Molecular techniques lecture 1

most common human fear

going to the dentist even though oral health is crucial

goal of innovations in dentistry

alleviate patient fears by providing trustable and more efficient care

where is dentistry going?

conventional approaches in health sciences are changing rapidly; dentistry as we know it today will be remarkably different as it is now different from the way it was 25 years ago

The dental profession is responsible for?

prevention, diagnosis and treatment of diseases and disorders of the oral cavity and related structures

innovative approaches offer?

exciting perspectives to regenerative dentistry and might prove fundamental for the long-sought regeneration of fully functional dental tissues

It takes an average of _______ years for only ____5 of new scientific discoveries to enter day to day clinical practices

17 years & 14%

translation

refers to the application of the results of basic biomedical research to the practice of medicine

Translations process

converting discoveries made in the laboratory into clinical interventions that provide a direct benefit to human health

where can translations occur

bench to bedside & bedside to bench

translational research

the foundation is to foster and promote multi-investigator and multi-institutional collaboration and sharing

multiple methods and technologies are used

numerous federal regulations, institutional policies and best practices govern cell, animal and human research

translational medicine

basic and oral health clinical research are interdependent

translation of basic science into human studies

basic research ←→ clinical reserach

translation of new knowledge into clinical practice → improved health

clinical findings also loop back to inform basic research

translational medicine as a bidirectional concept

encourages the flow of information from the laboratory to the clinic and back the same way

what is translational medicine the conversion of?

promising research outcomes into therapeutic, diagnostic or preventive agents

basic research

cell/molecular mechanism, biological validation, target validation, diagnostic tools = data acquisition

clinical research

diagnostic risk assessment, treatment, health outcomes, prevention = application/practice

the impacts of genomics on dental practice

• caries

• periodontal disease

• acute & chronic pain management

• orthodontic & craniofacial development

• oral microbiology

• oral cancer

what contributes to phenotype

genomics, proteomics, transcriptomic, metabolomic

phenotype

composite of an organism’s observable characteristics or traits

phenotypes of the craniofacial musculosketal complex

• contribute to malocclusion

• facial asymmetry

• development of the temporomandibular joint & associated pain perception

translation to clinic

pharmacogenetics, therapeutics agents, diagnostic & biomarkers, tissue engineering

Phases of translational research

T1, T2, T3, T4

T1

first phase of translational research or “bench to bedside”, moves a basic discovery into a clinical application

T2

“Bedside to practice” research provides evidence of the VALUE of taking the basic discovery in the clinical setting

T3

research that moves the evidence based guidelines developed in T2 into health practice

T4

research to evaluate the “real world” health outcomes

bench to bedside: overview

1. basic research - 1-3 years

2. preclinical testing - 3-6 years

3. clinical trials - 6-10 years

4. regulatory approval - 10-12 years

5. market launch

translational research is governed by:

• regulations & compliance

• ethical & philosophical mores

Key ethical considerations in translational research

• informed consent

• patient privacy

• benefit-risk analysis

• conflict of interest management

• scientific rigor

informed consent

ensuring patients fully understand the risks and benefits of participating in a clinical trial and have the ability to withdraw at any time

patient privacy

protecting patient data and maintaining confidentially throughout the research process

benefit-risk analysis

carefully weighing the potential benefits of a new treatment against th risks to patients

conflict of interest management

disclosing and appropriately managing any potential conflicts of interest related to industry collaborations or financial incentives

scientific rigor

adhereing to established research methodologies and data analysis practices to ensure reliable and reproducible results

Historical background

1819 - braces

1830 - amalgam

1901 - fluoride

1950s - dental drills

1965 - dental implants

1990s - digital dentistry

2010s - dental AI

Technologies that will shape the future of dentistry

1. AI

2. Smart toothbrush

3. Virtual reality in dentistry

4. Teledentistry

5. Computer-assisted design and 3D printing

6. Intraoral camera

7. Regenerative dentistry

8. CRISPR

9. Laser

Artificial intelligence

• Enables professionals to spot, treat, and predict the growth of oral cancer.

• despite its advantages, ethical concerns regarding accuracy still exist within the dental community

How can AI map and predict progression of cancer cells

can determine the rate of growth and the likelihood of successful treatment by quantifying the immune cells surrounding the cancer cells

How is AI helpful in detecting dental decay and periodontal disease

by using neural networks and radiographs, allowing early detection and timely treatment to prevent tooth loss and complications

where can you find AI in dentistry

• operative dentistry

• periodontics

• orthodontics

• prosthodontics

AI in operative dentistry

• finds cavities earlier

• detects vertical root fractures

AI in periodontics

• can measure bone level to help provide a more accurate diagnosis

• detect early stages of gum disease

AI in orthodontics

• helps create an efficient treatment plan

• shows predictive before & after simulation of what the treatment goal is

AI in prosthodontics

generate crowns and dentures through CAD integration

smart toothbrushes advantages

• highly recommended by dentists for at-home oral care due to their efficiency and user-friendly features

• they utilize sensors to detect plaque and other dental issues, providing valuable insight into oral health without the need for dental mirrors or guesswork

• often come with a mobile app that offers notifications for excessive brushing force and personalized recommendations, reducing the risk of plaque bulidup, decay, and periodontal disease

• ensure that you are brushing your teeth the right way through its app

Virtual reality

• allow learning dentistry skills in a virtual environment

  • students can view a dental surgeon performing surgery in another city or country

• students can learn intricate surgical skills from their homes

How can VR be useful for patients

dentists are using vr to dispel dental anxiety and make their patients more comfortable during their time in the chair

Augmented reality

• for dental treatments, it works like a face filter app on the phone

• using this reality to educate on the steps they take during a dental procedure

• the app will provide them with feedback based on precision

• can also be extremely useful in helping to improve the accuracy and look of cosmetic dental treatments such as porcelain veneers

• more prevalent in reconstructive and aesthetic procedures to help patients know what they will look like after the treatment

• it allows patients & dentists to configure parts of their teeth, such as height and spacing

History of Teledentistry

1994 - teledentistry projects were first started by US military for the troops

1997 - the term teledentistry was used by the federal government, and a definition was made for it

2004 - teledentistry network was introduced by the University of Minnesota Dentistry specialists with dentists and patients in remote rural areas

2005-2019 - dentistry was slower than other healthcare areas in terms of communication and information technologies on dental care

2020 - during the pandemic it became popular in the dental field, main purpose was to avoid person to person contact

teledentistry advantages

• patients can contact the dentist for emergencies after hours

• less expensive than in-person visits

• less need for travel

• can be used for quick appointments if theres no urgent need to be in person

teledentistry disadvantages

• cannot accurately assess the dentition and oral tissue

• image quality and lighting

• clinical examinations are not possible

• diagnosis may not be accurate

CAD design & 3D printing

• using CAD/CAM technology, the dentist drills the affected tooth and takes a picture

• then the image is transferred to a 3D printing machine, wherein the crown is made; in this way, it saves time for both dentists and patients

CAD/CAM Technology

• computer-assisted design and computer-assisted manufacturing

• new dental advancements that make crowns and bridges quickly

• after drilling the tooth to prepare for crown placement CAD/CAM technology enables us to snap a picture of the area

computer technology - computer-aided root canal therapy

• mini computer helps dentists clean infected root canals precisely

• digitally displays tooth root lengths

• helps dentist accurately seal root

• technology is common in dentistry and can be used for root canal treatments

3d dental imaging - computer-aided root canal therapy

• uses low-dose HD images

• helps identify all tooth roots, hidden roots, and unusual root anatomy

• useful for pre-treatment planning

• helps with post-treatment evaluation of failed root canals

3D printing

• manual modeling has been a pain in the neck for dentists over the years

• with 3D printing dentist can use imaging to instantly create a crown insert for the tooth, using 3D printing technology to reduce waiting times

• used to obtain accurate images and models of the anatomy of a patient’s teeth and jaws

3D printing timeline

intraoral scanner captures anatomy → data is used to construct 3D-CAD model → completed CAD file is uploaded to digital printer → dentists go through several alterations

3D printing advantages

• customization

• speed/efficiency

• cost-effective

• precision and accuracy

3D printing - dental implants

• allows for the creation of highly customized implants

• made of titanium or biocompatible materials

3D printing - crowns & bridges

• fixed and removable variates

• burnout resins to complete casting of a tooth

• patterns and geometries for casting are printed

3D bioprinting

led to the printing of biocompatible materials for the production of medical devices, as well as the replacement of human tissues and organs

3D dental technology

allows us to provide you with a more precise diagnosis, followed by optimally comfortable, safe, and predictable treatments

3D bioprinting materials must have

appropriate crosslinking mechanisms to allow for proper deposition and biocompatibility over the long term

what do 3D materials have to support?

support the proliferation of cells, as well as cellular function and attachment

applications of 3D bioprinting in dentoalveolar repair due to

maxillofacial injury, disease, pathology or trauma

autographs

is the transplantation of organs, tissues or even particular proteins from one part of the body to another in the SAME PERSON

allografts

is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the SAME SPECIES

3D bioprinting

• replace human tissue by full body transplant

• allows scientists to eliminate the wait list of organ transplants

• higher survival rate of printed cells

• offers high precise resolution

3D bioprinting disadvantages

• organ is not sure about whether they can fit into a human body

• 3D printers can create dangerous items such as guns and knives

• printing capabilities of complicated tissues

Intra oral camera

• dentists are facing problems seeing the condition of a patient’s rear teeth

• Intraoral cameras are a perfect solution to this problem. using this tool the dentist can get highly detailed and accurate images of the view inside the patient's mouth

intraoral camera technology

• dentists favor intra-oral camera technology for dental imaging, allowing them to see more clearly when performing dental procedures

• they provide more accuracy and precision, preventing pain for the patient during dental procedures due to errors

benefits of intra-oral dental camera

• early detection of dental problems

• improves patient/doctor communication during treatment planning

• proof & validation of disease - builds patients’ trust

• images can be used to optimize insurance reimbursements

• case documentation for education and future references

• diagnosis for hidden problems like small dental cavities or tooth cracks

• improves treatments because patients confidently choose the best treatments more often

regenerative dentistry

• brings up the idea of self-healing teeth and tooth regeneration

• salvaging your natural teeth is the optimal option in any dental procedure, and developing this technology is an exciting step in dentistry

• self-healing teeth and biological therapy has ensured that damaged teeth can heal by themselves

• ensures that patients can regrow their teeth and has less chance of root canal treatments

CRISPR

• genome editing methods help dentists to find, isolate and turn off genes associated with oral cancer

• also used to change the functioning of bacteria that are responsible for plaque

zirconia - bridges metal free “the white metal”

the strong aesthetic white metal, can be milled by a computerized cutting machine (CAD/CAM) into the shape of a tooth crown, dental post, bridge, and full arch implant bridge

technologies for safety, asepsis, and prevention

clean water technologies, medical grade sterilization, instrument sterilization pouches

touchless digital dental x-rays

Traditional X-ray sensors placed in your mouth may cause an uncomfortable pressure or pinching, pain, or elicit an uncomfortable gag reflex

New 3D/4D touchless x-rays are created by

a computerized parallel sensor technology. These new images are incrementally the same size as your corresponding dental anatomy. The same size means accurate measurements and precise, predictable diagnostics

primary purpose of new xrays

is to locate cavities; however, they are often used to check the support of the bone under the tooth and the placement of the implant

laser dentistry hard tissue applications

• cavity preparation

• caries prevention

• diagnostics

• bleaching

laser dentistry soft tissue applications

• uncovering impacted teeth

• wound healing

• malignancies

• tissue removal

• gingivitis

• periodontal disease

main focus of laser dentistry

• minimally invasive procedures

• improved patient comfort and reduced recovery time

challenges of laser dentistry

high prices and specialized designs limit accessibility for most dentists

what are the two purposes of LASER technology?

health and esthetics

lasers kill what % of bacteria embedded in tooth roots

98%

what is one main goal of effective gum therapy?

is to remove this bacteria and disinfect the roots

lasers

• produce less pain

• require less anesthesia

What is minimally invasive surgery (MIS) for gums?

gums are lifted without cutting a mucogingival flap or disturbing the gum papilla

what can MIS be used to treat?

a variety of gum problems, and is especially well suited for cosmetic gum procedures that require a great deal of precision and accuracy

MIS compared to traditional gum surgery

• patient experiences less pain

• significantly quicker recovery and healing

• predictable healing and consistent esthetic results

• minimally invasive

• less post-treatment side effects

• gums are generally thin on the facial of the upper and lower anterior teeth

• reduced potential for scarring

air abrasion technology

works like a mini sandblaster to spray away decay. A pressurized stream of fine particles is aimed at the stained or decayed tooth structure

what is the decay washed away with in air abrasion technology?

stream of aluminum oxide particles

oral appliances for sleep apnea main purpose

keep airway open during sleep

what do the oral appliances for sleep apnea prevent?

prevents your airway from collapsing which blocks the normal flow of air