Advancing Imaging, Device Production, and Clinical Capabilities in Digital Dentistry

OBJECTIVE

Digital dentistry refers to using digital tools, such as 3-dimensional (3D) imaging and processing software together with new materials and powerful manufacturing technologies, to produce dental devices and perform dental procedures. The objectives of this initiative are to: 1) advance development and optimization of core technologies across the digital dentistry workflow; and 2) enhance digital technologies for efficient, personalized treatment and care delivery to improve oral health. The initiative promotes research to advance patient-centered solutions including, but not limited to, imaging-based diagnostics and analytics, predictive expert systems for pre-surgical planning, dynamic surgical guidance and navigation, additive manufacturing (3-dimentional printing) methods and high-performing materials.

BACKGROUND

Digital technologies have revolutionized dental practiceby making patient care easier, faster, and more effective. Digital dentistry incorporates computer-controlled components such as: 3D cone beam computed tomography (CBCT) imaging, computer-aided design/computer-aided manufacturing (CAD/CAM), and 3D printing, into the clinical workflow. All disciplines of dentistry especially in the fields of prosthodontics and restorative dentistry benefit from routine application of CAD/CAM for inlays, onlays, veneers, crowns, fixed partial dentures, implant abutments, full-mouth reconstruction, and orthodontics. CAD/CAM addresses three challenges in dentistry: 1) ensure adequate strength of the restoration, especially for posterior teeth; 2) create restorations with a natural appearance; and 3) make tooth restoration easier, faster, and more accurate.

CAD/CAM systems are composed of three major parts: 1) a data acquisition unit through intraoral scanners; 2) software for designing virtual restorations; and 3) a computerized device for creating the restoration, either subtractively (milling/grinding), or additively (3D printing). Both manufacturing approaches present advantages for specific clinical applications. The integration of 3D CBCT, CAD/CAM, and 3D printing with advances in biomaterials has led to major improvements in dental care and treatment delivery. Paired with CAD/CAM, 3D printing and advanced image processing functionality, CBCT can improve the success rate of interventions. Dentists can simultaneously plan the implant and restoration, produce a surgical guide, place the implant, and then fabricate and place the permanent implant restoration, in some cases, all within the office and in a single patient visit with reduced risk of potential complications and improved treatment outcomes.

GAPS AND OPPORTUNITIES

There exist significant opportunities to advance development and optimization of core technologies across the digital dentistry workflow to meetgrowing demand on productivity without compromising quality care. Leveraging on the success of CAD/CAM and digital imaging it would be feasible to further existing capabilities and integrate new approaches in additive manufacturing, digital imaging, expert systems and high-performance materials that enable enhanced predictive planning of postoperative care, accurate oral health surveillance and better health outcomes.

Current pre-surgical planning is mainly performed using dental radiographs and computed tomography to predict post-operative anatomy and physiology. However, this type of pre-surgical planning has limited capability to detect disease, map anatomy, and consider mechanical force distribution through soft and hard oral tissues and dental biomaterials. Therefore, development and implementation of novel digital dentistry methods that integrate different imaging modalities (CBCT, MRI, ultrasound, optical) with advanced image processing methods and expert systems is needed for oral health assessment and pre-surgical planning.

Image processing technologies such as thresholding and morphological operations are essential in many fields of medical research and clinical practice. However, dental image processing software packages do not include adaptive or global thresholding and morphologic operation features. Hence, the benefits of these methods are not directly available, or realized for diagnostic purposes. Further, little to no use of artificial intelligence (AI) tools are available for image detection, classification, interpretation and clinical decision support. Image processing and enhancement functions are rarely incorporated in commercial software in dental radiology.

CAD/CAM milling uses ceramics to produce a restoration, while 3D printing primarily uses polymer resins. Recent developments in 3D printing involve use of melting non-precious metal alloys in powder form which are then coated with ceramic to produce a restoration. 3D printing can be highly accurate, handle intricate shapes even of the smallest dimensions not achievable through CAD/CAM. Like CAD/CAM, it can be integrated into the clinical workflow. Such advantages create significant opportunities to further optimize current capabilities of 3D printing techniques and high-performance materials for digital dentistry to achieve flexible, convenient and precise patient-centered solutions that are timely, cost effective, and complementary to current approaches.

Specific Areas of Interest

Validation of optimized 3D printing solutions and high-performance materials that meet industry standards and integrate into the digital dentistry workflow.
Development of smart expert systems for treatment planning to account for oral tissue biomechanics and material properties
Development of dynamic surgical guidance systems for real-time tracking, multimodal image fusion and navigation
Implementation of accurate dental image processing and AI software tools to detect disease, stratify risk and optimize patient-specific treatment
Development of innovative digital impressions that penetrate gingiva non-invasively without fluid effects
Development and clinical implementation of multimodal diagnostic imaging and dedicated image processing tools for intra- and extra-oral applications

FEASIBILITY AND TIMELINESS

This initiative is feasible and timely because recent advances in digital imaging, computer-aided design software, and subtractive and additive manufacturing technologies are significantly elevating the standard of care in restorative and reconstructive dentistry. Advances in 3D printing technologies, novel biomaterials and expert imaging systems offer unique and timely opportunities to further improve patient care delivery and treatment outcomes.

Additionally, recent developments in FDA regulatory policy, industry standards and patent expirations support broad implementation of 3D printing applications in dentistry.

CURRENT NIDCR/NIH PORTFOLIO

Currently, NIDCR supports several small business projects in response to PA-15-335(SBIR) and PA-15-336(STTR): Imaging Diagnostics of Dental Diseases and Conditions (Caries, Periodontal Disease, Cracked Teeth, and Pulp Vitality) , which are focused on diagnosis of cracks, dental caries, and measuring pulp vitality with hand held devices that utilize signal inputs and feedback. These FOAs will expire on September 2018. NIDCR currently funds an SBIR Phase II project on “Additive Manufacturing of Ceramic Dental Restorations.”

ALIGNMENT WITH NIDCR STRATEGIC PLAN

Goal 1, Objective 3: Conduct translational and clinical investigations to improve dental, oral, and craniofacial health

Goal 2, Objective 1: Support research toward precise classification, prevention, and treatment of dental, oral, and craniofacial health and disease

NIDCR 2030 Goals: Oral Health and Overall Health, and Precision Health

Last Reviewed

July 2018