DTC Journal of Computational Intelligence, Vol-1, Issue-1

Robotics Using Artificial

Intelligence in Dentistry
Shifa Syed1, Tirth B Dalwadi2 , Mohd Zaheen Khan3*

1
Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India,
2
Department of Computer Engineering, Jamia Millia Islamia, New Delhi, 3India,
Department of Mechanical Engineering, IET, Lucknow, India,
*[email protected]

Abstract

AI is a next-generation technology that has already aided the medical field in

achieving new frontiers. AI has given lives to machines that are now more capable than
a surgeon to operate on a living being. The use of such living machines in Dentistry has
enhanced the accuracy and precision of the treatments and has reduced the chances of
errors. Robotics systems continue to support doctors in the medical field with
assistance in the cardiac space, orthopedics, and neurosurgery. However, robotic
systems have not as yet been altogether acquainted with dental research nor have they
accomplished expense adequacy and innovative status to be completely fused into the
dental market. In this paper, we will discuss Robotics & AI and their combined
application in various fields of dentistry. We will also be discussing the AI
technologies which are used to assist the dentist.

Keywords: Artificial Intelligence, Artificial Neural Network, Dentronics, Dental

Robotics, Nanodentistry.

1. Introduction

The application of robots in the medical field has opened new boundaries with vast
areas of exploration and expansion specifically in the dental field, but it has not been
explored much to date. The idea of robotics was first applied in 1969. Even before the
introduction of robotic surgery, laparoscopic surgery was performed with the help of
small instruments and incisions. It was monitored using miniature cameras. Then with the
innovation, robotic arms were introduced which were used to mimic the dexterity of a
surgeon’s hands and assisted them in dental surgery. Earlier X-rays were used to
diagnose teeth that were not that efficient. Then an intra-oral scanner was invented that
can be used to directly scan the mouth and have the inner view of the mouth on a screen.
Then with time, 3-D printed models were used. Dental training robots were introduced in
the dental study to help the students to get an experience of dentistry on human-like
machines which proved much better than the earlier used mummies. Then with the
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innovation, the first realistic humanlike robot was made and was named Showa Hanako
which was capable of showing gestures and responses just like a human. But the
inventors were not satisfied with this much. They wanted to make a robot that was much
closer to humans and can be used for robotic surgery. And in this process to achieve
efficiency many robots were created like Geminoid-F which could mimic human
expression and could even laugh, and HRP-4 which was capable of singing too. But these
results too were not sufficient enough to satisfy the scientists. So, with much hard work
and with the help of evolving artificial intelligence techniques they made a robot that
could undergo surgery, can show emotional human responses, and can even rate &
evaluate the treatment procedures, named SIMROID.

2. Methods and Methodologies

2.1. Need for Robotics in dentistry

Next-generation technology is robotics. With the development of modern technology,

robots are now used in every field of science. It aids in completing activities that are
challenging for a dental clinician to complete. It made it possible to investigate and
advance several dental fields in new ways. Because of their ability to do accurate work
without overtiredness, it has even made its way into dentistry. The use of robotics in
dentistry gives advantages over freehand techniques for placing instrumentation. These
systems with navigational guidance, offers improved accuracy and precision in dental
treatment even streamlined work processes and better workflows, resulting in a higher
quality of maintenance.

2.2. Artificial Intelligence (AI)

AI is the branch of Computer Science that builds smart machines that are capable of
performing human activities. It is an ability of a computer or computer-controlled robot
to perform tasks of intelligent beings i.e., Humans. Robots using AI can now simulate
human intellectual processes like sensing, navigating, learning from past experience (past
data) and take decisions, and even can make decisions in vague situations which are too
complicated for humans. Robots learn all these human processes using Machine Learning
which is again a part of Artificial Intelligence. AI has given robots a computer vision to
perform all these human tasks more efficiently as compared to humans [1].

2.3. Use of Data Mining in robotics

Robotics is all about data. Data is the invaluable treasure of knowledge and insights
which can be processed using ML to extract important information. In the medical field,
it can be used to diagnose the health condition of patients. Robots deal with a large
amount of data to perform specific tasks - from collecting data to generating important
results (internal data) from them. Data is available in many different forms. So, managing
and dealing with all this data is an important issue. All these processes from collecting to
cleaning the data and generating meaningful responses and predictions from them are
termed Data Mining. Figure 1. represents the complete data mining process. Data mining
is considered to be a super-influential phenomenon in the field of science. Once, data

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mining was used to analyze the direct cause of extraction and was done on a large
number of medical records. The study concluded that the direct causes of teeth removal
were dental caries (43.8%),fractures (6.8%), prostheses (4.3%), impaction (3.1%),
orthodontics (2.7%), periodontal diseases (37.2%), and deciduous teeth (0.3%).

Figure 1. Depicts the flow of data from the source to the predictors passing through all
data mining steps

2.4. AI Methodologies

Methodologies are the contextual framework of a research i.e., a body of rules or

methods that is used to analyze the techniques and methods used by the researchers to
solve a particular problem rather than the whole program. AI methodologies used in
dentistry have immense capabilities to detect and diagnose even the small defects in the
human mouth(teeth) that a normal human eye can’t even notice. Various AI
methodologies are being used in dentistry [2-3]. Some of which are Artificial Neural
Networks (ANN), Genetic Algorithms (GA), and Fuzzy Logic (FL). In the next part, we
will discuss these methodologies in-depth and their application too.

2.5. Artificial Neural Networks (ANNs)

In order to comprehend and make decisions similarly to a human, ANN models the
networks of neurons seen in the human brain. Artificial neurons, a mathematical model
based on networks of human neurons, are the main elements of ANN. A network made
up of these layers of artificial neurons is put together and integrated to accomplish
specific tasks like image classification (e.g., locating canals during RCT, a radiographic
image showing a decayed tooth). Learning is used by ANN.
In a study by Kim et al. [2], ANN was employed to develop a model to anticipate
toothaches based on their relationship to daily brushing frequency and time, toothbrush
replacement pattern, and many other aspects like daily food and exercise. A highly
accurate toothache prediction model was created with the help of all the data gathered for
the aforementioned parameters and ANN. It came to the conclusion that maintaining

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good oral hygiene, eating a healthy diet, and managing stress are key elements in
reducing toothaches.

2.6. Genetic Algorithm (GA)

An adaptable algorithm that is inspired by Charles Darwin's idea of natural selection is

known as a genetic algorithm and is a subset of evolutionary algorithms. The concept of
"Survival of the Fittest" is at the core of the genetic algorithm, a stochastic search
technique. The genetic algorithm mimics the process of natural selection, in which only
those species that can adapt to environmental changes can endure and pass on to the
following generation. GA is utilised to produce excellent answers to search and
optimization issues. Although it is a strong optimization tool, it is simple to use and may
be put into practise [4].

2.7. Fuzzy Logic (FL)

Fuzzy logic Figure 2. was introduced by Lotfi Zadeh in 1965. In our daily life, we
come across many vague problems, finding solutions to which humans fail. Fuzzy Logic
comes useful in such situations for the reasoning of fuzzy problems. The FL forms the
basis of AI by allowing the use of more advanced decision-tree processing and better
integration with rules-based programming. The FL imitates the decision-making process
of humans which involves intermediate possibilities between digital values YES and NO.
It produces acceptable solutions to incomplete and ambiguous problems [1, 2].

Figure 2.Fuzzy Logic Gate.

3. Literature Review

3.1 Application of AI in Dentistry

3.1.1 AI and Orthodontics

It has always been a matter of dilemma for orthodontists during a treatment to decide
whether to extract the teeth or not. With the innovation in the field of AI and ML, we
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expect the development of systems that can assist orthodontists to practice efficiently and
improve the quality of decisions & care. Here, AI comes into play. AI-driven customized
orthodontic treatment is the recent revolution in the field of orthodontics. This led to the
development of several decision support systems which reduced the subjectivity of
decision making and the dilemma. ANN(s) have been used to develop such a support
system to help orthodontists and it has proved to be successful at predicting the extraction
decision. AI is used in different periods of orthodontics from diagnosis to treatment
planning and extraction decision. 3-D scans & virtual models are used to assess dental
and craniofacial abnormalities. With the help of the 3-D scans, aligners are printed, and
afterward, the treatment is customized. Here the Data algorithm helps intelligently to
decide how to remove the teeth/tooth, the exact point of application of pressure, and how
much pressure should be applied. The AI-driven treatment enhances the efficiency of the
treatment and reduces the time and chances of error in treatment [5].

3.1.2 AI and Endodontics

The diagnosis, treatment, and prevention of any illness in the dental pulp and lateral
tissues is known as endodontics. The procedure known as root canal therapy involves
removing the damaged dental pulp and replacing it with filling material. The use of AI's
ANNs in the field of endodontics has been demonstrated, and they have aided in the
study of the anatomy of the root canal system, the detection of periapical lesions and root
fractures, the prediction of the viability of dental pulp stem cells, and the efficacy of
treatment methods. In endodontics, AI has aided in the attainment of accuracy and
precision in disease detection, assessment, and prediction. The advancement of
endodontics is a result of better diagnosis and treatment.

3.1.3 Benefits of AI

 AI technology can help doctors in making better data-driven decisions.

 AI helps in increasing disease diagnosis efficiency.
 AI eases research and development by introducing insilico experimentation
options.
 AI has the potential to make healthcare more participatory by increasing the
time for interaction between patients and the doctor.

3.1.4 Challenges to AI

We realize that the use of AI in medical services plays an extremely encouraging part
however difficulties both in technical and ethical aspects exist all over the place.
Artificial intelligence-based frameworks are machine-based and constrained by computer
researchers with no clinical preparation which can cause limitations in the advancement
of AI application in healthcare delivery. Artificial intelligence additionally can't supplant
Contemporary healthcare delivery models whose functioning relies upon clinician
abilities and patient-doctor communication. Using robots as assistants have likewise
made different issues in medical services. Dental professionals are hesitant to
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acknowledge AI-based innovations. A better idea would be a model which obliges both
AI and human components so that thedata collection process and classification turns out
to be simple and simultaneously safeguard the human aspects of clinical consideration.

Figure 3 Challenges to AI

3.1.5. Robotics in navigational surgery

Progressions in technology and computer science have led to growth in the use of
robotics in navigational surgery for multiple medical specialties. Similar revolutionary
technologies are now being introduced into the dental industry that can assist
practitioners with a different variety of procedures, similar to the growth of the da Vinci
surgical system in the early 2000s to more advanced Artificial Intelligence (AI)
techniques in use today [5]. By employing nanomaterials, nanorobots, and the
engineering of novel diagnostic and healing modalities, robotics-assisted dentistry has
progressed beyond conventional navigational surgery to more complicated systems that
will be crucial in maintaining oral health and removing oral lesions. Robotics systems are
already being employed in dental procedures and helping practitioners with implant
therapy, even though these therapeutic interventions change our current ideas and
understanding of the world.

3.1.6. Nano dentistry

Nanotechnology is used in nano dentistry to diagnose, treat, and prevent disorders of the
mouth and teeth. It makes treatment options in periodontics, orthodontics, and restorative
dentistry possible. Nanorobotics can be utilised in restorative dentistry for cavity
preparation, restoration, and dental re-naturalization. The use of nanostructured
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components is done to maintain and enhance oral health. Faster, more precise, more
accurate diagnosis is made possible by nanotechnology in dentistry. It gives dental
materials improved qualities, which improve their superior treatment capabilities and
increase the material's tensile strength. It provides superior hardness and increased
flexural strength.Due to their size, nanobots work at the atomic, cellular, and molecular
levels to perform major tasks and can help dentists in managing complicated cases at the
microscopic level with ease and precision. Nanotechnology can also aid in bone
replacementand antibiotic delivery via nanoencapsulation while offering continuous oral
health maintenance using dental robots to destroy pathogenic bacteria found in plaque
biofilms. Additionally, nano dentistry can offer alternative techniques to induce
anesthesia and manipulate tissue to aid in managing complicated restorative and
periodontal treatments [6]

3.2. Application of Dental Robotics

3.2.1. Dental Patient Robots

For clinical training of dentists and dental students, and to advance their clinical skills
and practice in patients, dental patient robots have been designed to mimic real-life
treatment situations. They are popularly known as “Phantoms”. Mostly used dental
patient robots are:

3.2.2. Showa Hanako

With aid from the robotics firm Tmsuk, Showa University produces Showa Hanako in
Tokyo, Japan. Hanako is made to mimic a range of patient actions and reactions,
including blinking, coughing, sneezing, moving its tongue, shaking its head, rolling its
eyes, and even becoming tired from having its mouth open for an extended period of
time. This gives dental students a realistic experience treating real patients. Additionally,
the robot has the ability to mimic a gag response, which happens rather frequently during
dental treatments. The speech recognition technology, created by Japanese engineers to
enable conversational functionality, is also now available [7].

Figure 4. Showa Hanako

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3.2.3. Geminoid DK

Professor Hiroshi Ishiguro of Osaka University and his associates at the Advanced
Telecommunications Research Institute International in Japan created the Geminoid DK.
It is an exact duplicate of Aalborg University's Henrik Scharfe, a Danish professor. It is a
robot equipped with cutting-edge motion-capture technology that can accurately replicate
head movements and simulate human facial emotions. The robot is the first in a line of
characters with non-Japanese personalities. The device, according to its creator, is meant
to advance philosophy and android science in the pursuit of basic solutions [7-9].

Figure 5. Geminoid DK

3.2.4. Simroid

Simroid was created at The Nippon Dental University Kokoro in collaboration with
the manufacturer of dental equipment Morita Manufacturing. It is a realistic dental
training robot for dentists that focuses more on the student's attitude toward the patients
than the technique when performing a procedure. It is an improvement over the Simroid
robot, a less advanced dental training robot created in 2007. Simroid, according to its
creators, is a next generation dental patient simulator created to give dentists and dental
students in training more emotional feedback. The interesting thing about this robot is
that advancements in robotics and artificial intelligence make it react more lifelike and
give emotional responsesjust like a real patient. Sensors are being fixed in and around its
mouth that allows the robot to feel simulated pain and discomfort which the robot can
express by gestures making students more conscious of their techniques. A new variety
artificial skin has been used instead of Silicone, which used to get torn easily when the
robot had to open its mouth wide. Simroid is now equipped with far better speech
recognition capabilities allowing it to respond and react to questions or commands [7].

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Figure 6. Simroid

3.2.5. Endo Micro Robots

Endo Micro Robots were created to enhance endodontic treatment's precision and
effectiveness and provide top-notch root canal therapy. The endo micro robot
accomplishes autonomous drilling, cleaning, shape, and three-dimensional filling of the
root canal system with the aid of cutting-edge computer-assisted endodontic technology
through online supervision and an intelligent system. It gives precise treatment with
error-free outcomes, causing the dentist less discomfort and anxiety. Micro position and
orientation adjustment equipment, a travel distance controller, microsensors, an automatic
feed rate, and apex sensors with flexible drill and vacuum attachments are all components
of an endo-micro robot [10].

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Figure 7. Endo Micro Robot

3.2.6. Dental Nanorobots

Nanomaterials, which are measured in nanometers, are the building blocks of nanorobots.
These nanotechnology-based robots can be utilised for tooth repair, local drug delivery,
dentin hypersensitivity, single-visit orthodontic realignment, endodontic and conservative
dentistry, cavity preparation and restoration, local anaesthetic, and dental robotics. The
nanoscopic dental robots offer quick and accurate care [1].

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Figure 8. Dental Nanorobot

3.2.7. Surgical Robots

Application of robotics in oral and maxillofacial surgery, where the surgeon programs the
robot at the time of surgery after which the robot performs pre-programmed tasks in the
operation theatre such as osteotomy cuts, milling, and drilling of bones,selecting and
positioning of plates,surgical planning etc and also interacts with the surgeon [10].

Figure 9. Surgical Robot

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3.2.8. Dental Implantology Robots

The latest system of computer-assisted surgery for guided implant settlement is

accomplished by getting a 3-D built model that resembles the patient’s jaw formed from
cone-beam CT imaging data. The robot is then executed to drill a jaw splint at the site
assigned by a software planning system that forms a surgical guide [10].

Figure 10. Dental Implantology Robot

3.2.9. Robotic Dental Drill

Recent advancements were designed by tactile technologies. In which very thin

needles us used and pierced into the gum to find the site of the alveolar bone in a
restrained patient’s jaw, which is then transmitted wirelessly to a PC and amalgamated
with CT scan data that gives a set of drills guides.

3.2.10. Tooth–Arrangement Robots

A single manipulator robotic system is used for the fabrication of whole denture
prosthesis via 6 DOF (Degree of Freedom) CRS robots manufactured in Canada. They
are commonly used in the field of prosthetic dentistry. A 3-D virtual tooth plan
programming software commences the whole procedure.

3.2.11. Orthodontic Arch Wire Bending Robots

This robotic technology is used for bending orthodontic archwires to a precise shape
automatically. The bending equipment is known as SureSmileArchWire bending robot. It
consists of a resistive heating system and gripping apparatuses combined with the
application of 3D imaging, CAD/ CAM, and arranging and execution works out in a good
way, and those completed insufficiently by the unpractised and clueless staff bring about
terrible outcomes. Thus, the outcomes would just be pretty much as great as the
workforce updating the data into the robotic system.

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4. Limitations of Robotic dentistry

At whatever point another innovation is presented in a setup, it is exposed to a few

impediments of differing nature. One such deterrent is that mechanical improvements in
clinical/dental applications are amazingly costly. Additionally, robotic systems are
complex and require the ability for their legitimate activity. In addition, another crucial
perspective may be the obscure patient acceptance and consistency among dentists. The
input of data is very critical. As of now, in dentistry, we see two fundamental aspects—
Those cautious preoperative dentists that positively impact the field of dentistry.
However, compared to their counterparts in the medical field, dentists have been slow to
adopt this new technology. The realization that new and emerging technological
innovations may provide alternative treatments to patients while enhancing workflow,
increasing production, and improving the quality of care is on the horizon. Considering
that the overall goal in dental care is to provide optimal patient treatment, it is worth
reviewing these applications and their potential to increase the quality of dental care.
Robotics and AI techniques can provide dental practitioners with valuable

5. Conclusions

Dentistry is gaining ground toward another universe of robot-assisted and data-driven

medication. However, robotic systems have not as yet been altogether acquainted with
dental research nor have they accomplished expense adequacy and innovative status to be
completely fused into the dental market. Undoubtedly, various possibilities for the future
exist where dentistry and robotics merge. Considering that the overall goal in dental care
is to provide optimal patient treatment, it is worth reviewing these applications and their
potential to increase the quality of dental care. Robotics systems continue to support
doctors in the medical field with assistance in the cardiac space, orthopedics, and
neurosurgery. Robotics, microrobots, and nanotechnology have the potential to support
computers for the fabrication of orthodontic appliances.

7. Conflict of Interest

There is no conflict of interest in this work.

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