A Literature Review Discussing Emerging Digital Dentistry in Pakistan

                         A Literature Review Discussing Emerging Digital Dentistry in Pakistan

                                                                Dr Sarah Salim (Dental Surgeon)

                                                                        laureatefolks@gmail.com

Abstract

Dentistry is a medical speciality that researches, diagnoses, prevents, and cures illnesses of the mouth. In the laboratory, dentistry must replicate nature's functional and aesthetic characteristics. Dentistry and dental science address many elements of dentofacial dynamics. Digital dentistry is a newer technology in dentistry. Both restorative and diagnostic dental treatments may benefit from digital dentistry. Digital technology has changed dentistry as much as any other medical field. Digital dentistry is a new area, but it is not a new idea. Dental schools must educate both how to utilize and learn about digital technologies. Dental CAD/CAM was created to help dentists design innovative crown and bridge forms. To stay up with 3D scanners and dental treatment, are increasingly used globally. Laser dentistry is another new digital dentistry area. On both hard and soft tissue, Miaman used lasers initially in 1960. Teledentistry, a subset of telemedicine that focuses on dentistry, involves remote consultations, workup, and analysis, among other things. This article will cover the growing usage of digital technologies in Pakistan after the government's efforts to provide public health services to the people via ICT. Internet and digital platforms, such as social media, are becoming essential in the digitization of health-related sectors as well as the field of dentistry in Pakistan.

Keywords: Digital Dentistry; CAD/CAM; Teledentistry; Digitization; E-health; Pakistan

Introduction

Dentistry is a branch of medicine that studies, diagnoses, prevents, and treats diseases, disorders, and conditions of the oral cavity (the mouth), particularly those affecting dental health (the evolution and configuration of dentition) and surrounding structures, as well as adjacent and related structures and tissues, especially those affecting the craniofacial area. It is also known as dental medicine or as oral medicine. There are several aspects of dentofacial dynamics that are taken into consideration in dentistry and dental science, including teeth, the lymphatic system, the neurological system, the blood supply, and the soft and hard tissues that are connected. In order to carry out a successful treatment plan for a patient's dental problems, it is the primary responsibility of dentistry to duplicate precisely all of nature's functional and aesthetic qualities into a restorative solution in the laboratory. Treatment planning, provisionalization (if required), final placement, and final consultation are all stages in the restorative process that need the exchange of complete information between the physician and the laboratory technician at each stage. 

In this sense, it includes any information about present or planned circumstances and expectations, as well as information about actual conditions and expectations, that is provided to and received from the clinical setting. There are many different types of information that the technician must have in order to manufacture excellent functional and cosmetic restorations, including functional components, occlusion, phonetics, as well as aesthetic standards, among others. Conventionally, the dentist and technician communicate mostly via photocopies, written documentation, and impressions of the patient's existing dentition, clinical preparations, and opposing dentition. Models are created using this data and then mounted on an articulator that simulates the jaw movement of the mandible. However, the age of complete digital dentistry is a recent development, tailored to the most current aesthetic trends and offering superlative technology influence in order to achieve this goal. As technological advancements are no longer restricted to specific fields in today's world, the age of full digital dentistry is a concept that provides superior innovation power to achieve this goal. 

Wikipedia defines digital dentistry as “Digital dentistry refers to the use of dental technologies or devices that incorporates digital or computer-controlled components to carry out dental procedures rather than using mechanical or electrical tools. The use of digital dentistry can make carrying out dental procedures more efficient than using mechanical tools, both for restorative as diagnostic purposes. Used as a way to facilitate dental treatments and propose new ways to meet rising patient demands” (Digital dentistry, n.d.).

As a consequence of the integration of technology into the field of dentistry, incredible advances are being made in the field of dentistry that is altering people's smiles and lives in every way imaginable.

1.1 Digital Technologies in Dentistry

In every area, from dentistry to other professions, digital technology has had a profound impact. This is feasible due to the fact that computers work more rapidly, more precisely, and at a lower cost than humans do now. When a patient is hospitalized, their records are collected and saved, diagnostic information is gathered and processed, treatment plans are designed and made using computer technology, and three-dimensional (3D) images are produced. Computers are now being utilized in almost every aspect of healthcare practice. As a consequence, contemporary dental training programs must incorporate teaching in the use of digital technology as well as instruction in learning about it. Computer-aided design - computer-assisted manufacturing systems in data acquisition and processing, the fabrication of indirect restorations using milling and 3D printing, computer-supported implant dentistry, the designing and manufacturing of implants, and computer-supported implant dentistry include intraoral and extraoral digital radiography, cone beam computed tomography (CBCT), and their clinical applications, are some of the technological advancement used in modern dentistry (Touraj Nejatian, 2019)

Even though digital dentistry is an emerging field, it is not a new concept in and of itself; computer-aided design and computer-aided manufacturing (CAD/CAM) was launched in 1973 and started to be used more often in dentistry throughout the 1980s. However, it is undeniable that dental CAD/CAM has revolutionised dentistry; the goal of its development was to alleviate dentists' difficulties when designing new crown and bridge formations, which required the ability to freely construct a 3D crown form, including full occlusal proximal, labial, and lingual surfaces. To keep pace with fast advances in 3D scanners and CAD/CAM systems for dental treatment, are currently utilised on a global scale nowadays (Larsson, 2019).

Even though a wide range of digital technologies are frequently used in all areas of dentistry, including diagnostics, restorative dentistry, orthodontic surgery, and treatment planning, the most prominent technologies include the intraoral camera IOS, CAD/CAM technologies for implant placement and crown manufacturing, 3D printing, digital printing, such as CBCT to identify impacted teeth, dental lasers, digital X-rays, and dental loupes, among others.

Intraoral scans or intraoral cameras benefit consumers, the practitioner’s as well as dental professionals, which are now one of the most useful dental treatment tools available. With functioning models, the IOS accuracy is on par with or better than that of traditional impressions and indirect methods. IOS may be used in the restoration of up to four units therapeutically. A group examination and identification of catastrophe victims or dementia patients may make use of IOS's high repeatability, information processing capacity, multimedia capabilities, and ease of use and speed of communication. When using an intraoral scanner (IOS), an optical imprint is created by taking an optical measurement of the surface contour of the patient's teeth or gums in the mouth. IOSs offer numerous benefits, such as reducing patient discomfort and suffering, operator load and infection risk, real-time scanning and viewing of impressions, easy duplicating and selective scanning, cost and waste reduction and identification of dental cavities and fractures (Suese, 2020). 

The quality of IOS has improved considerably as intraoral scanner quality, size, speed, and the design software's user-friendliness have improved. In the area of prosthodontics, dental implantology, and orthodontics, this discovery has fuelled rapid chair-side rationale expansion and opened the door to new treatment and treatment planning methods (Zaruba, 2017).

Another most important technology used frequently in dentistry is Cone Beam Computerized tomography CBCT is widely used in dental and maxillofacial imaging because of its speed and accuracy. It was in the second half of the 1990s when CBCT scanners designed specifically for dental use began to appear on the market. CBCT use in dental, maxillofacial, and otolaryngology (ear, nose, and throat) increased dramatically as a result (Pauwels, 2015). Cone-beam computed tomography is used in implant design, endodontic, maxillofacial surgery, and orthodontics (CBCT). However, because of its widespread use, many concerns remain regarding the logic and

Another emerging field of dentistry using digital technology is laser dentistry. Miaman was the first dentist to utilise lasers on both hard and soft tissue in 1960. Lasers have gone a long way in 20 years. Cavity preparation, pulp chamber sensitivity, and growth stimulation are examples of soft tissue regeneration applications. Soft tissue applications include laser surgery and herpes simplex phototherapy. The hard tissue applications include bleaching and phototherapy. Lasers are a great way to improve the efficiency, precision, ease, and comfort of dental treatments (Maheshwari, 2020). When using laser technology, the physician has the option of selecting a certain wavelength based on his or her clinical practice. Gives dentists and other dental professionals a quick look at the many lasers accessible to them. Surgical and nonsurgical laser

treatments are becoming more common in modern dental practice, where they may be utilised in addition to or instead of more conventional methods (Srivastava V K, 2013).

Teledentistry is another relatively new field of dentistry that can be categorized as digital dentistry. When the pandemic first started to spread, Telecommunications and digital technology are being utilised in teledentistry, which is a developing profession that is using these technologies. By sending information almost instantly inside a facility as well as to interested parties all over the world, this technology contributes to the process. Therefore, teledentistry, a branch of telemedicine that is specifically focused on dentistry, works with networking, sharing digital dental information, providing remote consultations, workup, and analysis, among other things (Mihailovic, 2011).

Table: 1:1 Computerized and digital technologies used and implemented in Modern Dentistry

Computerized Method	Description	Telemedical Method
OralCDx	System for hanging oral lesions, brush bS op sic' and computerized analysis of histologic slides.	Telcmcdical consultation with pathologists to coiilarin the diagnosis. Distant access to slides by clinicians And therapists.
Digital radiology	Equivalent to traditional x-ray, but with a lower level of radiation of both patients and staff. exceptional                           quality, 2D anti-3D coniputcrizcLl rcconslniction and immediate measurements of anatomic structures-.	Telcmcdical Iransfcyr ©f files from x-ray centre Lo dentistry clinic, distant consultations of doctors and specialists, and distant planning of dentistry interventions and rcccnstmctions.
Decision support systems	Support dental clinicians in making proper decisions and choke adequate therapy. Especially important for complex: cr rare    arid in differential diagnosis.	Case reporting through the Internet to the provider of support system for decision-making, and downloading cf received file with suggestions for diagnosis and trcalincnt of the case.
CAD/CAM system*	Computer-guided machines for the production of prosthetic restorations (crowns, bridges' Onlays and inlays).	Distant support in designing the shape of dental prosthetic restoration and in determining inter jaw relationships. Sending of digital models in the lab for the production of restoration-
Denial practice iiianageiiicnt	Automation of many routine activities in dentistry clinics' running of electronic p^Lient histories and support in general m^n^gc-meal of the clinic.	Distant appointments, provisional review of Itch situation to be resolved, exchange of iii/nomination with health insurance companies.
Edtxc a total resources	Eduuzaitiorkail inter active- soft wares, mjcchxtrLical nruccdiai ar ■on-links rcsouLr-ccs in learning tlrw j(iia±iifcsEatio(ns of dental pathology, therapy, and practical use of critical Icnowledj^e and thinking-	Otu-linc accessible integrated o<lucatio<nal courses, artifice.jeans.r ■anti titles for studcrats a±ici post* graduates or acqu-ircnacmt of now ■ami up«iatecL Icnowlccigc by present professionals and specialists.
CZonripiLitcjrizcsi research	Analysis of large anaciuLnts of data to generate new .knowIcidlcomplex analysis* of ■data obtained within research.	T e Ic Modi c<il infrastroctuunc Hates the work of research. tiaras in -different fiC5Ofira.phic bocation^-

 

Digital Dentistry in Pakistan

Pakistan was under lock and key by the end of March 2020, as soon as the first fresh coronavirus case was identified. In order to reduce the spread of infectious diseases among dentists, staff and patients, a variety of measures including dental digital dentistry, telephonic video consultations, appointment distancing, limited aerosol-generating procedures, procedural technological innovations and additional infrastructural changes were required (Qazi, 2020). With the onset of pandemics and generous tax exemption laws, Pakistan has recently been compelled to speed its digitization (Wahid, 2019).

Modem treatments like CAD/CAM technology and computerised dentistry are becoming popular in Pakistani private dental clinics (Naqvi, 2017).

Pakistan just recently adopted dental laser technology, and schools like the Pakistan Institute of Laser Dentistry have been using it to educate future dentists ever since. Technology advances in additive manufacturing have made it feasible for this product to reach the consumer market in a short period of time during the last decade. The phrase '3D Printing' has mostly replaced the word 'additive manufacturing in the industry. Worldwide, the 3D printing industry is moving from desktop to industrial 3D printers in order to fulfil the needs of the industrial sector. At the moment, 3D printing is becoming more popular throughout the globe, including in Pakistan (A. Azhar, 2019). CBCT technologies have also been more popular in Pakistan in recent years, with virtually every major dental diagnostic service using this technique. Alvi Dental Hospital was the first dental clinic in Pakistan to use sophisticated digital x-ray equipment, and it is now the proud owner of Pakistan's first 3D cone beam CT scanning system, which is now available to any dental practice in the country (cutting edge diagnostics, n.d.).

When it comes to telemedicine and teledentistry internet and digital platforms or social media are playing an increasingly important role in the digitalization of health-related industries across Pakistan. Because of new technology, stakeholders (including patients and healthcare professionals) may now communicate with one another in virtual settings to address health-related concerns (Ittefaq). Social media apps like Marham, Oladoc are recent initiatives that are playing a significant role in promoting digital health and teledentistry in Pakistan. Pakistan's government is changing public health services by using information and communication technologies to bring them to the people. Holy Family Hospital is the main hub, while four additional facilities are scattered around the area. 

The main HUB is linked to the other hospitals by satellite, as well as the DHQ hospitals in Attock, DG Khan, and Khushab, as well as the THQ hospital in Pindi Gheb. The experts at this facility also offer consultations in other parts of Punjab and rural Sindh. Medical professionals at metropolitan health care facilities can advise, guide, and treat rural people without them having to travel hundreds of miles to the closest facility. These people have travelled thousands of miles and have spent all of their limited financial resources on transportation and accommodation connected with their journeys. E-patient records are handled extremely well throughout the country based on the findings of the national eHealth implementation study conducted in Finland. A large-coverage and filmless picture archiving and transmission system is now in use in 94% of American hospitals. Every country in the world offers basic health care. Teledentistry is a valuable resource for both the patient and the dentist. Teledentistry is a general term that may refer to a wide range of dental specialities. It cuts down on the time it takes to do different activities. 

The patient and doctor both save money by getting several expert views. Preventing disease in its earliest stage. Teledentistry makes it possible to detect any carious or soft tissue lesions in the mouth via telemedicine. Identifying periapical lesions correctly and arranging treatment for patients with carious teeth are made easier in endodontics with the use of this technique. By providing easy access to various experts through the transmission of radiologic images between them, it helps the diagnosis and development of treatment plans for complicated patients in the areas of oral medicine and radiology. Advanced dental imaging techniques (such as CBCT) in maxillofacial surgery, which are not always available in one place, may be helpful in identifying the best therapy for complicated patients. Orthodontists may do routine cephalometric examinations and supervise treatment in the office. Prosthodontists may construct inlays, onlays, and crown preparations by using a number of computer-aided diagnostic tools (such as CAD and CAM) (Akhtar). 

According to Subhan, Rootab, et al “While the majority of dental students and professionals attending COVID-19 had no prior awareness of the phrase "teledentistry," they were optimistic about its potential. As a result of obstacles including the absence of modem technology and inadequate dental professional education and training, regular dental care is still rare in Pakistan. In this period of COVID-19, and even beyond, there is a need to improve awareness about teledentistry and encourage its use in order to triage patients. Teledentistry implementation requires the creation of new policies and educational materials for dentists. After the pandemic, teledentistry may be utilised as a consultation tool and a convenient way for dental professionals and patients to connect” (Rootab Subhan, 2021).

Future Prospects and Conclusion

With UNFPA's assistance, Federal Government started telemedicine services by establishing a hotline for females and males to contact competent healthcare professionals on various reproductive health problems at the beginning of the epidemic. The hotline provided free medical and dental assistance to Pakistanis from all across the country, including those in outlying areas. The Population Council used digital and social media, with help from UNFPA, to disseminate messages in regional languages recorded by doctors. This kind of information was crucial in an era when people were drowning in information, some of which was correct and some of which was not.

Private and governmental hospitals are now regularly using telemedicine and teledentistry to offer Covid-19 patients with home-based treatment, reducing their in-patient burden. Scaling this approach to cover additional specialities would be a cinch. Slowly but surely, digital health-based treatments are finding their way into Pakistan's current healthcare system. In the form of limited internet facilities, limited software, and skilled health professionals, as well as a lack of regulatory frameworks and regulations governing data protection and security, there are still significant roadblocks that prevent effective interventions from taking place. 

Despite these obstacles, digital dentistry continues to grow thanks to the combined efforts of a wide range of stakeholders from the public and commercial sectors. Because not all treatments are being assessed or published, it's impossible to tell how successful they've been. There is a lot of hope for digital health in Pakistan, particularly with the government's recent digitalization programme.

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