensive machineries and effort; nonetheless, it usually not possible by all clinicians. A computer-integrated device allowed us to create, manipulate and produce according to a patient's need with lesser time and resources. When evaluating aesthetics, the wealth of accessible information on dental anatomy is considered. The study was in contrast to using a conventional framework. The most effective dental implant treatment technique combines intraoral scanning and CBCT. CAD-CAM systems cause several issues while cementing implant prostheses. As a result, Pareek et al., in their scoping assessment of AI applications, proposed an ANN (Artificial Neural Network) model with three unique layers that aid in the classification of dental arches and implants.⁵ Michelinakis et al., conducted an investigation comparing the accuracy of digital impression and intraoral scanner technologies for implants. The purpose of this study is to compare the precision of an intraoral scanner and conventional impression methods for single and multiple fixed implant prosthesis. The accuracy of impression taken with intraoral scanner was high for single and short span implant sites; and virtual implant position deviation was within acceptable clinical trial limits. However, in a completely edentulous arch with several implants, there is no evidence on the traditional treatment.⁶ Shajahan et al., conducted a review and concluded that artificial intelligence aids in locating the mandibular canal for preventing injury during implant placement. According to Sikri et al., AI aids in treatment by analyzing Cone beam computed tomographic pictures and creating a three dimensional model of the patient's jaw, allowing for selecting the optimal site and angle for implant placement. Artificial intelligence is also used to detect bone quality and quantity, as well as assess bone density, implant length, and implant diameter.⁷ According to Elgabra et al., scoping assessment, 12 implant planning software programs that work with CBCT and IOS are discovered. Atomica.ai and DTX studio clinic are two of the 12 fully automated digital software. This software assists with three dimensional image capture, landmark segmentation, multimodal image registration, bone volume assessment, digital wax-up, implant dimension selection, implant site, and surgical guide design.⁸

AI in fixed prosthesis

Giving out the best quality prostheses is the major expectation for both dentist and the patient. For giving out this best output, there is a need of higher number of man power and resources. Computer technology provide production units that enable us to design and fabricate customised prostheses for patients. The ability of AI to analyze and interpret prosthetics is a significant advantage, also when there is new cases on regular basis. Information about anatomy is utilized to evaluate appearance and outlook of prostheses. The traditional method of using manual tooth preparation kits took longer and involved more mistakes. Maktabi et al., did a comprehensive review to evaluate the efficacy and success of artificial intelligence. They conducted the investigation using 36 articles and concluded that AI algorithms can improve the casting process by reducing porosity and manufacturing time. AI assists in marking the finish line with 97.4% accuracy. The AI model automates the design of dental restorations. It improves the precision of shade matching.⁹ Atlan et al., did a study employing the CNN method to detect prosthesis restoration using artificial intelligence. YOLOv4, a detection system, is a real-time CNN algorithm that classifies target objects in a single pass. They concluded that ceramic restoration was 97.8% accurate, while gold restoration was 99.4% accurate. Artificial intelligence can identify crowns and bridges, and marginal fit can be assessed using extra tools.¹⁰ Bernauer et al., did a comprehensive review and found that the CNN model may be used to forecast the chances of CAD-CAM crown removal and generate a more accurate color matching system. Intrinsic AI and CAD software algorithms aid in tracing the margins of an implant abutment, even if it is a subgingival finish line, resulting in highly accurate marginal adaptation. The ANN model automatically detects cusps and ensures total repeatability. AI facilitates the debonding of composite resin crowns. AI eliminates gaps between crown margins in all types of restorations.¹¹

AI in removable prosthesis

Takahashi et al., studied the use of AI to construct RPD by categorizing partially edentulous arches using a CNN model. The CNN algorithm achieved diagnostic accuracy of 99.5% in the maxilla and 99.5% in the mandible, with a correct prediction rate of more than 95% across all dental arches.¹² Ali et al., conducted a literature study of 15 papers and they concluded that AI aids in the automated recognition of alveolar arches for NAM devices in cleft lip and cleft palate therapy, and the fabrication of NAM devices for cleft lip and cleft palate patients. AI aids in the prediction of models for denture tooth microhardness and surface roughness, as well as the prediction of facial soft tissue distortion after complete denture prosthesis. It also aids in predicting the cosmetic reconstructive consequences in edentulous patients.¹³ Vohra et al., used AI to analyze denture border extension and found that the LOGISTIC REGRESSION model - Naïve Bayes Algorithm can categorize denture base extensions based on photographs, IOPA, and OPG. It may classify and categorize dentures based on the quality of their extensions.¹⁴

AI in maxillofacial prosthesis

Maxillofacial prosthesis rehabilitation replaces missing structures caused by facial injuries or anomalies, restoring function and attractiveness. Patients suffer from genetic illnesses, cancer, or trauma, which causes abnormalities of the maxilla and face region. Because of the visual and psychological problems that these anomalies induce, high-quality prosthetic care is typically necessary. In many circumstances, it might be challenging to repair maxillofacial abnormalities while getting excellent aesthetic results. Individuals can pick from various dental prosthetic options provided by prosthodontists to enhance esthetics and funtion. Avoiding the complication connected with surgery, an attractive and functional maxillofacial prosthesis minimizes patient anxiety and improves their quality of life. Maxillofacial reconstruction entails inserting artificial substitutes for intraoral and extraoral features such as the eyes, ears, nose, maxilla, mandible, and palate. The bionic eye, created in the United States of America, was tested on 12 people with ophthalmic problems. Shajahan et al., conducted a review and concluded that artificial intelligence aids in the restoration of patient vision without the need for surgery. A smart camera is fit on customised glasses that allow you to read text and see faces. This portion is also attached to a tiny headset, which converts the image in the camera into sounds and transmits it to the ears. AI can also provide artificial olfaction. According to Ali et al., artificial intelligence is used to provide color for maxillofacial prostheses.

AI for patient care in prosthodontics

Vadivel et al., indicated that AI aids in appointment scheduling and playing the patient's selected music.¹⁵ Naseer et al., assess the quality and outcomes of AI approaches in dentistry, concluding that AI reduces chairside time and infection control.³ Shajahan et al., conducted a review and concluded that AI reduces patient anxiety while increasing patient comfort. AI has also introduced a non-invasive, self-controlling, precise tongue drive device that analyses tongue motions and responds to physician directions. These commands access a computer, operate a wheelchair, or manipulate the patient's surroundings. Augmented reality can increase patient comfort by improving its ability to regulate the patient's temperature, engage them with music, and modify the lighting so that the patient feels relaxed. AI aids in the postoperative surveillance of patients to prevent problems.⁴

Challenges in AI

Artificial intelligence has already had a huge impact on society, and it is expected to become even more as technology improves. There is always the risk that an incorrect symbol in the algorithm may cause a big error in the method, or that excessive load of mechanisms will easily cause collision in the computer.¹⁶ Furthermore, artificial intelligence technology is used in prosthodontics with increasingly important jobs, mistakes may have unexpected and highly negative consequences. AI is one of the most evolving technologies in dentistry. Still many factors, such as lack of data privacy, lack of training for dental practitioners, lack of providence-like experts, absence of human compassion, high implementation costs, and lack of standardization in AI algorithms, continue to prevent its implementation. Policy for AI is yet to develop. There is no established implementation strategy. AI has yet to garner patient engagement in the accepting artificial intelligence-powered therapeutic processes. AI depends on datasets, which need manual effort; thus, AI is only semi-automated at the moment. The outcomes of AI in dentistry are not readily applicable. Due to lack of data security and patient confidentiality, artificial intelligence is still addressing ethical concerns. Because AI has a limited number of studies, it requires excellent application on a broader number of patient populations to improve its scope and future developments. AI requires extensive training and support for people who want to use the databases in clinical practice. AI still confronts problems and challenges due to overloaded algorithms causing system crashes.¹⁷

Conclusion

Both the medical and dental practitioners have been impacted by artificial intelligence. Though AI is significantly the strength in dentistry and dental training, the capability of human biological system is composite, and recognized that technology advancements are still the result of human inventions and discoveries. Furthermore, the assistance of clinicians in executing professional responsibilities can be done by AI; but cannot replace human cognition, expertise, or treatment planning. AI necessitate additional research and investigation before it fully integrate into dental clinical practice. Full AI automation has yet to be documented and empirically validated. AI is implemented as an instructional module with appropriate staff training, awareness, and infrastructure. AI can be incorporated as a digital dentistry teaching module into the regulatory body of the undergraduate prosthodontics curriculum, enhancing aspiring dentists' knowledge, abilities, and expertise.

Conflicts of Interest

Nil