Digital Dentistry: Holes in the Teeth

With Pascal Kunz

There are still giant gaps in the teeth of Digital Dentistry. Individual industry players are still more focused on themselves instead of the patient or ‘digital’ to leverage dental care, resulting in significant disruptions, a poor user experience and unclaimed market potential. Pascal Kunz shares his insights into this fascinating industry.

It is time to break down barriers and collaborate in a way which brings a more integrated approach to the current innovation we are witnessing.

Here are the gaps and opportunities that I’ve spotted:

• Definitions of Digital Dentistry
• Medical Grade Industry-wide File Formats
• Strategic Partnerships
• Data Sharing Approaches
• A.I.-Supplemented Decision Making
• Funding & Adoption

A company could easily close these gaps with the right funding and connections. The company that successfully closes them would make themselves (and the digital dentistry industry) incredibly profitable, and far more accessible.

Definitions of Digital Dentistry

For every specialist, digital dentistry has a well-defined meaning, for example:

• Guided implant surgeries
• Orthodontic aligner treatments
• CAD/CAM-produced restorations
• Imaging

Many players are offering ‘Digital Dentistry’ in their respective segments. Specialities within these segments are targeted with digitalised offerings, but only a few industry players serve more than one speciality.

The gateway to this is general patient diagnostics for decision-making, managing treatments and record-keeping of digital information over time. Every patient has and will have their own specific mix of findings which must be observed or addressed, and certainly over time, will not respect specialist borders.

Dentistry is broader than what digital can cover today, and no player will likely be able to cover everything in one application. A universal digital platform has yet to exist.

Medical Grade Industry-wide File Formats

Some industry-wide file formats exist, such as DICOM for 2D & 3D X-Ray imaging. This sets a precedent for using a range of standardised data formats across the digital dentistry industry.

Beyond radiology, medical-grade file formats are not widely adopted – even though some already exist. General use variations, like .stl and .ply for optical impressions, have nowhere for extra data to go, which results in a loss of all crucial metadata (alongside general data) as information is transferred between applications and providers to perform dental treatments.

This can be especially frustrating when trying to use data from specific devices for specific applications. For example, an optical impression scan from one device may not provide enough accurate data for producing a screw-retained 6-unit implant bridge restoration.

If an industry-wide standard existed, the file format would clarify its origin and allow an industrial manufacturer to automatically accept or reject orders based on validation data (approved devices for the respective use or indication). Ultimately, such information – including unique identifiers for the individual patient – would be incredibly beneficial for the industry, but it requires widespread adoption of technology.

That’s why major industry players need to sincerely increase their efforts to harmonise and standardise file formatting. If safeguards are put in place to ensure proper data security, data distribution between different practices and technologies would only benefit the digital dentistry industry.

Forming Strategic Partnerships in Digital Dentistry

Switch on almost any ‘non-Apple’ personal computer, and you’ll likely find a Microsoft Windows operating system. This widespread unity lets people freely change software and devices, without having to learn new technology.

Also, device manufacturers do not have to carry the burden of developing their own operating system and can specialise on hardware, drivers, or application development instead. It’s a cohesive approach that results in better experiences for everyone involved. Digital Dentistry lacks unity, and it shows.

The current ‘dominant’ players are not centred around digital dentistry as a discipline, instead choosing to focus on a specific piece of equipment or value chain. Because of this, we see a lot of incompatible technology in the industry, which is only making it harder for digital dentistry to progress.

I believe the main reason we’re not seeing these developments is that it doesn’t have a short-term pay-off. Everyone wants to form their own digital ecosystem, so nobody is rising to dominance.

If industry players were to form partnerships and build strategic alliances, we could see the infrastructure of dentistry be completely revolutionised. Perhaps a separate, neutral entity is needed to develop and offer the unifying digital platform, which could remove this unproductive rivalry between competitors.

Data Sharing Approaches

The way dentistry exists currently, patients often will not get the highest possible level for all their treatment needs. Instead, patients search for a general practice or single specialist, rather than one that specialises in their real issue. The industry’s current ‘one-workflow-to-one-consumable’ mindset does not foresee treatment planning and treatment across specialities.

Closed

This is still the most common approach when it comes to processing patient data in digital dentistry-enabled treatment workflows. There are misconceptions that a Closed approach is safer for the patient, or that it provides a competitive advantage to the business which holds the data.

In fact, this makes the industry less accessible for patients, resulting in worse patient care.

But there is an alternative.

Open

By allowing the exchange of patient data in a controlled and medically compliant manner, we can increase access and appeal for the industry. How many more people would use digital dentistry services if their latest data was easily accessible by any dentist they visit?

This could also allow for greater specialisations, broader offerings, and individual patients could even make accurate and informed decisions on where to get the best treatment for a particular issue.

AI-Supplemented Decision Making

The potential applications for Artificial Intelligence in the digital dentistry space are unparalleled.

Pathology detection on 2D intraoral X-Rays is already significantly populated, but AI can be used for so much more. For instance, the organisation and automation of background workflows, from acquisition to analysis and beyond.

Today, even the simplest analysis usually needs switching of applications with tedious uploading steps to specific web portals. Analysis and annotated data reside exclusively on individual clouds, and multiple screens show different, sometimes contradicting information.

The concept of sharing verified findings with an overarching entity has not been launched yet. Old data is typically side-lined, even in the same practice, but even more so if the patient has moved locations.

Instead, imagine a patient visiting a new practice. They receive a check-up, where their current data is instantly mapped against all their personal dental history. The AI can then highlight the early stages of new pathology, and cross-reference progression levels to pre-existing data from their other teeth.

This alerts the practice that the patient needs urgent treatment at an earlier stage, due to faster-than-expected progression of tooth decay. Treatment can then begin to prevent more costly interventions at a later stage – fact based and informed.

Without the use of AI and previous patient data, the dentist may not have been able to properly gauge the severity of the issue.

Ideally, AI engines could work cross-platform to identify the presence and position of anatomical landmarks for specialist players. In return, their discoveries would be shared back and added to a list of identified and approved content.

This would result in much better patient treatment and could be far more profitable for all parties.

Funding & Adoption

Financially maintaining a new, collaborative infrastructure would be relatively straightforward with end-user subscriptions. Unfortunately, it’s the start-up and adoption where the issues lie.

For instance, multiple fragmented small-scale players make widespread adoption much more difficult — but not impossible.

In response, larger organisations would need to band together and demand compatibility to a standard. This would lead to an industry-wide shift, and as more members move over to a new style it’ll gain traction with other organisations.

The Way Forward for Digital Dentistry

Truly universal digital dentistry serves every patient, at every visit. The idea of everyone in the industry partnering up and working together is delusional, but that doesn’t change the facts.

Diagnostic imaging needs a unified all-modality approach

Diagnostic data should not be kept hostage, with worst-case examples ‘consuming’ 3D X-Ray datasets, for simply planning an implant in an edentulous space. This completely ignores the analysis of other relevant diagnostic findings outside that edentulous space.

Cross-speciality customer needs cannot be solved in isolation

The industry needs smart collaboration and strategic reorganisation to develop successful and specific equipment, software, or consumable segments. The key to success for the big players willing to partner is to hire the right people with the right mindsets and vision.

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