Innovations in dentistry: Navigational surgery, robotics, and nanotechnology

Robotics in navigational surgery

Advancements in technology and computer science have led to an increase in the use of robotics in navigational surgery for multiple medical specialties. From the development of the da Vinci surgical system in the early 2000s to more advanced artificial intelligence (AI) techniques in use today, similar revolutionary technologies are now being introduced into the dental field that can assist practitioners with a variety of procedures. The use of robotics in dentistry provides advantages over freehand techniques for placing instrumentation.¹ These systems, along with navigational guidance, offer increased accuracy and precision in dental treatment as well as streamlined work processes and better workflows, resulting in higher quality of care.² Robotics-assisted dentistry has evolved from traditional navigational surgery to more complex systems that will prove to be essential in the maintenance of oral health and repair of oral lesions using nanomaterials, nanorobots, and engineering of novel diagnostic and therapeutic modalities.³ While these therapeutic interventions alter our contemporary views and understanding, robotics systems are already being used in dental procedures and are assisting practitioners with implant treatment.³ Undoubtedly, other areas of dentistry that could benefit from robotic systems and AI applications include endodontics, general procedures in restorative dentistry, orthodontics, and periodontics.

Several concerns arise when considering implant surgery, such as injury due to perforation of the maxillary sinus, inferior border, lingual plate, labial plate, or inferior alveolar canal; nerve injury; tissue necrosis; and dehiscence.⁴ Furthermore, injuries during implant placement can cause infection and initiate chronic complications within the sinus cavity.⁴ Beyond injury and infection, implant failure is also a risk, with approximately 5% to 10% of dental implants failing.⁵ Failed implants can result from the lack of clinician experience, implant location, bone characteristics, and patient-related medical complications.⁶ With the assistance of robotics and navigational surgery, clinicians can achieve more successful implant placement procedures and lower the risk of failure. By providing the clinician with assistance as well as the freedom to change course during implant surgery, Neocis offers a physical guidance system using the haptic robotic technology known as Yomi.²

During traditional guided implant surgery, a surgical guide is placed to help the clinician navigate drilling during. However, surgical guides may be ill-fitted or seated improperly, causing incorrect angulation while performing surgery.⁷ In addition, the surgical guide requires a longer drill, which means the patient has to open his or her mouth very widely to allow the clinician more room to work, a problem for some patients.⁷ Furthermore, guided implant surgery is considered to be static, and creates limitations when the clinician needs the ability to change direction during the procedure.⁷ Yomi technology allows for these sudden changes during implant surgery with ease.¹

Yomi provides an alternative approach in surgical implant treatment, as this technology supplies the clinician with preoperative, intraoperative, and postoperative plans and clinical decision support during implant

surgery. In the preoperative phase, Yomi’s software provides imaging of anatomical features such as nerves, sinus cavities, and surrounding teeth and bone to provide a comprehensive overview to the dental provider.⁵ After the pre-operative plans have been arranged, the robotic arm and drill are then constrained in place, giving the provider complete control over drill position, depth, and angulation.¹ During the procedure, Yomi uses multisensory feedback to achieve the exact position and angulation in placing the dental implant accordingly.¹ In addition, Yomi provides clinical decision support throughout the surgery, as the computerized screen shows anatomy and drill location the entire time; likewise, the robotic arm resists if the surgeon is operating outside the set boundaries of the planned procedure.⁵ Not only can Yomi be used pre- and postoperatively and throughout all phases of surgery, this advanced technology uses a minimally invasive flapless approach while providing clear visualization and guidance at all times for the dental provider and faster recovery with less pain for the patient.²

Microrobots

Navigational surgery and robotics allow for consistency, superior workflow efficiency, and increased patient safety; all of which lead to higher

Micromachine for automatic endodontic treatment.

success rates, which is promising for all dental specialties.² Considering endodontic procedures require extreme precision and accuracy, endodontic microrobots can improve the quality and reliability of endodontic therapy.⁸ Commonly, endodontic issues such as perforation, apical foramen stripping, instrumentation beyondthe apex, or improper canal preparation canoccur as a result of endodontic treatment.⁹ Much like dental implant surgery, treatment outcomes vary depending on clinician experience and skill.⁹However, endodontic microrobots provide an opportunity to increase the quality of endodontic treatment and to reduce errors during the procedure.⁹ For example, the Advanced Endodontic Technology Project uses micromachine technology, in which a microrobot is mounted on the tooth in need of treatment and is computer-controlled and monitored as it performs the root canal procedure.⁹ In short, the micromachine provides automated precision probing, drilling, cleaning, and filling to assist the clinician in providing error-free therapy.⁹

While navigational surgery, robotics, and microrobots are making their way into dental treatment, other opportunities for robotics within the dental field exist through nanotechnology. Nanotechnology refers to the designing, building, and engineering of nanobots.¹⁰Nanobots are microscopic robotic machines that are close to a nanometer in size, may consist of thousands of mechanical pieces, and can be used for the purpose of interacting with or manipulating cells in the human body.⁹ Currently under development, nanobots are expected to change medical diagnosis and treatment, as well as methods of drug delivery.¹⁰ Furthermore, nanotechnology may play a vital role in surgery, the treatment of cerebral aneurysms, gene therapy, cancer detection and treatment, and general diagnosis and treatment within the dental space.¹⁰

Nanodentistry

Application of nanotechnology in dentistry, also known as nanodentistry, allows for treatment possibilities in restorative dentistry, orthodontics, and periodontics.¹¹Within restorative dentistry, nanorobotics can be used in cavity preparation, restoration, and even dentition renaturalization.^9,11Due to their size, nanobots work at the atomic, cellular, and molecular level to perform major tasks and can help dentists in managing complicated cases at the microscopic level with ease and precision.¹²Furthermore, dental materials have the potential for improvement, as nanosolutions can ensure homogeneity in bonding agents and nanofillers can improve hydrophilic properties for impressions.¹¹ Nanotechnology can also aid in bone replacementand antibiotic delivery via nanoencapsulation while offering continuous oral health maintenance using dentifrobots to destroy pathogenic bacteria found in plaque biofilms.^11,13Additionally, nanodentistry can offer alternative techniques to induce anesthesia and manipulate tissue to aid in managing complicated restorative and periodontal treatments.¹²

Conclusion

Robotics systems continue to support doctors in the medical field with assistance in the cardiac space, orthopedics, and within neurosurgery.⁷Robotics, microbots, and nanotechnology have the potential to support dentists and positively impact the field of dentistry. However, compared to their counterparts in the medical field, dentists have been slow to adopt this new technology. As a case in point, dentistry appears to be more than a decade behind in adopting or integrating new technologies on a widespread basis.¹⁴ It is important to note that as each of these AI and robotics developments advance in health care, it will be better for experts to explain the benefits of these advances, rather than the technology, to increase the adoption curve and lessen any fears about the use of AI and robots in the medical space.¹⁵ As dental professionals, it is important to embrace new technologies and be educated on the associated risks and benefits when used in dentistry. The realization that new and emerging technological innovations may provide alternative treatments to patients while enhancing workflow, increasing production, and improving the quality of care is on the horizon. Considering that the overall goal in dental care is to provide optimal patient treatment, it is worth reviewing these applications and their potential to increase the quality of dental care. Robotics and AI techniques can provide dental practitioners with valuable information in real time, allowing for more thorough examinations, accurate diagnoses, and clinical decision support throughout the duration of dental procedures. The a quest for advancements in dentistry is never ending, and the use of robotics for dental treatment could soon become standard practice for all dentists.

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Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles at this link and subscribe here.

Shannon Sommers, MSHI, BTDH, RDH, has a bachelor's of technology in dental hygiene from the State University of New York at Canton and a master of science in health informatics from the Medical University of South Carolina. She has over 20 years’ experience in dentistry and has been a dental hygienist since 2006. She aims to use her dental background and informatics skills to influence population health by promoting and advancing the use of dental informatics.

Alicia Webb, MSHI, BTDH, RDH, has been a clinician in dentistry since 2006 and has experience as an educator in dental hygiene. As one of the few registered dental hygienists to graduate with a master of science in health informatics, she wants to use her informatics knowledge coupled with her dental background to improve population health by developing and analyzing data-driven solutions to improve the delivery of quality dental care.