Digital Innovations in Periodontics: Transforming Periodontal and Implant Health With Advanced Dentistry Technologies

INTRODUCTION

The first computerised tomography (CT) scanners were introduced in the 1970s. This technology helped in assessment and treatment planning by enabling more accurate and detailed visualisation of the teeth and jaws. The first computerised dental drill was invented in 1971 by Robert Ledley, a dentist who was also a physicist at the National Institutes of Health. Dental operations can be carried out with increased accuracy and precision because of changes in drilling speed and direction. One of the first innovations in digital dentistry in the early 1990s was the Chairside Economical Restorative of Esthetical Ceramics (CEREC) technology, developed by the German company Sirona. With the use of computer-aided design (CAD) and digital photography, CEREC enables the completion of treatments, including crowns and bridges, in a single visit. As a result, the process’s complexity and duration were greatly reduced. Applied digital dentistry is the use of state-of-the-art digital technologies in dental offices and laboratories to enhance the overall standard, efficacy, and precision of dental procedures and treatments. This technology enables the creation of individualised treatment plans for all patients across various dental specialties, including orthodontics, dental implants, restorations, and cosmetic dentistry. To assist the computer in placing implants, 3D models of the patient’s oral anatomy were created using cone-beam computed tomography (CBCT) scans. These scans, along with computer-aided design and manufacturing (CAD/CAM) software, were used to precisely arrange the dental implants.^[1] Artificial intelligence (AI) and machine learning (ML) are increasingly used in digital dentistry. This opens the door to the creation of automated systems that can assist with diagnosis and treatment planning, providing tailored therapeutic recommendations based on the evaluation of patient data.^[2]

Nevertheless, some of the advantages may be outweighed by the technology’s increased sensitivity or cost. Several aspects of digital dentistry fall short in one or more of these areas and can be easily improved by adding disruptive, newer technology in place of outdated technology, or by adopting or appropriating technology from other economic sectors.^[3]

ADVANCEMENT IN PERIODONTAL PROBING

The periodontal pocket is measured using a calibrated metal instrument called a periodontal probe. Manual periodontal probing is a classic approach with many drawbacks.^[4] The literature presents a set of ultrasound probes used primarily with an intraoral approach. The probe is in contact directly with intraoral tissue for image production, providing a sagittal slice. Salmon et al.^[5] designed a probe for intraoral use. The probe was designed for use on all surfaces of the tooth using a handpiece. The prototypes for the oral cavity are smaller and use a head probe with a special angle, allowing access to the tightest spaces of the oral cavity. Components such as the transducer are necessarily miniaturised for ease of use. A coupling agent is often a commercial coupling gel, similar to water. The coupling gels used were not specifically designed for use in the oral environment or periodontology.^[5] Regarding the acoustic parameters of the probes, it is essential to remember that periodontal imaging aims to visualize structures close to the probe head. The depth of exploration is less than 10 mm, and the structures to be explored are sub-millimetric in size. In this specific case, emission of frequencies needs to be between 15 MHz to 40 MHz for best results. Beyond 20 MHz, we enter the field of high-frequency ultrasound to obtain high-resolution images, with a resolution of less than 100 microns. The images obtained can be modified to enhance readability, similar to X-ray images.^[6] Within the periodontal tissue, bone structures are more echogenic because they reflect a greater number of ultrasound waves. Impedance rupture between hard and soft tissues allows them to be clearly distinguished. Therefore, hard tissues appeared whiter than soft tissues on the grey scale. Ultrasound imagery produces unique artifacts, such as the “drop shadow”. This is because a structure always appears less echogenic (blacker) than it is when it is preceded (on the path of the ultrasound) by a hyperechoic structure.^[7] The study by Salmon et al reported the presence of artifacts due to non-specific coupling gel and distortions on ultrasound images.^[5]

LASERS

The use of lasers has expanded in nearly every area of dentistry because of technological advancements. Much more research is needed to verify many of the claims, even though many doctors using CO₂, Nd: yttrium aluminium garnet (YAG), erbium, and diode lasers, among other categories, have successfully incorporated the lasers into their operations, and their observations appear to support the assertions. Due to its application, experts’ interest in the disciplines of general practice, endodontics, prosthodontics, and periodontics has increased. Future developments will involve the incorporation of hands-free control software into dental operatory equipment, similar to that used in other digital dentistry domains, and integration with LED curing lights and intraoral cameras.^[8]

ROLE OF CBCT AND 3D VIRTUAL MODELS IN PERIODONTAL SURGERIES

It is challenging to precisely determine the true 3D defective morphology from the 2D image produced by intraoral radiography because of overlapping anatomical components.^[9] Several articles have recommended the use of CBCT for periodontal diagnosis. CBCT is superior to IRs in the detection of specific periodontal anomalies such as furcation defects, dehiscence-type, mid-buccal intra-bony defects, or three-wall intra-bony defects, according to several in vitro and in vivo studies.^[10,11] The cost-benefit ratio of the higher radiation dose is difficult to argue, but.^[12] For this reason, CBCT should only be utilised for periodontal diagnosis in cases where conventional imaging techniques are unable to yield sufficient data.^[13]

ROLE OF DIGITAL DENTISTRY IN ORAL IMPLANTOLOGY

The digital workflow in implant dentistry is evolving rapidly and continuously, resulting in improved treatment outcomes, enhanced precision of work, and the elimination of several traditional steps in regular dental practices.^[14] Digital modalities, such as 3D CBCT, have been used in diagnosis over time, and their use has become standard practice in dental implantology.

In dental implantology, the use of software applications to guarantee long-term success requires a multi-step procedure. This includes segmentation, artifact reduction, virtual dental implant insertion, and image superimposition (DICOM/STL) using a dual-scan technique. The 3D visualisation of possible implant placement using implant planning software. Additionally, major landmarks, such as nerves, sinuses, and the circulatory system, can be observed anatomically. They can be carefully analysed along with various features of the bone, such as density, quantity, quality, volume, and availability for the healing area. Additionally, simulating the implant placement at the recommended position allows for further assessment of its size, depth, and width before actual implantation. This method, referred to as “Go Guided” or prosthetic/restorative-driven implantology, is primarily carried out with the aid of surgical templates.

Surgical guides offer several advantages, including precise implantation, accurate placement of the angle with precise assessment of its position and depth, easier replacements, and reduced patient discomfort. Additionally, it is a faster flapless technique, has an anticipated implant prosthetic restorative outcome, and prevents long-term mechanical and biological issues.

Integrating scanners to create an optical or virtual (digital) impression is the next step in implantology. The implant scan body, frequently referred to as the CAD/CAM implant impression coping, is an essential component of the impression process and is typically employed during operations. It accurately depicts the location and course of the corresponding oral implant, analogue, and abutment in CAD/CAM scanning processes. Unlike single implants, where impressions are typically easy to obtain, multiple implants may have digital imprints that are linked to linear or angular errors. The best results for a complete mouth or multiple implant impressions can be achieved with the open-mouth impression technique, which is considered the gold standard. Conventional implant impressions can be supplemented with lab or extraoral scans and easily obtainable elastomers.^[15] Digital impressions are an efficient way to obtain the data, which may subsequently be uploaded to the dental laboratory via secure web portals. The CAD-assisted engineering of the abutment, also referred to as personalised abutment, comes next. It imparts optimal form, tissue support, and a completed prosthesis. Ultimately, the prosthesis and abutment can be constructed using additive manufacturing, commonly referred to simply as RP or Rapid Additive Manufacturing (RAM) technology, or subtractive milling, frequently abbreviated as CAM. The surgeon acquires the implants from the lab following the final placement of the prosthesis. The effective implementation of digital workflows has resulted in a substantial shift in dental implantology.^[16]

ROLE OF AI IN PREDICTION OF PERIODONTAL PROGNOSIS

The application of AI in periodontology, particularly through neural networks, has significantly enhanced the accuracy and efficiency of diagnosing periodontal diseases. AI-based models have demonstrated exceptional ability in identifying alveolar bone loss (ABL) and clinical attachment loss (CAL), two essential indicators for diagnosing and staging periodontal conditions.^[17,18,19] The effectiveness of AI technologies such as convolutional neural networks (CNNs), hybrid neural networks, and generative adversarial networks (GANs) underscores their transformative role in modern dental diagnostics.

Krois et al. introduced a seven-layer CNN that achieved 81% accuracy, sensitivity, and specificity in detecting ABL from panoramic radiographs, comparable to the 76% accuracy of experienced dentists.^[20] Additionally, Moran et al. explored advanced imaging techniques using super-resolution CNNs to enhance radiographic clarity, improving bone loss detection and diagnostic confidence.^[21] However, AI still faces challenges, particularly in accounting for anatomical variations, molars with complex root structures, and vertical bone loss. Studies like those by Bayrakdar et al. reported reduced AI performance in detecting vertical bone loss compared to horizontal loss, highlighting the necessity of comprehensive datasets and the integration of 3D imaging.^[22]

Recent advances in AI have further refined the detection of periodontal disease, surpassing the capabilities of conventional diagnostic methods.^[23,24] The present study utilised the YOLOv8 model to analyse panoramic radiographs, segmenting key structures such as teeth, the cemento-enamel junction (CEJ), and alveolar bone levels. It demonstrated superior accuracy (94.4%) and perfect sensitivity (100%) in detecting periodontal bone loss compared to human experts, including periodontists and general practitioners (GPs).

ROLE OF NAVIGATION SURGERY AND ROBOTIC SURGERY IN PERIODONTOLOGY AND IMPLANTOLOGY

This real-time navigational technology is derived from the Global Positioning System (GPS) and adapted for use in medical applications, particularly in the field of human anatomy. The patient’s jaw anatomy is first captured using CT imaging with a dental splint containing fiducial markers. This CT scan forms a virtual model of the patient, which is superimposed onto the actual patient during surgery through these markers. During the procedure, the IGITM system monitors the jaw and drill positions via infrared emitters attached to the patient and surgical instruments. The system’s processing unit continuously calculates the drill’s spatial position relative to the patient and provides real-time visual feedback on a navigation screen. It assists the surgeon in preparing the implant site precisely according to the planned position. The virtual drill tip’s angulation, depth, and positioning are displayed in real time against the pre-acquired CT scan. Any deviation from the planned path triggers both audio and visual alerts, helping the surgeon maintain accuracy and avoid critical structures. In cases of complex anatomy, computer-assisted navigation is superior to conventional implant surgery for treatment planning and reducing iatrogenic risks. By providing real-time virtual visualisation, this technology enhances surgical precision, reassuring both surgeons and patients and reducing surgical stress.

The use of robotics has advanced across multiple industries, including machinery, electronics, aerospace, and medicine, with a particularly strong impact on medical procedures. Robotic surgery has transformed medical interventions by improving intraoperative communication, enhancing visualisation of the surgical field and vital structures, and increasing surgical precision. These innovations enable surgeons to exercise improved hand-eye coordination, greater control, and reduced tissue damage.^[25]

ROLE OF 3D PRINTING IN PERIODONTOLOGY

The document on 3D printing provides an extensive analysis of its historical development, technologies, applications, benefits, challenges, and potential advancements. Also referred to as additive manufacturing, 3D printing has revolutionised various industries by enabling the production of intricate and customised objects with lower costs and minimal material waste. The document discusses different 3D printing technologies. Fused Deposition Modeling (FDM) is widely utilised in both consumer and industrial settings due to its cost-effectiveness and ease of operation. Stereolithography (SLA), recognised for generating highly detailed and smooth-surfaced objects using liquid resin and ultraviolet light. Selective Laser Sintering (SLS) is a preferred method for industrial applications, as it enables the fabrication of strong and functional components without the need for support structures. Digital Light Processing (DLP) functions similarly to SLA but leverages digital light projection for increased printing speeds.^[26]

The aerospace and automotive industries benefit from 3D printing by manufacturing lightweight yet high-performance components, reducing material waste, and expediting the prototyping process. Within the construction sector, 3D printing is being utilised to rapidly and cost-effectively construct homes and infrastructure, with some companies exploring its use for emergency housing solutions. Additionally, the fashion and consumer goods industries leverage 3D printing to produce personalised clothing, jewellery, and footwear tailored to individual preferences.^[27]

Despite these benefits, 3D printing still faces notable challenges. One of the primary concerns is material limitations, as not all materials are suitable for 3D printing, and the mechanical properties of printed objects may not always be equivalent to those produced via traditional methods. Production speed is another drawback, as 3D printing is often slower than conventional mass production techniques, making it less viable for large-scale manufacturing.^[28]

CONCLUSION

Due to improvements in precision, accuracy, process efficiency, and patient outcomes, digital dentistry has undergone a complete transformation. Dentists’ treatment of patients has undergone drastic changes due to digital dentistry, which offers greater accessibility, efficiency, and precision. The dental industry has undergone a tremendous transformation due to developments in imaging, CAD/CAM, in 3D printing, and regenerative dentistry. AI, AR, and telemedicine are examples of present and future digital dental applications that can enhance the field’s potential. A promising development in dental implantology has been the successful incorporation of digitalisation, which is directly related to digital procedures. Particularly in implantology, these workflows are practical and may be implemented regularly in dental practices. Digital implantology guarantees precision, patient comfort and safety, treatment predictability, the elimination of time-consuming steps, and ultimately, a more predictable outcome for the success of implant therapy.