Embracing AI Innovations in Orthodontics

Orthodontics is a field of dentistry that is devoted to improving and correcting “bad bites” (malocclusion). The most usual orthodontic treatments are of aligners, braces and retainers. Those orthodontic procedures are the pathway to achieving a perfect, symmetrical smile and healthy teeth (Cleveland Clinic, 2022). An orthodontist is a dentist whose job is to take the necessary precautions or use the corresponding treatments to cure dental symmetry problems and AI can appear to be very useful, when it comes to efficiency and speed of treatment.

Through AI, it is made possible to break down dental images with large rates of accuracy that would undoubtedly, boost the practice of orthodontics, especially, when it comes to the field of diagnostics. It employs the use of complex algorithms while at the same time, is able to manage X-rays, scans and images to find problems in the teeth that require treatment. Moreover, through AI, personalised treatment regiments can be introduced, supporting each individual’s special needs and expectations (Kazimierczak et al, 2024).

The advent of artificial intelligence (AI) has allowed it to have a significant effect on several different fields, including the medical one. To explore its potential effect in the field of orthodontics, I proceeded to interview my orthodontist, Dr. Manos Emmanouil. Dr. Emmanouil received his dental education at King’s College London (ranked no.1 dental school in Europe), followed by a 3 year residency program in Orthodontics at the University of Michigan, ranked no.1 in the world. He is

Board-certified with the American Board of Orthodontics. He practices Orthodontics in his clinic in both Athens and London.

Q1. How has AI transformed the field of Orthodontics, and what are common AI tools used in Orthodontics today?

We are currently in a time of several technological advancements in the field of orthodontics. The digital technology available to us such as digital scanners and 3D printers can allow us to better serve our patients. Incorporating digital methods in our daily practice, can also include using AI tools such as software that allows xray analysis or visualizing treatment outcomes.

For example, we can produce a digital scan of a patient and end up with a 3D digital model of our patients dentition i.e. instead of taking impressions the way we used to and then have an imprint of the teeth. This offers us many advantages as this 3D model can then be 3D printed and used for fabrication of orthodontic appliances, or it can be used to educate our patients regarding their clinical findings and demonstrate potential treatment options. AI tools available to us, also allow us to visualise potential teeth and/or jaw movements in order tofacilitate demonstrating to our patients what their treatment will entail.

Q2. Do you find that AI improves the speed and efficiency of treatment?

If used correctly, AI tools can allow us to be able to improve speed and efficiency. For example, when planning an Invisalign (clear aligner) treatment for a patient, by digitally scanning their teeth, we could be treatment planning their case the same day and designing in 3D exactly how their teeth will move. Once, we are happy with our treatment plan, we can then order the manufacturing of their aligners,

thus avoiding longer times for delivery by having to ship impressions. This can be very useful both for the patient and the clinician as it allows us to have their aligners ready faster and get their treatment started. I can think of several cases where digital methods allowed us to offer patients that live or study abroad and are time sensitive efficient treatment plan and fast delivery of their aligners so they could start treatment within their time limits.

Q3. Are AI tools used for monitoring patient’s progress during treatment (e.g. remote monitoring apps)?

Teledentistry or remote treatment has developed rapidly over the past few years, particularly following the COVID pandemic when it was the primary source of advice to our patients during lockdowns. While such tools can be useful and effective for monitoring a patient’s treatment remotely, research has shown that orthodontic patients prefer to be seen face to face and do not consider attendance to the clinic inconvenient. For myself, the part of my profession I most enjoy is the interaction it gives me with my patients, so my opinion is that while AI tools can be useful in specific cases, a patient’s relationship with their orthodontist

cannot be replicated digitally.

Q4. Do you think AI could eventually replace some aspects of the orthodontist’s role, or will it always be a complement to human expertise?

While AI can be a useful tool for orthodontists, it is very important that it is used correctly. To myself, as a clinician, it is very important to always be practicing Evidence-based Orthodontics, meaning anything I use in my practice, I want to know there is research that has been done behind it that validates and

supports it.

As AI methods continue to grow, I am a certain that the research concerning its potential effectiveness will continue to do so as well. For example, currently at the University of Michigan where I received my training, there is ongoing research on potential Virtual Reality (VR) applications into dental and orthodontic education, which allows us to visualise potential tooth and jaw movements. AI is also the focus of many Orthodontic conferences now, for example the American Association of

Orthodontists annual conference always has lectures on digital processes for your practice, and the University of Michigan hosts a conference once a year called Moyers Symposium, the topic of which for last year was “Artificial Intelligence: What Should Clinicians Know?”. But it is important to remember that AI, while it offers the advantages mentioned above, it does not have the training an orthodontist has regarding all the different factors that can influence a patient’s treatment plan

and how to collate those to create a customised treatment, especially for more complex cases.

Q5. What does it take to become an orthodontist?

Orthodontists must complete an intensive 3 year residency (specialty) program after their dental degree where they learn the techniques of proper, safe tooth movement as well as guided dental, jaw, and facial

development.

Through formal and hands-on training, orthodontists are equipped to diagnose, prevent, correct and treat dental and facial irregularities in patients of all ages.

Furthermore, we also continue to advance our learning through continuing education, such as attending congresses. We may also pursue additional qualifications, such as becoming certified with the American Board of Orthodontics. ABO Board Certification is a voluntary credential that represents an orthodontist’s

personal and public commitment to the standards of specialty practice and lifelong learning. The ABO Certification process requires the completion of peer-developed, externally validated written and clinical examinations. A Board-Certified Orthodontist has reached this level of achievement by pursuing additional

voluntary education and ongoing self- assessment.

We do all of the above, so that we have the knowledge and skills necessary to properly undertake the important task of our patients’ orthodontic treatment. While AI can be a useful tool in doing so, I do not believe it can or should replace the orthodontist’s role.

Image 1: Taken at Dr. Emmanuel’s office, depicting a digital impression scanner connected to a laptop

Image 2: Dr. Emmanouil

It was a great honor, to have been given an opportunity to be part of such an inspiring conversation with anexpert with technical knowledge on every topic that connects to orthodontics. Output was received by Dr. Emmanouil, being himself an orthodontist, regarding the effects of AI on the advancement of orthodontics as

well as its proper use, so its potential can be optimised.

References

Cleveland Clinic. “What Is Orthodontics?” Cleveland Clinic, 12 Oct. 2022, my.clevelandclinic.org/health/treatments/24285-orthodontics.

Kazimierczak, Natalia, et al. “AI in Orthodontics: Revolutionizing Diagnostics and Treatment Planning—a Comprehensive Review.” Journal of Clinical Medicine, vol. 13, no. 2, 7 Jan. 2024, pp. 344–344, www.ncbi.nlm.nih.gov/pmc/articles/PMC10816993/, https://doi.org/10.3390/jcm13020344. Accessed 20 Feb. 2024.

Features Cover Image:

Dentistry. Damian Gerikhanov Discusses AI in Orthodontics and Why He Believes the Future of Clear Aligner Treatment Planning Is “Bright and Promising”., 2023, dentistry.co.uk/2023/11/15/four-predictions-for-the-future-of-ai-in-orthodontics/. Accessed 1 Feb. 2025.