(Dr. Hangorsky) Hello and welcome to our session today. Your traditional visit to the dentist has been rapidly changing in the past decade. Not only have the dentist improved their diagnostic tools at their disposal, but there's also been a veritable revolution in the dental materials we're using to restore damaged intuitions. Those changes involve both the quality and aesthetics of the restorations, resulting in outstanding outcomes for the patients. Today's presentation will focus on three aspects of restorative dentistry. Number one would be the digital technologies, including artificial intelligence and the diagnostic and CAD/CAMs. Number two will be adhesives. Number three will be the aesthetics. To explain all of this for us who have invited today, one of the global experts in this area, Dr. Markus Blatz. Dr. Markus Blatz is a Professor of Restorative Dentistry, Chairman of the Department of Preventive and Restorative Sciences, and Assistant Dean for Digital Innovation and Professional Development at the University of Pennsylvania, School of Dental Medicine in Philadelphia, where he also founded the Penn Dental Medicine CAD/CAM Ceramic Center. Dr. Blatz is the recipient of multiple teaching and research awards and has published and lectured extensively on dental aesthetics, restorative dental materials, and implant dentistry. He was recently named one of the world's top hundred doctors in dentistry by his peers. Welcome Dr. Blatz. Dr. Blatz, can you provide a general overview of the dental domain you are going to discuss. What in your view is innovative in your domain, and why do you say there's a new frontier? (Dr. Blatz) Well, I'm in charge at the University of Pennsylvania at the Restorative Departments. Yes that's of course, our main topic is, how do we restore either the damaged tooth structure are structured as missing or missing teeth? There have been a number of improvements in the last decades actually in restorative dentistry. One of them is the ability to use adhesive dentistry. Being able to adhere restorative materials to tooth structure. Whereas in the past, we always have to make retentive preparations to keep the restorations in place. Now with the ability to bond to tooth structure, even with our composites, direct materials, or indirect ceramics for example, we're able to preserve much more tooth structure and that is one of the key aspects today is minimally invasive dentistry. Another aspect is to use digital technologies. To be more precise or predictable, and ultimately also more cost-effective. That has been changing our field quite tremendously over the last few decades. With those technologies, to be able to provide more aesthetic and more functional outcomes, this is exactly the goal of using these technologies in the first place. (Dr. Hangorsky) Could you please tell us how your domain addresses the clinical needs of the population? How do these techniques impact access to dental care for patients? (Dr. Blatz) Of course, the ultimate idea with using these technologies is exactly that. To provide better, more precise, and more cost-effective care to the patient population. The main goal for a restorative dentist is of course to help our patients keep their teeth as long as possible. That's why this is minimally invasive approach has been very important in how we do dentistry. With adhesive dentistry, we can adhere restorative materials directly to the tooth structure. By that, preserving tooth structure as much as possible. Now, digital technologies on the other hand, help us with first diagnostics. We can do a scan. In the past we would do a physical impressions with impression materials. Now we're using scanning technologies to scan the existing teeth. Or if you've done the preparation to scan this preparation. From there on, we can use this information for treatment planning, and then we can also use this information for providing restorations that are extremely well-fitting because we can fabricate them in the laboratory with CAD/CAM milling technologies, with 3D printing, being more predictable with those protocols. The cool thing about these CAD/CAM technologies, a lot of people think it's done by computers, so everybody looks the same. We will have the same smile. Actually, it's the total opposite. With these digital technologies we can use scans of real teeth and of real people, and then do a treatment plan on the computer screen by providing a new smile, by providing new teeth, and checking it with the patient on a computer. Say, "This is what we have in mind. This will be the ultimate treatment plan for you from an aesthetic and from a functional standpoint." We can then discuss with the patient, is this the direction you want to go to or slightly different? But the great thing is that we can use real teeth, real scans, and then make a design on a computer and try it out before we even go for a definitive restoration. Another really nice aspect of this digital technologies, we can communicate with all different other specialties in a very convenient way. Like we communicate today anyways. I can send radiographs, I can scan scans, computer tomograms. To the surgeon, to the orthodontist; we can discuss it virtually. It makes it much more easier to work in a team because ultimately, everything we do is more interdisciplinary. How we work together with the laboratory, with the different specialties is extremely important to really be able to get the patient the proper outcomes that they want. Ultimately, of course, you would also expect that these technologies help us be more cost-effective because we don't have to drive to the specialty or to another specialists with the patient. Now we can send scans of faces, of computer tomograms to the specialist and discuss it virtually. These are certainly some of the advantages. Then, the communication with the laboratory is, for us, one the key communications. So that they understand what we and the patient expect, and they can come up with the restorations that are the most appropriate for our patients. These tools are very helpful from a communication standpoint, from a treatment planning standpoint from the very beginning. Then of course, how we fabricate this restorations in the end, putting them in place with the latest techniques and technologies, such as adhesive dentistry. (Dr. Hangorsky) Dr. Blatz, could you please tell us a little bit more about how the technology and research has enabled this domain to develop? CAD/CAM technologies - it's nothing really new. We have used it for 30, 40 years. The idea here was in the beginning to take a scan of a natural tooth or of your preparation, instead of using a rubber material to take an impression on imprint, which we typically would do, and then have a scanned model. On that, we can then fabricate a restoration with CAD/CAM milling technologies. That has pretty much changed the way how we do dentistry, not only in the clinics, but also in the laboratory. That has been a huge step forward. We have integrated that in our curriculum from the very beginning. These technologies to scan teeth and fabricate restorations, that's pretty much at the back end of what we do as restorative dentist. But nowadays, we are looking much more at the front end and that includes artificial intelligence. For example, technologies that can help computerized or reading of radiographs, where with AI, we can have a computer pretty much tell us, there's caries here there with a very high accuracy in a very short period of time. With those artificial intelligence tools, they can help us to be better with detecting radiographs, for example, but also, we have to think about the big data that's available now. This technology can help us to be more precise and more accurate with our treatment planning as well. Also what we understand now more than ever is the interconnection between oral health and general health. This is where we can use these technologies very favorably to make this connection and understanding much better how certain pathologies are interconnected between oral health and general health. Another area that's very important for our patients is, of course, aesthetics. Besides the functional aspect, I mean, they want to be able to chew and function properly, but the aesthetic appearance is very important. Here, of course, we have the digital tools to manufacturer a variety of materials that we were not able to manufacture before, which our conventional technologies. In the past, we had to use retentive preparation designs to keep restorations in place. Now with adhesive technologies, we can bond, for example, composite materials directly to the tooth structure, but also indirect ceramics with the proper pretreatment to be less invasive, to preserve tooth structure, and then help our patients keep their teeth as long as possible. The materials also was an area that has, I would say, exploded over the last few years. The type of ceramics that we're using to try to make the restorations look as natural as possible. That is the goal here. (Dr. Hangorsky) What do you see as possible further advances in this area? If you had to guess what will happen 10, 20 years from now. How do you envision the practice of dentistry utilizing these techniques? (Dr. Blatz) Of course, apart from techniques and technologies today that stems our research where we're trying to even grow teeth. Apart from that, in restorative dentistry, I think we will see more of these tools being used by many more dentists, and by that, been able to have a more calibrated approach amongst different dentists towards the industry with these tools. We start training our students already in the preclinic. They learn how to scan teeth and make restorations, how they've been milled, how to select the proper materials, and then how to put them in place ultimately. We will see, of course, a much greater use of these technologies in the future with a newer generation of dentists coming into the practices. I think this, especially AI, will allow us to be much more knowledgeable about, as I mentioned, the interaction between oral health and general health, and also being able to do some quality control as well. Some insurance companies are already jumping on these technologies quite a bit using these automated radiographic tools, reading tools, to do quality control and see if the restoration was warranted in the first place. Was it done properly? So these tools are being used already and will be used much more for quality control. One of the advantages of using artificial intelligence and all these digital tools is that we can combine the information for one patient. We call it the virtual patient. What we can do, we can get automated radiograph reading, as I mentioned before, bring it in to the files with the scans, intraoral scans, extraoral scans, face scans, computer tomographs, and then have the computer gives us a treatment suggestion. The difference between us and many other areas is that every patient is different, every patient has different needs. But with AI, we can be more calibrated in serving those needs specifically. As I said, the usage of scans of real teeth, of smiles even from other people, we can use and then superimpose them into the patient and make a suggestion for what the treatment could be like from an aesthetic and from a functional standpoint, bringing all this information together, having a, I would say more calibrated outcome amongst different dentists, but just pretty much helping them in the patient to get the best outcomes. With that, it's also the ability to provide better access to care. This is, of course, another idea that's very important by using these technologies to provide better access to care. Ultimately, lowering cost also of the care and be more precise and predictable. (Dr. Hangorsky) Dr. Blatz, thank you so much for a fascinating discussion today. Thank you.
