EXAM 1: Translational Dentistry, Biomarkers, and CRISPR Technologies

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Translational dentistry

The application of scientific discoveries and technologies to improve prevention, diagnosis, and treatment in dentistry.

Translation

The process of applying results of basic biomedical research to medical or dental practice.

Translational medicine

The conversion of promising research outcomes into therapeutic, diagnostic, or preventive agents.

Bench-to-bedside (B2B)

The movement of discoveries from laboratory/basic research into clinical applications.

Bidirectional translation

Translation is not one-way; information should flow from laboratory to clinic and from clinic back to laboratory.

Importance of translational research

Scientific discoveries can take many years to become routine clinical practices, so translational research helps move discoveries toward practical patient benefits.

Average time for scientific discoveries to enter routine clinical practice

Approximately 17 years for only about 14% of new scientific discoveries to enter day-to-day clinical practice.

Foundation of translational research

Multi-investigator and multi-institutional collaboration, sharing of information and resources, and use of multiple methods and technologies.

Regulations affecting translational research

Federal regulations/CFRs, FDA regulations, HHS privacy regulations/HIPAA, export controls and shipping, conflict of interest policies, NIH Grants Policy, Material Transfer Agreements, institutional oversight, and industry agreements.

Translational research involving cells, animals, or humans

Research involving these materials is governed by regulations, institutional policies, ethical requirements, and best practices.

What does translational medicine encourage?

Flow of information from laboratory to clinic and from clinic back to laboratory.

Bench-to-bedside is not simple or linear

Translation involves multiple stages and feedback between discovery, toxicology, clinical trials, and clinical practice.

General B2B sequence

Discovery → toxicology → Phase I → Phase II → Phase III → regulatory/clinical goal.

Definition of T1 translation

Movement from basic scientific discovery toward a clinical application.

T1

Bench-to-bedside translation; basic discovery is moved toward clinical application.

T2

Provides evidence concerning the value of taking the basic discovery into a clinical setting.

T3

Moves evidence-based guidelines developed during T2 into actual health practice.

T4

Evaluates real-world health outcomes after implementation in practice.

T1-T4 sequence

T1 = discovery to clinical application; T2 = clinical evidence/value; T3 = evidence to health practice; T4 = real-world outcomes.

Bench-to-bedside years 1-3

Basic research.

Bench-to-bedside years 3-6

Preclinical testing.

Bench-to-bedside years 6-10

Clinical trials, including Phase I, Phase II, and Phase III.

Bench-to-bedside years 10-12

Regulatory approval and market launch.

Genomics

The study of the genome, DNA, and genetic variation.

Transcriptomics

The study of RNA and gene-expression patterns.

Proteomics

The study of proteins and protein expression/function.

Metabolomics

The study of metabolites and metabolic products/pathways.

Omics technologies in personalized oral health

Genomics, transcriptomics, proteomics, and metabolomics can contribute to personalized oral health, pharmacogenetics, therapeutics, diagnostics, and biomarkers.

Phenotype

The composite of an organism's observable characteristics or traits.

Craniofacial phenotype examples

Malocclusion, facial asymmetry, temporomandibular joint development, and pain perception associated with the TMJ.

Relationship between omics and phenotype

Genomics, transcriptomics, proteomics, and metabolomics contribute to biological processes that ultimately produce an observable phenotype.

Ethical concerns in translational research

Informed consent, patient privacy, benefit-risk analysis, conflicts of interest, data manipulation, research integrity, preliminary-data disclosure, and scientific rigor.

Informed consent

Patients must understand the nature of participation, risks, benefits, and their right to withdraw before participating in research.

Patient privacy in translational research

Patient medical information and research data must be protected and handled confidentially.

Benefit-risk analysis

Researchers must weigh potential benefits of a treatment or study against potential risks to participants.

Conflict of interest

A situation in which financial, professional, or other interests could influence or appear to influence research.

Managing conflicts of interest

Researchers should disclose and appropriately manage conflicts of interest.

Scientific rigor

The use of established research methodologies, appropriate data analysis, reliable results, and reproducible findings.

Historical dentistry 1819

Braces; the lecture shows a woven crib of wire.

Historical dentistry 1830

Amalgam; the lecture associates it with mercury and zinc.

Historical dentistry 1901

Fluoride; used to prevent caries.

Historical dentistry 1950s

Dental drills.

Historical dentistry 1965

Dental implants.

Historical dentistry 1990s

Digital dentistry, including X-rays, CAD/CAM, and digital imaging.

Historical dentistry 2010s

Dental artificial intelligence.

Future technology in dentistry

Artificial intelligence, smart toothbrushes, virtual reality, teledentistry, CAD/CAM, 3D printing, intraoral cameras, regenerative dentistry, CRISPR, lasers, and other emerging technologies.

Artificial intelligence in dentistry

AI can assist with detection, diagnosis, treatment planning, prediction, imaging interpretation, and monitoring of dental diseases.

AI and oral cancer

AI can assist with oral-cancer detection, treatment planning, prediction of progression, mapping cancer-cell progression, quantifying immune cells surrounding cancer cells, estimating growth rate, and estimating likelihood of treatment success.

AI and dental caries

AI can assist in detecting dental decay earlier.

AI and periodontal disease

AI can assist in detecting periodontal disease, including through analysis of radiographs and other diagnostic information.

AI and vertical root fractures

AI can assist in detecting vertical root fractures.

AI and bone levels

AI can assist in measuring bone levels.

AI and treatment planning

AI can help generate efficient treatment plans and predictive before/after simulations.

AI and CAD/CAM

AI can be integrated with CAD systems to help generate crowns and dentures.

Major concern with AI in dentistry

Accuracy and reliability of AI-generated diagnoses or recommendations.

Smart toothbrush

A toothbrush containing sensors and/or connected technology that can monitor brushing behavior and provide feedback.

Smart toothbrush capabilities

Detection of plaque or brushing problems, real-time feedback, brushing-force monitoring, coverage tracking, duration tracking, missed-area detection, mobile-app integration, and personalized recommendations.

Smart toothbrushes for children

Some systems provide interactive mobile applications and feedback designed to encourage children to brush properly.

Potential benefit of smart toothbrushes

May reduce plaque accumulation and therefore reduce risk of dental decay and periodontal disease.

Virtual reality (VR) in dental education

VR can allow students to learn dental skills virtually and observe dental procedures performed remotely.

VR and dental surgery education

VR can allow learners to observe complex dental surgeries performed in other locations without physically traveling there.

VR and dental anxiety

VR can distract patients and potentially reduce fear and anxiety during dental procedures.

Augmented reality (AR)

Technology that overlays digital information onto the real environment.

AR in dentistry

Can provide procedural guidance, precision feedback, treatment planning, and visualization while the user remains in the real environment.

AR and cosmetic dentistry

Can help patients and dentists visualize cosmetic outcomes such as changes in tooth height and spacing and plan porcelain veneers.

Teledentistry

Delivery of dental support, consultation, assessment, or follow-up remotely using communication technologies.

Teledentistry capabilities

Patients can send images, communicate by video, discuss concerns, receive advice, obtain emergency guidance, and track treatments remotely.

Advantages of teledentistry

Improved access, convenience, reduced travel, potentially lower cost, quick appointments, after-hours support, and usefulness for patients unable to attend in person.

Limitations of teledentistry

Cannot perform a complete physical oral examination; image quality, lighting, and lack of direct examination can reduce diagnostic accuracy.

Teledentistry versus in-person examination

Teledentistry can improve access but cannot completely replace a comprehensive in-person clinical examination.

CAD/CAM

Computer-Aided Design/Computer-Aided Manufacturing.

Basic CAD/CAM workflow

Tooth preparation → digital image/scan → digital design → computerized manufacturing of restoration.

Main advantage of CAD/CAM

Allows crowns, bridges, and other restorations to be produced more quickly and efficiently.

Computer-assisted root canal therapy

Uses digital imaging and computer assistance to help clean infected root canals, determine root/tooth lengths, and assist with sealing.

3D dental imaging

Provides detailed three-dimensional visualization of roots and surrounding anatomy for diagnosis and treatment planning.

3D imaging and root canals

Can help locate all roots, identify hidden or unusual root anatomy, plan treatment, and evaluate failed root-canal therapy.

3D printing in dentistry

Uses digital anatomical information to manufacture customized dental models, restorations, surgical guides, and potentially implants.

3D-printing workflow

Intraoral scan → anatomical data → 3D CAD model → digital printer → printed restoration/model.

Advantages of 3D printing

Customization, speed, efficiency, cost-effectiveness, precision, and accuracy.

3D printing and dental implants

Can produce highly customized implants using materials such as titanium and other biocompatible materials.

3D printing and crowns/bridges

Can produce fixed and removable restorations, burn-out resin patterns, and casting geometries.

3D bioprinting

The use of printing technologies to deposit cells and/or biomaterials to create biological structures or potentially replace/regenerate tissues.

3D bioprinting material requirements

Materials need appropriate crosslinking, deposition characteristics, long-term biocompatibility, and ability to support cell proliferation, cell function, and cell attachment.

Dental applications of 3D/4D imaging

Surgical implant placement, nerve tracking, sinus/air-space visualization, guided implants, implant planning, teeth-in-a-day approaches, airway evaluation, sleep-apnea evaluation, jaw-motion testing, TMJ analysis, periodontal diagnosis, trauma evaluation, tooth/bone fracture evaluation, root-canal visualization, root-crack diagnosis, wisdom-tooth planning, and orthodontic diagnostics.

3D-guided implant placement

Uses low-dose 3D scans and implant-planning software to create precise surgical guides.

Stereolithography

A process used to convert a digital design into a physical three-dimensional object, including surgical guides.

Autograft

Transplantation of tissue, cells, organs, or proteins from one part of a person's body to another part of the same person.

Allograft

Transplantation of cells, tissues, or organs from a genetically non-identical donor of the same species.

Autograft key concept

Self → self.

Allograft key concept

One human → genetically different human.

Problem with grafts

Grafts may need to be manually shaped to fit defects during surgery, potentially producing inaccuracies or esthetic limitations.

3D bioprinting potential benefits

Potential tissue replacement, potentially reduced transplant waiting lists, higher survival of printed cells, and high-resolution printing.

3D bioprinting challenges

Uncertainty about how printed tissues/organs will fit in the human body, difficulty printing complicated tissues, and potential misuse of 3D printers.

Intraoral camera

A small camera used to obtain detailed images inside the oral cavity.

Benefits of intraoral cameras

Early detection, improved patient-doctor communication, treatment planning, documentation, validation of disease, patient education, future case reference, insurance documentation, and detection of small cavities and cracks.

Regenerative dentistry

A field focused on biological repair or regeneration of damaged dental tissues rather than simply replacing damaged structures.

Goal of regenerative dentistry

Promote self-healing, tooth regeneration, and biological restoration of natural dental tissues.

Zirconia

An esthetic, strong, metal-free dental material sometimes described in the lecture as a 'white metal.'

Zirconia CAD/CAM uses

Zirconia can be digitally milled into crowns, posts, bridges, and full-arch implant bridges.

Clean water technology in dentistry

Technology intended to address contamination of dental waterlines.